내당능장애 및 제 2형 당뇨병 환자에서 인슐린 분비능과 인슐린저항성의 변화

이대호,정주영,염충호,김진석,송병철 제주대학교 생명과학연구소 2003 제주생명과학연구 Vol.6 No.1

연구배경: 인슐린 저항성과 인슐린 분비능을 일상적인 상황에서는 측정하기가 쉽지 않으며 내당능장애나 당뇨병의 발생에 미치는 역할에 대해서도 많은 논란이 있어 왔다 저자 등은 성인에서 경구당부하 검사를 통하여 분류된 내당능장애와 제 2형 당뇨병 환자들에서 인슐린 분비능과 인슐린 저항성 지수를 구하여 정상군, 내당능장애군, 그리고 당뇨병 환자군 사이에 차이를 비교하고, 내당능장애와 당뇨병의 발생과 이들 지수와의 관계를 알아보고자 하였다. 방법: 40세 이상 성인 105명의 75g 경구당 부하검사 결과를 인슐린 측정치와 함께 분석하였으며 정상대조군(n=26) 내당능장애군(n=28), 제 2형 당뇨병 환자군(n=51)으로 분류하여 인슐린 분비능과 인슐린 저항성을 평가하였다 초기 인슐린 분비반응은 당부하 30분에 혈당 증가치에 대한 인슐린 증가치의 비 △ Ins(30)/△ Glu(30)]로 평가하였고, 전체 인슐린 분비반응은 2시간 및 3시간 동안의 평균 인슐린농도로 평가하였다 인슐린 저항성은homeostasis model assessment (HOMA)를 적용하여 구하였다(HOMA IR). 결과: 1). 당부하 후 정상대조군에 비해서 내당 능장애와 당뇨병 환자군에서 인슐린 분비반응이 지연되고 초기 인슐린 분비반응을 나타내는 △ Ins(30)/△ Glu(30) 비도 의의 있게 감소되어 있었다. 2) 당부하 후 전체 인슐린 분비반응을 알아보기 위해 측정한 2시간 동안의 평균 인슐린 농도는 세 군간에 유의한 차이가 없었으나 3시간 동안의 평균 인슐린 농도는 정상대조군에 비해서 내당능장애군에서 유의하게 증가되어 있었다. 3) 인슐린 저항성(HOMA IR)은 당뇨병환자 군에서 정상대조군에 비해서 유의하게 높았고 대조군과 내당능장애 사이에는 차이가 없었다 4) 상관분석에서는 공복혈당과 △ Ins(30)/△ Glu(30) 비 및 HOMA IR은 비슷한 상관 관계를 보였으며 당부하 후 2시간 혈당과의 상관계수는 △ Ins(30)/△ Glu(30)비가 HOMA IR에 비하여 높았다. 5) 로지스틱 회기분석 결과 △ Ins(30)/△ Glu(30). HOMA IR. 그리고 체질량지수가 당뇨병의 발생위험도와 유의한 관계가 있는 것으로 나타났다 결론: 정상인에 비해서 내당능 장애군과 경도의 당뇨병 환자군에서 전체 인슐린 분비능은 감소되지 않고 초기 인슐린 분비반응이 감소된 소견과 인슐린 저항성이 당뇨병 환자군에서만 의의 있게 존재하는 것으로 보아 초기인슐린 분비반응이 내당능에 미치는 영향에 대한 고려와 이에 대한 연구가 더 필요할 것으로 사료된다. Background: Glucose intolerance depends on a complex interaction between insulin secretion and insulin resistance. So the purpose of the present study was to report the results of assessment of insulin resistance and insulin secretory response in adults with normal glucose tolerance and in patients with impaired glucose tolerance(IGT) or type 2 diabetes mellitus(Type 2 DM). Methods: A total of 105 subjects was selected who were given 75-g oral glucose tolerance test(OGTT) with simultaneous measurement of serum insulin. They were classified as normal (n = 26), IGT(n = 28), or Type 2 DM(n = 51) by WHO criteria. The ratio of incremental insulin response at 30 min to incremental glucose response at 30min〔△ Ins(30)/△ Glu(30)〕 was used to assess the early-phase insulin secretion, and mean insulin concentration for- 2 hours or 3 hours after glucose load was regarded as total insulin response. The homeostasis model assesment(HOMA) was used to assess insulin resistance(HOMA IR). Results: Subjects with IGT or Type 2 DM were characterized by delayed peak insulin responses and lower levels of △ Ins(30)/△ Glu(30). Total insulin responses for 2 hours after glucose load were not different among the groups but those reponses for 3 hours were significantly increased in subjects with NGT, Subjects with Type 2 DM showed higher HOMA IR when compared with subjects with NGT. There was no difference between normal controls and subjects with IGT in the values of HOMA IR. Significant relationship was revealed between fasting blood glucose and Llns(30)/,LGlu(30) or HOMA IR. Compared with HOMA IR, △ Ins(30)/△ Glu(30) was more correlated with blood glucose at 2 hr during the OGTT. Logistic regression analyses showed that △ Ins(30)/△ Glu(30), HOMA IR, and body mass index are related with increased odds ratio of development of Type 2 DM. Conclusions: Above results showed that although total insulin response to glucose load is not decreased in subject with glucose intolerance, early-phase insulin response is decreased. Considering the level of insulin resistance in our subjects, it is necessary to clarify the role of defect in early-phase insulin secretion in the development of IGT or Type 2 DM in Korean.

