한국 조현병 환자에서 검지-약지 길이비와 발병 연령 및 대사 장애와의 연관성
The Association of the 2nd to 4th Digit Ratio with the Age of Onset and Metabolic Factors in Korean Patients with Schizophrenia
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초록
대사증후군은 고혈압, 당 대사 이상, 복부비만, 이상지질혈증 등 심혈관 질환을 일으키는 여러 가지 독립적인 위험 인자들이 한 개인에 공존하는 질환군(syndrome)을 의미하며 이런 위험 인자들이 복합적으로 존재할 경우 심혈관계 질환으로 사망할 가능성이 증가한다는 데 임상적인 중요성이 있다.1) 조현병 환자의 사망 원인 중 약 70% 이상이 적어도 한 가지 이상의 신체질환으로 인한 것이며2) 이로 인해 조기에 사망할 확률이 일반 인구군에 비해 2~4배가량 높다고 한다.3) 그중 심혈관 질환 및 합병증이 가장 큰 원인이며 이에 대한 원인으로 대사증후군이 가장 주요한 위험 인자로 알려져 있다.4) 더욱이조현병 환자의 평균 수명이 증가하면서 대사증후군에 걸릴가능성이 높아지고 있고, 이는 조현병 환자들의 삶의 질 저하와 관련이 있으며, 약물 순응도를 떨어뜨려 장기적으로 보아치료에 방해요인으로 작용할 가능성이 높다.5-7) 항정신병 약물관련 대규모 연구인 Clinical Antipsychotic Trials of Intervention Effectiveness(CATIE)에서 조사된 바에 의하면 조현병 환자의 대사 장애 유병률은 일반 인구군보다 2배가량 높았는데 이 원인에 대해서는 여러 가지 가능성이 알려져 있다.8) 이에 대해 조현병 환자들의 음성 증상으로 인한 활동량 부족등 생활양식에 관련된 요소, 항정신병 약물 치료, 조현병 자체가 가진 생물학적 취약성이 상호작용하여 대사장애증후군의위험성을 높일 것이라고 알려져 있지만9-13) 아직 명확히 규명된 바는 없다.
Abstract
Objectives : The ratio of second to fourth digit length (2D : 4D) could be a potential epigenetic marker of sexual dimorphism reflecting prenatal testosterone exposure. Testosterone is known to affect the development of the brain through an epigenetic mechanism. The purpose of this study was to investigate the effects of exposure to fetal testosterone on the metabolic syndrome based on 2D : 4D of schizophrenia patients and the relationship with the age of onset of schizophrenia. Methods : A total of 214 schizophrenia patients participated in this study. The participant’s physical and blood tests were performed according to the American National Cholesterol Education Program’s Third Amendment of the Metabolic Syndrome Diagnostic Criteria, and the 2D : 4D was measured by the method designed by McFadden. Data were statistically analyzed by t-test, Pearson’s correlation analysis and multiple regression model analysis. Results : 2D : 4D was significantly higher in female than male in both hands, and there was a statistically significant negative correlation between 2D : 4D and the age of onset of schizophrenia in male. However, 2D : 4D did not show statistically significant correlation with metabolic factors. Conclusions : Fetal testosterone suggests the possibility of affecting the age of onset of schizophrenia through the epigenetic mechanism, but there is no clear relationship with metabolic factors.
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