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한국 폐경 여성에서 생물학적 스트레스 지표와 대사증후군의 요소

Biologic Stress Markers and Components of Metabolic Syndromein Postmenopausal Korean Women

주일우|오한진|최영근
대한임상건강증진학회 (Korean Society For Health Promotion And Disease Prevention)|2009.03|Korean Journal of Health Promotion|제9권 제1호|pp. 50-55

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참고문헌

키워드

스트레스stress대사증후군metabolic syndromeDHEA-Scortisol코르티솔코르티솔(cortisol)/ DHEA-S
주제분류기타자연과학

초록

연구배경 대사증후군의 핵심 병리기전은 인슐린 저항성이다. 만성스트레스는 뇌하수체-시상하부-부신 축의 활성화로 코르티솔(cortisol) 수치의 증가를 유발하여 혈당상승, 인슐린 저항성의 증가 및 혈압의 상승을 초래할 수 있다. 이에 우리는 폐경이란 특수 상황을 공통적으로 겪은 폐경후 여성을 대상으로 대사증후군의 요소와 생물학적 스트레스 지표인 코르티솔(cortisol), dehydroepiandrosterone(DHEA-S), 그리고 코르티솔(cortisol)/DHEA-S와의 연관성에 대해 알아보고자 하였다. 방 법 2001년 1월부터 2008년 3월까지 서울시내 일개 종합병원에 스트레스를 주소로 내원한 폐경후 여성 223명을 대상으로 하였다. 대사증후군은 NCEP-ATP III 진단기준을 적용하되 허리둘레 대신 체질량지수를 사용하였다. 생물학적 스트레스 지표들과 대사증후군의 요소과의 상관성에 대해 확인하였다. 결 과 공복혈당은 코르티솔(cortisol)과 양의 상관관계(p=0.01)를 보이고 중성지방과 DHEA-S간에는 음의 상관관계(p=0.019)를 보였다. 대사증후군의 요소 각각에 대해 정의에 따른 분리점을 사용하여 두 군으로 나누어 생물학적 지표의 두 집단 간 평균 비교를 했을 때 DHEA-S만이 혈압을 제외한 네 가지 요소에서 유의한 평균 차이(체질량지수, p=0.022; 공복혈당, p=0.004; 중성지방, p=0.012; HDL-C, p=0.010)를 보였다. 대상환자를 정상과 대사증후군으로 구분하여 비교하였을 때 DHEA-S와 코르티솔(cortisol)/DHEA-S의 집단간 평균이 유의(p<0.001, p=0.039)한 차이가 있었다. 결 론 본 연구 결과가 만성 스트레스와 대사증후군 간의 인과 관계를 명확히 밝힐 수는 없으나 DHEA-S의 대사증후군의 요소 증가에 따른 유의한 차이와 각 요소와의 관련성은 만성스트레스와 대사증후군간의 밀접한 연관성을 시사한다고 볼 수 있다. 향후 대규모의 구체화된 실험적 연구가 필요할 것이다.

Abstract

Background The key pathophysiology of metabolic syndrome (MS) is insulin resistance. Chronic stress may induce increased insulin resistance, high blood glucose, visceral obesity, and high blood pressure via increased cortisol levels from chronic activation of the hypothalamus-pituitary-adrenal axis (HPA axis). However, the relationships between cortisol, dehydroepiandrosterone sulfate (DHEA-S), and cortisol)/DHEA-S and each of the components of MS have not yet been thoroughly investigated. In our study, we evaluated the relationships between cortisol, DHEA-S, and cortisol/DHEA-S as biologic stress markers and components of MS in postmenopausal Korean women. Methods This study was a cross-sectional analysis of 223 postmenopausal women who visited our climacteric clinic at a university hospital in Seoul with stressful events. These women were seen between January 2001 and March 2008. Metabolic syndrome was diagnosed according to the NCEP-ATP III criteria using body mass index (BMI) instead of waist circumference. We evaluated the relationships between each biological stress marker and the components of MS. Independent t-tests were conducted on each cut-off point of the MS components. The study population was classified as normal subjects (no MS components) or MS subjects (>3 MS components). Mean differences in biologic stress markers between normal and MS subjects were evaluated by independent t-tests. Results Cortisol levels were positively associated with FPG (p=0.01), and DHEA-S levels were negatively associated with TG (p=0.019), but not with the other components of MS. DHEA-S levels showed statistically significant mean differences from BMI, FPG, TG, and HDL-C (p=0.022; p=0.004; p=0.012; p=0.010) by independent t-tests. Significant mean differences in DHEA-S and cortisol/DHEA-S between normal subjects and MS subjects were also observed (p=0.0002, p=0.039), but the mean difference in cortisol was not significant. Conclusions It has been hypothesized that persistent chronic psychosocial stress may be a causative factor of MS. Unfortunately, we were unable to look into this hypothesis because of the limitations of the cross-sectional design. However, this study suggests that DHEA-S levels and MS might be meaningfully correlated.

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