대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)

  • 제52권2호
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  • Pages.119-127
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  • 2020
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  • 1738-3544(pISSN)
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  • 2288-1662(eISSN)
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)
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비흡연 성인에서 맥압과 폐기능 장애의 상관성

Association between Pulse Pressure and Impaired Pulmonary Function in Non-Smoking Adults

  • 윤현 (원광보건대학교 임상병리과)
  • Yoon, Hyun (Department of Clinical Laboratory Science, Wonkwang Health Science University)
  • 투고 : 2020.04.22
  • 심사 : 2020.05.10
  • 발행 : 2020.06.30
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초록

선행 연구에서 동맥경화와 폐기능이상과 연관성이 있었다. 맥압은 동맥경화의중요한 예측이지만 아직까지 폐기능이상과 맥압의 연관성은 불분명하다. 따라서, 본 연구는 대한민국 비흡연 성인을 대상으로 맥압과 폐기능장애(예측 강제 폐활량, 예측 강제 날숨량 1초율)의 관련성을 알아보고자 실시하였다. 본 연구는 2013년부터 2015년까지 3년간의 대한민국 국민건강영양조사자료에서 비흡연 성인(6,857명)을 대상으로 실시하였다. 본 연구의 주요 결과는 맥압과 폐기능장애에 대한 관련 변수를 보정한 후의 결과에서, 정상 맥압(pulse pressure, PP≤60 mmHg)에 비하여 고맥압(PP>60 mmHg; 1.337 [95% confidence interval (CI), 1.049~1.703)에서 제한성 폐질환(restrictive pulmonary disease, RPD; the predicted FVC<80.0% with FEV1/FVC≥70.0%)의 교차비(odds ratio, OR)가 유의하게 높았다. 추가적으로, 정상맥압에 비하여 고맥압(1.339 [95% CI, 1.093~1.642])에서 폐쇄성 폐질환(obstructive pulmonary disease, OPD; FEV1/FVC<70.0%)의 교차비가 유의하게 높았다. 결론적으로, 대한민국 비흡연 성인에서 제한성 폐질환 및 폐쇄성 폐질환은 고맥압과 유의한 관계가 있었다.

According to previous studies, an impaired pulmonary function is associated with arterial stiffness (AS). The pulse pressure (PP) is an important predictor of AS, but the association of an impaired pulmonary function with the PP is unclear. Therefore, this study assessed the associations between the PP and the predicted forced vital capacity (predicted FVC) and predicted forced expiratory volume in one second (predicted FEV1) in Korean non-smoking adults. The data obtained from 6,857 adults during the 2013~2015 Korean National Health and Nutrition Examination Survey were analyzed. After adjusting for the related variables, the ORs of restrictive pulmonary disease (RPD, the predicted FVC<80.0% with FEV1/FVC≥70.0%) using the normal PP group (PP≤60 mmHg) as a reference group was significant for the high PP group (PP>60 mmHg; 1.337 [95% confidence interval (CI), 1.049~1.703]). In addition, the ORs of obstructive pulmonary disease (OPD, FEV1/FVC<70.0%) using the normal PP group as a reference group were significant for the high PP group (1.339 [95% CI, 1.093~1.642]). In conclusion, a high PP is positively associated with both RPD and OPD in Korean non-smoking adults.

