Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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비만 소아들에서의 경동맥 내막중막 두께 측정

Carotid Intima-Media Thickness Measurement in Obese Children

  • 박경옥 (건국대학교 의학전문대학원 소아과학교실) ;
  • 최석주 (순천향대학교 의과대학 소아과학교실) ;
  • 염희현 (순천향대학교 의과대학 소아과학교실) ;
  • 정소정 (건국대학교 의학전문대학원 소아과학교실) ;
  • 유정진 (건국대학교 의학전문대학원 소아과학교실) ;
  • 박영신 (순천향대학교 의과대학 소아과학교실) ;
  • 이동환 (순천향대학교 의과대학 소아과학교실)
  • Park, Kyung Ok (Department of Pediatrics, Konkuk University School of Medicine) ;
  • Choi, Suk Ju (Department of Pediatrics, Soonchunhyang University College of Medicine) ;
  • Yeom, Hee Hyun (Department of Pediatrics, Soonchunhyang University College of Medicine) ;
  • Chung, Sochung (Department of Pediatrics, Konkuk University School of Medicine) ;
  • Yu, Jeong Jin (Department of Pediatrics, Konkuk University School of Medicine) ;
  • Park, Youngshin (Department of Pediatrics, Soonchunhyang University College of Medicine) ;
  • Lee, Dong Hwan (Department of Pediatrics, Soonchunhyang University College of Medicine)
  • 투고 : 2005.06.02
  • 심사 : 2005.07.22
  • 발행 : 2005.09.15
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초록

목 적 : 소아 비만은 동맥 경화에 따른 성인 심혈관 질환의 독립적인 위험인자이다. 저자들은 비만 소아들을 대상으로, 동맥경화증의 조기 병변인 경동맥 내막중막 두께가 정상아들에 비해 증가되어 있는지를 확인해 보고자 본 연구를 시행하였다. 방 법 : 총 32명을 대상으로 하였는데, 체질량지수가 연령, 성별 표준치의 85 백분위수 이상인 21명의 비만아/과체중아들을 비만군으로 하였고, 85 백분위수 미만이었던 11명을 정상 대조군으로 하였다. 모든 대상 소아들에서 만성 질환력과 약물 투여력이 없었다. 연령, 성별, 신장, 체중, 수축기/이완기 혈압 등이 조사되었고, 초음파를 통해 경동맥 내막중막 두께가 측정되었다. 19명의 비만아군 환아들에서 혈청 포도당, 간 transaminase 수치, 콜레스테롤 수치 등이 검사되었다. 결 과 : 비만아군의 경동맥 내막중막 두께가 대조군에 비해 증가되어 보였으나 유의한 차이를 보이지는 않았다(0.42 vs. 0.40, P=0.0592). 단순선형회귀분석 결과 체질량지수를 포함하여 경동맥 내막중막 두께의 변화를 통계적으로 의미있게 설명해 주는 변수는 없었으나, 체질량지수가 유의성에 근접하였다(P=0.0585). 결 론 : 소아들을 대상으로 경동맥 내막중막 두께 측정이 연구된 것은 저자들이 조사한 바로는 국내에서 본 연구가 시초의 것으로 생각된다. 통계적 유의성에 근접하였으나 조사 대상수의 부족으로 비만아에서 경동맥 내막중막 두께의 상승이나 체질량지수와의 의미있는 연관성을 증명해 내지는 못하였다. 향후 보다 많은 비만 소아들을 포함한 연구가 후속되어야 할 것으로 판단된다.

Purpose : The aim of the present study was to ascertain whether the increase of carotid intima-media thickeness(cIMT) as one of premature pathologic changes of atherosclerosis, was present in obese children compared to normal weight children. Methods : The obese group consisted of 21 obese/overweight(body mass index(BMI) above 85 percentile of age, sex standards) children and the control group of 11 normal weight children. None of the children had any chronic illnesses or previous medication history. We investigated the age, sex, height, weight, and systolic/diastolic blood pressure. We measured cIMT by ultrasonogram. In 19 of the obese group, we tested the serum glucose level, liver transaminase level, and cholesterol level etc. Results : The increase of cIMT in obese group did not achieved statistical significance(obese group vs. control group; 0.42 vs. 0.40 mm, P=0.0592). In addition, cIMT showed no significant correlation with any physical/laboratory variables including BMI(P=0.0585). Conclusion : To our knowledge, this is the first study to measure the cIMT in Korean children. Though the results approached statistical significance, we could not prove an increase of cIMT in obese children or an association between cIMT and BMI, due to the study's small sample size. In the future, larger and more extensive trials are needed.

