가정의학회지 (Korean Journal of Family Medicine)

  • 제26권10호
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  • Pages.614-620
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  • 2005
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  • 2005-6443(pISSN)
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  • 2092-6715(eISSN)
대한가정의학회 (The Korean Academy of Family Medicine)
권호 표지

대사증후군과 심혈관 위험인자의 관련성

The Relation of Cardiovascular Risk Factors to Metabolic Syndrome

박샛별
Park, Sat-Byul

  • 발행 : 20051000
⟨ 이전 논문 다음 논문 ⟩

초록

연구배경: 대사증후군이란 고중성지방혈증, 고혈압, 당대사이상 및 비만과 같은 관상동맥위험인자가 함께 나타나는 증후군으로 명확한 발생기전은 밝혀지지 않았으나 인슐린 저항성이 주요 역할을 하는 것으로 알려져 있다. 본 연구에서는 대사증후군에서 인슐린저항성에 따른 심혈관 위험인자와의 관련성을 평가하고 인슐린저항성 발생에 유의한 위험요인을 분석하여 인슐린저항성에 대한 대사증후군의 임상적 유용성을 알아보고자 하였다. 방법: 일개 대학병원의 건강증진센터에서 건강검진을 받은 수진자 중 병원전산시스템을 사용하여 기록미비자들을 제외한 총 993명을 NCEP-ATP III 진단기준에 따라 구분하여 대사증후군군 502명, 대조군 491명을 대상으로 하였다. 설문 조사를 통하여 사회인구학적 인자와 생활습관요인을 조사하였고, 신장과 체중, 수축기 혈압과 이완기 혈압을 측정하였으며, 공복 혈당, 혈청 총 콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤, 인슐린을 측정하였다. W/BH ratio, AI와 HOMA-IR을 산출하여 심혈관질환 위험요인과의 관련성을 알아보았다. 결과: 대사증후군은 남자가 여자에 비해 유의하게 많았으며(P＜0.05), 대사증후군군의 평균연령과 체질량지수는 대조군보다 유의하게 높았다(P＜0.05). ROC curve를 이용하여 구한 대사증후군에 대한 심혈관 위험인자의 절단점은 W/BH ratio가 0.529, AI 4.34, HOMA-IR 1.94, Insulin 6.35 ｕIU로 AUC는 통계학적으로 유의한 차이가 있었고 (P=0.000), 그 중 대사증후군을 진단하는데 가장 특이도가 높은 변수는 W/BH ratio이었다. 대상군을 인슐린저항성 여부에 따라 구분한 후 심혈관 위험인자와의 관련성을 평가하였는데 고혈압과 고중성지방혈증, 저HDL-콜레스테롤혈증은 대사증후군군에서 교차곱비가 유의하게 높았으나(P＜0.05), 당뇨병의 발병은 대사증후군 여부와는 상관없이 인슐린저항성이 있는 경우에 유의하게 높게 나타났다(P＜0.05). 대사성 위험요인에 대한 인슐린저항성의 위험성은 생활습관 요인의 보정 후 더 높은 경향을 나타내었다. 결론: 대사증후군의 진단기준은 인슐린 저항성을 조기 발견하기 위한 간접측정도구로 의의가 있으며 당뇨병의 발병은 대사증후군 여부와는 상관없이 인슐린저항성이 있는 경우에 높게 나타났다. 따라서, 대사증후군으로 진단받은 환자를 적극적으로 치료하고 생활습관을 개선시키는 것이 심혈관 질환의 발생을 줄일 수 있을 것으로 생각하며, 향후 대사증후군 환자의 추적조사를 통한 지속적인 연구가 필요하다.

Background: Possible risk factors relating to the development of insulin resistance was analyzed and the clinical availability of metabolic syndrome on insulin resistance was examined to evaluate the relationship between the metabolic syndrome and insulin resistance. Methods: A total of 993 clients were selected according to the criteria of clinical identification by NCEP-ATP III. The metabolic syndrome group was 502 subjects and the control group was 491 subjects. Sociodemographic data and lifestyle factors were surveyed by questionnaire. Height, weight, blood pressure, fasting blood cholesterol, triglyceride, HDL cholesterol, glucose, and insulin levels were measured. W/BH ratio, AI, and HOMA-IR were calculated and analyzed in relation to cardiovascular risk actors. Results: In the metabolic syndrome group, men were significantly greater than women (P＜0.05). The mean age and BMI in the metabolic syndrome group were significantly higher than controls (P＜0.05). The cut-off point for cardiovascular risk factor using the ROC curve with W/BH ratio was 0.529, AI 4.34, HOMA-IR 1.94, and Insulin 6.35 ｕIU. The area under the ROC curve for variables was significantly greater than the reference value (P=0.000). Therefore, W/BH ratio was a strong predictor of incident metabolic syndrome. The study subjects were grouped according to insulin resistance and then the relationship of cardiovascular risk factors was evaluated. Odds ratios of hypertension, hypertriglyceridemia, and low HDL-cholesterolemia were significantly increased in the metabolic syndrome group (P＜0.05), while the individuals with insulin resistance had a much higher incident diabetes than those without it, regardless of whether NCEP criteria for metabolic syndrome was met. The risk of insulin resistance in relation to metabolic risk factors tended to increase after adjustment of life style factors. Conclusion: The diagnostic criteria for the metabolic syndrome was useful in finding out early stage of insulin resistance as an indirect measurement tool. Incident diabetes related to insulin resistance regardless of the presence of metabolic syndrome. Therefore, clinical treatment and life style modification in metabolic syndrome patients may decrease the development of cardiovascular disease and contribute to health promotion. Further study is needed to follow-up on metabolic syndrome patients.

키워드

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