한국 남성에서 흡연에 따른 폐기능과 신기능의 연관성: 2011년도 국민건강영양조사를 이용하여
Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES)
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연구배경: 만성 신부전 환자에서 폐기능 저하와 신기능감소가 관련이 있다는 근거들이 제시되고 있다. 그러나 신기능 저하 환자가 아닌 일반 흡연자를 대상으로 폐기능과신기능 감소의 연관성을 평가한 연구는 아직 없는 상태이다. 본 연구는 한국 남성에서 흡연 여부에 따라 폐기능과신기능의 관련성이 있는지 확인하고자 하였다. 방법: 제 5기 2차 국민건강영양조사 자료를 이용하여 암을 진단받은 자를 제외한 40세 이상 성인 남성 1,246명을대상으로 폐기능의 지표와 신기능의 연관성을 흡연상태에따라 나누어 조사한 단면연구이다. 폐기능과 신기능의 관련성은 Pearson correlation analysis로 확인하였고, 비흡연자군와 흡연자군에서 알부민뇨 동반유무, 추정 사구체 여과율(estimated glomerular filtration rate, eGFR)에 따른 1 초간 노력성호기량(Forced expiratory volume in 1 second, FEV1)과 노력성폐활량(Forced vital capacity, FVC)의 차이는 공분산분석을 시행하였다. 결과: 흡연자군과 비흡연자군 모두에서 FEV1과 FVC는소변 알부민 크레아티닌 비와 음의 상관관계를 보였으며eGFR과 양의 상관관계를 보였다. 흡연자군에서는 나이, 성별, 체질량지수, 당뇨, 고혈압의 유무, 운동, 음주인자를보정한 후에도 알부민뇨에 따라 유의하게 FEV1과 FVC가감소하였다(각각 P＝0.012, P＝0.001). 결론: 한국 남성 흡연자에서 알부민뇨가 동반되는 경우폐기능의 저하가 관찰되었다. 일차 진료 현장에서는 흡연자의 관리에 있어 폐기능뿐 아니라 신기능이 함께 저하될수 있음을 인지하고 신기능 저하를 조기 진단할 필요성이있음을 인지해야 할 것이다.
Abstract
Background: Several studies have found an association between decreased respiratory function and renal impairment in those with chronic kidney disease. The relationship has not been investigated for healthy smokers. The aim of this study was to examine the association between respiratory function and renal function according to smoking status in Korean male population. Methods: From the 5th Korean National Health and Nutrition Examination Survey (KNHANES), we enrolled 1246 male participants who were 40 years or older. As a cross‐sectional study, the association between respiratory function and renal function were analysed depending on the ’ smoking status. Pearson correlation analysis was used to find the association between respiratory function and renal impairment. Covariance Analysis allowed to compare renal function (albuminuria, eGFR) with respiratory function (FEV1, FVC) according to smoking status. Results: Regardless of smoking status, there was a negative correlation between respiratory function (FEV1 and FVC) and urinary albumin to creatinine ratio (LogUACR), and positive correlation between respiratory function (FEV1 and FVC) and estimated glomerular filtration rate (eGFR). Smokers have lower FEV1 and FVC in case they have albuminuria, after adjusting for covariant (P＝0.012, P＝0.010, respectively). Conclusions: Respiratory function was significantly lower in male smokers with albuminuria. Primary care physicians need to recognize that albuminuria may accompany with decreased respiratory function and to detect renal function impairment earlier in male smokers.
