대사증후군과알라닌아미노전이효소와의관련성 : 국민건강영양조사제 3 기 (2005 년 )

Transcription

1 원저 대사증후군과알라닌아미노전이효소와의관련성 : 국민건강영양조사제 3 기 (2005 년 ) 한미아류소연박종강명근김기순 조선대학교의과대학예방의학교실 조선대학교내성세포연구센터 서론 alcoholic steatohepatitis NASH) 2 2 [1] 2001 NCEP-ATP III Panel [2] (nonalcoholic fatty liver disease ) [3] [4] 1980 [5] (simple steatosis) (non- [6-8] 3-24%[9] 29% [10] 9-26% [11-12] 2 [3] NHANES III 2 2 [9] [13] [14] (alanine aminotransferase; ) NASH 90% [15] (aspartate aminotransferase; SGOT) 25

2 83% [16] [17] Hispanic Health and Nutrition Examination Survey (>43 IU/L) 41 [18] SGOT 40 IU/L [11] ) ( 130/85 mmhg ) ( 150 mg/dl) ( < 40 mg/dl < 50 mg/dl) ( 110 mg/dl ) 3 3 자료분석 SPSS ver 120 [22] 2005 (The Third Korea National Health and Nutrition Examination Survey; KNHANES 2005) 대상및방법 1 대상 HBsAg SGOT/ 2 SGOT 160 IU/L 40g 20g 방법 40 IU/L NCEP/ATP III [2] - ( p-value 005 연구성적 1 성에따른대사증후군과 증가와의관련성 279%(242 ) 266%(84 ) 137%(242 ) 33%(84 ) 90% 260% 20% 68% 26

3 Table 1 Association between the metabolic syndrome and the elevated alanine aminotransferase level by sex Metabolic syndrome Men(N=1764) Women(N=2561) Total Elevated Total Elevated No 1271(721) 114( 90) * 1880(734) 38(20) * Yes 493(279) 128(260) 681(266) 46(68) Abdominal obesity No 1291(732) 121( 94) * 1474(576) 20(14) * Yes 473(268) 121(256) 1087(424) 64(59) High blood pressure No 976(553) 106(109) * 1803(704) 45(25) * Yes 788(447) 136(173) 758(296) 39(51) High triglyceride No 1106(627) 79( 71) * 2009(784) 51(25) * Yes 658(373) 163(248) 552(216) 33(60) Low HDL-cholesterol No 926(525) 93(100) * 913(357) 22(24) * Yes 838(475) 149(178) 1648(643) 62(38) High blood glucose No 1508(855) 197(131) 2308(901) 64(28) * Yes 256(145) 45(176) 253( 99) 20(79) Values are expressed as frequency(%) * p<005 (Table 1) 460(95% CI= ) Table 2 Odds ratios for the elevated alanine aminotransferase level according to presence of the metabolic syndrome by sex (95% CI) Men(N=1764) (95% CI) (95% CI) Women(N=2561) (95% CI) Metabolic syndrome 355( ) 460( ) 351( ) 349( ) Abdominal obesity 332( ) 394( ) 454( ) 433( ) High blood pressure 171( ) 230( ) 211( ) 173( ) High triglyceride 428( ) 432( ) 244( ) 213( ) Low HDL-cholesterol 193( ) 195( ) 158( ) 145( ) High blood glucose 141( ) 188( ) 301( ) 239( ) OR odds ratio; CI confidence interval Adjusted for age(continuous variable) marital status(single with spouse widowed divorced separated) education status( elementary school middle school high school college) health insurance(community health insurance employer-provided health insurance medical aid uninsured) smoking(nonsmoker current smoker) and exercise(none regular) 27

