제2형 당뇨 환자에서 혈당조절 효과에 대한 혈액학적 지표
Association between Glycemic Control and Hematologic Indices in Type 2 Diabetic Patients
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배경: 당뇨병은 혈당 조절 장애와 다양한 합병증을 특징으로 하는 질환이다. 만성적인 염증과 혈소판의 활성화는 인슐린 저항성 혹은 당뇨성 합병증의 발생에 역할을 하는 것으로 제안되어 왔다. 이에 저자들은 염증이나 혈소판 반응성과 관련된 혈액학적 지표들이 당뇨병 환자에서 혈당 조절이나 합병증을 추적 관찰하는 데 유용한지를 조사하고자 하였다. 방법: 총 90명의 대상군은 HbA1c 수준에 따라 두 군으로 나누었으며 HbA1c<7%인 당뇨병 조절군에 59명이 속하였고, HbA1c≥7%인 당뇨병 비조절군에 31명이 포함되었다. 백혈구 및 혈소판 관련 지표들은 자동혈액분석기 LH-780 (Beckman Coulter, Ireland)에서 측정되었다. 결과: 백혈구 수(P=0.021), 호중구 수(P=0.005), 단구 수(P= 0.040), 호중구 백분율(P=0.042), 호중구-림프구 비율(NLR) (P= 0.032)은 당뇨병 조절군에 비해 당뇨병 비조절군에서 유의하게 높았다. 반면 림프구 수, 림프구 백분율, 단구 백분율, 평균호중구용적, 평균단구용적, 혈소판 수, 평균혈소판용적(MPV)은 두 군간 차이가 없었다. 또한, 호중구 수와 NLR은 당뇨병 조절군에 비해 합병증을 동반한 당뇨병 비조절군에서 높았다. HbA1c와 상관성을 분석한 결과 백혈구 수(r=0.389, P<0.001)와 호중구 수(r=0.361, P<0.001)는 유의한 양의 상관관계를 보였다. 결론: 당뇨병 환자에서 호중구 수와 NLR은 당뇨 조절 및 합병증의 발생과 관련이 있었다. 또한, 호중구 수는 HbA1c와 유의한 양의 상관관계가 보였다. 그러므로 당뇨병 환자의 추적 관찰 시 호중구 수와 NLR을 혈당조절 및 합병증과 관련이 있는 지표로 이용할 수 있을 것으로 판단된다.
Abstract
Background: Diabetes mellitus (DM) is characterized by impaired glucose regulation and various complications. It is known that chronic inflammation and platelet activation play a role in development of insulin resistance or diabetic complications. This study investigated whether hematologic parameters are useful for monitoring blood glucose regulation or complications in DM patients. Methods: Total 90 diabetic patients were divided into two groups according to their hemoglobin A1c (HbA1c) levels: 59 regulated DM patients with HbA1c levels<7% and 31 unregulated DM patients with HbA1c levels≥7%. Results: White blood cell counts (P=0.021), neutrophil counts (P=0.005), monocyte counts (P=0.040), neutrophil % (P=0.042) and the neutrophil lymphocyte ratio (NLR) (P=0.032) were significantly higher in the unregulated DM group compared to that in the regulated DM group. There were no differences in lymphocyte counts, lymphocyte %, monocyte %, mean neutrophil volume, mean monocyte volume, platelet count, and mean platelet volume between groups. Neutrophil counts and NLR were higher in unregulated DM patients with complications than in the regulated DM group. A positive correlation was observed between HbA1c and white blood cell count (r=0.389, P<0.001) and neutrophil count (r=0.361, P<0.001). Conclusions: In DM patients, neutrophil counts and NLR were related to glycemic control and the presence of complications. Additionally, neutrophil counts showed a positive correlation with HbA1c. Therefore, neutrophil counts and NLR can be used as related markers for diabetic regulation and complications during the follow-up of diabetic patients.
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