만현재까지아시아인구를대상으로대한한연구는거의없다. 이에본연구에서는한국성인을대상으로체질량지수와허리둘레 (waist circumference) 에따라정상체중 (normal ), 과체중 (over), 비만 (obesity) 으로나누어혈청 cystatin C와의연관성을알아보고자

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1 Original Article Korean J Obes 215 December;24(4): pissn X eissn 한국성인에서비만과혈청 Cystatin C 의연관성 강양호 * 부산대학교의학전문대학원양산부산대학교병원내과 Association of with Serum Cystatin C in Korean Adults Yang Ho Kang* Department of Internal Medicine, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea Background: Serum cystatin C has been reported as a marker of preclinical kidney disease and might be associated with cardiovascular risk factors. However, there are few data on the association between obesity and serum cystatin C, especially in the Asian population. The aim of this study is to evaluate this association using body mass index (BMI) and waist circumference in Korean adults. Methods: We analyzed the anthropometric and biochemical data of 1,528 subjects (928 men and 6 women) who visited the health promotion center for a routine medical checkup. Subjects were classified as normal, over, or obese according to BMI and waist circumference. Results: According to BMI, mean serum cystatin C was significantly increased from normal to obesity in men (normal,.91 mg/ L; over,.92 mg/l; obese,.94 mg/l, P<.5) and women (normal,.81 mg/l; over,.83 mg/l; obese, mg/l, P<.1). Regarding waist circumference, mean serum cystatin C was also significantly increased in both genders. The prevalence of increased serum cystatin C ( 1. mg/l) was significantly increased and the relative risks of increased serum cystatin C for the prevalence of obesity were significantly increased in men (OR, 1.42; P=.13) and women (OR, 1.74; P=.26). Conclusion: According to increases in BMI and waist circumference, level of serum cystatin C was significantly increased in Korean adults. These findings suggest that obesity is associated with serum cystatin C in the Asian population. Key words: Body mass index,, Waist circumference, Cystatin C 서론 혈청 cystatin C는 cystatine protease inhibitors 족 (family) 에속하는저분자 (13 kd) 단백질로사구체로자유롭게여과되고신세관세포에의해거의완전히재흡수된후이화되는특성으로혈청크레아티닌보다신기능을평가하는데더유용하여조기신질환을예측할수있는인자로알려져있다. 1,2 또한, 혈청 cystatin C는당뇨병성신질환에서기능저하를평가하고예측하는데유용한것으로보고되고있다. 3-6 혈청 cystatin C는심혈관계질환과연관된위험인자들과도연관성이높은것으로보고되고있는데, 고혈압 7, 고혈당 8,9, 인슐린저항성 1 과같은심혈관위험인자와연관성이알려져있고, 이를포괄하 는개념인대사증후군 과도밀접한연관성이있는것으로보고되고있다. 