Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits

경동맥 내중막 두께가 정상 C-반응성 단백질 농도를 가진 안정형 협심증 환자에서 가지는 임상적 의의

  • Kwon, Jong-Bum (Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Park, Kuhn (Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Choi, Si-Young (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Park, Chan-Beom (Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Kim, Yong-Hwan (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Her, Sung-Ho (Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Park, Mahn-Won (Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine) ;
  • Lee, Jong-Ho (Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine)
  • 권종범 (가톨릭대학교 의과대학 대전성모병원 흉부외과학교실) ;
  • 박건 (가톨릭대학교 의과대학 대전성모병원 흉부외과학교실) ;
  • 최시영 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실) ;
  • 박찬범 (가톨릭대학교 의과대학 성바오로병원 흉부외과학교실) ;
  • 김용환 (가톨릭대학교 의과대학 의정부성모병원 흉부외과학교실) ;
  • 허성호 (가톨릭대학교 의과대학 대전성모병원 순환기내과학교실) ;
  • 박만원 (가톨릭대학교 의과대학 대전성모병원 순환기내과학교실) ;
  • 이종호 (가톨릭대학교 의과대학 대전성모병원 흉부외과학교실)
  • Received : 2010.01.29
  • Accepted : 2010.04.20
  • Published : 2010.10.05
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Abstract

Background: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). Material and Method: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP ($\geq$0.5 mg/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (>50% of the original luminal diameter involving one or more major coronary artery). Result: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ mg/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). Conclusion: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

배경: 본 연구에서는 정상 고감도 C-반응성 단백질(hs-CRP) 농도를 가진 안정형 관상동맥 질환 환자에서 관상동맥 질환의 중증도를 알아보기 위한 도구로서 신뢰도가 높고, 용이한 방법인 경동맥 내중막 두께의 가치를 알아보고자 하였다. 대상 및 방법: 688명의 안정형 관상동맥 질환 환자에서 고감도 C-반응성 단백질이 비정상적으로 높은 농도를 보인($\geq$0.5 mg/dL) 121명의 환자를 제외한 567명의 환자를 대상으로 이미 알려진 관상동맥 유발 위험 인자들과 좌측 경동맥 내중막 두께 그리고 관상동맥 질환 중증도의 연관성을 알아 보았다. 환자들은 중간값(median-value)을 기준으로 경동맥 내중막 두께가 높은 군과 낮은 군으로 나누었고 관상동맥 조영술 상 3개의 주 관상동맥 중 적어도 1개 이상의 관상동맥에서 원래 직경의 50% 이상 좁아진 환자들을 대상으로 하였다. 결과: 567명의 환자들 중, 중간값인 0.76 mm을 기준으로 300명(52.9%)은 경동맥 두께가 낮은 군에, 267명(47.1%)은 높은 군에 속하였다. 다변수 로지스틱 회귀분석에 의하면 높은 연령(49세 이하 vs. 70세 이상; 상대적위험률=6.552), 높은 공복 혈당(99 mg/dL 이하 vs. 120 mg/dL 이상; 상대적위험률=1.713), 관상동맥질환의 중증도(1 혈관질환 vs. 2 혈관질환; 상대적위험률=1.711, 1 혈관질환 vs. 3 혈관질환; 상대적위험률=1.714)에서 유의하게 의미가 있었다. 결론: 우리는 안정형 관상동맥질환 환자에서 경동맥 내중막 두께가 의의있게 큰 경우 C-반응성 단백질의 농도가 정상이라도 관상동맥 질환이 더 다혈관질환일 가능성이 크다고 생각할 수 있다.

Keywords

References

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