일개 대학병원에 내원한 뇌경색 환자와 정상인에서 대사증후군 유병률 비교

Abstract

Department of Internal Medicine and Neurology*, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine; Department of Internal Medicine, Catholic University School of Medicine**, Seoul, Korea Background: Ischemic stroke is the important cause of mortality after coronary heart disease and cancer, and the leading cause of disability. Metabolic syndrome confers an increased risk for cardiovascular morbidity and mortality. But, the study on the relationship between cerebral infarction and metabolic syndrome has been scarcely reported. The aim of this study is to elucidate the incidence of metabolic syndrome in patients with ischemic stroke and the differences between the two groups divided by the presence or absence of metabolic syndrome. Methods: 127 patients with ischemic stroke documented with brain MRI and 130 age, sex-matched control subjects without any medical history were studied. Blood pressure, body mass index (BMI), fasting blood glucose, triglyceride, high-density lipoprotein (HDL) cholesterol, total cholesterol and low-density lipoprotein (LDL) cholesterol were checked. NCEP-ATP III criteria for metabolic syndrome was used and BMI was used instead of abdominal circumference. Statin users are classified as positive for triglyceride or HDL-cholesterol component. The subjects with ischemic stroke were subclassified into 5 groups according to Trials of Org 10172 in Acute Stroke treatment (TOAST) criteria. Results: Prevalence of metabolic syndrome reached up to 41.7% in patients with documented ischemic stroke, compared with 29.2% in normal controls. Among the individual components of metabolic syndrome, only the prevalence of fasting hyperglycemia was significantly higher in ischemic stroke group than normal controls. Mean blood pressure and the number of involved components of metabolic syndrome were higher in ischemic stroke group than normal controls and significantly more subjects with ischemic stroke had smoking history. The odds ratio for ischemic stroke by the presence of metabolic syndrome was 1.734(95% CI, 1.034 to 2.908) and if analyzed separately, the presence of fasting hyperglycemia showed significantly increased odds ratio for ischemic stroke among the components (OR=4.049; 95% CI, 2.373 to 6.908). According to TOAST criteria, small vessel occlusions were the most prevalent(35.5%) and large artery thrombosis were the next(30.6%). Although statistically insignificant, small vessel occlusion and larg eartery thrombosis groups showed relatively higher prevalence of metabolic syndrome(46.4 and 40.5%). Conclusions: Patients with ischemic stroke had higher prevalence of metabolic syndrome compared with normal controls and the presence of metabolic syndrome increased the risk for ischemic stroke Among the metabolic components, fasting hyperglycemia significantly increased the risk for ischemic stroke. This result emphasizes the importance of managing the metabolic syndrome in ischemic stroke patients. Key Words: Metabolic syndrome, Ischemic stroke, Fasting hyperglycemia