The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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The Relationship of epicardial adipose tissue to metabolic syndrome and cardiovascular risk factors

심장외막지방과 대사 증후군 및 심혈관 질환 위험인자와의 연관성

Baik, Seung-Hee;Ahn, Sung-Gyun;Choi, Jung-Hyun;Koh, Bo-Ram;Yoo, Jun-Hwan;Kang, Soo-Jin;Choi, Byoung-Joo;Choi, So-Yeon;Yoon, Myeong-Ho;Tahk, Seung-Jea;Shin, Joon-Han
백승희;안성균;최정현;고보람;유준환;강수진;최병주;최소연;윤명호;탁승제;신준한

  • Published : 20070300
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Abstract

Background : Increased adiposity is widely accepted as the main expression of obesity and an important risk factor for the development of cardiovascular and metabolic syndrome. The significance of epicardial adipose tissue (EAT), frequently observed during a transthoracic echocardiographic examination, is not well recognized. The purpose of this study was to investigate the relationship of EAT to metabolic syndrome and cardiovascular risk factors. Methods : We collected clinical, biochemical, and anthropometric information from 289 consecutive and prospective patients (147 men; 59±11 years) who visited our hospital for a complaint of chest pain. EAT thickness was measured by transthoracic echocardiography on the free wall of the right ventricle in the parasternal long axis and short axis views at the base level during end-diastole. Results : EAT thickness was significantly increased in 185 (64%) patients with metabolic syndrome as compared with patients without metabolic syndrome (4.3±2.5 mm vs. 3.6±2.8 mm, p=0.005). By a simple linear regression analysis, EAT was correlated to age (r=0.484, p<0.001), waist circumference (r=0.177, p=0.01), the level of HDL cholesterol (r=-0.182, p=0.001) and log CRP (r=0.268, p=0.012). Multivariate analysis showed that age and log CRP were the independent variables that correlated to EAT thickness. Conclusions : These results suggest that echocardiographic EAT should be considered as a new useful imaging indicator of visceral adipose tissue related to metabolic syndrome and cardiovascular disease.

목적 : 저자 등은 1) 심장외막지방과 대사 증후군과의 연관성과 2) 심혈관 질환의 위험인자와의 상관관계를 알아보고 3) 심장외막지방과 인슐린 저항성 정도를 알아보고자 본 연구를 수행하였다. 방법 : 흉통을 주소로 내원하여 처음 관동맥조영술을 시행 받은 289명을 대상으로 경흉부 심초음파을 이용한 심장외막지방의 두께 및 인체 계측, 혈청 총 콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤, 저밀도지단백 콜레스테롤, 공복 시 혈당, 공복 시 인슐린, CRP, 섬유소 (fibrinogen), 요산 등을 측정하였다. 결과 : 1) 대사 증후군의 환자군(185명, 64%)에서 심장외막지방의 두께가 의미있게 두꺼웠다(평균 4.3±2.5 mm vs. 평균 3.6±2.8 mm, p=0.005). 2) 심장외막지방 두께의 중앙값인 3.4 mm을 기준으로 환자를 두 군으로 분류하여 심혈관 질환의 위험인자들을 비교해 보았을때 두꺼운 군에서 대사 증후군 동반 빈도가 높고, 대사증후군의 구성요소의 유병률이 높았으며. 나이, 허리둘레, 총 콜레스테롤, log CRP 등이 통계학적으로 의미 있게 높았고 고밀도지단백 콜레스테롤은 통계학적으로 의미있게 낮았다. 3) 대사 증후군의 여부에 따라 심장외막 지방의 ROC curve를 분석하여 심장외막지방의 두께 3.2 mm가에서 민감도 58%, 특이도 58%를 보여 가장 신뢰성 있는 cut-off 수치였다. 로지스틱 회귀 분석을 이용하여 심장외막지방의 두께가 0.1 mm 증가할 때마다 대사 증후군의 유병률이 1.78배 증가함을 알 수 있었다. 4) 나이, 허리둘레, 고밀도지단백 콜레스테롤, log CRP가 통계학적으로 의미있는 상관관계가 있었고. 이들 중 나이, log CRP는 다중 회귀 분석을 통하여 심장외막지방의 두께와 독립적으로 상관관계가 있었다. 5) 비 당뇨 환자군에서 인슐린 및 HOMA-IR score도 심장외막지방의 두께와 연관이 있었다. 결론 : 경흉부 심초음파로 측정한 심장외막지방의 두께는 대사 증후군 및 심혈관 질환의 위험인자와 연관성을 보였고, 인슐린 저항성과도 관련성을 보여 앞으로 내장 지방의 새로운 지표로서 대사 증후군 및 심혈관 질환을 예측하는 새롭고 부가적인 유용한 지표가 될 수 있으리라 생각된다.

Keywords

References

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