2006년부터 2008년까지 아주대학교병원 건강검진센터에서 검진을 받 은 20세 이상의 성인 수검자 중에서 문진을 하는 동안 본 연구의 내용을 설명하고 참여하는 것에 동의한 2,151명을 연구 대상자로 포함시킨 후 설문지의 작성이 불충분하거나 인슐린 저항성에 영향을 미칠 수 있는 약 물을 복용하는 경우 만성 간질환,신장 질환의 과거력으로 투석 중이거 나 약물을 투여 받고 있는 경우,그리고 심혈관 질환 및 당뇨의 과거력 으로 투약을 받고 있는 환자들은 연구에서 제외시켰고 최종적으로 1,316 명이 연구에 참여하게 되었다.
4
Radioimmunoassay (Packard, USA)를 사용하여 Insulin을 측정한 후 다음의 공식을 사용하여 HOMA-IR(Homeostasis model assessment of insulin resistance)을 계산하여 인슐린 저항성을 평가하였다.HOMA-IR = [fasting glucose (mmol) x fasting insulin level (μU/mL)] / 22.5.인슐린 저항성의 기준은 국내에서 대규모의 건강한 성인들을 대상으로 시행된 연구에서 제시한 HOMA-IR이 2.43 이상일 때로 정의하였다(Rye S 등,2005).대 사증후군은 변형된 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)I기준을 사용하여 정의하였는데(Grundy 등, 2005)기존의 기준에서 허리둘레만 국내에서 제시하는 절단점을 기준으 로 바꾼 것으로 (Lee 등,2006)허리둘레를 남자는 90cm이상,여자는 85cm이상일 때 복부비만이라고 정의하였다.
5 -C.통계적 분석
대사증후군을 가지고 있는 참여자들과 가지고 있지 않은 참여자들 간 의 일반적인 신체계측과 혈액 검사,그리고 흡연,신체 활동 등의 생활 습관 등은 Independent T test를 사용하여 비교하였다 (표1).제한성 폐질 환과 대사증후군의 각 구성인자 및 인슐린 저항성과의 관련성은 성별, 연령,흡연 여부,음주,신체 활동 등을 보정하여 로지스틱 회귀 분석을 사용하여 확인하였다.특히 인슐린 저항성을 종속 변수로 규정하여 선형 회귀 분석으로써 노력성폐활량의 독립적인 연관성을 시험하였다.마지막 으로 대상자들을 인슐린 저항성 및 대사 증후군 존재 여부에 따라서 두 가지 모두 없는 군,둘 중에 한 가지만 가지고 있는 군,그리고 둘 다 가 지고 있는 군으로 분류하여 제한성 폐질환의 위험성을 로지스틱 회귀 분 석으로 조사하였다.
6
7
-된 혈압,높은 공복혈당과 높은 중성지방에 대해서만 통계적으로 유의한 연관성이 유지되었고 인슐린 저항성과는 관련되지 않았다.
연구 참여자들을 대사증후군 및 인슐린 저항성의 존재 유무에 따라서 네 군으로 분류하여 각 군에서 제한성 폐질환과의 연관성을 확인하였다 (Figure 1).대사증후군과 인슐린 저항성이 모두 없는 군에 비하여 대사 증후군만을 가지고 있거나 두 가지 모두 존재하는 참여자들은 제한성 폐 질환을 가질 위험성이 각각 약 3배 (OR : 2.95 95% CI=1.62-5.37)와 약 2.5배 (OR : 2.45, 95% CI=1.24-4.81)이상 통계적으로 유의하게 증가하였 다.그러나 인슐린 저항성만을 가지고 있는 군에서는 제한성 폐질환의 위험성이 유의하게 증가하지 않았다.
8
Abbreviations: MS, metabolic syndrome; HDL, high density lipoprotein;
HOMA-IR, homeostasis model assessment of insulin resistance; NS, non significant.
