대한방사선기술학회지:방사선기술과학 (Journal of radiological science and technology)

  • 제32권2호
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  • Pages.161-168
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  • 2009
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  • 2288-3509(pISSN)
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  • 2384-1168(eISSN)
대한방사선과학회 (Korean Society of Radiological Science)
권호 표지

뇌경색 환자에서 초음파로 측정한 경동맥 내막-중막두께와 죽상경화반의 관련성에 대한 연구

Study on Relationship Between Intima Medial Thickness and the Plaque in Stroke Patients on Carotid Artery Sonography

  • 이미화 (PHILIPS 초음파 임상지원팀) ;
  • 권덕문 (대구보건대학 방사선과) ;
  • 강영한 (대구가톨릭대학교병원 영상의학과)
  • Lee, Mi-Hwa (Philips Korea Clinical Application Specialist Ultrasound) ;
  • Kwon, Duk-Mun (Radiotechnology Daegu Health College) ;
  • Kang, Yeong-Han (Department of Diagnostic Radiology, Daegu Catholic University Hospital)
  • 발행 : 2009.06.30
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초록

초음파에 의한 경동맥 내막-중막 두께의 측정은 동맥경화의 조기발견, 뇌혈관질환, 죽상동맥경화증의 지표로서 사용되지만, 죽상경화증이 내막에 국한되어 발생하는 현상임에도 불구하고 경동맥 내막-중막 두께의 측정은 혈관 벽의 전반적인 두께를 측정하며 일차적으로 중막의 변화를 측정한다는 문제점을 가지고 있다. 이에 반해 죽상경화반의 경우는 혈관벽을 따라 넓게 분포한 것이 아니라 일부분의 위치에 국한되어 나타나는 현상으로 죽상경화증을 더 반영한다고 볼 수 있다. 따라서 본 연구는 뇌경색환자에 대해 경동맥 초음파 검사를 실시하여 경동맥 내막-중막 두께와 죽상경화반의 관계를 파악하고 뇌경색 예측인자인 죽상경화반의 선별검사로 경동맥 초음파 검사가 유용한지 알아보고자 하였다. 2008년 1월에서 3월까지 뇌졸중 전문병원 신경과에 입원한 환자를 대상으로 B-mode 초음파를 이용한 경동맥 내막-중막 두께와 죽상경화반을 검사하였다. 뇌경색환자는 자기공명촬영을 통해 확인하고 나이, 성별과 두개강외 혈관 협착의 위험 인자들을 분석하였다. 대상자의 연령이 높은 군에서 경동맥 내막-중막 두께가 이상이 있는 사람의 분포가 높은 것으로 나타났고(p = 0.004), 경동맥 분지에서의 죽상경화반은 연령이 높은 군에서 그 분포가 높은 것으로 나타났다(p = 0.006). 경동맥 내막-중막 두께가 정상인 사람 총 131명 중 죽상경화반이 발견된 경우는 90명(69%)이었고, 경동맥 내막-중막 두께가 이상인 사람 총 91명 중 죽상경화반이 발견된 경우는 84명(92%)이어서 경동맥 내막-중막 두께가 이상적으로 두꺼운 사람에서 죽상경화반이 발견된 경우가 유의하게 높게 나타났다(p < 0.05). 따라서, 경동맥 내막-중막 두께와 죽상경화반은 밀접한 관련성이 있고, 뇌혈관 질환발생 여부 미치는 영향을 보기 위해 정상인을 대상으로 한 전향적 연구가 필요한 것으로 사료된다.

