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Statin 치료시 LDL 콜레스테롤의 직접 측정값과 계산값의 비교
김현진 ( Hyeon Jin Kim ),석지혜 ( Ji Hye Suk ),강지현 ( Ji Hyun Kang ),권혁용 ( Hyuk Yong Kwon ),황치성 ( Chi Sung Hwang ),김명준 ( Myoung Joon Kim ),김미경 ( Mi Kyung Kim ),김태익 ( Tae Ik Kim ),김인주 ( In Joo Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
Background/Aims: Lowering low-density lipoprotein cholesterol (LDL-C) is the primary target for the prevention of cardiovascular disease. Previous studies have shown that estimated LDL-C levels calculated using Friedewald`s formula (FLDL-C) are closely correlated with directly measured LDL-C levels (DLDL-C). However, because statins not only reduce LDL-C, but also alter the levels of parameters used to calculate FLDL-C (i.e., total cholesterol, triglycerides, and high-density lipoprotein cholesterol), whether calculated LDL-C levels remain a reliable estimate of actual levels after statin treatment is unclear. Methods: Subjects included 985 patients at high risk of cardiovascular disease who had taken statins for more than 6 months. FLDL-C data were compared to DLDL-C data. Results: A strong correlation was observed between DLDL-C and FLDL-C data (R2=0.879). However, the absolute values for FLDL-C and DLDL-C differed significantly according to a paired t-test, and 42.3% of patients showed a difference of greater than 10% between these two values. Among patients with diabetes, the percentage of patients deemed to have achieved target LDL-C levels differed significantly according to the method of LDL-C determination (p=0.007). Conclusions: FLDL-C and DLDL-C data remained well correlated after statin treatment, although the absolute values differed significantly according to the LDL-C determination method. Furthermore, the percentage of subjects deemed to achieve target LDL-C levels differed significantly according to the method of determination among patients with diabetes. (Korean J Med 79:277-284, 2010)
제2형 당뇨병 환자에서 스타틴 치료 시 HDL 콜레스테롤의 변화
박종률 ( Jong Ryul Park ),장혜정 ( Hye Jung Jang ),문정윤 ( Jung Youn Moon ),석지혜 ( Ji Hye Suk ),김미경 ( Mi Kyung Kim ),박정현 ( Jeong Hyun Park ),이병두 ( Byung Doo Rhee ) 대한내과학회 2008 대한내과학회지 Vol.74 No.4
목적: 스타틴은 심혈관계 질환의 일차 및 이차 예방에 효과적인 것으로 받아들이고 있지만 HDL 콜레스테롤을 올리는데 있어서는 개인간에 편차가 큰 것으로 알려져 있다. 본 연구는 제 2형 당뇨 환자에서 스타틴 치료 시 HDL 콜레스테롤의 변화를 살펴보기 위해 시행하였다. 방법: 217명의 제 2형 당뇨와 이상지혈증을 가진 환자를 대상으로 스타틴의 반응을 살펴보았다. 진료기록부를 근거로 한 후향적 연구로 본 연구를 시행하였다. 피브린산 유도체나 니코틴산을 병합하여 사용하고 있는 환자나 이전에 스타틴을 사용한 환자, 크레아티닌이 1.5 mg/dL 이상, 공복 중성지방이 300 mg/dL 이상인 경우, 그리고 만성 간질환이 있는 경우는 연구 대상에서 제외시켰다. 결과: HDL 콜레스테롤은 평균 2.3% 감소하였다. HDL 콜레스테롤의 퍼센트 변화에 영향을 준 인자는 기저 HDL 콜레스테롤, LDL 콜레스테롤의 퍼센트 변화, 총 콜레스테롤, 기저 총 콜레스테롤이었다. 그 중 기저 HDL 콜레스테롤이 퍼센트 변화에 가장 강력한 인자였다. 기저 HDL 콜레스테롤으로 대상을 5분획으로 나누어 보면 기저 HDL 콜레스테롤 값이 높을수록 HDL 콜레스테롤 값은 많이 감소하였다. 결론: 제2형 당뇨병 환자에서 스타틴 치료 시 HDL 콜레스테롤 변화는 기대했던 효과와 달리 오히려 그 수치가 감소하는 환자들도 있었다는 것이 관찰되었고, 향후 이에 대한 전향적인 연구가 더 필요할 것으로 생각된다. Background/Aims: Statins have been a mainstay of treatment for primary and secondary prevention of coronary heart disease through their beneficial effect on lipid profile. However, their effect on the HDL cholesterol level has been determined to be equivocal or unclear. This study sought to investigate HDL cholesterol response to statin treatment in type 2 diabetic patients. Methods: We retrospectively assessed the effect of statins in 217 patients with type 2 diabetes and dyslipidemia through chart review. Patients who were using medications such as fibrates, niacin, or thiazolidinediones, or had a plasma creatinine concentration greater than 1.5 mg/dL, a fasting triglyceride level greater than 300 mg/dL, or chronic liver disease, were excluded from the study. Result: The mean level of LDL cholesterol was significantly decreased, and the percentage of patients who achieved the normal LDL cholesterol level was increased in this study. The mean HDL cholesterol level after statin treatment was decreased by 2.3%. The percent change of HDL cholesterol was affected by baseline HDL cholesterol level, percent change of total cholesterol, percent change of LDL cholesterol, and baseline total cholesterol level. When subjects were divided into quintiles according to baseline HDL cholesterol, HDL cholesterol level was found to be increased in the lowest two quintiles while it was decreased in the highest two quintiles. Conclusions: There were some patients whose HDL cholesterol level was decreased after statin treatment, depending on their baseline HDL cholesterol level. We think further study on the effect of statins on HDL level will be needed in the future.(Korean J Med 74:411-417, 2008)
제2형 당뇨병환자의 사망원인에 대한 10년간의 추세 변화 : 부산 시내 6개 종합병원을 중심으로
박수경 ( Su Kyung Park ),박미경 ( Mi Kyoung Park ),석지혜 ( Ji Hye Suk ),김미경 ( Mi Kyung Kim ),김용기 ( Yong Ki Kim ),김인주 ( In Ju Kim ),강양호 ( Yang Ho Kang ),이광재 ( Kwang Jae Lee ),이현승 ( Hyun Seung Lee ),이창원 ( Chang 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.1