키워드

참고문헌

  1. WHO. Disease burden and mortality estimates 2000-2016 [Internet]. Geneva: WHO; 2017 [cited 2020 May 08]. Available from: https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html
  2. Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the renfrew and paisley prospective population study. BMJ. 1996;313:711-715. https://doi.org/10.1136/bmj.313.7059.711
  3. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest. 2005;127: 1952-1959. https://doi.org/10.1378/chest.127.6.1952
  4. Yokomichi H, Nagai A, Hirata M, Kiyohara Y, Muto K, Ninomiya T, et al. Survival of macrovascular disease, chronic kidney disease, chronic respiratory disease, cancer and smoking in patients with type 2 diabetes: BioBank Japan cohort. J Epidemiol. 2017;27(3S):98-106. https://doi.org/10.1016/j.je.2016.12.012
  5. Imaizumi Y, Eguchi K, Kario K. Lung disease and hypertension. Pulse. 2014;2:103-112. https://doi.org/10.1159/000381684
  6. McAllister DA, Maclay JD, Mills NL, Mair G, Miller J, Anderson D, et al. Arterial stiffness is independently associated with emphysema severity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;76:1208-1214. https://doi.org/10.1164/rccm.200707-1080OC
  7. Mills NL, Miller JJ, Anand A, Robinson SD, Frazer GA, Anderson D, et al. Increased arterial stiffness in patients with chronic obstructive pulmonary disease: a mechanism for increased cardiovascular risk. Thorax. 2008;63:306-311. https://doi.org/10.1136/thx.2007.083493
  8. Costanzo L, Pedone C, Battistoni F, Chiurco D, Santangelo S, Antonelli-Incalzi R. Relationship between FEV1 and arterial stiffness in elderly people with chronic obstructive pulmonary disease. Aging Clin Exp Res. 2017;29:157-164. https://doi.org/10.1007/s40520-016-0560-3
  9. Benetos A, Thomas F, Joly L, Blacher J, Pannier B, Labat C, et al. Pulse pressure amplification a mechanical biomarker of cardiovascular risk. J Am Coll Cardiol. 2010;55:1032-1037. https://doi.org/10.1016/j.jacc.2009.09.061
  10. Zhao L, Song Y, Dong P, Li Z, Yang X, Wang S. Brachial pulse pressure and cardiovascular or all-cause mortality in the general population: a meta-analysis of prospective observational studies. J Clin Hypertens. 2014;16:678-685. https://doi.org/10.1111/jch.12375
  11. Dart AM, Kingwell BA. Pulse pressure-a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37:975-984. https://doi.org/10.1016/s0735-1097(01)01108-1
  12. Zheng X, Jin C, Liu Y, Zhang J, Zhu Y, Kan S, et al. Arterial stiffness as a predictor of clinical hypertension. J Clin Hypertens. 2015;17:582-591. https://doi.org/10.1111/jch.12556
  13. Park SY, Oh HJ, Yoon H. Association of metabolic syndrome, metabolic syndrome score and pulse pressure in Korean adults: Korea National Health and Nutrition Survey, 2012. J Korea Acad Industr Coop Soc. 2014;15:5660-5667. http://doi.org/10.5762/KAIS.2014.15.9.5660
  14. Swanney MP, Ruppel G, Enright PL, Pedersen OF, Crapo RO, Miller MR, et al. Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction. Thorax. 2008;63:1046-1051. https://doi.org/10.1136/thx.2008.098483
  15. Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J. 2011;80:84-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229853/
  16. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2:8-11. https://doi.org/10.1513/pats.200404-032MS
  17. Tozawa M, Iseki K, Iseki C, Takishita S. Pulse pressure and risk of total mortality and cardiovascular events in patients on chronic hemodialysis. Kidney Int. 2002;61:717-726. https://doi.org/10.1046/j.1523-1755.2002.00173.x
  18. Domanski M, Mitchell G, Pfeffer M, Neaton JD, Norman J, Svendsen K, et al. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 2002;287:2677-2683. https://doi.org/10.1001/jama.287.20.2677
  19. Assmann G, Cullen P, Evers T, Petzinna D, Schulte H. Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM. Eur Heart J. 2005;26:2120-2126. https://doi.org/10.1093/eurheartj/ehi467
  20. Korhonen P, Kautiainen H, Aarnio P. Pulse pressure and subclinical peripheral artery disease. J Hum Hypertens. 2014;28: 242-245. https://doi.org/10.1038/jhh.2013.99
