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한국인 성인에서 내장지방량과 죽상경화증 위험인자 및 좌심실 비대와의 상관관계

윤중원(Jung Won Yun),이원영(Won Young Lee),김지연(Ji Youn Kim),박현덕(Hyun Duk Park),임성호(Seong Ho Lim),정찬희(Chan Hee Jung),김영춘(Young Chun Kim),김선우(Sun Woo Kim) 대한내과학회 2002 대한내과학회지 Vol.63 No.2
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  KCI
  
  KISS
배경: 비만증은 심혈관 질환의 위험요소일 뿐 아니라 고혈압, 이상지질혈증, 인슐린 저항증 등의 대사증후군과 밀접하게 연관되어 있다. 많은 연구들에서 복부 내장지방량이 주요한 역할을 하는 것으로 보고하였다. 좌심실 비대는 심혈관 질환의 독립적인 위험인자로 알려져 있으나, 체지방분포와의 관계에 대해서는 많은 연구가 되어 있지않다. 본 연구에서는 한국인 성인 남녀에서 체지방 분포와 죽상경화증 위험인자와의 상관관계를 알아보고자 대사지표 및 좌심실 질량과의 상호 연관성을 조사하였다. 방법: 1999년 3월부터 2001년 6월까지 강북삼성병원에서 건강검진을 받은 138명(남자 97명, 여자 41명)을 대상으로 복부 전산화 단층촬영, 체성분 분석을 시행하였다. 결과: 남녀에 따른 체지방분포에서 내장지방은 남자에서 유의하게 높았고, 피하지방과 체지방율은 여자에서 유의하게 높았지만(p<0.05) 복부 지방율은 유의한 차이를 보이지 않았다. 연령에 따른 체지방은 연령대가 증가할수록 내장지방과 복부 지방율이 유의하게 증가되었다(p<0.05). 복부 내장지방은 체질량지수(r=0.556), 허리/둔부 둘레비(r=0.569), 수축기혈압(r=0.282), 이완기혈압(r=0.356), 총콜레스테롤(r=0.218), 중성지방(r=0.309), 요산(r=0.377)과 유의한 상관관계를 보였지만(p<0.05), 피하지방과의 상관관계는 없었고, 연령과 성별로 보정 후에도 같은 유의성을 보였다. 좌심실 질량과는 체질량지수(r=0.392), 허리/둔부 둘레비(r=0.404), 내장지방량(r=0.362), 복부 지방율(r=0.479)이 유의한 상관관계를 보였고(p<0.05), 연령과 혈압 및 체질량지수를 보정한 후 실시한 다중회귀분석상 내장지방량(β=0.252, p<0.05)이 좌심실 질량의 중요한 예측 인자임을 알 수 있었다. 결론: 이상의 결과로 보아 체지방의 분포가 죽상경화증의 위험인자와의 상관관계가 있음을 보았다. 복부지방이 대사증후군 및 심혈관 질환의 위험인자인 좌심실 비대와 상관관계가 있었고, 특히 복부지방중 내장지방이 주요한 대사장애의 원인임을 알 수 있었다. Background: Obesity is an independent risk factor for the development of coronary artery disease and associated with insulin resistance, hyperlipidemia and hypertension. In many studies, visceral adipose tissue is highly correlated with adverse coronary risk profile. Left ventricular (LV) hypertrophy also is an independent risk factor for cardiovascular mortality and morbidity. However, few data are available concerning the relations of LV hypertrophy to body fat composition, especially in Korean subjects. Therefore, this study was intended to evaluate the relation between body fat distribution and atherosclerotic risk factors including metabolic parameters and LV mass. Methods: Total 138 subjects who visited the healthy promotion center in Kangbuk Samsung hospital (97 men, 41 women) were to recruited to the study. Body fat distribution was assessed by Abdomial CT (computer tomography) and Bioelectrical impedance analysis (Body Composition Analyzer Inbody 2.0, Biospace, Seoul, Korea) Results: Visceral adipose tissue volume was higher in male subjects while subcutaneous adipose tissue volume and % body fat were higher in female subjects (p<0.05). Serum triglyceride and uric acid level were elevated in male subjects but HDL-cholesterol level was elevated in female subjects (p<0.05). Increasing age was correlated with waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio, LV mass (p<0.05). Visceral adipose tissue volume was positively correlated with body mass index, waist-hip ratio, blood pressure, total cholesterol, triglyceride, uric acid and negatively correlated with HDL-cholesterol (p<0.05). After adjustment for age and sex, this correlation was significantly remained. LV mass was positively correlated with body mass index, waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio (p<0.05). In the multiple regression analysis, the independent predictor for LV mass was visceral adipose tissue volume (β=0.252, p<0.05). Conclusion: Body fat distribution is associated with traditional cardiovascular risk factors. Especially, visceral adipose tissue is correlated with the components of metabolic syndrome and LV mass which is independent risk factor of cardiovascular morbidity and mortality. (Korean J Med 63:177-185, 2002)
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위암 재발에 의한 속발성 식도이완불능증 1 예

박인옥(In Ok Park),서정열(Jung Yul Suh),정수석(Su Suk Chung),임성호(Seong Ho Lim),이은정(Eun Jung Rhee),윤중원(Jung Won Youn),이호철(Ho Chul Lee),박승하(Seung Ha Park),김정욱(Jeong Wook Kim),조용균(Yong Kyun Cho),이준행(Jun Haeng Lee 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.1
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Achalasia can be provoked by organic causes, and it is called secondary achalasia. Sometimes it is very difficult to distingush secondary achalasia from primary achalasia. We report a case of secondary achalasia due to recurrence of stomach cancer. A 45-year-old man came to our hospital due to three months history of dysphagia and regurgitation. Barium esophagogram showed concentric narrowing at the distal esophagus and dilatation of proximal esophagus. The esophagogastroduodenoscopy showed stenosis of gastroesophageal junction and the endoscope could not pass through it, but there was no evidence of malignancy. Esophageal manometry showed aperistalsis, compatible with achalasia. Abdominal CT showed soft tissue density near the gastroesophageal junction. However it was not possible to differentiate whether it was due to adhesion or malignancy. For correct diagnosis and treatment, explorolaparotomy was performed and it was diagnosed as secondary achalasia due to recurrence of stomach cancer.(Korean Journal of Gastrointestinal Motility 2002;8:53-57)