스트레스와 녹내장과의 연관성: 국민건강영양조사 2008-2012
Association between Psychological Stress and Glaucoma: Korea National Health and Nutritional Examination Survey 2008–2012
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목적: 최근 스트레스가 녹내장과 연관이 있는지에 대한 논란이 제기되고 있다. 본 연구는 한국인에서 스트레스가 녹내장 유병과 연관이 있는지를 알아보고자 하였다. 대상과 방법: 국민건강영양조사 2008-2011의 데이터를 이용하여, 16,426명을 대상으로 분석하였다. 녹내장 유병 여부는 안압 측정, 시신경유두검사, 망막신경섬유층검사, 시야검사, 그리고 전방각검사를 통하여 국민건강영양조사의 녹내장 진단 기준에 맞추어 진단하였다. 스트레스를 받는지에 대한 여부는 5가지의 설문조사 항목을 이용하였는데, 중등도 이상의 스트레스를 받고 있는지, 지속적인 우울한 감정을 느끼는지, 자살 충동을 느끼는지, 자살 시도를 한 적이 있는지, 그리고 정신건강의학과 상담을 받은 적이 있는지를 측정하여 분석하였다. 로지스틱 회계분석을 이용하여 스트레스와 녹내장과의 연관성을 조사하였다. 결과: 로지스틱 단변수 분석 결과, 스트레스 인지 여부(odds ratio [OR]=0.84, confidence interval [CI]=0.70-1.01), 우울감(OR=1.22, CI=0.97-1.55), 자살 시도(OR=0.73, CI=0.33-1.59), 정신과 상담 경험(OR=0.72, CI=0.43-1.21) 등은 녹내장의 유병과 통계적인 관련을보이지 않았고, 유일하게 자살 충동의 경우 녹내장 위험도가 28% 증가함을 보였다(OR=1.28, CI=1.02-1.60). 그러나 녹내장의 위험인자들을 보정한 다변량 로지스틱 회귀분석에서는 녹내장과의 연관성을 보이지 않았다. 결론: 본 연구에서는 통계적으로 유의한 수준의 스트레스와 녹내장 유병과의 연관성을 확인하지 못하였다. 본 연구의 결과는 녹내장의 발병기전은 스트레스 같은 간접적인 원인보다는 나이 또는 고혈압 같은 생리적인 원인에 의한 발병기전에 보다 부합한다는 주장에 힘을 실어 준다.
Abstract
Purpose: To evaluate the possible association between psychological stress and glaucoma, given that there are emerging issues and controversy regarding whether psychological stress is one of contributing factors of glaucoma development. Methods: We used the medical records of 16,426 patients from the Korean National Health and Nutritional Examination Survey 2008–2011. Glaucoma was defined based on examinations including the intraocular pressure, optic disc, visual field, and retinal nerve fiber layer. Stress was evaluated using five questionnaires regarding sustained stress, depression, feelings of suicide, history of suicide attempt/s, and history of psychological counseling. We used univariable and multivariable logistic regression analyses after adjusting confounding factors for glaucoma. Results: Univariable logistic regression analysis revealed no significant association between glaucoma and psychological stress (odds ratio [OR] = 0.84; confidence interval [CI] = 0.70-1.01), depression (OR = 1.22; CI = 0.97-1.55), suicide attempt/s (OR = 0.73, CI = 0.33-1.59), and psychological counseling (OR = 0.72, CI = 0.43-1.21). Using univariate analysis, only the feelings of suicide factor (OR = 1.28, CI = 1.02-1.60) was significantly associated with glaucoma. Using multivariable analysis after adjusting for confounding factors, no significant association was found in any psychological stress factor. Conclusions: There was no significant association between psychological stress and glaucoma. The results of this study indicated that the pathogenesis of glaucoma is more consistent with the pathogenesis of physiological causes such as age or hypertension, rather than indirect causes such as stress.
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