  21. Chrysant GS. Peripheral vascular disease is associated with increased pulse wave velocity and augmentation index: clinical implications. J Clin Hypertens. 2014;16:788-789. https://doi.org/10.1111/jch.12407
  22. Nitta K, Akiba T, Uchida K, Otsubo S, Otsubo Y, Takei T, et al. Left ventricular hypertrophy is associated with arterial stiffness and vascular calcification in hemodialysis patients. Hypertens Res. 2004;27:47-52. https://doi.org/10.1291/hypres.27.47
  23. Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R, et al. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation. 2011;124:2491-2501. https://doi.org/10.1161/CIRCULATIONAHA.110.011031
  24. Palmieri V, Devereux RB, Hollywood J, Bella JN, Liu JE, Lee ET, et al. Association of pulse pressure with cardiovascular outcome is independent of left ventricular hypertrophy and systolic dysfunction: the strong heart study. Am J Hypertens. 2006;19:601-607. https://doi.org/10.1016/j.amjhyper.2005.12.009
  25. Toprak A, Reddy J, Chen W, Srinivasan S, Berenson G. Relation of pulse pressure and arterial stiffness to concentric left ventricular hypertrophy in young men (from the Bogalusa Heart Study). Am J Cardiol. 2009;103:978-984. https://doi.org/10.1016/j.amjcard. 2008.12.011
  26. Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36:130-138. https://doi.org/10.1016/s0735-1097(00)00687-2
  27. Haider AW, Larson MG, Franklin SS, Levy D. Systolic blood pressure, diastolic blood pressure, and pulse pressure as predictors of risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2003;138:10-16. https://doi.org/10.7326/0003-4819-138-1-200301070-00006
  28. Brahimi M, Dahan M, Dabiré H, Levy BI. Impact of pulse pressure on degree of cardiac hypertrophy in patients with chronic uraemia. J Hypertens. 2000;18:1645-1650. https://doi.org/10.1097/00004872-200018110-00016
  29. Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003;107:2864-2869. https://doi.org/10.1161/01.CIR.0000069826.36125.B4
  30. Kaushal M, Shah PS, Shah AD, Francis SA, Patel NV, Kothari KK. Chronic obstructive pulmonary disease and cardiac comorbidities: a cross-sectional study. Lung India. 2016;33:404-409. https://doi.org/10.4103/0970-2113.184874
  31. Pelà G, Li Calzi M, Pinelli S, Andreoli R, Sverzellati N, Bertorelli G, et al. Left ventricular structure and remodeling in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:1015-1022. https://doi.org/10.2147/COPD.S102831
  32. Olson TP, Beck KC, Johnson BD. Pulmonary function changes associated with cardiomegaly in chronic heart failure. J Card Fail. 2007;13:100-107. https://doi.org/10.1016/j.cardfail.2006.10.018
  33. Kolb TM, Hassoun PM. Right ventricular dysfunction in chronic lung disease. Cardiol Clin. 2012;30:243-256. https://doi.org/10.1016/j.ccl.2012.03.005
  34. Guntheroth WG. Increased pulse pressure causes vascular injury in pulmonary and systemic arteries. Decreasing the pulsatility with banding and vasodilators can stabilize pulmonary hypertension. J Clinic Experiment Cardiol. 2010;1:107. https://doi.org/10.4172/2155-9880.1000107
  35. Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series). Pulm Circ. 2014;4:560-580. https://doi.org/10.1086/677370
  36. Jankowich MD, Taveira T, Wu WC. Decreased lung function is associated with increased arterial stiffness as measured by peripheral pulse pressure: data from NHANES III. Am J Hypertens. 2010;23:614-619. https://doi.org/10.1038/ajh.2010.37
  37. Zureik M, Benetos A, Neukirch C, Courbon D, Bean K, Thomas F, et al. Reduced pulmonary function is associated with central arterial stiffness in men. Am J Respir Crit Care Med. 2001; 164:2181-2185. https://doi.org/10.1164/ajrccm.164.12.2107137
  38. Peled N, Shitrit D, Fox BD, Shlomi D, Amital A, Bendayan D, et al. Peripheral arterial stiffness and endothelial dysfunction in pulmonary arterial hypertension. J Rheumatol. 2009;36:970-975. https://doi.org/10.3899/jrheum.081088
  39. Nettleton JA, Follis JL, Schabath MB. Coffee intake, smoking, and pulmonary function in the atherosclerosis risk in communities study. Am J Epidemiol. 2009;169:1445-1453. https://doi.org/10.1093/aje/kwp068
  40. Mahmud A, Feely J. Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension. 2003;41:183-187. https://doi.org/10.1161/01.hyp.0000047464.66901.60