The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Comparison of Heart Rate Variability in Kidney Transplantation and End-Stage Renal Disease Patients on Dialysis

신장 이식 환자와 말기 신부전 환자의 심박수 변이도 비교

  • Lee, Hee-Ryong (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Oh, Joon-Seok (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Choi, Seung-Ho (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Jung, Peel (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Ryu, Tae-Hyun (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Kim, Sung-Min (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Sin, Yong-Hun (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Kim, Joong-Kyung (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Bae, Woo-Hyung (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Hong, Taek-Jong (Department of Internal Medicine, Pusan National University Hospital)
  • 이희룡 (김원묵기념 봉생병원 내과) ;
  • 오준석 (김원묵기념 봉생병원 내과) ;
  • 최승호 (김원묵기념 봉생병원 내과) ;
  • 정필 (김원묵기념 봉생병원 내과) ;
  • 류태현 (김원묵기념 봉생병원 내과) ;
  • 김성민 (김원묵기념 봉생병원 내과) ;
  • 신용훈 (김원묵기념 봉생병원 내과) ;
  • 김중경 (김원묵기념 봉생병원 내과) ;
  • 배우형 (김원묵기념 봉생병원 내과) ;
  • 홍택종 (부산대학교병원 의학전문대학원 내과학교실)
  • Published : 2012.11.01
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Abstract

Background/Aims: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. Methods: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. Results: The mean ages of KT and dialysis patients were $54.2{\pm}12.3$ and $53.7{\pm}12.6$ years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. Conclusions: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis.

목적: 심박수 변이도는 동결절의 교감신경 및 부교감신경의 평형상태를 나타내어 체내 자율신경계의 활성도를 평가하는 지표이다. 현재까지 말기 신부전으로 투석치료를 받고 있는 환자의 연구는 있었으나 신장이식 환자에 있어서 심박수 변이도 변화에 대한 연구는 비교적 드문 실정이다. 이에 저자들은 신장이식이 자율신경계에 미치는 영향을 알아보기 위해 24시간 활동 심전도를 이용하여 심박수 변이도를 조사하였다. 방법: 2008년 1월부터 2011년 6월까지 김원묵기념 봉생병원 신장내과에 내원한 환자 중 말기신부전으로 진단받고 신장 이식을 시행한 23명을 대상으로 24시간 활동 심전도를 시행하고 심박수 변이도를 조사하였다. 당뇨병성 신증으로 말기 신부전에 이른 환자의 경우는 대상에서 제외하였다. 연령과 성별이 유사한 투석 환자 56명을 대상으로 하여 같은 검사를 시행하였다. 심박수 변이도 분석 지표는 시간 계열 분석 (time domain analysis)과 주파수 계열 분석(frequency domain analysis)으로 산출하였다. 결과: 연구 대상 이식 환자는 23명으로 남자가 17명, 여자가 6명이었고, 평균 나이는 $54.2{\pm}12.3$이고 범위는 24-73세였다. 또한 연령과 성별이 유사한 대조군으로 투석 환자는 56명으로 평균 나이는$53.7{\pm}12.6$세였으며 범위는 28-78세였다. 심박수 변이도 분석 지표 중 이식환자의 HRV index, VLF, SDNNi, LF, LF norm, LF/HF가 투석 환자들보다 높았다. 결론: 말기 신부전으로 신장이식을 시행한 환자들은 투석 환자들과 비교하여 전반적인 자율신경계의 활성이 증가하였다.

Keywords

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