체내 철 저장 상태와 비알코올 지방간 발생과의 연관성
Relationship of body iron stores with the development of nonalcoholic fatty liver disease
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목적 : 비알코올 간질환의 발생과 진행에 있어 체내 철 과잉 상태가 영향을 미치는지에 대한 연구가 다양하게 이루어지고 있지만, 체내 철 저장 상태의 단계에 따라 비알코올 지방간의 발생을 비교한 연구는 부족하였다. 이에 이번 연구는 건강 검진 수진자중 철결핍의 빈도가 상대적으로 높은 여성 수진자를 대상으로 체내 철 저장 상태가 비알코올 지방간 발생에 미치는 영향을 평가하고자 하였다. 방법 : 일개 대학병원에서 건강 검진을 받은 여성 수진자들 중 의미있는 알코올 섭취(하루 20 g 이상)자, HBsAg양성자, anti-HCV 양성자 등을 제외한 5,259명(평균 연령: 40.6±8.9세)을 연구에 포함시켰다. 임상양상, 복부 초음파검사, 인슐린 저항성 및 철대사와 관련된 생화학 검사를 포함한 혈액검사 소견을 파악하여 비알코올 지방간 발생과 체내 철 저장 상태와의 연관성을 분석하였다. 결과 : 체내 철 저장 상태에 따른 비알코올 지방간의 유병율을 비교하였을 때, 정상 체내 철 저장 상태(10.6%), 저장 철 고갈 상태(4.1%), 철결핍성 적혈구 조혈 이상 상태(6.5%) 및 철결핍성 빈혈 상태(11.2%) 간에 유의한 차이를 보였다(p<0.001). 비알코올 지방간 발생에 영향을 미치는 인자들을 알아 보기 위하여, 다변량 분석을 시행하였을 때, 연령(odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.116-1.507) per 10 years), 과체중(OR= 1.952; 95% CI: 1.395-2.732), 당뇨병(OR=1.694; 95% CI: 1.198-2.397), 고중성지방혈증(OR=2.434; 95% CI: 1.737- 3.409, 복부 비만(OR=3.559; 95% CI: 2.538-4.992), 인슐린 저항성(OR=2.665; 95% CI: 1.979-3.587), 빈혈(OR=2.015; 95% CI: 1.150-3.532), 저장 철 고갈(OR=0.580; 95% CI: 0.405-0.830) 등이 유의한 연관성을 보였다 결론 : 체내 철 저장 상태가 비알코올 지방간의 발생에 영향을 미칠 수 있으며, 특히 저장철의 고갈 및 빈혈 발생에 의한 인슐린 저항성의 변화가 비알코올 지방간 발생과 관련되는 것으로 사료된다.
Abstract
Background : Although numerous reports have shown the influence of the iron overload state on the development of nonalcoholic fatty liver disease (NAFLD), there have been few reports on the prevalence of NAFLD according to the body iron stores. The aim of the present study was to determine the relationship of body iron stores with the development of NAFLD in apparently healthy women. Methods : The present cross-sectional study was performed with data obtained from 5,249 women (mean age: 40.6±8.9 years), that received an annual health check-up. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, level of C-reactive protein and serum iron tests were measured in each subject. Results : The prevalence of NAFLD was significantly different according to body iron status (normal iron store/iron store depletion/iron deficient erythropoiesis/iron deficiency anemia: 10.6%/4.1%/6.5%/11.2%, p<0.001). Multivariate analysis revealed that age (odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.1161.507) per 10 years), being overweight (OR=1.952; 95% CI: 1.3952.732), diabetes mellitus (OR=1.694; 95% CI: 1.198-2.397), hypertriglyceridemia (OR=2.434; 95% CI: 1.737-3.409), abdominal obesity (OR=3.559; 95% CI: 2.538-4.992), insulin resistance (OR=2.665; 95% CI: 1.979-3.587), anemia (OR=2.015; 95% CI: 1.150-3.532) and stored iron depletion (OR=0.580; 95% CI: 0.405-0.830) were profoundly associated with the development of NAFLD. Conclusion : The present study reveals a possible correlation between the development of NAFLD and body iron stores, and stored iron depletion and anemia seem to be key factors for this correlation. (Korean J Med 73:587-595, 2007)
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