205 Korean J Clin Lab Sci. 2011, 43(4) : ISSN The Elevation Factors Associated with Increased Blood Glucose in Pregnant Women Mi-Hwa

Size: px

Start display at page:

Download "205 Korean J Clin Lab Sci. 2011, 43(4) : ISSN The Elevation Factors Associated with Increased Blood Glucose in Pregnant Women Mi-Hwa"

홍 함
4 years ago
Views:

1 205 ISSN The Elevation Factors Associated with Increased Blood Glucose in Pregnant Women i-hwa Lee Department of Clinical Pathology, Jinju Health College, Jinju , Korea Gestational diabetes mellitus(gd) is likely to develop type 2 diabetes mellitus, cardiovascular disease, metabolic syndrome after delivery. Infants of diabetic women have higher incidence of congenital malformations than those of non-diabetic women. This study was performed to determine elevation factors associated with increased blood glucose in 350 pregnant women. Subjects were examined in June, 2011 to September, 2011 in Geongnam province. Fasting blood glucose, total cholesterol, triglyceride levels were measured by Olympus AU 680, and their body mass index (BI) calculated. The mean total cholesterol levels were mg/dl, triglyceride mg/dl, and fasting blood glucose mg/dl. Serum glucose level was significantly higher in the age group of 40 years(109.51±16.26 mg/dl) than 20 years and 30 years. And increase in triglyceride(>250 mg/dl) was significantly related to high blood glucose level(110.83±24.78 mg/dl), and increase in BI(>26) was significantly related to high blood glucose level(114.03±27.09 mg/dl). However, cholesterol levels were not significantly related to high blood glucose level. In conclusion, the significant elevation factors in relation to the glucose levels were age, triglyceride, and BI. Key Words : Gravida, BI, Cholesterol, Triglyceride, Age 서론 임신중에호르몬및대사변화로인하여당뇨병이발생 하거나당내성이손상된것을임신성당뇨 (gestational diabetes mellitus, GD) 라고한다 (National Diabetes Group, 1979). 임신성당뇨가발생되는기전은인슐린저항성과췌장랑게르한스섬베타세포의기능부전으로알려져있는데 (Buchanan 등, 1990; Ryan 등, 1995), 당뇨병발생산모로부터출생한영아들은황달, 신생아호흡곤란, 과체중, 저칼슘혈증, 심장기형등이발생할수있다고한다 (Ferencz 등, 1990; Warrell 등, 2003). 전세계적으로임신성당뇨의유병 Corresponding Author : Lee, i-hwa, Department of Clinical Pathology, Jinju Health College, Jinju , Korea Tel: mhleejh@hanmail.net Received : 25 NOV 2011 Return for modification : 20 DEC 2011 Accepted : 28 DEC 2011 률은지속적으로증가하고있으며 (Dabelea 등, 2005; Getahun 등, 2008), 임신성당뇨의발생빈도는전체 0.6~15% 범위내에서보고되고있다 (Albareda 등, 2003). Jang 등 (1995) 은임신전체질량지수 (body mass index, BI), 연령, 체중증가, 당뇨병의부모력과함께임신성당뇨병의관련성이높다고하였다. 우리나라에서는고령출산증가, 비만산모에따른고지혈증, BI 증가로현성당뇨병이나임신성당뇨가증가하고있는추세이다. 또한생활양식과음식문화가서구화되면서가임여성의비만이증가되고임산부의 6~10% 가비만과관련되어있으며비만은약 19% 에서당뇨병을동반하는것으로알려져있다 (Kilegman, 1985; Browers, 1999). 우리나라의임신성당뇨빈도는 3% 로보고되고있는데 (Lee 등, 2001) 분만후 1년이내에당뇨병이발생할위험성은임신중혈당농도가높은여성중에서고령임산부와비만임산부가고위험도를나타내는것으로보고되었다 (etzger 등, 1985). 임신성당뇨병의선별검사는시행범위나필요성, 양성판정기준이연구자마다다양하 205