Table 1. General characteristics of study participants
9
-Dependant variable Independent variable β coefficient ± SE P
Log HOMA-IR Age 0.001 ± 0.002 0.700
(R2=24.1%) Gender 0.086 ± 0.043 0.047
Smoking 0.040 ± 0.021 0.055
Alcohol intake -0.001 ± 0.000 <0.001 Physical activity -0.044 ± 0.010 <0.001 Body mass index 0.110 ± 0.006 <0.001
Physical activity -0.043 ± 0.009 <0.001 Body mass index 0.089 ± 0.006 <0.001 Metabolic syndrome 0.396 ± 0.044 <0.001
FVC -0.003 ± 0.001 0.003
Abbreviation: HOMA-IR, homeostasis model assessment of insulin resistance;
FVC, functional vital capacity
† include metabolic syndrome as a confounding variable for adjustment.
Table 2.Multivariable linear regression model to examine the association between forced vital capacity and insulin resistance in participants
10 -Crude OR
(95% CI) P Adjusted OR
(95% CI) P
Central obesity 1.17 (0.78 to 1.75) 0.45 1.11 (0.74 to 1.69) 0.61 High blood pressure 1.73 (1.17 to 2.54) 0.01 1.67 (1.11 to 2.50) 0.01 High fasting glucose 1.87 (1.16 to 3.00) 0.01 1.94 (1.18 to 3.17) <0.01 Low HDL-C 1.60 (1.01 to 2.55) 0.04 1.63 (0.99 to 2.67) 0.05 High TG level 1.69 (1.13 to 2.51) 0.01 1.87 (1.23 to 2.84) <0.01 Insulin resistance 1.31 (0.85 to 2.02) 0.23 1.29 (0.82 to 2.04) 0.27 Data are adjusted for age, gender, smoking status, alcohol intake, physical activity and body mass index.
Abbreviations: HDL-C, high density lipoprotein - cholesterol; TG, triglycerides.
Table 3.Odds ratios of restrictive lung disease for components of the
metabolic syndrome and insulin resistance in participants
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-Fig. 1 Adjusted odds ratios for restrictive lung disease, stratified by the presence of metabolic syndrome and/or insulin resistance
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13
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-린 저항성의 유무에 따라서 살펴보았다.즉 현재 가장 많이 사용되고 있 는 The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)의 기준으로 대사증후군을 정의하였을 때 대사증후군을
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-Ⅴ 결론
인슐린저항성은 노력성폐활량과 역의 상관관계를 나타내었지만 제한성 폐질환과는 관련되지 않았으며 대사증후군과 제한성폐질환의 연관성에 영향을 주지 않았다.
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ABSTRACT
-The Relationship between Low Pulmonary Function and Insulin Resistance in Adults with or without the Metabolic Syndrome
Chan-Won Kim
Department of Medical Sciences The Graduate School, Ajou University
(Supervised by Associate Professor Sat Byul Park)
Background and objective: Low lung function has been associated with metabolic syndrome. Insulin resistance(IR) was suggested as a possible mediator in the link between reduced pulmonary function and metabolic syndrome. Although IR differs by the presence of metabolic syndrome in healthy adults, no studies have differentiated between subjects with metabolic syndrome and those without metabolic syndrome in the relationship between lung function and IR. Therefore, the aim of this study was to examine the relationship between lung function and IR according to the presence of metabolic syndrome in adults.
Methods: One thousand three hundred sixteen healthy adults (1022 men and
21
-294 women) who visited a university hospital for health screening between April 2006 and June 2008, were included in the analysis. Participants underwent lung function test and blood test after 10 hours of fasting.
Participant's lifestyle factors were obtained from self-reported questionnaire.
Insulin resistance was estimated using homeostasis model assessment of IR (HOMA-IR).
Results: Participants with metabolic syndrome were more insulin resistant and had higher mean values of cardiovascular risk factors, compared to those without metabolic syndrome. Among the components of metabolic syndrome, high blood pressure, increased fasting plasma glucose and triglycerides were associated with restrictive lung disease after adjustment of the confounding variables. FVC was inversely associated with IR. After classifying participants, according to the presence of metabolic syndrome and IR, Odds ratio of restrictive lung disease was 2.95(95% CI=1.62-5.37)in those having metabolic syndrome without IR and 2.45(95% CI=1.24-4.81) in those with metabolic syndrome and IR.
Conclusion: An inverse relationship between FVC and IR was observed in healthy adults. Restrictive lung disease was not associated with IR, but was related to metabolic syndrome. Prospective study is required to demonstrate the association of IR with FVC and restrictive lung disease.
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Keywords: Lung function, Insulin resistance,Metabolic syndrome