치수 치근단 병소의 전구 위험요인으로서의 제 2 형 당뇨의 역할에 관한 소고

김진희,배광식,서덕규,홍성태,이윤,홍삼표,금기연 大韓齒科保存學會 2009 Restorative Dentistry & Endodontics Vol.34 No.3

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1 and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whet her Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked. leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue under control of BGL. 당뇨(Diabetes Mellitus)란 혈당을 조절하는 인슐린의 분비나 기능에 장애를 야기하는 질환으로 인슐린 의존성 여부에 따라 제 1 형과 제 2 형으로 분류된다. 본 종설은 최근 증가 추세에 있는 제 2 형 당뇨가 치수 치근단 병소의 병인 과정에 전구 위험 요인으로 작용할 수 있는지를 평가 하고자 문헌고찰을 통해 당뇨의 병인 과정에서 특징적으로 나타나는 혈관 합병증에 관해 알아보고, 부가적으로 제 2 형 당뇨 쥐 모델에서 인위적인 치수감염 후 얻은 치근단 조직의 조직병리학적 분석을 시행하였다. 조직학적 관찰 결과 제 2 형 당뇨 쥐에서 대조군에 비해 치수 치근단 병소의 크기가 증가하였고, 치수 염증 반응도 심하게 나타난 것으로 보아 당뇨 자체가 숙주를 감염에 취약한 상태로 만드는 전구 위험요소로 작용하였음을 알 수 있었다. 이러한 이유로는 첫째, 당뇨 시 전반적으로 나타나는 혈관 내 죽상 침착(atheromatous deposits)에 의해 혈관 내벽의 두께가 두꺼워져 미세 순환의 장애는 물론 탐식 세포의 기능 저하, 면역 세포의 혈류 이동이 차단되어 치수 감염 시 쉽게 치근단 병소로 이환될 가능성이 높고, 둘째 치수 혈관에서 특징인 측부 순환(collateral circulation)의 부재에 따른 살균성 다형핵 백혈구의 활동 억제를 포함한 미세 혈관계의 취약성으로 인해 치수 조직의 재생능이 저하되어 추가적인 감염원의 공격에 대한 방어 및 치유 저하를 더욱 심화시키기 때문인 것으로 사료된다. 따라서 제 2 형 당뇨 환자의 수복치료 시 치과의사는 당뇨 조절 하에서 치수 조직의 자극을 최소화하기 위한 세심한 처치가 필요하다.

