지속성 외래 복막투석 환자에서 만성 염증 및 감염과 죽상경화증과의 상관성

Abstract

Background : In ESRD patients, the annual mortality rate due to cardiovascular disease (CVD) is 10 to 20 fold higher than that of the general population. Much recent interest have been focused on the association between chronic inflammation and the increased mortality rate due to CVD in ESRD patients. This study was performed to investigate whether the C．pneumoniae infection and inflammation play important roles in the change of the carotid intimamedia thickness (IMT) in ESRD patients. Methods : 5" patients undergoing CAPD were enrolled in the study. We measured IMT by using B-mode ultrasonography. 1L-6, antibody titers to C．pneumoniae, cell－adhesion molecules were assessed by ELISA. Results : Significant increase in carotid IMT (0.71±O.02 to 0.77±0.12 mm, p＜0.05), cIM area (19.62±4.21 to 21.82±4.80 mm², p＜0.05), prevalence of plaque (36.5% to 57.7%, p＜0.05) were observed in 52 patients. `The patients were divided into two groups according to the change in IMT. Progressor for 32 patients who had more than 0.1 mm increase in IMT and nonprogressor for 20 who had lesser than 0.1 mm increase or no changes in IMT. Log IL-6, IgA antibody titers to C. pneumoniae, ICAM-l level were significantly higher in progressors compared to nonprogressors (4.2０±5.14 vs. 1.44±0.58pg/mL, 1.14±0.60 vs. 0.77±0.32, 297.42±88.22 vs. 23３．93±88.89 ng/mL, p<0.05). Logistic regression analysis showed that elevated log IL-6 and IgA antibody titers to C. pneurnoniae were independent factors adversely affecting change of IMT. Stepwise multiple regression analysis showed that log IL-6, ICAM-1, and IgA antibody titers to C. pneumoniae were independent factors affecting carotid IMT. Conclusion : Our data suggest that inflammation and seropositivity of IgA to C. pneumoniae can be associated with the progression of atherosclerosis in CAPD patients.