당뇨병 및 내당능장애가 없는 정상 성인에서 인슐린 저항성과 혈중 Apolipoprotein B 및 대사증후군 인자와의 연관성
Insulin resistance and apolipoprotein B as a metabolic syndrome risk factor in normal glucose tolerance
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서론 : 본 연구는 당뇨병의 기왕력이 없으며, 공복 혈당이 정상인 한국인 성인에서 인슐린저항성이 최근 심혈관 질환의 위험요인으로 강조되고 있는 혈중 Apolipoprotein B의 농도 및 Apolipoprotein AI/Apo B 비와 연관성이 있는지를 알아보고자 하였다. 대상 및 방법 : 2002년 1월부터 12월까지 병원에서 종합건강검진을 받은 수진자 33,583명 중 당뇨병의 기왕력이 없으며 공복 혈당이 정상인 7,427명(남자 4,356명, 여자 3,071명)을 대상으로 체질량지수 , 허리둘레, 혈압, 공복 혈당, 혈청 중성지방, 총 콜레스테롤, 고밀도지단백콜레스테롤, 저밀도지단백콜레스테롤, Apolipoprotein B (Apo B), Apolipoprotein AI을 측정하였다. HOMA 값을 사등분하여 인슐린저항성과 Apo B 등 심혈관 질환 위험인자와의 연관성을 알아보았다. 결과 : 허리둘레, 체질량지수, 중성지방, Apo B, 총 콜레스테롤/고밀도지단백콜레스테롤, 저밀도지단백콜레스테롤/고밀도지단백콜레스테롤의 값은 인슐린저항성이 낮은 군보다 높은 군에서 유의하게 증가하였고, 통계적으로 유의한 양의 상관관계를 보였다. 고밀도지단백콜레스테롤, Apo AI, Apo AI/Apo B, 고밀도지단백콜레스테롤/Apo AI, 저밀도지단백콜레스테롤/Apo B의 값은 인슐린저항성과 통계적으로 유의하게 음의 상관관계를 보였다. 다중 회귀분석 결과에서 Apo B에 대해 나이, 성별, 공복혈당, 중성지방, 총 콜레스테롤, 고밀도지단백콜레스테롤, 저밀도지단백콜레스테롤, HOMA 값과 함께 허리둘레가 독립적인 위험인자로 나타났다. 결론 : 당뇨병의 기왕력이 없으며, 공복 혈당이 정상인 한국인 성인에서 인슐린저항성과 심혈관 질환의 지표인 Apolipoprotein B 농도, Apo AI/Apo B는 유의한 관련성이 있으며 향후 이에 대한 전향적인 연구가 필요하고, 인슐린저항성 및 대사증후군의 유병률의 증가에 대한 적극적인 진단및 치료로 심혈관 질환의 발생을 예방하는 것이 매우 중요하다고 생각된다.
Abstract
Background : Insulin resistance is associated with greatly increased risk of coronary artery disease. Serum apolipoprotein B and the ratio of apo A-1/Apo B are important markers of the coronary artery disease. The aim of this study was to assess the association of serum apolipoprotein B and the ratio of apo A-1/Apo B with insulin resistance in normal glucose tolerance. Methods : From individual, who participated in medical screening at health promotion center in Kangbuk Samsung Hospital from Jan. to Dec. 2002, total 7427 participants (4356 men, 3071 women) were enrolled in this study. All participants was no personal history of diabetes and normal fasting glucose. We assess the clinical characteristics and biochemical parameters of subjects. Results : Apolipoprotein B, total cholesterol/HDL-C and LDL-C/HDL-C show an positive correlation with metabolic syndrome and insulin resistance (p<0.001). Apo A-I, Apo A-I/Apo B, LDL/Apo B and HDL/Apo A-I show an negative correlation with metabolic syndrome and insulin resistance (p<0.001). Conclusion : These data suggest that insulin resistance are associated with serum apolipoprotein B and the ratio of apo A-1/Apo B in normal glucose tolerance. And early diagnosis and tight control of insulin resistance in normal glucose tolerance should be administered for the prevention of coronary artery disease.