참고문헌 (30)
- Edwards R, "The problem of tobacco smoking", BMJ, 328(7433), pp.217~219 (2004)
- "The 5th Korea National Health and Nutrition Examination Survey (KNHANESV‐1)" (2010)[URL]
- 송혜령, "우리나라 흡연관련 질환의 역학", Korean Journal of Family Medicine, 29(08), pp.563~571 (2008), 대한가정의학회
- Gambaro G, "Del Prete D, Renal impairment in chronic cigarette smokers", J Am Soc Nephrol, 9(4), pp.562~567 (1998)
- Noborisaka Y, "Smoking and chronic kidney disease in healthy populations", Nephrourol Mon, 5(1), pp.655~667 (2013)
- Locatelli F, "The importance of early detection of chronic kidney disease", Nephrol Dial Transplant, 17(Suppl 11), pp.2~7 (2002)
- Stevens PE, "Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline", Ann Intern Med, 158(11), pp.825~830 (2013)
- Jafar TH, "Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo‐Asian population", Nephrol Dial Transplant, 22(8), pp.2194~2200 (2007)
- Tkácová R, "Hildebrand T. Spirometric alterations in patients with reduced renal function", Wien Klin Wochenschr, 105(1), pp.21~24 (1993)
- Yoon JH, "Poor lung function has inverse relationship with microalbuminuria, an early surrogate marker of kidney damage and atherosclerosis: the 5th Korea National Health and Nutrition Examination Survey", PLoS One, 9(4), pp.e94125~ (2014)
- Casanova C, "Microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease", Am J Respir Crit Care Med, 182(8), pp.1004~1010 (2010)
- Miller MR, "Standardisation of spirometry", Eur Respir J, 26(2), pp.319~338 (2005)
- 최정근, "한국인의 정상 폐활량 예측치", Tuberculosis and Respiratory Diseases, 58(3), pp.230~242 (2005), 대한결핵및호흡기학회
- Levey AS, "A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation", Ann Intern Med, 130(6), pp.461~470 (1999)
- National Kidney Foundation, "K", DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification, 2002, pp.39(2 Suppl 1), S1~S266
- Anand S, "High prevalence of chronic kidney disease in a community survey of urban Bangladeshis : a cross‐sectional study", Global Health, 10, pp.9~ (2014)
- Pinto‐Sietsma SJ, "Smoking is related to albuminuria and abnormal renal function in nondiabetic persons", Ann Intern Med, 133, pp.585~591 (2000)
- Maeda I, "Cigarette smoking and the association with glomerular hyperfiltration and proteinuria in healthy middle‐aged men", Clin J Am Soc Nephrol, 6(10), pp.2462~2469 (2011)
- Shankar A, "The association among smoking, heavy drinking, and chronic kidney disease", Am J Epidemiol, 164(3), pp.263~271 (2006)
- Yamagata K, "Risk factors for chronic kidney disease in a community‐based population: a 10‐year follow‐up study", Kidney Int, 71(2), pp.159~166 (2007)
- Briganti EM, "Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study", Am J Kidney Dis, 40(4), pp.704~712 (2002)
- Halimi JM, "Effects of current smoking and smoking discontinuation on renal function and proteinuria in the general population", Kidney Int, 58(3), pp.1285~1292 (2000)
- Noborisaka Y, "Alcohol and cigarette consumption, renal function and blood pressure in middle‐aged healthy men", J Hum Hypertens, 21(12), pp.966~968 (2007)
- Yoon HJ, "The differential effect of cigarette smoking on glomerular filtration rate and proteinuria in an apparently healthy population", Hypertens Res, 32(3), pp.214~219 (2009)
- Zhang L, "Prevalence and factors associated with CKD: a population study from Beijing", Am J Kidney Dis, 51(3), pp.373~384 (2008)
- Bazzano LA, "Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States", Ann Intern Med, 138(11), pp.891~897 (2003)
- Gan WQ, "The interactions between cigarette smoking and reduced lung function on systemic inflammation", Chest, 127(2), pp.558~564 (2005)
- Eagan TM, "Systemic inflammatory markers in COPD: results from the Bergen COPD Cohort Study", Eur Respir J, 35(5), pp.540~548 (2010)
- Arici M, "End‐stage renal disease, atherosclerosis, and cardiovascular mortality: is C‐reactive protein the missing link?", Kidney Int, 59(2), pp.407~414 (2001)
- Yanbaeva DG, "Systemic effects of smoking", Chest, 131(5), pp.1557~1566 (2007)