제2형 당뇨병 환자의 직계자녀에서의 경구 당부하 검사시 혈청 프로인슐린 분비반응

이지현,유성수,박경찬,류헌모,윤현대,손호상 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.4

연구배경: 혈청 프로인슐린 농도의 증가는 베타세포에서 프로인슐린 생성과정의 이상 또는 비정상적인 인슐린 분비를 의미한다. 최근의 연구결과들은 제2형 당뇨병 환자와 내당능장애 환자에서 프로인슐린의 농도가 증가됨을 보고하고 있으며 혈청 프로인슐린 농도는 베타세포의 기능이상을 나타내는 표지자 또는 발병 예견인자로 생각하고 있다. 제2형 당뇨병 환자의 직계자녀는 당뇨병 발병의 고위험군이며 이들에서 베타세포에서 인슐린 분비의 저하 또는 비정상적인 인슐린 분비에 대한 많은 연구결과가 있다. 이에 저자 등은 제2형 당뇨병 환자의 직계자녀에서 경구 당부하 검사를 통한 베타세포의 프로인슐린의 분비반응을 알아보고자 하였다. 방법: 부모 중 한 사람이 임상적으로 제 2형당뇨병 환자인 직계자녀 25명과 가족 중 당뇨병의 병력이 없는 대조군 23명을 대상으로 경구 당부하 검사를 실시하여 혈청 인슐린, 프로인슐린분비반응을 조사하였다. 또한 이들에서 신장, 체중을 측정하여 체질량지수를 계산하고 수축기및 이완기 혈압을 측정하였으며 공복시 혈청 중성지방, 총콜레스테롤 및 고밀도 콜레스테롤 농도를 측정하였다. 결과: 경구 당부하 검사상 직계자녀군과 대조군 사이에 혈청 포도당 및 순수 인슐린 농도는 차이가 없었다. 프로인슐린 농도는 경구 당부하검사에서 시간이 진행될수록 증가하였으며 직계자녀군에서 대조군에 비하여 낮은 경향을 보였다. 프로인슐린/총 인슐린 비율은 직계자녀군과 대조군에서 비슷한 경향을 보였으며 직계자녀군과 대조군 두군 모두에서 경구 당부하 검사에서 시간이 진행될수록 농도가 증가하였다. 결론: 당뇨병 발병의 고위험군인 제2형 당뇨병 환자의 직계자녀에서 정상 포도당 대사소견을 보이는 상태에서는 공복 및 경구 당부하 검사를 통한 베타세포의 자극 상태에서도 프로인슐린의 분비 증가 소견을 보이지는 않았다. Background: An elevated proinsulin concentration reflects abnormal proinsulin processing and could indicate abnormal insulin secretion. Recent data suggest that proinsulin is elevated disproportionately in subjects with type 2 diabetes and impaired glucose tolerance. So an elevated proinsulin level was interpreted as an early indicator of beta-cell dysfunction. First-degree relatives of patients with type 2 diabetes are at high risk of developing diabetes. There are many studies showing decreases in insulin secretion or abnormal secretion in nondiabetic relatives of subjects with type 2 diabetes. We examined the proinsulin level and the ratio of proinsulin/total insulin in first-degree relatives of patients with type 2 diabetes. Methods: We investigated proinsulin and insulin responses during an oral glucose tolerance test in twenty-five male offspring of patients with type 2 diabetes and twenty-three age- and sex-matched controls. We measured clinical and biochemical parameters, height, weight, body mass index, blood pressure and lipid profile. Results: There were no differences in serum glucose and true insulin concentrations between the offspring and the control group during the oral glucose tolerance test. The proinsulin concentration was gradually increased as time ensued and the offspring's value tended to be lower than the control groups during the oral glucose tolerance test. The proinsulin to total insulin ratio was similar between the offspring and control groups during the oral glucose tolerance test and the ratio was gradually increased as time ensued. Conclusion: Young offspring of patients with type 2 diabetes, who have a high risk of developing diabetes, do not exhibit elevated levels of fasting or glucose-stimulated proinsulin as long as they are in a normal glucose tolerance state.

