Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

비만 청소년에서 동맥경화증을 조기에 예측하기 위한 경부 초음파를 이용한 경동맥 측정

Measurement of the Common Carotid Artery by Ultrasound as a Predictor of Atherosclerosis in Obese Adolescents

  • 김예진 (이화여자대학교 의과대학 소아과학교실) ;
  • 심윤희 (이화여자대학교 의과대학 소아과학교실) ;
  • 유정현 (이화여자대학교 의과대학 진단방사선과학교실) ;
  • 이근 (이화여자대학교 의과대학 소아과학교실) ;
  • 홍영미 (이화여자대학교 의과대학 소아과학교실)
  • Kim, Ye Jin (Departments of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Shim, Yoon Hee (Departments of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Yoo, Joung Hyun (Departments of Radiology, College of Medicine, Ewha Womans University) ;
  • Lee, Keun (Departments of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Hong, Young Mi (Departments of Pediatrics, College of Medicine, Ewha Womans University)
  • 투고 : 2005.02.07
  • 심사 : 2005.04.04
  • 발행 : 2005.07.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 소아 비만의 증가에 따라 소아기에 고혈압, 관상동맥 질환, 당뇨병 등의 소아 성인병이 문제가 되고 있다. 중등도 이상의 비만 청소년에서 경부 초음파로 경동맥의 내피두께, 직경, 동맥의 유연도와 신전도를 측정함으로 조기에 동맥 경화증으로 진행을 예측할 수 있는지 알아보고, 동맥벽 두께와 혈청 사이토카인 등 여러 지표와의 관련성을 알아보고, 비만 청소년에서 관상동맥 질환으로 진행할 수 있는 위험 인자로 유용한지 알아보고자 하였다. 방 법 : 16-17세의 29명의 중등도 이상의 비만 청소년을 대상군으로 하였고, 같은 연령의 정상 청소년을 대조군으로 하였다. 체질량 지수와 피부두께를 측정하였고, 생체전기저항 분석을 이용하여 체지방, 지방 분포를 측정하였다. 안정된 상태에서 수축기, 이완기 혈압을 측정하였다. 10시간 이상 금식 후 총 콜레스테롤, 중성 지방, HDL 콜레스테롤, LDL 콜레스테롤, 혈당, 호모시스틴, 인슐린, 인슐린 저항성을 측정하였다. 경부 초음파를 이용하여 경동맥의 내피 두께, 수축기와 이완기 동안의 내경, 동맥의 유연도와 신전도를 측정하였다. 결 과 : 경동맥의 수축기 내경, 이완기 내경은 상완둘레, 체질량 지수, 지방분포, 체지방이 증가함에 따라 유의하게 증가하였다. 수축기 혈압이 높을수록 수축기 및 이완기 내경이 유의하게 증가하였고, 이완기 혈압이 증가할수록 내피두께는 유의하게 증가하였다. 인슐린치가 증가할수록 수축기 및 이완기 내경이 유의하게 증가하였다. 호모시스틴치가 증가할수록 내피 두께가 유의하게 증가함을 알 수 있었다. 결 론 : 소아에서도 비만 정도가 심할수록, 혈압이 높을수록 경동맥의 내경이 증가하였고, 경동맥의 내피두께는 이완기 혈압과 유의한 상관성이 있었다. 혈압, 인슐린, 호모시스틴을 측정함으로 조기에 동맥경화증으로 진행을 예측하는데 유용하리라 생각되고 소아기 비만에서도 적극적인 체중 감량을 통해 소아 성인병으로 진행되는 것을 적극적으로 예방하여야 될 것으로 생각한다.

Purpose : Adolescent obesity is known to be associated with complications such as hypertension, coronary artery disease and insulin resistance. We measured the common carotid artery by ultrasound as a predictor of atherosclerosis, and investigated the relationship between carotid artery parameters and serum cytokines in obese adolescents. Methods : Twenty-nine obese adolescents(16-17 years old, obesity index>130 percent) and twentyseven normal controls were included. Obesity index and body mass index were calculated from their height and weight. Skin fold thickness was measured at the triceps, and fat mass and fat distribution by bioelectrical impedence analysis. Blood pressure was measured at resting state and serum lipid, insulin, and homocysteine levels after a 12-hour fasting period. Intimal wall thickness, systolic and diastolic diameters of the common carotid artery were measured by ultrasound, and compliance and distensibility calculated by equation. Results : Systolic and diastolic diameters of the carotid artery significantly correlated with arm circumference, body mass index, fat distribution and fat mass. The higher systolic blood pressure was, the larger systolic and diastolic diameter. The higher diastolic blood pressure was, the larger carotid intimal thickness. Insulin levels had positive correlations with systolic, diastolic diameters and serum homocysteine level with intimal thickness. Conclusion : The carotid artery diameter significantly increased with the degree of obesity and blood pressure. The carotid intimal wall thickness significantly correlated with diastolic blood pressure. Measurement of carotid artery thickness, insulin and homocysteine levels might be useful to predict the development of coronary artery disease.

