성인 터너증후군 환자에서 당뇨병과 고혈압 발생의 예측 인자에 관한 연구
Predictive Factors of Diabetes and Hypertension in Adult Turner Syndrome
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목 적:성인 터너증후군에서 갑상선 질환, 비만, 당뇨병과 같은 내분비 질환을 비롯하여 고혈압, 동맥경화증 같은 심혈관계 질환의 빈도가 높다. 본 연구는 터너증후군 환자의 임상적, 생화학적 지표를 분석하여 당뇨병 및 고혈압의 발생 가능성에 대한 예측 인자를 알아보고자 하였다. 방 법:서울아산병원에서 추적 중인 18세 이상의 터너증후군 29명을 대상으로 하였다. 의무기록을 통해 대상 환자들의 신체 계측치 등의 임상지표와 혈중 인슐린, 당화 혈색소, 혈중 지질 농도 등의 생화학적 지표들을 분석하였다. 결 과:환자군의 24.1%(7명)가 공복혈당장애(6명) 또는 당뇨병(1명)이 있었고 10.3%(3명)가 복부비만, 17.2%(5명)가 고중성지방혈증, 13.8%(4명)가 저밀도지단백콜레스테롤혈증, 20.7%(6명)가 고혈압이 있어, 10.3%(3명)가 대사증후군에 합당하였다. 공복혈당장애 또는 당뇨병이 있는 환자군에서 허리둘레가 유의하게 증가하여 있었다(67.1± 5.4 vs 79.4± 8.3, P=0.009). 혈중 인슐린, HOMA-IR, 렙틴과 아디포넥틴은 두 군간에 유의한 차이를 보이지 않았다. 환자군 중에서 혈압이 높은 군에서 체질량지수가 더 높았다(26.2± 5.7 vs 22.5± 3.1, P=0.042). TC, LDL-C, TG 농도 모두 혈압이 높은 군에서 높았으나, TC농도만 통계적으로 유의한 차이를 보였다(P=0.004, 0.070, 0.177). 결 론:터너증후군 환자들에서 복부 비만의 정도가 심한 경우 또는 비만의 정도가 심하고 혈중 콜레스테롤 수치가 높은 경우 공복혈당장애나 당뇨병 및 고혈압 같은 심혈관 질환에 대한 적극적인 감시, 예방 및 치료가 중요하겠다.
Abstract
Purpose:The risk of cardiovascular diseases (CVD) including hypertension, artherosclerosis and endocrinologic diseases such as thyroid disease, obesity, diabetes mellitus are elevated in adult Turner syndrome (TS). Clinical and biochemical parameters of TS patients were analyzed to investigate the predictive factors of diabetes and hypertension. Methods:Twenty nine patients with TS were enrolled in this study. Clinical and biochemical parameters including height, weight, body mass index (BMI), blood pressure, waist and hip circumferences, lipid profile, insulin, fasting glucose, and HbA1c were retrospectively reviewed. Results:Seven (24.1%) out of 29 had either impaired fasting glucose (IFG) or diabetes, 3 (10.3%) had central obesity, 5 (17.2%) had hypertriglyceridemia, 4 (13.8%) had low HDL cholesterol, 6 (20.7%) had hypertension, and 3 (10.3%) out of 29 were consistent with the criteria of MS. The waist circumference was longer in patients with either IFG or diabetes (67.1±5.4 cm vs 79.4±8.3 cm, P=0.009). Insulin, homeostasis model assessment-insulin resistance (HOMA-IR), and adipokine levels were not significantly different according to the presence of either IFG or diabetes. Among TS patients, BMI was higher in patients with hypertension (26.2±5.7 kg/m2 vs 22.5±3.1 kg/m2, P=0.042). Total cholesterol exhibited a significant difference between patients with hypertension and those without hypertension (177.3±29.6 mg/dL vs 222.8±28.5 mg/dL, P=0.004). Conclusion:Adult TS patients should be carefully followed regarding the development of diabetes and hypertension in case of severe central obesity and dyslipidemia.
