장기 흡연 남성의 흡연 상태와 C-반응성 단백질 및 대사증후군과의 관련성
Association between Smoking Status, C-reactive Protein and the Metabolic Syndrome in Long-term Smokers among Middle-aged Korean Men
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구배경: 흡연자에게서 대사증후군의 유병률은 높은 것으로 알려져 있지만 장기 흡연자의 흡연 상태(흡연 시작 시기, 흡연 기간, 하루 흡연량, 누적 흡연량)와 관련된 연구는 거의 없다. 한편 흡연자의 C-반응성 단백질(C reactive protein, CRP) 수치는 높은 것으로 알려져 있고, 증가된 CRP 수치는 대사증후군 유병률을 높이는 것으로 알려져 있어 본 연구는 장기간의 흡연을 한 남성을 대상으로 흡연 상태와 CRP, 대사증후군과의 관련성에 대해 조사하였다. 방법: 본 연구는 2001년 11월부터 2004년 10월까지 3년간 삼성서울병원 건강의학센터를 방문한 40세 이상의 남성 중 비 흡연자와 20년 이상의 장기 흡연자를 대상으로 하였다. 대상자의 임상적 특성은 건진 설문지 및 검사실 항목, 운동 부하 검사를 통해 조사되었다. ATP III 기준 및 아시아/태평양 체질량 지수를 적용하여 대사증후군의 유병률을 산출하였으며 흡연 상태와 CRP, 대사증후군과의 관련성을 다변량 회귀 분석 방법으로 알아보았다. 결과: 총 대상자는 4,485명이었고 이 중 비흡연자는 1,860명, 흡연자는 2,625명이었다. 비 흡연자, 흡연자에 있어 대사증후군의 유병률은 각각 17.5%, 21.4% (P＜0.05)였다. 흡연자의 대사증후군 발생 교차비는 하루 흡연 10개비 미만군에 비해 하루 20∼29개비군이 2.46 (95% CI 1.31∼4.62), 30개비 이상 군이 2.57 (95% CI 1.20∼5.50)였고, 정상 CRP 군에 비해 높은 CRP 군(0.3 mg/dl 이상)의 교차비는 1.41 (95% CI 1.01∼1.97)이었다. 또한 하루 흡연량이 증가할수록 CRP 수치는 증가하는 양상을 보였다(β=0.059; P＜0.05). 결론: 남성 장기 흡연자에서 대사증후군의 유병률은 높게 나타났으며, 하루 흡연량이 많은 군에서 더 높게 관찰되었다. 또한 하루 흡연량이 증가할수록 CRP수치는 증가하였다.
Abstract
Background: There are few studies about association between the metabolic syndrome and smoking status (onset of smoking, duration, number of cigarettes per day, pack-years) in long-term smokers. And CRP level, a risk factor of the metabolic syndrome, is known to be higher in smokers than in non-smokers. This study was done to assess the association of smoking status and CRP level with the metabolic syndrome in long-term smokers. Methods: Healthy men aged 40 years old or more who visited the Samsung Medical Health Promotion Center were selected. We examined the participants' clinical characteristics by using self-reporting questionnaires, laboratory data, and Bruce treadmill test. We estimated the prevalence of the metabolic syndrome and identified the association between smoking status, CRP, and the metabolic syndrome by multiple logistic regression method. Results: The prevalence of the metabolic syndrome was higher in the long-term smokers (21.4%) than in the non-smokers (17.5%). The odds ratios of developing the metabolic syndrome were 2.46 (95% CI 1.31∼4.62) and 2.57 (95% CI 1.20∼5.50) in men who smoked 20∼29 and 30 or more cigarettes, respectively, compared with those who smoked 1∼9 cigarettes. And the odd ratio was 1.41 (95% CI 1.01∼1.97) in men who had high CRP level (≥0.3 mg/dl) compared with the normal CRP group. The number of cigarettes had statistically positive association with the CRP level (coefficient β=0.059; P＜0.05). Conclusion: The prevalence of the metabolic syndrome was higher in the long-term smokers than in the non-smokers, and proportional to the number of cigarettes in the long-term smokers. The number of cigarettes smoked per day was correlated positively to the CRP level in the middle-aged Korean men. (J Korean Acad Fam Med 2008;29:94-101)
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