역시중요한심혈관계위험인자중하나인비만과의연관성에있어서, Muntner 등 14 은체질량지수 (body mass index, BMI) 에따라정상체중, 과체중, 비만, 고도비만등으로분류하여 cystatin C 수치를비교하였을때, 체질량지수가높을수록혈청 cystatin C가증가하는것으로보고하였고, Shankar 등 15 도역시높은체질량지수가 cystatin C의증가와독립적으로관련이있음을보고하였다. 그러나이는모두미국인을대상으로한연구들이고이전보고 16 에서 cystatin C는인종에따라차이가있는것으로나타나서아시아인에서비만지표와혈청 cystatin C의연관성을알아보는것도의미가있을것으로생각되지 Corresponding author Yang Ho Kang Department of Internal Medicine, School of Medicine, Pusan National University Yangsan Hospital, 2 Geumo-ro, Mulgeum-eup, Yangsan 5612, Korea Tel Fax kangyh@pusan.ac.kr Received Feb. 16, 215 Reviewed Mar. 28, 215 Accepted Apr. 28, 215 Copyright 215 Korean Society for the Study of This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited

2 만현재까지아시아인구를대상으로대한한연구는거의없다. 이에본연구에서는한국성인을대상으로체질량지수와허리둘레 (waist circumference) 에따라정상체중 (normal ), 과체중 (over), 비만 (obesity) 으로나누어혈청 cystatin C와의연관성을알아보고자하였다. 방법 1. 연구대상 213년 1월부터 12월까지단일기관건강검진센터에서종합검진을받은 2세에서 7세사이의성인을대상으로하여, Muntner 등 14 의분석을참조하여체질량지수가 18.5 kg/m 2 미만으로저체중인경우는제외하였고, 수치가정상기준치의 3배이상증가되어간질환이의심되는경우, 갑상선질환이혈청 cystatin C 수치에영향을미치는것으로알려져있으므로 17 갑상선자극호르몬 (thyroid stimulating hormone, TSH) 이정상범위 (TSH <.27 μiu/ml 또는 TSH > 4.2 μiu/ ml) 를벗어나는경우, 혈청크레아티닌치가 1.2 mg/dl 이상으로증가되어만성신질환이의심되는경우, high sensitivity C-reactive protein (hs-crp) 가 1 mg/dl 이상으로증가되어급성감염질환이의심되는경우등을제외하고혈청 cystatin C가측정된 1,528명 ( 남자 928 명, 여자 6명 ) 을본연구분석에포함하였다. 본연구의데이터수집과정은후향적으로이루어졌고종합검진대상자의정보수집에대한동의를얻었으며대상자의개인정보는모두제거된상태에서데이터수집및분석이이루어져임상시험윤리위원회 (IRB) 에서심의를면제받았다. 2. 연구방법신장과체중은자동신장체중계를이용하여소수첫째자리까지측정하였고허리둘레는줄자를이용하여최하위늑골하부와골반장골능의중간부위에서측정하였다. 체질량지수는체중 (kg)/ 신장의제곱 (m 2 ) 으로계산하고소수첫째자리까지표기하였다. 혈압은앉은자세에서 5분간안정을취한후우측상완에서측정하였다. 8시간공복상태후혈액검사를실시하여혈당, 인슐린, 총콜레스테롤, LDL 콜레스테롤, HDL 콜레스테롤, aspartate aminotransferase (AST), alanine aminotransferase (ALT), 중성지방, hs-crp 등을측정하였다. 혈청 cystatin C는 immunoturbidimetric assay (TBA-2FR NEO; Toshiba, Tokyo, Japan) 를이용하여측정하였다. 18 인슐린저항성의지표인 homeostasis model assessment insulin resistance (HOMA- IR) 는다음과같은공식으로계산하였다. 3. 통계분석혈청 cystatin C는남자에서여자보다높은것으로알려져있어 14 성별로따로구분하여분석하였다. 한국인에서과체중과비만기준 19 에의거하여체질량지수는 18.5 체질량지수 < 23. kg/m 2 인경우정상체중군, 23. 체질량지수 < 25. kg/m 2 인경우과체중군, 25. kg/ m 2 인경우비만군으로분류하였고, 허리둘레는남자에서 9 cm, 여자에서 85 cm인경우비만군으로분류하였다. 이전혈청 cystatin C의만성신질환발생에대한임계점 (cut-off point) 에대한연구결과 14,2 를근거로하여혈청 cystatin C가 1. mg/l 이상증가할때혈청 cystatin C 증가군으로분류하였다. 연속변수들은평균 (mean) ± 표준편차 (standard deviation, SD) 로표시하였다. 체질량지수에따른정상체중군, 과체중군, 비만군간각지표들의비교는일원배치분산분석 (one way ANOVA test) 과사후분석 (post-hoc analysis) 으로 Student-Newman-Keuls test를이용하였다. 