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비만 성인에서 대사증후군과 동맥경화증 예측인자로서 초음파를 이용한 복부 내장지방두께의 유용성
김종섭 ( Jong Sub Kim ),이희중 ( Hui Joong Lee ),김종열 ( Jong Yeol Kim ),강덕식 ( Duk Sik Kang ),이덕희 ( Duk Hee Lee ),감신 ( Sin Kam ),이성국 ( Sung Kook Lee ),이정범 ( Jeong Beom Lee ) 대한비만학회 2007 The Korean journal of obesity Vol.16 No.1
연구배경: 내장지방의 과잉축적이 동반된 복부비만이 대사증후군과 동맥경화증 발생에 중요한 역할을 하는 것으로 알려져 있다. 따라서 이들 질환의 위험인자를 평가하는데 있어 정확한 내장지방량의 평가는 매우 중요하며, 최근 초음파는 내장지방을 평가하기 위한 쉽고 안전하며 믿을만한 방법으로 보고되고 있다. 본 연구에서는 비만 성인을 대상으로 초음파를 이용한 내장지방두께가 대사증후군 관련인자를 포함한 죽상경화증 위험인자와 상관관계가 있는지 알아보고, 대사증후군 및 죽상경화증 유병의 예측인자로 유용한지 규명해 보고자 하였다. 방법: 체질량지수 25 kg/㎡ 이상의 비만 성인 200명 (남성 109명, 여성 91명)을 연구대상으로 하였다. 제대 바로 위에서 호흡이나 압박에 의한 왜곡 없이 복부 초음파를 시행하여 내장지방두께, 피하지방두께, 내장지방/피하지방두께의 세 가지 지표를 얻었다. 또한 경동맥 초음파를 시행하여 경동맥 내중막두께를 측정하고 죽상경화판 동반여부를 관찰하였다. 동시에 총콜레스테롤, 저밀도지단백콜레스테롤, 고밀도지단백콜레스테롤, 중성지방, 공복 혈당, 혈압 및 체질량지수를 측정하였다. 결과 세 가지 초음파 지표 중 내장지방두께가 남녀 모두에서 죽상경화증 위험인자와 가장 좋은 상관관계를 보였으며, 나이, 체질량지수, 수축기 혈압, 공복 혈당, 중성지방, HDL 콜레스테롤, 경동맥 내중막두께와 유의한 상관관계를 보였다. 대상증후군 및 경동맥 죽상경화판 동반여부에 따른 내장지방두께는 대사증후군 및 경동맥 죽상경화판을 동반한 군에서 없었던 군에 비해 남녀 모두에서 유의하게 높았다. 다중 로지스틱 회귀분석에서 내장지방두께는 남녀 모두에서 대사증후군 유병에 관여하는 독립적 결정인자로 나타났으며, 또한 남성에서만 경동맥 죽상경화판 유병에 관여하는 독립적 결정인자로 나타났다. 결론: 결론적으로 비만 성인에서 초음파를 이용한 내장지방두께는 대사증후군 관련인자를 포함한 죽상경화증 위험인자와 유의한 상관관계를 보이고, 또한 대사증후군과 남성에서 경동맥 죽상경화증 유병의 예측인자로 유용하게 이용될 수 있을 것으로 생각된다. Background: Abdominal obesity with visceral fat accumulation is known to be an important contributing factor to the development of metabolic syndrome and atherosclerosis. Therefore, estimating the precise amount of visceral fat is an important step in assessing the risks of these diseases. Recently, it has been reported that ultrasonography is a simple, noninvasive and reliable method for visceral fat evaluation. This study was undertaken primarily to investigate how visceral fat thickness measured by ultrasonography correlates with atherosclerotic risk factors including components of metabolic syndrome, and secondly to assess its usefulness as a predictor of metabolic syndrome and atherosclerosis in obese adults. Methods: Total of 200 obese (BMI≥25 kg/㎡) subjects (109 men and 91 women) were recruited in this study. An ultrasonographic evaluation of abdomen just above the umbilicus was conducted to obtain three ultrasonographic indexes. visceral fat thickness (VFT), subcutaneous fat thickness (SFT), and visceral 10 subcutaneous fat thickness ratio (VSR). The measurements were taken cautiously to avoid distortions caused by respiration or compression. Also, an ultrasonographic evaluation of carotid artery was conducted to evaluate intima-media thickness (IMT) and to determine the presence of atherosclerotic plaque. Concurrently serum total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, fasting serum glucose, blood pressure and body mass index (BMI) were measured. Results: Of the three ultrasonographic indexes, VFT was most closely correlated with atherosclerotic risk factors, and VFT was correlated with age, BMI, systolic blood pressure, fasting serum glucose, triglyceride, HDL-cholesterol and carotid IMT in both male and female subjects. VFT was significantly higher in the subjects with metabolic syndrome and carotid atherosclerotic plaque than in those without these diseases in both men and women. According to multiple logistic regression analysis, VFT was an independent determinant of metabolic syndrome in both men and women, and an independent determinant of carotid atherosclerotic plaque in only men. Conclusion: VFT using ultrasonography significantly correlates with atherosclerotic risk factors including components of metabolic syndrome in obese adults. Also, VFT using ultrasonography can be used as a predictor of metabolic syndrome in obese adults and carotid atherosclerosis in obese male adults.
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하창윤 ( Chang Yoon Ha ),김종열 ( Jong Yeol Kim ),김갑철 ( Gab Chul Kim ),염헌규 ( Hun Kyu Ryeom ),김혜정 ( Hye Jung Kim ),이희중 ( Hui Joong Lee ),강덕식 ( Duk Sik Kang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3
Background/Aims: Intraperitoneal tuberculous abscesses develop infrequently. Because of overlapping features it is difficult to differentiate a tuberculous abscess from carcinomatosis peritonei. The aim of this study was to define the computed tomography (CT) findings and clinical course of the intraperitoneal tuberculous abscess. Methods: The study included 11 patients (3 males, 8 females, mean age 34.8 years) with a pathologically proven intraperitoneal tuberculous abscess. We analyzed the CT findings and reviewed the medical records retrospectively. Results: Sixteen abscesses were found in 11 patients. The locations of the abscesses were in the right subphrenic space (n=1), right perihepatic space (n=4), left perihepatic space (n=4), left subphrenic space (n=2), perisplenic space (n=3), right lower abdominal space (n=1), and left lower abdominal space (n=1). Five patients were proven to have abdominal tuberculosis while six patients had paradoxical responses to antituberculosis therapy for tuberculous peritonitis. The abscess lesions presented on the CT scan as thin walled cystic enhancing lesions without calcification (n=16), a septated mass (n=12), with enlargement of lymph nodes (n=2), and peritoneal and omental haziness (n=3). The mean duration from commencement of treatment to onset of a paradoxical response was 88 days. All patients had antituberculosis therapy for 6 to 12 months and five patients underwent surgery. The mean follow-up was 15 months. Conclusions: The intraperitoneal tuberculous abscess appeared as an ovoid cystic lesion with a slightly enhanced thin wall in the upper abdomen, in the perihepatic space on the CT scan; such as lesion can be the primary lesion of abdominal tuberculosis or associated with the paradoxical response of tuberculous peritonitis. (Korean J Med 74:243-249, 2008)
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