키워드

참고문헌

  1. Sass C, Herbeth B, Chapet O, Siest G, Visvikis S, Zannad F. Intima-media thickness and diameter of carotid and femoral arteries in children, adolescents and adults from the Stanislas cohort : effect of age, sex, anthropometry and blood pressure. J Hypertens 1998;16:1593-602 https://doi.org/10.1097/00004872-199816110-00005
  2. Virkola K, Pesonen E, Akerblom HK, Siimes MA. Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia : a controlled study by ultrasound. Acta Paediatr 1997;86:1203-7 https://doi.org/10.1111/j.1651-2227.1997.tb14847.x
  3. Levrencic A, Kosmina B, Keber I, Videcnik V, Keber D. Carotid intima-media thickness in young patients with familial hypercholesterolaemia. Heart 1996;76:321-5 https://doi.org/10.1136/hrt.76.4.321
  4. Tonstad S, Joakimsen O, Stensland-Bugge E, Leren TP, Ose L, Russell D, et al. Risk factors related to carotid intima-media thickness and plaque in children with familial hypercholesterolemia and control subjects. Arteriscler Thromb Vasc Biol 1996;16:984-91 https://doi.org/10.1161/01.ATV.16.8.984
  5. Pauciullo P, Iannuzzi A, Sartorio R, Irace C, Covetti G, Costanzo AD, et al. Increased intima-media thickness of the common carotid artery in hypercholesterolemic children. Arterioscler Thromb 1994;14:1075-9 https://doi.org/10.1161/01.ATV.14.7.1075
  6. Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, et al. Increased aortic intima-media thickness, a marker of preclinical atherosclerosis in highrisk children. Circulation 2001;104:2943-7. https://doi.org/10.1161/hc4901.100522
  7. Jarvisalo MJ, Putto-Laurila A, Jartti L, Lehtimaki T, Solakivi T, Ronnemaa T, et al. Carotid artery intima-media thickness in children with type I diabetes. Diabetes 2002;51:493-8 https://doi.org/10.2337/diabetes.51.2.493
  8. Peppa-Patrikiou M, Scordili M, Antoniou A, Giannaki M, Dracopoulou M, Dacou-Voutetakis C. Carotid atherosclerosis in adolescents and young adults with IDDM. Relation to urinary endothelin, albumin, free cortisol, and other factors. Diabetes Care 1998;21:1004-7 https://doi.org/10.2337/diacare.21.6.1004
  9. Gunczler P, Lanes R, Lopez E, Esaa S, Villarroel O, Revel- Chion R. Cardiac mass and function, carotid artery intimamedia thickness and lipoprotein(a) levels in children and adolescents with type 1 diabetes mellitus of short duration. J Pediatr Endocrinol Metab 2002;15:181-6
  10. Parikh A, Sochett EB, McCrindle BW, Dipchand A, Daneman A, Daneman D. Carotid artery distensibility and cardiac function in adolescents with type 1 diabetes. J Pediatr 2000;137:465-9 https://doi.org/10.1067/mpd.2000.109002
  11. Sorof JM, Alexandrov AV, Cardwell G, Portman RJ. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics 2003;111:61-6 https://doi.org/10.1542/peds.111.1.61
  12. Sorof JM, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai D, et al. Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. Pediatr Nephrol 2003;18:1020-4 https://doi.org/10.1007/s00467-003-1187-0
  13. Slyper AH. What vascular ultrasound testing has revealed about pediatric atherogenesis, and a potential clinical role for ultrasound in pediatric risk assessment. J Clin Endocrinol Metab 2004;89:3089-95 https://doi.org/10.1210/jc.2003-030644
  14. Gunnell DJ, Frankel SJ, Nanchahal K, Peters TJ, Davey Smith G. Childhood obesity and adult cardiovascular mortality : a 57-year follow-up study based on the Boyd Orr cohort. Am J Clin Nutr 1998;67:1111-8
  15. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood. JAMA 2003;290:2277-83. https://doi.org/10.1001/jama.290.17.2277
  16. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal- medial thickness is related to cardiovascular risk factors measured from childhood through middle age. The Muscatine study. Circulation 2001;104:2815-9 https://doi.org/10.1161/hc4601.099486
  17. Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children : a prospective study. Lancet 2001;358:1400-4 https://doi.org/10.1016/S0140-6736(01)06525-4
  18. Iannuzzi A, Licenziati MR, Acampora C, Salvatore V, Auriemma L, Romano ML, et al. Increased carotid intimamedia thickness and stiffness in obese children. Diabetes Care 2004;27:2506-8 https://doi.org/10.2337/diacare.27.10.2506
  19. Hong YM, Moon KR, Seo JY, Sim JG. Nationalwide study on body mass index, skinfold thickness, and arm circumference in Korean children. J Korean Pediatr Soc 1999;42: 1186-200
  20. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Report of the second Task Force on blood pressure control in children-1987. Pediatrics 1987;79:1-25