허리둘레에따른정상군과비만군간의비교는독립표본 T 검정 (independent t-test) 을실시하였다. 혈청 cystatin C와나이, 체질량지수, 허리둘레의상관관계는 Spearman 편상관분석을이용하였다. 혈청 cystatin C 증가군 ( 1. mg/l) 과비증가군간의비만빈도비교는 chi-square test를이용하였고 % 로표시하였다. 혈청 cystatin C 증가군에서체질량지수또는허리둘레에따른비만빈도에대한비교위험도를알아보기위해비보정 (non-adjusted), 나이보정 (age-adjusted), 다변수보정 ( 나이, 총콜레스테롤, 수축기혈압을함께보정 ) 모형으로나누어다변량로지스틱회귀분석을이용하여각각에대한 OR 값 (odd ratio) 과 95% 신뢰구간 (95% confidence interval, 95% CI) 을산출하였다. 모든통계적유의수준은 P<.5로설정하였다. 모든통계분석은 SPSS 통계패키지버전 18 (SPSS Inc., Chicago, IL, USA) 을이용하였다. 결과 1. 체질량지수에따른각군간의대사적지표들의특징체질량지수에따라정상체중군 ( 남자 246명, 여자 37명 ), 과체중군 ( 남자 29명, 여자 138명 ), 비만군 ( 남자, 392명, 여자 155명 ) 으로분류하여비교하였을때, 정상체중에서비만으로체질량지수가증가할수록남녀모두에서허리둘레, 수축기혈압, 이완기혈압, 공복혈당, 공복인슐린, HOMA-IR, 중성지방, AST, ALT, 요산, hs-crp 등의유의한증가가관찰되었고 HDL 콜레스테롤은유의한감소를보였다. 또한, 여자에서총콜레스테롤과 LDL 콜레스테롤의유의한증가를보였다 (Table 1). HOMA-IR= 공복인슐린 (μu/ml) 공복혈당 (mmol/l)/

3 Table 1. Baseline characteristics according to the groups defined by the ranges of body mass index in men and women Variables (N= 246) (N= 29) (N= 392) P for trend (N= 37) (N= 138) (N= 155) P for trend Age (yr) 51.7± ± ± ± 8.6 a 51.3± 8.3 b 55.7± 8.4 c <.1 (cm) 8.2± 4.7 a 86.8± 3.9 b 94.1± 6.3 c < ± 5.1 a 81.1± 4.6 b 9.4± 7.1 c <.1 BMI (kg/m 2 ) 21.4± 1.1 a 23.9±.5 b 27.1± 2. c <.1 2.9± 1.3 a 23.7±.5 b 27.4± 2.6 c <.1 SBP (mmhg) 114.9± 12.5 a 119.3± 12.3 b 121.6± 11.6 c <.1 11.± 13.5 a 116.5± 12. b 122.± 12.7 c <.1 DBP (mmhg) 77.1± 9.8 a 79.6± 9.8 b 81.3± 9.3 c < ± 9.9 a 75.2± 9.1 b 77.5± 7.9 c <.1 FBG (mg/dl) 96.1± 21. a 11.1± 27.3 b 14.2± 23.9 b < ± 12.2 a 93.9± 2.6 b 1.4± 21.3 c <.1 Insulin (μu/ml) 3.44± 1.78 a 4.49± 2.9 b 6.48± 3.8 c <.1 3.6± 1.74 a 4.65± 2.31 b 6.53± 3.6 c <.1 HOMA-IR.82±.48 a 1.13±.85 b 1.7± 1.24 c <.1.8±.44 a 1.1±.65 b 1.64± 1.1 c <.1 TC (mg/dl) 215.7± ± ± ± 36.2 a 215.6± 34.1 ab 221.2± 44.5 c.5 LDL-C (mg/dl) 132.8± ± ± ± 33.2 a 131.5± 33.6 b 137.8± 4.9 b <.1 TG (mg/dl) 117.± 72.3 a 141.9± 9.3 b 175.2± 15.3 c < ± 57.9 a 14.3± 82.6 b 13.3± 98.3 c <.1 HDL-C (mg/dl) 55.6± 12.9 a 5.8± 11.4 b 47.5± 11.1 c < ± 12.9 a 59.1± 13.7 b 54.4± 12.8 c <.1 AST (IU/L) 24.4± 1.1 a 3.± 1. a 32.5± 12.3 b < ± 1.6 a 24.8± 8.1 a 27.7± 11. b.5 ALT (IU/L) 24.4± 12.7 a 29.3± 14.5 b 35.4± 18.5 c < ± 11.8 a 19.8± 13. a 26.± 15.7 b <.1 BUN (mg/dl) 13.7± 3.2 a 14.4± 3.5 b 14.6± 3.4 ab ± 3.4 a 13.3± 3.8 b 13.9± 3.4 ab.76 Creatinine (mg/dl).93±.1 a.96±.11 b.96±.11 b.3.7±.9.71±.9.71± Uric acid (mg/dl) 6.± 1.3 a 6.5± 1.2 b 6.5± 1.5 b <.1 4.5±.9 a 4.8± 1. b 5.