한국인에서 7년간의 안압 변화와 전신인자 변화의 연관성: 종단적 연구
Association between 7-year Changes in Intraocular Pressure and Systemic Factors in Koreans: A Longitudinal Study
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목적: 한국인의 7년간의 안압 변화와 전신인자 변화와의 연관성을 종단적 연구를 통해 알아보고자 하였다. 대상과 방법: 2005년부터 2014년까지 건국대학교병원에서 7년의 간격으로 2회 건강검진을 받은 사람들 중에서, 정상 안저사진, 정상안압 범위 및 안과적 질환의 과거력이 없는 한국인을 대상으로 초기 안압과 7년 후 최종 안압의 변화를 분석하고 신체계측, 혈액검사 및 설문지를 통해 안압 변화에 영향을 미치는 전신인자의 변화를 선형 혼합 모형(linear mixed model)을 이용하여 분석하였다. 안압은 비접촉안압계를 이용해 측정하였고, 모든 피험자의 좌안을 대상으로 분석하였다. 결과: 총 524명의 검사자 중 안저이상을 보이거나 검사 결과가 누락된 55명을 제외한 469명(평균나이 40.94 ± 7.87세)이 연구에 포함되었다. 그중 여성이 188명(평균나이 41.70 ± 8.24세), 남성이 281명(평균나이 39.90 ± 7.14세)이었다. 초기 안압과 7년 뒤 안압은 각각 평균안압 14.50 ± 3.14, 14.72 ± 3.38 mmHg로 유의한 차이는 확인되지 않았고(paired T test, p=0.074), 성별에 따른 분석에서 여성은 유의한 차이가 없었으나 남성은 0.36 ± 0.26 mmHg의 안압 상승이 확인되었다(paired T test, p=0.035). 또한 생활습관에 따른 분석에서 흡연자, 음주자 및 운동부족군에서 안압이 각각 0.44 ± 0.15, 0.62 ± 0.24 및 0.36 ± 0.36 mmHg 상승한 결과를 보였다(paired T test, respectively, p=0.014, 0.010 and 0.024). 또한 전신인자들의 영향을 서로 보정한 선형 혼합 모형(linear mixed model)을 이용한 종단적 분석 결과, 나이가 증가함에 따라 안압은 감소하는 경향을 보이나 통계적으로 유의하지는 않았고(estimate -0.03, p=0.082), 남성이 여성에 비해 안압이 더 상승하였으며, 수축기 혈압, 체질량지수, 혈중 콜레스테롤 및 저밀도 지질단백질의 농도가 증가할수록 안압이 상승하는 결과를 보였다. 결론: 7년간 연령 증가에 따른 한국인의 안압 변화는 감소하는 경향을 보였으나 통계적으로 유의하지는 않았고, 남성, 수축기혈압, 체질량지수, 혈중 콜레스테롤 및 저밀도지질단백질의 변화와 양의 상관관계를 보였다.
Abstract
Purpose: To investigate the changes in intraocular pressure (IOP) and associated systemic factors over 7 years in a healthy Korean population. Methods: This longitudinal study included healthy subjects with no history of ocular disease and who had been receiving health examinations seven years apart at the Konkuk University Medical Center, Healthcare Center. The participants completed lifestyle questionnaires and underwent general health examinations (blood pressure, height and weight, and blood biochemical tests) and ocular examinations including noncontact tonometry and fundus photography. Subjects with abnormal fundus photography findings and ocular hypertension were excluded. Changes in IOP and systemic factors over 7 years were analyzed. Results: Of 524 possible subjects, 469 were enrolled (55 subjects were excluded: 50 due to abnormal fundus photography and 5 for missing data). The left eye was analyzed in all patients. In all subjects, initial IOP (mean 14.50 ± 3.14 mmHg) was not significantly different from final IOP (14.72 ± 3.38 mmHg) (paired t-test, p = 0.074). In male patients, the final IOP was significantly higher than the initial IOP (paired t-test, p = 0.035). Lifestyle questionnaire variables were associated with a final IOP that was significantly higher than the initial IOP (smokers, alcohol drinkers and less exercisers, paired t-test; p = 0.014, 0.010 and 0.024, respectively). A linear mixed-effects model analysis showed that the change in IOP was negatively associated with age, but this was not statistically significant. Changes in systolic blood pressure (SBP), body mass index (BMI), total cholesterol (T.Chol) and low density lipoprotein (LDL) were positively correlated with change in IOP. Conclusions: A linear mixed-model analysis showed IOP decreased with age but this was not statistically significant. Changes in SBP, BMI, T.Chol and LDL were significantly positively correlated with change in IOP.
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