항정신병약물을 복용 중인 환자의 공복혈당장애: 이환율과 공복혈당의 내당능장애에 대한 선별 검사로서의 유용성
Impaired Fasting Glucose in Psychiatric Patients Taking Antipsychotics; Prevalence & Usefulness of Fasting Glucose as a Screening Test of Impaired Glucose Tolerance
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목적: 항정신병약물을 투여 받는 환자에서 당뇨병과 고혈당의 이환율이 높음을 시사하는 연구들이 많이 있어 왔다. 본 연구에서는 비정형 항정신병약물을 포함한 다양한 항정신병약물을 투여 받고 있는 환자들을 대상으로 공복혈당장애의 이환율을 알아보고, 심혈관 질환의 위험도를 잘 반영한다고 알려져 있는 당부하 검사를 함께 시행하여, 공복혈당과 당부하 후 혈당 간의 상관관계를 분석함으로써 항정신병약물을 투여 받고 있는 환자들에서의 공복혈당 선별 검사의 유용성을 밝히고자 하였다. 방법: 최소 2개월 이상 같은 종류의 항정신병약물을 복용한 환자 96명을 대상으로 8시간 이상의 공복 상태를 유지하게 한 후 공복혈당 검사를 하였고, 바로 경구 포도당 75g을 복용하게 한 후 2시간 후에 다시 혈당 검사를 하였다. 환자를 미국 당뇨협회에서 제시한 공복혈당(fasting blood glucose, 이하 FBG)을 기준으로 하여 정상 공복혈당군(FBS<100mg/dl)과 공복혈당장애군(FBS≥100mg/dl)의 두 군으로 나누어 당부하 후 혈당을 비롯한 인구학적인 특성과 임상적인 특성들을 비교 분석하였다. 환자에 대한 기본 정보는 환자와의 직접 면담과 의무 기록을 통해 얻었으며, 기존의 당뇨병 환자는 제외되었다. 결과: 총 96명의 대상 환자 중 공복혈당장애는 22명(22.9%)였으며 이 중 10명(45.5%)에서 당부하 검사 상 내당능장애가 있었고 나머지 12(54.5%)명은 정상 소견이었다. 정상공복혈당 군 74명 중 52명(70.3%)은 당부하 검사 상 정상이었고, 22명(29.7%)에서는 공복혈당장애가 없으면서 내당능장애가 있는 것으로 나타났다. 공복혈당장애군과 정상 공복혈당군 간의 당부하 후 혈당에는 유의한 차이가 있었지만 공복혈당과 당부하 후 혈당의 상관 관계는 높지 않았으며(Spearman's R= 0.265, p<0.01). 항정신병약물 중 정형 약물과 비정형 약물 간의 공복혈당 및 당부하 후 혈당의 유의한 차이는 없었다. 결론: 항정신병약물을 복용 중인 환자에서 공복혈당은 환자의 당부하 혈당과 상관 관계가 낮아 환자의 심혈관 질환의 위험도를 제대로 반영하지 못할 수 있으며 따라서 선별 검사로서 적합하지 않을 수 있다.
Abstract
Objectives: The aims of this study were to examine the prevalence of impaired fasting glucose, to analyze the correlation of fasting glucose level with 2-hour glucose level after oral glucose loading, and to clarify the usefulness of the fasting glucose test as screening in the patients who are taking antipsychiotic medications. Methods: We examined the fasting glucose level and 2 hour glucose level after loading 75g of glucose in 96 hospitalized psychiatric patients who had been taking the same medications for at least 2 months. We divided the subjects into 2 groups, impaired fasting glucose and normal fasting glucose group, based on American Diabetes Association criteria proposed in 2004, and compared the demographical and clinical characteristics between the two groups. The subjects with preexisting diabetes mellitus were excluded. Results: Among 96 subjects, impaired fasting glucose group were 22(22.9%), 10 of them(45.5%) had impaired glucose tolerance, and the rest 12(54.5%) were normal in oral glucose tolerance test. In the normal fasting glucose group of 74 subjects, 52(70.3%) were normal, and 22(29.7%) had impaired glucose tolerance but normal fasting glucose. There was a positive correlation between fasting glucose levels and 2-hour glucose levels after oral glucose loading but the correlation was not strong (Spearman's R= 0.265, p<0.01). There were no significant differences in fasting and 2-hour glucose levels between typical and atypical antipsychotics groups. Conclusions: Fasting glucose test could not reflect the cardiovascular risk well in patients who are taking antipsychotics, thus it would not be appropriate to use this as screening test.
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