2형 당뇨 환자에 있어서 C형 간염의 유병률에 관한 연구

김구영,서광섭,유광렬,임병욱,채선애,강남훈,김창훈,권영우,김희수,류성태,이정환,박성우,오웅식,김정한 중앙대학교 의과대학 의과학연구소 2003 中央醫大誌 Vol.28 No.1

Background: We have doubt about the truth that Type 2 DM is associated with chronic hepatitis C infection. The aim of our study was to prove a close relationship between chronic HCV infection and type 2 DM in korean patients. Methods: We reviewed the out-patient's medical records of 466 patients with type 2 DM who visit the Sung-ae hospital from March 2000 to August 2001. Diabetic patients were analyzed for the following variables: age, sex, waist circumference, weight, waist/hip ratio, using of self monitoring of blood glucose, method of therapy, duration of disease, experience of previous transfusion, major surgical procedure, accompanied disease, liver function tests (LFT), HbA1 c. We ruled out patients with liver cirrhosis. Results: Hepatitis C virus infection was observed more frequently in patient with Type 2 DM. Of 466 Type 2 DM patients, 13 patients were infected with Hepatitis C virus (2.79%). Compared with mean prevalence of Korean population (1.3~1.6%), it's value is very high. the other hand, 21 patients were infected with Hepatitis B virus (4.5%). Such results are similar to mean prevalence of the general public (4~5%). Conclusions: Prevalence of hepatitis C was closely associated in korean patients with type 2 DM. And an increased prevalence is independent of cirrhosis.

제 2형 당뇨병 환자에서 대사증후군의 유병률 및 관련요인의 특징

박철진,박거운,박일구,신지혜,김진화,배학연,김상용 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.3

Background: People with insulin resistance has a higher risk of developing cardiovascular disease. This leads to the importance in diagnosing metabolic syndrome. The incidence of metabolic syndrome has increased significantly in korea because of an increased population of obese people and also the incidence of DM. There have been many studies done on the incidence of metabolic syndrome in the general population. Therefore, the authors have designed this study to identify the incidence of metabolic syndrome in patients with type 2 DM and also the associated characteristics in that population. Methods: The study included 169 adults over the age of 20 (84 males and 85 females) admitted to the endocrinology department of Chosun University between Jan, 1st 2005 and May, 31st 2006. Out of the people diagnosed with type 2 DM people were excluded when any of the physical measurements (height, weight, blood pressure, abdominal circumference) and blood measurements (TG, HDL-cholesterol, fasting blood sugar) were insufficient and when the patient was taking any drugs other than anti-hy-pertensive agents and oral anti-diabetic agents. Obesity and the other risk factors were defined by the Asian-Pacific guideline and 2001 ATP III of NCEP, respectively. Result: The each prevalence according to the metabolic syndrome criteria of the type 2 DM patients showed low HDL cholesterolemia with the highest incidence of 57.4% followed by hypertng1yceridemia(52.0%), obesity(40.9%) and hypertension(33.0%). The each incidence of diagnostic criteria in metabolic syndrome according to sex was different, In males, hypertriglyceridemia was the highest with the incidence of 57.7% followed by low HDL-cho1estero1emia(49.5%), obesity(40.9%) and hypertension (30.0%). In women, the incidence were low HDL-cho1estero1emia(64.8%), hyperthg1yceridemia(47.6%), obesity(45.0%) and hypertension(36.0%), in a descending order. The analysis between the diagnosis of metabolic syndrome in type 2 DM patients and the criteria showed that hyperthglyceridemia (correlative value 0.575) had the highest correlation followed by low HDL-cholesterolemia (correlative value 0.446), obesity (correlative value 0.350) and hypertension (correlative value 0.410). All the correlations were statistically significant with a p-value less than 0.01. Conclusions: Type 2 DM is a important factor of metabolic syndrome based on insulin resistance. The control of blood glucose with prevention and early diagnosis of the other factors related to metabolic syndrome in type 2 DM is important for preventing cardiovascular complications.