± 1.1 b <.1 Hs-CRP (mg/dl).13±.18 a.15±.39 a.2±.38 b.31.7±.18 a.11±.16 a.19±.35 b <.1 Data are presented as mean ± standard deviation (SD)., 18.5 BMI< 23. kg/m 2 ;, 23. BMI< 25. kg/m 2 ;, 25. kg/m 2. N, number; yr, years;, waist circumference; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood sugar; HOMA-IR, homeostasis model assessment of insulin resistance; TC, total cholesterol; LDL-C, low density lipoprotein cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; hs-crp, high sensitivity C-reactive protein. P value was calculated by one-way analysis of variance analysis followed by post hoc testing with the S-N-K test. a,b,c the same latters indicate insignificant difference between groups. 2. 혈청 cystatin C와나이, 체질량지수, 허리둘레의상관관계혈청 cystatin C는체질량지수와허리둘레를보정하였을때, 남자 (r =.243, P<.1) 와여자 (r =.343, P<.1) 모두에서나이와유의한양의상관관계를보였다. 나이를보정한후혈청 cystatin C는체질량지수 ( 남자 ; r =.13, P<.1, 여자 ; r =.153, P<.1) 와허리둘레 ( 남자 ; r =.19, P<.5, 여자 ; r =.135, P<.5) 와양의상관관계를보였다 (data not shown). 3. 체질량지수와허리둘레에따른평균혈청 cystatin C의비교체질량지수에따라분류한군간의평균혈청 cystatin C치의비교에서남자 ( 정상체중군,.91 mg/l; 과체중군,.92 mg/l; 비만군,.94 mg/l, P<.5) 및여자 ( 정상체중군,.81 mg/l; 과체중군,.83 mg/ L; 비만군, mg/l, P<.1) 모두에서체질량지수가증가함에따라평균혈청 cystatin C 는유의한증가를보였고이는여자에서더유의한차이를보였다. 또한, 허리둘레에따른각군비교에서도역시남자 ( 정상군,.92 mg/l; 비만군,.94 mg/l, P<.5) 및여자 ( 정상군,.82 mg/l; 비만군, mg/l, P<.1) 에서유사한결과가관찰되었다 (Fig. 1). 4. 체질량지수와허리둘레에따른혈청 cystatin C 증가군 ( 1. mg/l) 의빈도비교체질량지수에따라분류한군간의혈청 cystatin C 증가군 ( 1. mg/l) 의빈도비교에서남자 ( 정상체중군, 34.5%; 과체중군, 39.3%; 비만군, 44.4%, P <.5) 및여자 ( 정상체중군, 12.8%; 과체중군, 16.7%; 비만군, 32.3%, P<.1) 모두에서체질량지수가증가함에따라혈청 cystatin C 증가군은유의한빈도증가를보였고또한, 허리둘레에따른각군비교에서도남자 ( 정상군, 36.9%; 비만군, 44.6%, P<.5) 및여자 ( 정상군, 13.5%; 비만군, 32.%, P<.1) 에서유사한결과가관찰되었고역시여자에서더유의성이높았다 (Fig. 2). 5. 비만빈도에대한혈청 cystatin C 증가군 ( 1. mg/l) 의비교위험도비만빈도에대한혈청 cystatin C가 < 1. mg/l인군과비교하여혈청 cystatin C 증가군 ( 1. mg/l) 의위험도를알아보았을때, 남자에서체질량지수를기준으로한비만 ( 체질량지수 25 kg/m 2 ) 에대한비교위험도는유의한증가를보였고이는나이또는나이, 총콜레스테롤, 수축기혈압을같이보정한경우에도유의한증가가유지되었

4 A B Mean serum cystatin C, mg/l * < 9 cm.94 9 cm Mean serum cystatin C, mg/l < 85 cm 85 cm Fig. 1. Mean serum cystatin C levels according to the groups defined by the ranges of body mass index and waist circumference in men (A) and women (B)., waist circumference;, 18.5 BMI< 23. kg/m 2 ;, 23. BMI < 25. kg/m 2 ;, 25. kg/m 2. P value was calculated by one-way analysis of variance analysis followed by post hoc testing with the S-N-K test among the groups defined