종합검진 수진자에서 비알콜성 지방간과 대사 증후군의 연관성
The Association of Nonalcoholic Fatty Liver Disease with Metabolic Syndrome
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연구배경: 최근 종합 검진센터에서 복부 초음파 검사율이 증가하면서 비알콜성 지방간의 발견 빈도가 증가하고 있는 추세이다. 비만, 제2형 당뇨병, 이상지질혈증과 연관성이 알려진 비알콜성 지방간의 대사적 특징을 알아보고, 대사 증후군과의 연관성을 분석하고자 하였다. 방법: 2003년 11월부터 2004년 1월까지 3개월간 일개 대학병원 종합 건강검진센터를 방문한 35세 이상의 성인 1,675명 중, 1주일에 40 g 이상의 음주력이 있거나 바이러스성, 독성 간염의 병력이 있는 경우를 제외한 401명을 대상으로, 신체 계측, 혈액 검사, 복부 초음파를 실시하였다. 먼저, 비알콜성 지방간의 유병률 및 ATP III, 아시아 태평양 지역 복부비만 기준에 따른 대사 증후군의 유병률을 알아보고, 로지스틱 회귀분석을 이용해 대사 증후군에 대한 비알콜성 지방간의 교차비를 산출하였다. 결과: 비알콜성 지방간의 유병률은 27.2%였고, 이들 환자군에서 대조군보다 혈압, 체중, 체질량 지수, 허리둘레와 총콜레스테롤, 중성지방, 공복혈당, 간 효소 수치가 의미 있게 높았으며 고밀도 지단백은 의미 있게 낮았다. 또한 환자군에서 비만, 당대사 이상, 이상지질혈증, 고혈압의 유병률이 더 높았다. 대사 증후군의 전체 유병률은 19.2%였고 비만군과 비비만군에서 비알콜성 지방간이 있는 경우 대사 증후군의 유병률이 높았다. 대사 증후군에 대한 비알콜성 지방간의 교차비는 6.458 (95% C.I. 3.178∼13.124)이었다. 결론: 비알콜성 지방간은 비만 유무에 상관없이 대사 증후군과 밀접한 연관성이 있다.
Abstract
The Association of Nonalcoholic Fatty Liver Disease with Metabolic SyndromeSu Yun Kim, M.D., Kyung Won Shim, M.D.†, Hong Soo Lee, M.D., Sang Hwa Lee, M.D., Hai Lim Kim, M.D., Young A Oh, M.D. Background: Recently, the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been made more frequently, as the use of ultrasonography on health screening has been on the rise. The aim of this study was to elucidate the relationship between NAFLD and the metabolic syndrome defined by NCEP-ATP III criteria. Methods: A total of 1,675 subjects, who attended for routine physical check‐ups, were screened. Among those, 401 subjects were selected after excluding the subjects with either significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, or overt thyroid disease. NAFLD was diagnosed if the subjects had a “bright liver” on ultrasonographic examination. The diagnosis of metabolic syndrome was made according to the criteria of NCEP-ATP III established in 2001. Results: The prevalence of NAFLD was 27.2%. Blood pressure, body weight, body mass index, waist circumference, and serum levels of total cholesterol, triglyceride, fasting glucose and liver enzymes were higher among the subjects with NAFLD than the control. The prevalence of obesity, IFG/DM, dyslipidemia and hypertension was higher in the NAFLD group. The prevalence of the metabolic syndrome was 19.2%, which was higher in the NAFLD group than the control group. The odds ratio of NAFLD for the metabolic syndrome was 6.458 (95% C.I. 3.178∼13.124). Conclusion: NAFLD was closely associated with the metabolic syndrome regardless of the presence of obesity. (J Korean Acad Fam Med 2007;28:667-674)
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