참고문헌 (22)
- Gravholt CH, "Turner syndrome in adulthood", Horm Res, 64(Suppl 2), pp.86~93 (2005)
- Gravholt CH, "Morbidity in Turner syndrome", J Clin Epidemiol, 51, pp.147~158 (1998)
- Stochholm K, "Prevalence, incidence, diagnostic delay, and mortality in Turner syndrome", J Clin Endocrinol Metab, 91, pp.3897~3902 (2006)
- Holt RI, "International Diabetes Federation re-defines the metabolic syndrome", Diabetes Obes Metab, 7, pp.618~620 (2005)
- Kim HM, "Prevalence of the metabolic syndrome among Korean adults using the new International Diabetes Federation definition and the new abdominal obesity criteria for the Korean people", Diabetes Res Clin Pract, 77, pp.99~106 (2007)
- 김주화, "터너증후군을 가진 성인 환자에서 대사증후군의 발생과 인슐린저항성과의 관계", Korean Journal of Pediatrics, 52(3), pp.370~375 (2009), 대한소아과학회
- Gravholt CH, "Body composition is distinctly altered in Turner syndrome: relations to glucose metabolism, circulating adipokines, and endothelial adhesion molecules", Eur J Endocrinol, 155, pp.583~592 (2006)
- Landin K, "Importance of obesity for the metabolic abnormalities associated with an abdominal fat distribution", Metabolism, 38, pp.572~576 (1989)
- de Koning L, "Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies", Eur Heart J, 28, pp.850~856 (2007)
- Gravholt CH, "Glucose metabolism, lipid metabolism, and cardiovascular risk factors in adult Turner's syndrome. The impact of sex hormone replacement", Diabetes Care, 21, pp.1062~1070 (1998)
- Salgin B, "Insulin resistance is an intrinsic defect independent of fat mass in women with Turner's syndrome", Horm Res, 65, pp.69~75 (2006)
- Bakalov VK, "Impaired insulin secretion in the Turner metabolic syndrome", J Clin Endocrinol Metab, 89, pp.3516~3520 (2004)
- Ostberg JE, "Adipokine dysregulation in turner syndrome: comparison of circulating interleukin-6 and leptin concentrations with measures of adiposity and C-reactive protein", J Clin Endocrinol Metab, 90, pp.2948~2953 (2005)
- Godsland IF, "The influence of female sex steroids on glucose metabolism and insulin action", J Intern Med Suppl, 738, pp.1~60 (1996)
- Landin-Wilhelmsen K, "Cardiac malformations and hypertension, but not metabolic risk factors, are common in Turner syndrome", J Clin Endocrinol Metab, 86, pp.4166~4170 (2001)
- Weyer C, "Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia", J Clin Endocrinol Metab, 86, pp.1930~1935 (2001)
- Yildiz BO, "Alterations in the dynamics of circulating ghrelin, adiponectin, and leptin in human obesity", Proc Natl Acad Sci U S A, 101, pp.10434~10439 (2004)
- Kolaczynski JW, "Acute and chronic effects of insulin on leptin production in humans: Studies in vivo and in vitro", Diabetes, 45, pp.699~701 (1996)
- Tanizawa Y, "Direct stimulation of basal insulin secretion by physiological concentrations of leptin in pancreatic beta cells", Endocrinology, 138, pp.4513~4516 (1997)
- Luna R, "High serum leptin levels in children with type 1 diabetes mellitus: contribution of age, BMI, pubertal development and metabolic status", Clin Endocrinol (Oxf), 51, pp.603~610 (1999)
- Kubota N, "Disruption of adiponectin causes insulin resistance and neointimal formation", J Biol Chem, 277, pp.25863~25866 (2002)
- Shetty GK, "Circulating adiponectin and resistin levels in relation to metabolic factors, inflammatory markers, and vascular reactivity in diabetic patients and subjects at risk for diabetes", Diabetes Care, 27, pp.2450~2457 (2004)