연령, 성별, 동맥경화 위험인자의 수는 관상동맥 경화증 환자에서 내피세포 기능장애의 독립적 인자이다 = Age, Gender, and Number of Atherosclerotic Risk Factors are the Independent Factor of Endothelial Dysfunction in Patients with Coronary Atherosclerosis

다국어 초록 (Multilingual Abstract)

Background and Objectives：The endothelial function is impaired in patients with atherosclerosis risk factors as wel as in those with atherosclerotic disease, such as coronary artery disease. This study was performed to evaluate the impact of individual risk factors and their number in patients with coronary atherosclerosis, who Subjects and Methods：The endothelial function was measured in 884 consecutive patients (mean age; 59 years old, 486 male) undergoing coronary angiography, using high-resolution ultrasound. The flow-mediated brachial artery dilation (FMD, %) was used to measure the endothelial function. The risk factors were classified according to the hypertension, diabetes mellitus, smoking and dyslipi-demia, and their number classified from 0 to 4. Results：The FMD was lower (3.85± 2.1% vs. 4.27± 2.1%, p<0.005) (n=431) than in those without (n=453); however, no significant diference was shown according to the presence of other risk factors. A multivariate analysis showed age (β=-0.204, p<0.001), gender (β=0.18, p<0.01) and the number of risk factors (β=-0.150, p<0.01) were independent risk factors of the FMD in patients with coronary atherosclerosis. Furthermore, the FMD was significantly associated with the number of risk factors in our study subjects (r=-0.083, p<0.05, n=884). Conclusion：This study sugests that the increased number of risk factors, old age and male are independent factors for endothelial dysfunction, even in patients with coronary atherosclerosis, who already had an impaired endothelial function.

국문 초록 (Abstract)

배경 및 목적：
내피세포 기능의 감소는 관상동맥 질환과 같은 동맥경화 환자에서뿐만 아니라 동맥경화의 위험인자만을 갖는 사람에서도 보인다. 저자들은 내피세포의 기능이 이미 감소되어 있는 관상동맥 질환자에서 각각의 위험인자와 위험인자 수가 내피세포 기능에 미치는 영향에 대해 알아보고자 하였다.
방 법：
관상동맥 조영술에서 병변이 확인된 884명(평균 59세,남성 486명)의 환자들을 대상으로 고해상도 초음파를 이용하여 내피세포 기능을 측정하였다. 내피세포기능은 내피세포의존성 혈관확장능(FMD)로 나타내었다. 위험인자는 고혈압, 당뇨병, 이상지혈증, 흡연으로 하였으며 위험인자의 수에 따라서 0에서 4로 분류하였다.
결 과：
내피세포 기능은 고혈압 환자군(431명)에서 정상에 비해감소되었다(3.85±2.1% vs. 4.27±2.1%, p<0.005). 그러나 다른 위험인자에 따른 내피세포 기능의 차이는 없었다. 다변 수 분석에서 연령(β=-0.204, p<0.001)과 성별(β=0.118,
p<0.01) 그리고 위험인자의 수(β=-0.150, p<0.01)는 관상동맥 경화증 환자에서 내피세포 기능의 독립적인 위험인자임을 알 수 있었다. 더욱이 본 연구의 대상자에서 위험인자의 수는 내피세포 기능과 주요한 연관성이 있었다(r=-0.083,p<0.05, n=884).
결 론：
연령과 남성 그리고 동맥경화 위험인자의 수는 내피세포기능이 감소된 관상동맥 질환자에서도 내피세포 기능의 독립적인 위험인자임을 알 수 있었다.

참고문헌 (Reference)

1 "Risk stratification for postoperative cardiovascularevents via noninvasive assessment of endothelial function:aprospective study" 105 : 1567-72, 2002

2 "Protein lipid relationships in human plasma" 11 : 480-93, 1951

3 "Prognostic value of coronaryvascular endothelial dysfunction" 106 : 653-8, 2002

4 "Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease" 101 : 1899-906, 2000

5 "Postprandial hypertriglyce-ridemia impairs endothelial function by enhanced oxidant stress" 155 : 517-23, 2001

6 "Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis" 340 : 11-5, 1992

7 "Menopause is associated with endothelial dysfuntion in women" 28 : 576-82, 196

8 "Long-term follow-up of patients with mild cor-onary artery disease and endothelial dysfunction" 101 : 948-54, 2000

9 "Induction of calcium-dependent nitric oxide syn-thases by se hormones" 91 : 5212-6, 1994

10 "Impaired endothelium-me-diated vasodilatation in the peripheral vasculature of patients with congestive heart failure" 19 : 918-25, 192

11 "Gender difference in age-related changes in vascular function" 250 : 29-36, 2001

12 "Flow-dependent coronary artery dilatation in humans" 80 : 466-74, 1989

13 "Flow-dependent coronary artery dilatation in essential hyperten-sion" 258 : -11, 1990

14 "Endothelial dysfunction in patients in patients with chest pain and normal coronary arteries" 86 : 1864-71, 1992

15 "Endogenous nitric oxide synthase inhibitor:a novel marker of atherosclerosis" 99 : 1141-6, 1999

16 "Effects of physiological levels of estrogen on coronary vasomotor function in postmeno-pausal women" 2545-51, circulation1994

17 "Correlation between endothelial function and the extent of coronary atherosclerosis" 34 : 752-60, 2004

18 "Aging is associated with endoth-elial dysfunction in healthy men years before the age-related decline in women" 24 : 471-6, 1994

19 "Age-related reduction of NO availability and oxidative stres in humans" 38 : 274-9, 2001

20 "17β-estradiol preserves endothelial vasodilator function and limits low-density lipopro-tein oxidation in hypercholesteoleic swine" 2251-9, circulation1994