담석증과 당뇨병 발생위험: 코호트 연구
A Cohort study of Gallstones and Incidence of Diabetes in a Korean population
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연구배경: 담석과 인슐린저항성이 관련이 있다고 밝혀져있으나, 담석증이 있는 환자에서 당뇨병 발생위험이 더 높은지 본 연구는 희박하다. 본 연구는 담석증이 없을 때보다 담석증이 있는 경우 당뇨병 발생위험이 증가하는지 알아보고자 코호트 연구를 수행하였다. 방법: 2005년 1월부터 2006년 12월까지 건강검진 수검자중에서 30-59세의 당뇨병이 없는 남녀성인 41,518명을 대상으로 2011년 11월까지 추적 관찰하였다. 담석증은 상복부초음파를 통하여 진단되었고, 당뇨병은 공복혈당(≥ 7.0 mmol l-1), 당화혈색소(≥ 6.5%), 당뇨병약 복용력이 있는경우로 정의하였다. 담석증에 따른 당뇨병 발생 위험도는Cox proportional hazard model을 이용하여 분석하였다. 결과: 총 192,999인·년(person-years) 추적 관찰 기간 동안, 2,232명에서 당뇨병 발생이 관찰되었다(발생률, 11.6/1000 인·년). 담석증이 없을 때보다, 담석증 또는 담낭절제술을받은 군에서 당뇨병 발생률이 유의하게 높았고, 이러한 관련성은 여성에서만 관찰되었다. 혼란변수를 보정한 다변량 분석결과, 담석증이 없는 경우와 비교하여, 당뇨병 발생상대위험도(95% 신뢰구간)는 남자에서는 담석증군 0.95배(0.63-1.42), 담낭절제술을 받은 경우 1.13배(0.53-2.38) 높았고, 여자에서는 담석증군 1.64배(1.13-2.40), 담낭절제술군에서 2.04배(1.01-4.11) 당뇨병 발생위험이 높았다. 결론: 건강한 성인 여성에서 담석증이 있는 경우, 당뇨병발생위험이 유의하게 높았으나, 남성에서는 이러한 관련성이 없었다. 담석증이 있는 여성에서 당뇨병 발생 예방을위한 노력이 필요하겠다.
Abstract
Background: Gallstones are associated with insulin resistance but the relation between gallstone disease and the risk of developing diabetes mellitus (DM) is unclear. We examined if gallstones are associated with an increased incidence of DM compared to no gallstones. Methods: A cohort study was performed in 41,518 Koreans aged 30-59 without DM, who underwent a health checkup during 2005-2006 and then were followed annually or biennially until December 2011. Throughout the study period, gallstones were defined as ultrasound-documented gallstones by standard criteria and DM was defined as fasting serum glucose ≥7.0 mmol l-1, A1c ≥6.5%, or use of DM medications. Results: During 192999 person-years of follow-up, 2,232 participants developed DM (incidence rate 11.6 per 1,000 person-years). The incidence of DM was higher in subjects with gallstones or cholecystectomy than in those without gallstones for women but not for men. In multivariate-adjusted models, the hazard ratios (95% confidence intervals) for DM comparing gallstones and cholecystectomy vs. no gallstones were 0.95 (0.63-1.42) and 1.13 (0.53-2.38), respectively, in men and 1.64 (1.13-2.40) and 2.04 (1.01-4.11), respectively, in women. These associations did not differ significantly between relevant subgroups. Conclusions: In an apparently healthy population, gallstones were independently and modestly associated with increased incidence for DM in women but not in men. Women with gallstones should be provided with adequate measures for preventing DM.
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