제 2형 당뇨병 환자의 이환기간에 따른 심혈관계 질환 위험요인 분석

홍혜숙(Hong Hye Sook),류한경(Ryu Han Kyoung),박종숙(Park Jong Suk),김화영(Kim Wha Young) 韓國營養學會 2007 Journal of Nutrition and Health Vol.40 No.6

The purpose of this study was to investigate the impact DM duration on cardiovascular disease risk factors in Korean Type 2 diabetes mellitus patients. The subject were 250 (male: 134, female: 118) Korean Type 2 DM patients recruited from a general hospital’s DM clinic. Anthropometric and hematological variables and dietary intake were assessed. The subject’s mean age was 60.2 years and duration of diabetes was 9.5 years. As far as DM duration was concerned, male subjects with long duration (≥ 5 years and longer) showed significantly lower weight, fat free mass, skeletal muscle mass, BMI (p < 0.05) and higher 2hrs-postprandial plasma glucose (p < 0.05) and concentration of Hemoglobin A1c (p < 0.01) compared to those with less 5years of duration. In female subjects, same trend was found. Female subjects with long duration (≥ 5 years and longer) showed significantly higher fat free mass (p < 0.05) and skeletal muscle mass (p < 0.05), Hemoglobin A1c (p < 0.01), HDL-cholesterol (p < 0.01) and triglyceride (p < 0.05), dietary intakes of protein (p < 0.05) and fat (p < 0.05) compared to those with less 5years of duration. In conclusion, Type II DM patients of long duration had higher blood lipid concentrations and higher carbohydrates intakes. Subjects followed diet prescription strictly showed lower blood lipid concentration, suggesting the effectiveness of diet to manage Type 2 DM patients.

12주 규칙적인 유산소 트레이닝이 제 2형 당뇨(T2DM) 환자의 간 효소(Hepatic enzyme)에 미치는 영향

김영일(Young-Il Kim),곽이섭(Yi-Sub Kwak) 한국생명과학회 2009 생명과학회지 Vol.19 No.6

본 연구에서는 12주 유산소 트레이닝 전에 비해 트레이닝 후, 간 기능을 나타내는 효소들이 모두 감소함을 나타냈으나 모두 통계적으로 유의한 차이는 나타내지 못했으며 이는 트레이닝이 간 기능에 영향을 미치지 못한 선행연구[5,15]들에서와 같은 결과를 나타냈다. 하지만 부분적으로 전체 대상자 13명 중 3명(23%)의 간 효소들 즉, 임상적 비정상을 나타낸 알부민(albumin), 토탈빌리루빈(total bilirubine), AST가 트레이닝 후, 정상적인 임상수치로 돌아와 규칙적인 12주 유산소 트레이닝이 제 2형 당뇨(T2DM) 환자의 간 효소에 통계적으로 유의한 차이는 나타내지 못했지만 임상적 판단 수치에 영향을 미친 것은 사실이다. 하지만 모든 비정상적인 간 기능 효소가 정상으로 회기한 것도 아니며 통계적으로 유의한 차이도 나지못했기 때문에 제 2형 당뇨환자(T2DM)의 간 기능 효소를 증진시키는 데 있어 운동 트레이닝의 효과는 성급히 판단하기 어려우며 운동 강도와 기간 등 좀 더 세분화고 다양한 연구가 필요하다고 생각된다. The purpose of the this study was to examine the effects of 12 weeks of regular aerobic exercise training on hepatic enzymes in type 2 diabetes mellitus (T2DM) patients. The subjects consisted of 13 middle-aged male type 2 diabetes mellitus (T2DM) patients, all of whom had no other complications. Subjects participated in regular aerobic exercise training for 12 weeks, in which they started to exercise for 20~60 min, at 60~80% HRmax (exercise intensity was increased gradually), per day, 3~5 times a weeks. The results after 12 weeks were compared to baseline values. Weight and BMI, % body fat, and fasting glucose significantly decreased, and peakVO₂, exercise time (ET) significantly increased after 12 weeks of aerobic exercise training. On the other hand, there were no significant differences in hepatic enzymes of Albumin, Total bilirubin, Alkaline phosphatate, AST, and ALT after training compared to baseline values. Conclusively, 12 weeks of aerobic exercise training may result in a decrease of insulin resistance factors (Weight, BMI, % body fat, fasting glucose) and an increase of aerobic capacity, but hepatic enzymes did not significantly decrease in middle age T2DM patients.