참고문헌 (35)
- "Role of insulin resistance in human disease", 37, pp.1595~1607 (1988)
- "Cardiovascular morbidity and mortality associated with the metabolic syndrome", 24, pp.683~689 (2001)
- "Abdominal obesity and the metabolic syndrome", 24, pp.465~468 (1992)
- "Microalbuminuria is associated with insulin resistance in nondiabetic subjects", 47, pp.793~800 (1998)
- "Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease", 14, pp.173~194 (1991)
- "The deadly guartet: upper-body obesity, glucose intolerance, hyper-tryglyceridemia, and hypertension", 149, pp.1514~1520 (1989)
- "Development of the multiple metabolic syndrome in the ARIC Cohort: joint contribution of insulin, BMI, and WHR", 7, pp.407~416 (1997)
- "Insulin resistance and compensatory hyperinsulinemia: role in hypertension, dyslipidemia and coronary artery disease", 121, pp.1283~1288 (1991)
- "Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults", 285, pp.2486~2497 (2001)
- "Approach to lipoprotein management in 2001 national cholesterol guidelines", 17, pp.11i~21i (2002)
- "Glucose clamp technique: a method for quantifying insulin secretion and resistance", 237, pp.E214~E223 (1979)
- "Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man", 28, pp.412~419 (1985)
- "The homeostasis model in the San Antonio heart study", 20, pp.1087~1092 (1997)
- "Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men", 95, pp.69~75 (1997)
- "Nonfasting apolipoprotein B and triglyceride levels as a useful predictor of coronary heart disease risk in middle-aged UK men", 22, pp.1918~1923 (2002)
- "Coronary artery disease is associated with the ratio of apolipoprotein A-I", B and serum concentration of apolipoprotein B, but not with paraoxonase enzyme activity in Iranian subjects, 2002, pp.162, 381~389
- "Non-HDL cholesterol and apolipoprotein B in the dyslipidemic classification of type 2 diabetic patients", 26, pp.2048~2051 (2003)
- "High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study) a prospective study", 358, pp.2026~203 (2001), 3
- "Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment", 361, pp.777~780 (2003)
- "Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance", 320, pp.702~706 (1989)
- "Insulin, proinsulin and insulin resistance status in relation to lipid profiles among school children in Taiwan-The Taipei Children Heart Study", 36, pp.367~372 (2003)
- "Insulin resistance: definition and consequences", 109, pp.S135~S148 (2001)
- "Relation of components of insulin resistance syndrome to coronary disease risk", 5, pp.274~289 (1994)
- "Type 2 diabetes mellitus: the thrifty phenotype hypothesis", 35, pp.595~601 (1992)
- "Repeatability characteristics of simple indices of insulin resistance: implications for research applications", 86, pp.5457~5464 (2001)
- "Insulin resistance and cardiovascular disease", 106, pp.453~458 (2000)
- "Hyperinsulinemia as an independent risk factor for ischemic heart disease", 334, pp.952~957 (1996)
- "Plasma very low density lipoproteins contain a single molecule of apolipoprotein B", 29, pp.1461~1473 (1988)
- "Hypertriglyceridemic hyperapob: the unappreciated atherogenic dyslipoproteinemia in type 2 diabetes mellitus", 135, pp.447~459 (2001)
- "Apolipoprotein A-1 and B levels and the risk of ischemic heart disease during a 5-year follow-up of men in the Quebec cardiovascular study", 94, pp.273~278 (1996)
- "Total cholesterol", HDL cholesterol ratio vs LDL cholesterol, pp.2001, 161[DOI]
- "Relationships of apolipoprotein B100 with the metabolic syndrome in type 2 diabetes mellitus", 57, pp.199~207 (2002)
- "Non-HDL cholesterol and apolipoprotein B in the dyslipidemic classification of type 2 diabetic patients", 26, pp.2048~2051 (2003)
- "Mechanisms of hepatic very low density lipoprotein overproduction in insulin resistance: evidence for enhanced lipoprotein assembly, reduced intracellular ApoB degradation, and increased microsomal triglyceride transfer protein in a fructose-fed hamster model", 275, pp.8416~8425 (2000)
- "Hepatic very low density lipoprotein-ApoB overproduction is associated with attenuated hepatic insulin signaling and overexpression of protein-tyrosine phosphatase 1B in a fructose-fed hamster model of insulin resistance", 277, pp.793~803 (2002)