폐경 후 여성에서 아디포카인과 비만 및 대사 합병증
Adipokines, the obesity and metabolic complications in the postmenopausal women
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초록
폐경이행기가 되면 체지방 증가 및 지방 분포의 변화가 일어나며, 복부비만 증가에 의한 인슐린 저항성, 지질대사 이상 등의 대사 합병증을 초래한다. 지방조직은 에너지 저장뿐만 아니라 다수의 아디포카인을 분비하는 내분비기관이며, 내재성 면역기관이다. 비만인 경우 대식세포가 지방조직에 침윤하면 다수의 아디포카인이 지방 세포에서 분비되어 인슐린 저항성, 고지혈증, 고혈압, 고지혈증, 이소성 지방 침착, 제 2형 당뇨병 등의 대사 합병증을 야기시킨다. 지방세포에서 분비되는 아디포카인으로는 렙틴, 아디포넥틴, 레지스틴, 레티놀 결합 단백질 등이 있으며, TNF-α, IL-6 등의 호염증성 사토카인 등이 있다. 아디포넥틴은 인슐린 감수성을 높이는 역할을 하지만 렙틴, 레지스틴, 호염증성 사이토카인은 인슐린 저항성을 증가시킨다. 폐경은 대사 합병증을 높이는 방향으로 아디포카인의 농도가 변화시키지만 아직 명확하게 밝혀진 것이 없다. 아디포카인은 지방조직과 여성 생식기관의 조절에 관여하며, 특히 폐경 후 여성에서 대사증후군 및 심혈관계 질환 발병의 증가와 관련되어 있으므로 이들에 대한 깊은 연구가 필요하다.
Abstract
During the menopausal transition there are changes in body fat and its disrtribution, and central adiposity is associated with the metabolic complications such as insulin resistance and dyslipidemia. Adipose tissue is increasingly recognized as an endocrine organ with many secretory products and a part of the innate immune system. With obesity, macrophages infiltrate into adipose tissue, and numerous adipokines and cytokines are secreted by both macrophages and adipocytes. The adipokines play important roles in the pathogenesis of metabolic complications such as insulin resistance, dyslipidemia, hypertension, ectopic fat accumulation, type 2 diabetes, and cardiovascular disease. It has been shown that adipocytes secrete several proteins including tumor necrosis factor-alpha (TNF-α), IL-6 and adipokines such as leptin, adiponectin, resistin, retinol binding protein 4, visfatin. Adiponectin improves insulin sensitivity, but leptin, resistin, pro-inflammatory cytokines increase insulin resistance. It is well known that menopause is associated with notable change in levels of the adipokines toward the direction to increase of metabolic complications, but the influence of menopause on adipokine levels is still poorly understood. Further studies are needed to understand the relationship of adipokines and metabolic syndrome, cardiovascular disease in the postmenopausal women.
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