The Effect of 8 Weeks of Aerobic Exercise on Serum Lipids and Kidney Function in Middle-Aged T2DM Patients

Cheol-Woo Kim(김철우),Yi-Sub Kwak(곽이섭),Gun-Do Kim(김군도),Young-Il Kim(김영일) 한국생명과학회 2012 생명과학회지 Vol.22 No.5

본 연구의 목적은 8주 유산소 트레이닝이 제 2형 당뇨(T2DM)환자의 콜레스테롤과 신장기능에 미치는 영향을 규명하기 위함이다. 피험자는 총 4명(남 3, 여 1)이며 8주 유산소 걷기 트레이닝의 운동강도는 최대심박수(HRmax)의 60~75%, 주당 3~5 회, 20~45 분간 실시되었으며 다음과 같은 결과를 얻었다. 신체적 특성 중 체지방률과 공복시 혈당은 8주 유산소 걷기 트레이닝 후 유의하게(p<0.05) 감소함을 나타냈고, 혈중지질인 총 콜레스테롤(TC)과중성지방(TG)도 유의한 감소를 나타냈다. 그러나 신장기능[BUN, uric acids, creatinine]은 유의한 변화를 나타내지 못했다. 결과적으로 8주 유산소 트레이닝은 제 2형 당뇨(T2DM)와 당뇨병성 신증 환자의 1예에서 체지방률과 공복시혈당, 지질을 감소시키는데 영향을 미쳤지만 신장기능 증진에는 어떠한 영향도 미치지 못했다. The purpose of this study was to examine the effect of 8 weeks of aerobic exercise on serum lipids and kidney function in middle-aged T2DM patients. Subjects participated in aerobic exercise training during 8 wk. They started with an exercise intensity of HRmax 60-75%, 20~45 minutes per day, 3~5 times a week. The results were compared to the baseline after 8 weeks. After the 8-week aerobic exercise routine, the body fat percentage and fasting glucose were significantly decreased, and the total cholesterol (TC) andtriglycerides (TG) were significantly decreased. Additionally, kidney function (Blood Urea Nitrogen (BUN], uric acids, and creatinine) was not significantly changed. In conclusion, a regular 8-week aerobic exercise training routine may improve serum lipids; however, kidney function (BUN, uric acids, and creatinine) did not change in middle-age type 2 diabetes mellitus (T2DM) and T2DM in diabetic nephropathy patients.

제2형 당뇨병 환자의 운동교육방법이 혈당 및 지질대사와 건강관련체력에 미치는 영향

안근희(An, Geun-Hee) 한국체육과학회 2011 한국체육과학회지 Vol.20 No.5

The purpose of this study was to determine the effects of differences in exercise education on glucose control, lipid profile, fasting insulin and health-related physical fitness in type 2 diabetics. During 3 months follow up education were carried out with diabetes management by endocrinologist, nurse, dietitian and exercise physiologist. Participants(N:50) had been assigned to individual exercise education group(G1, N:22), group exercise education group (G2, N:14) and control group(G:3, N:14). The following results were obtained. 1. Post prandial 2 hours glucose(PP2) significantly dropped in all groups. Fasting plasma glucose was decreased after the period in G1. HbA1c was decreased after the period in G2 and G3. But there were no significant differences in lipid profile and fasting insulin after the period in the three groups. 2. METs at anaerobic threshold was increased after the period in G1. There was significant difference in anaerobic threshold METs after the period between G1, G2 and G2, G3. Maximal METs was increased after the period between 2 exercise education groups(G1 and G2) and was decreased in control group. There was significant difference in maximal METs after the period between G1, G2 andG2, G3. Abdominal strength endurance(curl up) was significantly improved in individualized education and group education. Lower strength endurance(30-second chair stand) was significantly increased in G1. There was no significant difference in flexibility after the period in the three groups. Percent fat significantly dropped in all groups. Muscle mass was significantly increased in G1.

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)