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국민건강영양조사 자료를 이용하여 분석한 망막신경섬유층 결손과 전신적인 지표와의 관계

Associations between Retinal Nerve Fiber Layer Defect and Systemic Indices According to the KNHNES 2010-2012

박혜영|박찬기|정석훈|전수지
대한안과학회 (The Korean Ophthalmological Society)|2019.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제60권 제11호|pp. 1089-1097

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키워드

HypertensionDiabetes mellitusBlood pressureRetinal nerve fiber layer defect
주제분류안과학

초록

목적: 한국인에서 망막신경섬유층 결손과 전신적인 지표와의 관계를 알아보고자 하였다. 대상과 방법: 제5기 국민건강영양조사(2010-2012) 자료를 바탕으로 녹내장이 아닌 2,999명, 녹내장인 424명을 대상으로 망막신경섬유층 결손의 유무 및 위치에 따라 체질량지수, 혈압 그리고 혈액검사 수치들을 비교하였으며 여러 기저 질환들과 연관이 있는지 분석하였다. 결과: 비녹내장군에서 망막신경섬유층 결손이 있는 군이 없는 군에 비해 체질량지수(p=0.035), 수축기 혈압(p<0.001), 이완기 혈압(p=0.018), 공복 혈당(p<0.001), 당화혈색소(p<0.001), 혈청페리틴(p=0.008)의 수치가 유의하게 높았으며, 망막신경섬유층 결손은 당뇨(p=0.001), 고혈압(p<0.001), 고지혈증(p=0.003), 심근경색 또는 협심증(p=0.037), 편두통(p=0.004)과 유의한 연관성을 보였다. 녹내장군에서 상부 망막신경섬유층 결손이 있는 군이 하부 망막신경섬유층 결손이 있는 군에 비해 수축기 혈압(p=0.034)이 유의하게 낮았고, 이외 체질량지수, 혈액검사에서의 기타 항목에 대한 차이는 두 군 간에 유의하지 않았으며, 상부 망막신경섬유층 결손은 당뇨(p=0.047), 뇌졸중(p=0.031)과 유의한 연관성을 보였다. 결론: 비녹내장군 및 녹내장군의 망막신경섬유층 결손은 전신적 지표와 관련이 있었다. 이러한 전신적 지표 이상의 경우 망막신경섬유층 결손의 가능성을 유추해 볼 수 있으며, 더 적극적인 치료가 필요함을 확인할 수 있었다.

Abstract

Purpose: To investigate the associations between retinal nerve fiber layer (RNFL) defects and systemic factors in the Korean population. Methods: Based on data from the 5th Korean National Health and Nutritional Examination Survey (2010-2012), 2,999 non-glaucomatous patients and 424 glaucoma patients were included. We compared body mass index (BMI), blood pressure, and blood test values according to the presence and location of RNFL defects in the groups and analyzed whether these defects were associated with various underlying diseases. Results: In the non-glaucomatous group, RNFL defects were significantly and linearly related with BMI (p = 0.035), systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.018), fasting blood glucose (p < 0.001), HbA1c (p < 0.001), serum ferritin (p = 0.008), and RNFL defects were also significantly associated with diabetes mellitus (p = 0.001), hypertension (p < 0.001), dyslipidemia (p = 0.003), a history of myocardial infarction or angina (p = 0.037), and migraines (p = 0.004). In the glaucoma group, patients who had superior RNFL defects had a significantly lower systolic blood pressure (p = 0.034) than patients who had inferior RNFL defects. The other systemic indices did not differ significantly between these two subgroups. Superior RNFL defects were significantly associated with diabetes mellitus (p = 0.047) and a history of cerebrovascular accident (p = 0.031). Conclusions: RNFL defects in both the non-glaucomatous and glaucoma groups were associated with systemic factors. We could identify that the possibility of RNFL defects can be deduced from these systemic abnormalities and active treatment is needed in abnormal systemic condition.

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