The carotid intima-media thickness (IMT) is an early structural marker of the atherosclerotic process and is the only non-invasive test that is currently recommended by the American Heart Association for evaluation of the risk. However, use of this parameter has a limitation because it assumes uniform thickness throughout the blood vessel, whereas atherosclerosis is a focal phenomenon that is confined to intima. In fact, plaque can be found along the atherosclerotic blood vessels even though its value is unknown. The aim of this study is to analyze the carotid plaque and IMT in the stroke patients. We investigated the patients with ischemic stroke, who were admitted to the department of neurology at the Stroke Special Hospital from January to March 2008. After the carotid IMT and plaque were assessed by B-mode ultrasonography, IMT and carotid plaque to risk variables (age, sex) were analyzed. The distribution of CCA IMT was significantly different in terms of age (p = 0.004). Likewise, the distribution of carotid plaque was also significantly different in terms of age (p = 0.006). Carotid plaque was 69 and 92% in normal and abnormal CCA IMTs respectively. The results showed that the CCA IMT was closely associated with carotid plaque.

키워드

참고문헌

  1. Alain S, Jerome G, Gilles C, Jean-Louis M, Jaime L. Intima-media thickness : a new tool for diagnosis and treatment of cardiovascular risk. Journal of Hypertension 159-16, 2002 https://doi.org/10.1097/00004872-200202000-00001
  2. 안정천, 심완주, 박상원, 송우혁, 임도선, 노영무 등. 경동맥의 내막 중막 두께와 관상동맥 질환 및 동맥경화증 위험인자와의 상관관계. 한국심초음파학회지. 130-7, 1996
  3. Grobbee DE, Bots ML, Carotid intima-media thickness as an indicator of generalised atherosclerosis. J Int Med. 236:567-73, 1994 https://doi.org/10.1111/j.1365-2796.1994.tb00847.x
  4. Chambless LE, Heiss G, Folsom AR Rosamond W. Szklo M, Sharrett AR, Clegg LX, Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors : the Atheroscleoisis Risk in Communities(ARIC) Study, 1987-1993. Am J Epidemiol. 146:483-494, 1997 https://doi.org/10.1093/oxfordjournals.aje.a009302
  5. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, Azen SP. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 128:262-269, 1998 https://doi.org/10.7326/0003-4819-128-4-199802150-00002
  6. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr, for the Cardiovascular Health Study Collaborative Research Group Carotid-artey intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 96:1432-7, 1997
  7. Adam MR, Nakagomi A, Robinson J, McCredie R, Bailey BP, Freedom SB, Celermajer DS. Carotid intima-media thickness is only weakly correlated with the extent and severity of coronary artery disease. Circulation 92:2127-2134, 1995 https://doi.org/10.1161/01.CIR.92.8.2127
  8. Aminbakhsh A, Frohilich J, Mancini GBJ. Detection of early atherosclerosis with B mode carotid ultrasonography : assessment of a new quantitative approach. Clin invest Med 22:265-274, 1999
  9. Handa N, Mastumoto M, Maeda H, Hougaku H, Itoh T, Okazaki Y, Kimura K, Kamada T : An ultrasonic study of the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease in Japanese. Japanese Journal of Geriatrics 29:742-747, 1992 https://doi.org/10.3143/geriatrics.29.742
  10. Salonen JT, Salonen R : Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation87[suppl II] 56-65, 1993
  11. Kwamori R, Hougaku H, Yamasaki Y, Maeda H, Nishizawa H, Matsumoto M, Nao K, Kamada T : Prevalence of carotid atherosclerosis in diabetic patients. Ultrasound high-resolution B-mode imaging on carotid arteies care 15, 1291-1294, 1992