by the ranges of body mass index and by independent t-test between the groups defined by the ranges of waist circumference. *P<.5 vs normal ; P<.5 vs < 9 in Fig. 1A; P<.1 vs normal ; P<.1 vs < 9 in Fig. 1B. A B Prevalence of elevated serum cystatin C, % * < 9 cm cm Prevalence of elevated serum cystatin C, % < 9 cm cm Fig. 2. Prevalence of the subjects with elevated serum cystatin C ( 1. mg/l) according to the groups defined by the ranges of body mass index and waist circumference in men (A) and women (B)., waist circumference;, 18.5 BMI < 23. kg/m 2 ;, 23. BMI < 25. kg/m 2 ;, 25. kg/m 2. P value was calculated by chi-square test. *P<.5 vs normal ; P<.5 vs < 9 in Fig. 2A; P<.1 vs normal ; P<.1 vs < 9 in Fig. 2B. Table 2. Odds ratios (95% CI) for the prevalence of obesity defined by the range of body mass index or waist circumference in men and women Cystatin C OR* (95% CI) P value OR (95% CI) P value OR (95% CI) P value For BMI 25 kg/m 2.1 mg/l 1.37 ( ) ( ) ( ).13 For 9 cm.1 mg/l 1.39 ( ) ( ) ( ).84 For BMI 25 kg/m 2.1 mg/l 2.94 ( ) < ( ) ( ).26 For 85 cm.1 mg/l 3.2 ( ) < ( ) ( ).37 OR, odds ratio; CI, confidence interval. *non-adjusted model; age adjusted model; multivariable model (additionally adjusting for total cholesterol, and systolic blood pressure)

5 다 ( 비보정 [OR, 1.37; P =.19], 나이보정 [OR, 1.47; P =.5], 다변수보정 [OR, 1.42; P =.13]). 그러나허리둘레를기준으로한비만 ( 허리둘레 9 cm) 에대해서는다변수보정에서는유의성이상쇄되었다 ( 비보정 [OR, 1.39; P =.14], 나이보정 [OR, 1.33; P =.39], 다변수보정 [OR, 1.27; P =.84]). 반면, 여자에서는체질량지수비만 ( 비보정 [OR, 2.94; P<.1], 나이보정 [OR, 1.88; P =.8], 다변수보정 [OR, 1.74; P =.26]) 과허리둘레기준 ( 85 cm) 비만 ( 비보정 [OR, 3.2; P <.1], 나이보정 [OR, 1.82; P =.11], 다변수보정 [OR, 1.67; P =.37]) 모두에서유의성이유지되었고 OR값도남자보다높게나타났다 (Table 2). 고찰 본연구에서는한국성인에서혈청 cystatin C와체질량지수및허리둘레에따른비만과의연관성을알아보았고체질량지수와허리둘레가높을수록혈청 cystatin C가유의하게증가되어있음을남녀모두에서관찰할수있었다. 이전연구들 14,15 이모두미국인을대상으로한자료이나본연구는아시아인구를대상으로한것으로아시아인종에서비만과혈청 cystatin C의연관성에대한추가자료가될수있을것으로생각된다. 저자들은이전혈청 cystatin C와대사증후군의연관성에대한연구 11 를시행하여대사증후군지표들중허리둘레가혈청 cystatin C와유의한양의상관관계 (r =.215, P<.1) 를보였고혈청 cystatin C에영향을미치는유의한독립변수였다. 이와비교하여본연구는남녀따로구분하여분석하였고역시허리둘레와체질량지수모두혈청 cystatin C와유의한양의상관관계를보였다. 혈청 cystatin C는나이, 남자외에도대표적인염증인자인 CRP의증가와연관성이있는것으로알려져있고 21,22, 비만역시 CRP 증가와연관성이높은것으로알려져있다. 