개방각녹내장과 뇌척수압 및 사상판경유압력차의 관계: 제5기 국민건강영양조사 자료
Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V
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목적: 한국인에서 개방각녹내장과 뇌척수압 및 사상판경유압력차의 관계를 알아보고자 하였다. 대상과 방법: 본 연구는 제5기 국민건강영양조사 자료를 바탕으로 19세 이상의 성인 6,132명(10,801안)을 대상으로 정상안, 개방각녹내장 의심군, 개방각녹내장군으로 분류하였다. 대상군의 연령, 체질량 지수, 이완기 혈압 및 안압을 바탕으로 뇌척수압 및 사상판경유압력차를 추정하였고 각 군 간 뇌척수압 및 사상판경유압력차의 분포를 비교하였다. 결과: 정상안에서 추정한 평균 뇌척수압은 11.6 ± 3.7 mmHg였고 평균 사상판경유압력차는 2.2 ± 4.4 mmHg였다. 녹내장의심군의 평균 추정 뇌척수압은 11.2 ± 3.8 mmHg, 평균 사상판경유압력차는 3 ± 4.7 mmHg였으며 녹내장군의 평균 추정 뇌척수압은 8.7 ± 3.3 mmHg, 평균 사상판경유압력차는 5.7 ± 4.4 mmHg로 두 군 모두 정상군과 비교하여 뇌척수압은 유의하게 낮았으며(p<0.001) 사상판경유압력차는 유의하게 높았다(p<0.001). 단순 선형 회귀분석 및 다중 선형 회귀분석을 통해 뇌척수압 및 사상판경유압력차와 연관 있는 인자를 확인한 뒤 이를 보정하였을 때 녹내장의심군은 정상군과 비교하였을 때 유의한 뇌척수압 분포의 차이는 없었으며(p=0.111; beta: 0.022; B: 0.241; 95% CI: -0.056, 0.538) 사상판경유압력차는 유의하게 높은 분포를 보였고(p<0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72), 녹내장군은 정상군보다 뇌척수압이 유의하게 낮게 분포하였으며(p<0.001; beta: -0.12; B: -2.306; 95% CI: -2.717, -1.895) 사상판경유압력차는 유의하게 높은 분포를 보였다(p<0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289). 결론: 한국인에서 뇌척수압과 사상판경유압력차는 녹내장성 시신경 손상에 주요한 역할을 하며 개방각녹내장의 발병에 중요한 위험인자가 될 수 있다.
Abstract
Purpose: To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population. Methods: A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure. Results: The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively. Conclusions: Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.
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