당뇨병 전단계 성인의 비만 상태에 따른 고혈압과 미세알부민뇨의 관계
Relationship between Hypertension and Mircroalbuminuria according to Obesity Status in Prediabetes
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연구배경: 미세알부민뇨는 당뇨병뿐만 아니라 당뇨병 전단계에서도 나타나며, 당뇨병성 신증과 심혈관계 질환에 의한 사망의 주요 예측인자이다. 당뇨병성 신증은 혈당과 혈압 조절을 통해 예방할 수 있으며, 아시아인은 서양인에 비해 비만이 아닌 사람에서의 당뇨병 발생률이 상대적으로 높아 당뇨병 전단계에서도 비만 상태를 고려한 예방과 관리가필요하다. 본 연구에서는 당뇨병 전단계 성인의 비만 상태에 따른 고혈압과 미세알부민뇨 발생 관계를 알아보고자 하였다. 방법: 2015년 11월부터 2016년 2월까지 한국건강관리협회16개 지부 검진센터에서 실시하는 당뇨병 예방 프로그램에참여한 당뇨병 전단계(당화혈색소 5.7-6.4% 또는 공복혈당100-125 mg/dL)인 30-70세 성인 1,183명을 대상으로 하였다. 비만은 체질량지수 25 kg/m2를 기준으로 분류하였고, 혈압은 수축기/이완기 혈압이 <120/80 mmHg이면 정상혈압, 120-139/80-89 mmHg이면 고혈압 전단계, ≥140/90 mmHg 이면 고혈압으로 분류하였다. 비만 상태에 따른 고혈압과 미세알부민뇨의 관계를 알아보기 위해 성, 연령 및 다른 요인들을 보정한 후 다중로지스틱 회귀분석을 실시하였다. 결과: 비만군은 고혈압인 경우에만 미세알부민뇨와 연관성이 있는 반면, 정상체중군은 고혈압과 고혈압 전단계인경우 미세알부민뇨와의 연관성이 있었다. 비만 상태와 고혈압 정도에 따른 미세알부민뇨 발생 위험은 정상체중이면서정상혈압인 경우를 기준으로, 정상체중이면서 경계혈압인경우는 오즈비 1.85 (95% CI, 1.15-2.98), 정상체중이면서 고혈압인 경우는 오즈비 6.39 (95% CI, 2.90-14.10), 비만이면서 고혈압인 경우는 오즈비 3.22 (95% CI, 1.62-6.41)로 미세알부민뇨 발생 위험이 높았다. 결론: 당뇨병 전단계 성인은 비만하지 않은 정상체중이더라도 정기적인 미세알부민뇨 검사와 혈압의 모니터링이 더욱 필요할 것으로 생각된다.
Abstract
Background: Microalbuminuria (MA) is a predictor for diabetic nephropathy and mortality of cardiovascular disease. Diabetic nephropathy can be prevented by blood glucose and blood pressure control. Koreans have been found to have a significantly higher risk of type 2 diabetes than Caucasians, despite having normal weights. It is necessary to consider obesity status in the prevention of type 2 diabetes. This study aimed to determine the relationship between MA and hypertension according to obesity status in prediabetes. Methods: This study was retrospectively conducted in 1,183 prediabetes, aged 30-70 years with fasting blood glucose levels of 100-125 mg/dL or hemoglobin A1c levels of 5.7-6.4% who health examinees at 16 health promotion centers from 2015 to 2016. Study subjects were classified according to obesity and hypertension. Obesity is defined as body mass index of ≥25 kg/m2. Blood pressure was categorized as follows: normal blood pressure, <120/80 mmHg; prehypertension, 120-139/80-89 mmHg; and hypertension,≥140/90 mmHg. We analyzed the relationship between MA and hypertension according to obesity using multivariable logistic regression analysis. Results: While both prehypertensive and hypertensive subgroups were significantly associated with MA in the nonobese, the hypertensive subgroup was only associated with MA in the obese. In the combined effects of obesity and hypertension, prediabetes with normal weight and hypertension had the highest risk of MA (adjusted odds ratio, 6.39; 95% confidence interval, 2.90-14.10) compared to those with nonobese and normal blood pressure. Conclusions: Our findings suggest that nonobese prediabetes with hypertension would need to be more concerned about MA than do obese prediabetes with hypertension.
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