23 Muntner 등 14 은미국제3차국민건강영양조사 (The Third National Health and Nutrition Examination Survey, NHANES III) 자료를이용하여진행된신질환이없는성인을대상으로체질량지수에따라정상체중, 과체중, 비만, 고도비만으로군을나누어분석하였을때, 평균혈청 cystatin C치가체질량지수가높은단계로갈수록유의하게증가하였고, 혈청 cystatin C가증가된군의빈도도체질량지수가증가함에따라유의하게증가하였으며, 비만에대한비교위험도역시나이, 혈압, 콜레스테롤등을포함한다변수보정회귀분석에서도유의하게증가함을보고하였다. Shankar 등 15 도 1999년에서 22 년사이미국국민건강영양조사자료를분석하여체질량지수에따라, < 25. kg/m 2, kg/m 2, 3. kg/m 2 로분류하여비교하였을때역시단계별로증가된혈청 cystatin C와비만에대한비교위험도가유의하게증가함을보고하였다. 본연구에서도역시체질량지수 에따른비만지표분석에서이와일치하는소견이관찰되었고, 추가로본연구에서허리둘레에따라정상군과비만군 ( 남자 9 cm, 여자 85 cm) 으로나누어분석하였을때에도허리둘레가증가할수록유의한혈청 cystatin C 증가군과비만에대한비교위험도의증가가나타났다. 위언급한두연구들과본연구결과모두에서비만발생에대한증가된혈청 cystatin C의위험도가남자보다여자에서더높게나타났는데, 이를직접적으로설명할수있는기전으로는명확하지않지만, 비만이주된발생원인으로관여하는제2형당뇨병과연관된연구들의결과에서추론해보면여자에서남자보다정상혈당에서고혈당으로진행한군에서혈관내피세포이상이더많이관찰되었고 24, 심혈관계위험인자들과밀접한연관성을가지고있는염증인자인 CRP가여자에서남자보다더높았다는점 25, 그리고혈청 cystatin C의생산은증가된지방조직과연관성이있을수있으므로 26 남녀간의비만지표나지방분포의차이등을가능할수있는이유들로생각할수있겠다. 비만과신질환의발생에있어서, Framingham Heart study에의하면, 18.5년간추적관찰하였을때체질량지수가한표준편차만큼증가할수록신질환이발생할위험도는 23% 증가하였다고한다. 27 그리고, Shlipak 등 2 은 3단계에서 5단계이상진행된만성신질환이없으면서혈청 cystatin C가증가되어있어초기신질환이의심되는경우를불현성신질환 (preclinical kidney disease) 으로언급하였고, 이는향후만성신질환으로의진행, 심혈관계질환이환및사망률증가와유의한연관성이있는것으로보고하였다. 혈청 cystatin C는현재까지혈청크레아티닌보다신질환의감소나진행을평가하는더유용한지표로알려져있고 2, 본연구에서도체질량지수가정상체중, 과체중, 비만으로증가함에따라혈청 cystatin C는유의한증가가관찰되었지만혈청크레아티닌은세군사이에유의한차이가관찰되지않았다. 그러므로, 비만지표의증가에따른혈청 cystatin C의유의한증가는불현성신질환의발생을조기예측하는데도움이될수있겠고이는비만및증가된혈청 cystatin C와연관하여향후발생할수있는고혈압, 당뇨병등의심혈관계질환발생예방에도기여할수있을것으로생각된다. 28 본연구의제한점으로는첫번째, 건강검진센터를방문한성인들을대상으로한단면적연구로연구결과의인과관계를설명할수없고, 두번째, 단일기관연구로분석에포함된대상수가상대적으로작아서분석결과에영향을미쳤을수있고이는향후대규모, 다기관의자료분석이필요할수있을것으로생각된다. 세번째, 대상성인의흡연력, 음주력, 기존고혈압이나당뇨병, 고지혈증등에대한과거력등에대한자료를확보하지못하여이들변수가결과에미치는영향을보정하지못했다는점들을들수있겠다. 결론적으로, 한국성인에서체질량지수와허리둘레에따른비만도

6 가증가함에따라혈청 cystatin C는유의하게증가하였고혈청 cystatin C 증가의비만에대한비교위험도도남녀모두에서유의하게증가되어있었다. 이는비만에서혈청 cystatin C 증가가연관성이있음을아시아인구에서도보여주는결과로생각된다. 요약 배경 : 혈청 cystatin C는조기신질환을예측할수있는인자로알려져있고여러심혈관질환위험인자들과연관성이알려져있다. 그러나, 비만과의연관성에있어서는연구가많지않고, 특히아시아인구를대상으로한연구는거의없다. 이에본연구는한국성인을대상으로체질량지수와허리둘레를이용하여혈청 cystatin C와의연관성을알아보고자하였다. 방법 : 단일기관건강검진센터에서종합검진을받은혈청 cystatin C가측정된성인 1,528명 ( 남자 928명, 여자 6명 ) 을대상으로하였고체질량지수와허리둘레에따라정상체중, 과체중, 비만으로분류하였다. 결과 : 체질량지수가증가함에따라남자 ( 정상체중군,.91 mg/l; 과체중군,.92 mg/l; 비만군,.94 mg/l, P<.5) 및여자 ( 정상체중군,.81 mg/l; 과체중군,.83 mg/l; 비만군, mg/l, P<.1) 에서평균혈청 cystatin C는유의한증가를보였다. 허리둘레에따른각군비교에서도역시남자 ( 정상군,.92 mg/l; 비만군,.94 mg/l, P<.5) 및여자 ( 정상군,.82 mg/l; 비만군, mg/l, P<.1) 에서유의한증가가관찰되었다. 혈청 cystatin C 증가군 ( 1. mg/l) 의빈도도체질량지수와허리둘레가증가함에따라유의하게증가하였고비만빈도에대한혈청 cystatin C 증가군의비교위험도역시남자 (OR, 1.42; P =.13) 와여자 (OR, 1.74; P =.26) 모두에서유의하게증가하였다. 결론 : 한국성인에서체질량지수와허리둘레에따른비만도가증가함에따라혈청 cystatin C는유의하게증가하였고이는비만에서혈청 cystatin C 증가가연관성이있음을아시아인구에서도보여주는결과로생각된다. 