키워드

참고문헌

  1. Cho KB, Park SB, Park SC, Lee DH, Lee SJ. The prevalence and trend of obesity in children and adolescents. J Korean Pediatr Soc 1989;32:597-605
  2. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents : a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992;327:1350-5 https://doi.org/10.1056/NEJM199211053271904
  3. 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
  4. Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness : a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002;20:159-69 https://doi.org/10.1097/00004872-200202000-00001
  5. Vaudo G, Schillaci G, Evangelista F, Pasqualini L, Verdecchia P, Mannarino E. Arterial wall thickening at different sites and its association with left ventricular hypertrophy in newly diagnosed essential hypertension. Am J Hypertens 2000;13:324-31 https://doi.org/10.1016/S0895-7061(99)00229-0
  6. 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
  7. Leeson CP, Whincup PH, Cook DG, Mullen MJ, Donald AE, Seymour CA, et al. Cholesterol and arterial distensibility in the first decade of life : a population-based study. Circulation 2000;101:1533-8 https://doi.org/10.1161/01.CIR.101.13.1533
  8. Megnien JL, Gariepy J, Saudubray JM, Nuoffer JM, Denarie N, Levenson J, et al. Evidence of carotid artery wall hypertrophy in homozygous homocystinuria. Circulation 1998;98:2276-81 https://doi.org/10.1161/01.CIR.98.21.2276
  9. Hong YM, Moon KR, Seo JW, Shim JG, Yoo KH, Jeong BJ, et al. Guideline of diagnosis and treatment in childhood obesity. J Korean Pediatr Soc 1999;42:1338-45
  10. Jelliffe DB. The assessment of the nutritional status of the community. WHO Monogr Ser World Health Organ, Geneva( Switze rland), WHO, 1966:53:3-271
  11. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Mille OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992;340:1111-5. https://doi.org/10.1016/0140-6736(92)93147-F
  12. Sung HK, Lee SD. Physiology. 5th ed. Seoul : Eui-Hak Publishing Co, 1991:157-8
  13. Litwin M, Trelewicz J, Wawer Z, Antoniewicz J, Wierzbicka A, Rajszys P, et al. Intima-media thickness and arterial elasticity in hypertensive children: controlled study. Pediatr Nephrol 2004;19:767-74 https://doi.org/10.1007/s00467-004-1480-6
  14. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002;106:100-5 https://doi.org/10.1161/01.CIR.0000020222.63035.C0
  15. Crea F, Gaspardone A, Tomai F, Shoulders C, De Fazio A, Versaci F, et al. Risk factors in schoolchildren associated with a family history of unheralded myocardial infarction or uncomplicated stable angina in male relatives. J Am Coll Cardiol 1994;23:1472-8 https://doi.org/10.1016/0735-1097(94)90394-8
  16. Glowinska B, Urban M, Koput A, Galar M. New atherosclerosis risk factors in obese, hypertensive and diabetic children and adolescents. Atherosclerosis 2003;167:275-86 https://doi.org/10.1016/S0021-9150(03)00003-0
  17. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996;97:2601-10 https://doi.org/10.1172/JCI118709
  18. Arcaro G, Zamboni M, Rossi L, Turcato E, Covi G, Armellini F, et al. Body fat distribution predicts the degree of endothelial dysfunction in uncomplicated obesity. Int J Obes Relat Metab Disord 1999;23:936-42 https://doi.org/10.1038/sj.ijo.0801022
  19. Caballero AE, Arora S, Saouaf R, Lim SC, Smakowski P, Park JY, et al. Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes. Diabetes 1999;48:1856-62 https://doi.org/10.2337/diabetes.48.9.1856
  20. Daniels SR, Morrison JA, Sprecher DL, Khoury P, Kimball TR. Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation 1999; 99:541-5 https://doi.org/10.1161/01.CIR.99.4.541
  21. Owens S, Gutin B, Ferguson M, Allison J, Karp W, Le NA. Visceral adipose tissue and cardiovascular risk factors in obese children. J Pediatr 1998;133:41-5 https://doi.org/10.1016/S0022-3476(98)70175-1
  22. 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
  23. Markus RA, Mack WJ, Azen SP, Hodis HN. Influence of lifestyle modification on atherosclerotic progression determined by ultrasonographic change in the common carotid intima-media thickness. Am J Clin Nutr 1997;65:1000-4
  24. Aminbakhsh A, Mancini GB. Carotid intima-media thickness measurements : what defines an abnormality? A systematic review. Clin Invest Med 1999;22:149-57
  25. Chambless LE, Folsom AR, Clegg LX, Sharrett AR, Shahar E, Nieto FJ, et al. Carotid wall thickness is predictive of incident clinical stroke : the Atherosclerosis Risk in Communities( ARIC) study. Am J Epidemiol 2000;151:478-87 https://doi.org/10.1093/oxfordjournals.aje.a010233
  26. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors : the Atherosclerosis Risk in Communities (ARIC) study, 1987-1993. Am J Epidemiol 1997;146:483-94 https://doi.org/10.1093/oxfordjournals.aje.a009302