1형 당뇨병 환자에서 미세혈관 합병증의 발생 빈도와 위험 인자
Frequencies and Related Factors for Microvascular Complications in Patients with Type 1 Diabetes
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목적: 본 연구에서는 1형 당뇨병 환자를 대상으로 미세혈관 합병증의 발생 빈도와 이와 관련된 인자들을 알아보고자한다. 방법: 연세대학교 세브란스 병원에서 1형 당뇨병으로 진단받는 환자들 중, 만 10세가 넘고 당뇨병 유병기간이 적어도2년이 넘는, 총 271명의 1형 당뇨병 환자(남자 111명, 여자 160명, 평균 나이 21.9±5.8세)를 대상으로 당뇨병성 신증, 망막병증, 신경병증의 세가지 미세혈관 합병증을 조사하고, 이와 관련된 인자들을 분석하였다. 결과: 미세혈관 합병증은 전체 271명 중 83명(30.6%)에서 발생하였다. 미세알부민뇨는 39명(14.4%)에서, 지속성 미세알부민뇨는 31명(11.4%)에서 발생하였으며, 단백뇨는 12명(4.4%)에서 발생하였다. 또한, 당뇨병성 망막병증은 35명(12.9%)의 환자에서, 신경병증은 39명(13.7%)의 환자에서 발생하였다. 10년 동안의 평균 당화혈색소는 미세혈관합병증이 있는 군에서 합병증이 없는 군 보다 더 높았다(10.5±2.8% vs. 8.4±1.4%). 또한 인슐린 치료법 중 적극적치료법의 비율은 미세혈관 합병증이 없는 군에서 미세혈관 합병증이 있는 군보다 더 높았다. 미세알부민뇨는 여자보다남자에서 더 많이 발생하였으나, 당뇨병성 망막병증이나 신경병증에서는 성별의 차이를 보이지 않았다. 또한, 사춘기및 당뇨병의 유병기간도 미세혈관 합병증의 위험인자로 생각된다. 결론: 1형 당뇨병 환자에서 미세혈관 합병증의 발생률은 점차적으로 낮아지고 있다. 하지만, 지속적인 고혈당뿐만 아니라 성별, 사춘기, 당뇨병의 유병기간도 미세혈관 합병증 발생과 연관된 위험인자이기 때문에, 적극적 인슐린 치료법을 통해 철저히 혈당을 관리하고, 사춘기 연령이거나 당뇨병의 유병기간이 5년이 넘는 환자에서는 미세혈관 합병증에대한 정기적인 선별검사가 필요하다.
Abstract
Purpose: We observed the frequencies of microvascular complications and their related factors in patients with type 1 diabetes. Methods: Two hundred seventy one patients (111 males and 160 females, mean age 21.9 ± 5.8 years) with type 1 diabetes were included. Subjects were all at least 10 years old and had diabetes for at least two years. Three types of microvascular complications (diabetic nephropathy, retinopathy, and neuropathy) were evaluated, and their frequencies and risk factors were analyzed. Results: The overall prevalence of microvascular disease was 83/271 (30.6%). Microalbuminuria had developed in 39 patients (14.4%), persistent microalbuminuria in 31patients (11.4%), and proteinuria in 12 (4.4%). Diabetic retinopathy had developed in 35patients (12.9%) and neuropathy in 39 patients (13.7%). The mean HbA1c for 10 years was significantly higher in the patients with microvascular complications (10.5 ± 2.8%vs. 8.4 ± 1.4%). The rate of intensive management in the non-complication group was higher than in the microvascular complication group. The incidence of microalbuminuria was greater in males than females, but there were no gender differences in either diabetic retinopathy or neuropathy. Puberty and the duration of diabetes may be associated with microvascular complications. Conclusion: The incidence of microvascular complications in type 1 diabetes is declining. Sex, puberty, and the duration of diabetes as well as prolonged hyperglycemia are all related to microvascular complications. Therefore, intensive insulin management and regular screening for microvascular complications should be performed in patients who have either entered into puberty or have had diabetes for more than 5 years.
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