4 (Table 2) 349(95% CI= ) 2 연령에따른대사증후군과 증가와의관련성 % % % %(165 ) %(124 ) 65 52%(37 ) % 258% % 143% 65 28% 77% (Table 3) (95% CI= ) (95% CI= ) Table 3 Association between the characteristics of the study population and the elevated alanine aminotransferase level by age Metabolic syndrome Age years (N=2065) Age years (N=1555) Age 65 years (N=705) Total Elevated Total Elevated Total Elevated No 1809(876) 99( 55) * 987(635) 43( 44) * 355(504) 10( 28) * Yes 256(124) 66(258) 568(365) 81(143) 350(496) 27( 77) Abdominal obesity No 1586(768) 83( 52) * 840(540) 42( 50) * 339(481) 16( 47) Yes 479(232) 82(171) 715(460) 82(115) 366(519) 21( 57) High blood pressure No 1746(846) 103( 59) * 822(529) 41( 50) * 211(299) 7( 33) Yes 319(154) 62(194) 733(471) 83(113) 494(701) 30( 61) High triglyceride No 1629(789) 65( 40) * 1007(648) 47( 47) * 479(679) 18( 38) * Yes 436(211) 100(229) 548(352) 77(141) 226(321) 19( 84) Low HDL-cholesterol No 967(468) 61( 63) * 619(398) 45( 73) 253(359) 9( 36) Yes 1098(532) 104( 95) 936(602) 79( 84) 452(641) 28( 62) High blood glucose No 1987(962) 153( 77) * 1291(830) 88( 68) * 538(763) 20( 37) * Yes 78( 38) 12(154) 264(170) 36(136) 167(237) 17(102) Values are expressed as frequency(%) * p<005 28

5 Table 4 Odds ratios for the elevated alanine aminotransferase level according to presence of the metabolic syndrome by age Age years (N=2065) Age years (N=1555) Age 65 years (N=705) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) Metabolic syndrome 600( ) 457( ) 365( ) 392( ) 288( ) 343( ) Abdominal obesity 374( ) 516( ) 246( ) 369( ) 122( ) 146( ) High blood pressure 384( ) 203( ) 243( ) 216( ) 188( ) 192( ) High triglyceride 716( ) 460( ) 333( ) 298( ) 235( ) 239( ) Low HDL-cholesterol 155( ) 214( ) 117( ) 142( ) 179( ) 223( ) High blood glucose 217( ) 151( ) 215( ) 185( ) 293( ) 279( ) OR odds ratio; CI confidence interval Adjusted for age(continuous variable) marital status(single with spouse widowed divorced separated) education status( elementary school middle school high school college) health insurance(community health insurance employer-provided health insurance medical aid uninsured) smoking(nonsmoker current smoker) and exercise(none regular) (95% CI= ) 65 (Table 4) 343 고찰 [21] Mallory ( ) [19] [20] [12] [23] ( ) [24] [ ] HBsAg SGOT/ 2 SGOT 160 IU/L 29

6 SGOT/ 2 90% [28] 4 (160 IU/L) [2930] 5 Tsai 22 ( 41U/L 31U/L) [28] ( 40 U/L) [17] 참고문헌 [29] 1 Reaven GM Role of insulin resistance in human disease Diabetes 1988; 37: Expert panel on detection evaluation and treatment of high blood cholesterol in adults: 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 (adult treatment panel III) JAMA 2001; 285: Marchesini G Brizi M Bianchi G Tomassetti S Bugianesi E Lenzi M et al Nonalcoholic fatty liver disease: a feature of the metabolic syndome Diabetes 2001; 50: Kim JM Park JY Nam HK Kim JW Park SK Nam KJ et al Prevalence of metabolic syndrome in type 2 DM patients with non-alcoholic fatty liver J Korean Diabetes Assoc 2006; 30(6):