중심단어 : 체질량지수, 비만, 허리둘레, Cystatin C Conflicts of Interest No potential conflict of interest relevant to this article was reported. Acknowledgments This study was supported by a Clinical Research Grant (214) of Pusan National University Yangsan Hospital. References 1. Tanaka A, Suemaru K, Araki H. A new approach for evaluating renal function and its practical application. J Pharmacol Sci 27; 15: Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a metaanalysis. Am J Kidney Dis 22;4: Mussap M, Dalla Vestra M, Fioretto P, Saller A, Varagnolo M, Nosadini R, et al. Cystatin C is a more sensitive marker than creatinine for the estimation of GFR in type 2 diabetic patients. Kidney Int 22;61: Pucci L, Triscornia S, Lucchesi D, Fotino C, Pellegrini G, Pardini E, et al. Cystatin C and estimates of renal function: searching for a better measure of kidney function in diabetic patients. Clin Chem 27;53: Willems D, Wolff F, Mekahli F, Gillet C. Cystatin C for early detection of renal impairment in diabetes. Clin Biochem 29;42: Jeon YK, Kim MR, Huh JE, Mok JY, Song SH, Kim SS, et al. Cystatin C as an early biomarker of nephropathy in patients with type 2 diabetes. J Korean Med Sci 211;26: Watanabe S, Okura T, Liu J, Miyoshi K, Fukuoka T, Hiwada K, et al. Serum cystatin C level is a marker of end-organ damage in patients with essential hypertension. Hypertens Res 23;26: Donahue RP, Stranges S, Rejman K, Rafalson LB, Dmochowski J, Trevisan M. Elevated cystatin C concentration and progression to pre-diabetes: the Western New York study. Diabetes Care 27;3: Sahakyan K, Lee KE, Shankar A, Klein R. Serum cystatin C and the incidence of type 2 diabetes mellitus. Diabetologia 211;54: Lee SH, Park SA, Ko SH, Yim HW, Ahn YB, Yoon KH, et al. Insulin resistance and inflammation may have an additional role in the link between cystatin C and cardiovascular disease in type 2 diabetes mellitus patients. Metabolism 21;59: Kim SY, Song SH, Jeon YK, Kim JR, Bae JH, Kim SS, et al. Association of serum cystatin C with metabolic syndrome and its related components in Korean adults. Korean Diabetes J 28;32: Servais A, Giral P, Bernard M, Bruckert E, Deray G, Isnard Bagnis C. Is serum cystatin-c a reliable marker for metabolic syndrome? Am J Med 28;121: Surendar J, Indulekha K, Aravindhan V, Ganesan A, Mohan V. As

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