  12. 조유리, 김대중, 김하동, 최성희, 김수경, 김형진 등. 한국인의 경동맥 내중막 두께 정상치와 죽상경화증 위험인자와의 상관관계. 대한내과학회지 64:275-283, 2003
  13. 송영빈, 안지현, 이상엽, 김상민, 조성원, 이광제 등. 고립성 수축기 고혈압 환자에서 경동맥 내막-중막 두께의 변화. 대한고혈압학회지 1:128-135, 2001
  14. 박병현, 정진원, 조정구. 제 2형 당뇨병 환자에서 고혈압 유무에 따른 경동맥 중상경화증 및 죽상경화증 위험인자들의 비교. 임상당뇨병 52-62, 2000
  15. 고영국, 박석원, 김대중, 안철우, 남수연, 남재현 등. 인슐린비의존형 죽상동맥경화증 위험인자들과의 관계. 당뇨병 23:234-242, 1999
  16. 박태선, 이길홍, 임성희, 이승호, 백홍선, 정경호. 인슐린 비의존형당뇨병 환자에서 경동맥 초음파로 측정한 경동맥 중막-내막 두께와 죽상경화증 위험 인자와의 관계. 당뇨병 20:145-152, 1996
  17. Crouse JR, Toole JF, cKinney WM, Dignan MB, Howard G, Kahl FR, McMahan MR, Harpold GH : Risk factors for extracranial carotid artery atherosclerosis. Stoke 18:990-996, 1987
  18. Wendelhag I, Gustavsson T, Suurkula M, Berglund G, Wikstrand J : Ultrasound measurement of wall thickness in the carotid artery : fundamental principles and description of a computerized analysing system. Clin Physiol 11:565-577, 1991 https://doi.org/10.1111/j.1475-097X.1991.tb00676.x
  19. Wikstrand J, Wiklund O : Frontiers in cardiovascular science : Quantitative measurements of atherosclerotic manifestations in humans. Arerioscler Thromb12:114-119, 1992 https://doi.org/10.1161/01.ATV.12.1.114
  20. 박병현, 조정구, 제 2형 당뇨병 환자에서 대혈관합병증 발생예측인자로서 경동맥 내막중막두께 및 죽상경 환반. 당뇨병 24;603:613
  21. Ebrahim S, Papacosta O, Whincup P, et al. Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women : the British Regional Heart Study Stroke 30-841, 1999 https://doi.org/10.1161/01.STR.30.4.841
  22. Howard G, Sharrett AR, Heiss G, et al. Carotid artery IMT distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke 24:1297, 1993 https://doi.org/10.1161/01.STR.24.9.1297
  23. Heiss G, Sharrett AR, Barnes R, et al. Carotid atherosclerosis measured by B-mode ultrasound in populations : associations with cardiovascular risk factors in the ARIC study. AM J Epidemiol 134:250, 1991 https://doi.org/10.1093/oxfordjournals.aje.a116078
  24. Fisher CM, Gore I, Okabe N, White PD, Atherosclerosis of the carotid and vertebral arteries-extracranial and intracranial. J neuropathol Exp Neurol 24:455-476, 1965 https://doi.org/10.1097/00005072-196507000-00007
  25. Gariepy J, Salomon J, Denarie N, Laskri F, Megnien JL, Lenenson J, Simon A. Sex and topographic differences in associations between large-artery wall thickness and coronary risk profile in a French working cohort : the AXA Study.
  26. Deparion M, Tutta P, van Melle G, Hayoz D, Kappenberger L, Darioli R, Reference values for IMT of carotid and femoral arteries in subjects 20 to 60 years and without cardiovascular rik factors. Arch Mal Coeur Vaiss 93:721-726, 2000
  27. Mannami T, Konishi M, Baba S, Nishi N, Terao A. Prevalance of asymptomatic carotid atheroscleotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city. Stroke, 28:518-525, 1997 https://doi.org/10.1161/01.STR.28.3.518
  28. Armstrong ML. Megan MB, Heistad DD. Adaptive responses of the arterial wall as human atherosclerosis develops. In Glagov S, Nemman WP, Schaffer SA, editors. Pathobiology of Human Atherosclerotic Plaque. pp.469-480, New York, Springer & Verlag, 1989
  29. Geroulakos G, O'Gornan DJ, Kalodiki E, Sheridan DJ, Nicolaides AN. The carotid IMT as a marker of the presense of severe symtomatic coronary artery diease. Eur heart J 15:781-785, 1994 https://doi.org/10.1093/oxfordjournals.eurheartj.a060585
  30. J. David Spence. Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease. AM J cadiol 89-10B-16B, 2002 https://doi.org/10.1016/S0002-9149(02)02404-9