7 449 (Korean) 5 Angulo P Nonalcoholic fatty liver disease N Engl J Med 2002; 346: Wanless IR Lentz JS Fatty liver hepatitis(steatohepatitis) and obesity: an autopsy study with analysis of risk factors Hepatology 1990; 12(5): Dixon JB Bhathal PS O Brien PE Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severly obese Gastroenterology 2001; 121(1): Yu AS Keeffe EB Nonalcoholic fatty liver disease Rev Gastroenterol Disord 2002; 2: Clark JM Brancati FL Diehl AM Nonalcoholic fatty liver disease Gastroenterology 2002; 122: Jimba S Nakagami T Takahashi M Wakamatsu T Hirota Y Iwamoto Y et al Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults Diabet Med 2005; 22: Park SH Kim BI Yoo TW Kim JW Cho YK Sung IK Park CY et al Nonalcoholic fatty liver disease and abnormal liver function test in the heh screen examinees: the relationship with insulin resistance Korean J Gastroenterol 2003; 41: (Korean) 12 Oh SY Cho YK Kang MS Yoo TW Park JH Kim HJ et al The association between increased alanine aminoransaminase activity and metabolic factors in nonalcoholic fatty liver disease Metabolism 2006; 55: Moon KW Leem JM Bae SS Lee KM Kim SH Chae HB et al The prevalence of metabolic syndrome in patients with nonalcoholic fatty liver disease Korean J Hepatol 2004; 10: (Korean) 14 Kim SM Kim JA Han JH Cho KH Yoon DK Nonalcoholic fatty liver disease and metabolic syndrome in nonobese nondiabetic adults Korean J Obese 2006; 15(1): (Korean) 15 Daniel S Ben-Menachem T Vasudevan G Ma CK Blumenkehl M Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients Am J Gastroenterol 1999; 94: Pratt DS Kaplan MM Evaluation of abnormal liver enzyme results in asymptomatic patients N Engl J Med 2000; 342: Tsai PY Yen CJ Li YC Chiu TY Chen CY Jan CF Association between abnormal liver function and risk factors for metabolic syndrome among freshmen J Adolesc Health 2007; 41: Meltzer AA Everhart JE Association between diabetes and elevated serum alanine aminoransaminase activity among Mexican Americans Am J Epidemiol 1997; 146: Ludwig J Viggiano TR McGill DB Oh BJ Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease Mayo Clin Proc 1980; 55: ; 0: ; 7(2): Yeon JE Nonalcoholic fatty Liver disease: pathogenesis and treatment Korean J Med 2006; 70(3): (Korean) ; 0: Green RM Flamm S AGA technical review on the evaluation of liver chemistry tests Gastroenterology 2002; 123: Brunt EM Nonalcoholic steatohepatitis Semin Liver Dis 2004; 24: Ruhl CE Everhart JE Determinants of the association of overweight with elevated serum alanine aminoransaminase activity in the United States Gastroenterology 2003; 124: Nam SM Yu HY Lee MY Koh JH Shin JY Shin YG et al Alcohol consumption liver enzymes and prevalence of metabolic syndrome in Korean aults men J Korean Diabetes Assoc 2007; 31(3): 31

8 (Korean) 28 Cohen JA Kaplan MM The SGOT/ ratio-an indicator of alcohol liver disease Dig Dis Sci 1979; 24: Bacon BR Farahvash MJ Janney CG Neuschwander-Tetri BA Nonalcoholic steatohepatitis: an expanded clinical entity Gastroenterology 1994; 107: Diehl AM Goodman Z Ishak KG Alcoholic liver disease in nonalcoholics: a clinical and histologic comparison with alcohol-induced liver injury Gastroenterology 1988; 95: Park HS Han JH Choi KM Kim SM Relation between elevated serum alanine aminoransaminase and metabolic syndrome in Korean adolescents Am J Clin Nutr 2005; 82: Choi KM Lee KW Kim HY Seo JA Kim SG Kim NH et al Association among serum ferritin alanine aminotransferase levels and metabolic syndrome in Korean postmenopausal women Metabolism 2005; 54:

9 Metabolic Syndrome and Serum Alanine Aminotransferase Levels in Korean Adults : The Third Korea National Health and Nutrition Examination Survey (KNHANES ) 2005 Mi Ah Han 1)2) So Yeon Ryu 1)2) Jong Park 1)2) Myung Geun Kang 1) Ki Soon Kim 1) Purpose: The aim of this study was to investigate the association between the metabolic syndrome and alanine aminotransferase() levels in Korean adults Methods: The study subjects were 4325 adults aged 19 years without an apparent cause of liver disease from the Third Korea National Health and Nutrition Examination Survey(2005) The metabolic syndrome was defined using criteria established by the NCEP/ATP III while abdominal obesity was assessed based on the Asia-Pacific guidelines Subjects with 40 IU/L were considered to have elevated levels Demographic characteristics waist circumference blood pressure triglyceride HDL cholesterol fasting blood sugar were recorded for statistical analysis Results: The prevalence of elevated levels was significantly increase with the presence of the metabolic syndrome and its components In multiple logistic regression analyses odds ratio for the elevated levels was significantly high in the subjects with the metabolic syndrome compared to the subjects without metabolic syndrome after adjusted for socio-demographic characteristics and health-related behavior Conclusions: The metabolic syndrome was independently associated with levels in Korean adults : Metabolic Syndrome X Alanine Aminotransferase() 33