2 고판별기준이없어서미국산부인과학회도임신성당뇨의선별검사로각의료기관별로정한고유의진단기준과선별검사를인정한다고하였으나제5차임신성당뇨병국제회의에서는위험군별로나누어서검사할것을권고하고있다. 임신주기가진행될수록트리글리세리드와콜레스테롤이증가하며 BI가상승하는데이에따라혈당농도가상승한다는많은보고가있었고임산부의고령화가가속됨에따라이러한현상은점차증가될것으로예측하고있다. 이에본연구에서는우리나라임산부의혈당, 트리글리세리드 (triglyceride, TG), 콜레스테롤, 연령, 체질량지수 (BI) 를조사하여혈당을상승시키는요인을찾고자하였다. 대상및방법 1. 연구대상 2011년 6월부터 2011년 9월까지경남지역의산부인과병원을방문한임신 24주에서 28주사이의임산부 350명을대상으로공복혈당, 트리글리세리드, 총콜레스테롤, 체질량지수 (body mass index, BI) 와연령을조사하여혈당을상승시키는요인을분석하였다. 2. 조사방법임산부들의 BI를구하고공복혈액을채취하여 Chemistry Autoanalyzer(Olympus AU 680) 로혈당및지질성분을측정하였다. 분류기준은혈당 120 mg/dl 미만, 120 mg/ dl 이상으로하여트리글리세리드, 총콜레스테롤, BI, 연령에따라각변수를연관시켜분석하였다. 3. 자료처리모든분석은 PASW 18.0 for Windows를이용하였다. 트리글리세리드, 총콜레스테롤, BI, 연령에따른혈당의차이를알아보기위하여각변수에따른혈당의분포차이를빈도와비율을측정하여교차분석을실시하였다. 각변수의군에따른혈당의평균차이를알아보기위해서평균과표준편차를산출하였다. 독립표본 t-검정과일원변량분석을통하여평균차이의유의성을조사하였고, 유의한차이가 나타난경우에는 의사후검정을실시하여각군별차이를조사하였다. 각변수와혈당간의상관성을알아보기위하여피어슨의상관관계분석을통하여변수간의상관성을확인하였다. 모든분석의유의수준은 p =.05이다. 결과 임산부의혈당과연령, 트리글리세리드, 총콜레스테롤, BI 간의관계를알아보기위하여 350명의임산부를대 상으로연구한결과, 평균연령은 23.5세이며이들의평균 트리글리세리드는 mg/dl, 총콜레스테롤은 mg/dl, BI은 28.80이며, 혈당은 mg/dl이었다. 연 령별분류는 20대연령군이 105명 (30.0%), 30대연령군이 207 명 (59.1%), 40대연령군이 38명 (10.9%) 이었다 (Table 1). Table 1. Characteristic of subjects Characteristic N (%) ±* Age (yrs.) 23~ (30.0) 23.5±5.2 30~ (59.1) (10.9) Triglyceride (mg/dl) < (27.1) ± ~ (23.4) 201~ (29.7) > (19.7) Cholesterol (mg/dl) < (26.3) ± (73.7) BI < (52.9) 28.80± ~ (31.7) >26 54 (15.4) 287 (82.0) ± (18.0) * mean ± standard deviation 1) 연령에따른임산부의혈당농도 23~29세연령군은혈당의평균농도가 96.57±18.18 mg/ dl이었고, 30~39세연령군은 ±22.53 mg/dl이었으 며, 40세이상연령군은 ±16.26 mg/dl로써 40세이 206 Glucose in pregnant women

3 상군의혈당농도가유의하게높은것으로나타났다 (Table 2). Table 2. Comparison of glucose level by age Age (yrs.) ean± 23~29 a 92 (87.6%) 13 (12.4%) ~39 b 169 (81.6%) 38 (18.4%) a,b<c 40 c 26 (68.4%) 12 (31.6%) *p<.05, **p<.01 χ 2 (p)=7.011 * (.030) F=5.460 ** (.005) 2) 트리글리세리드 (TG) 농도에따른임산부의혈당농도 TG의평균농도가 250 mg/dl 이하인군에서는혈당평균농도가 100 mg/dl 이하인데비해 TG의평균농도가 250 mg/dl 이상인군의혈당평균농도는 mg/dl으로나타나 TG가증가할수록혈당농도가유의하게높은것으로나타났다 (Table 3). Table 3. Comparison of glucose level by triglyceride 3) 콜레스테롤농도에따른임산부의혈당농도콜레스테롤에따라서는임산부의혈당농도에유의한차이는없는것으로나타났다 (Table 4). Table 4. Comparison of glucose level by cholesterol Cholesterol (mg/dl) ean± < (87.0%) 12 (13.0%) (80.2%) 51 (19.8%) χ 2 (p)=2.077(.150) t=-.288(.773) 4) BI에따른임산부의혈당농도 BI가 23미만인군의혈당평균농도가 94.96±15.53 mg/dl이었고, 23~25인군은 102,15±22.22 mg/dl이었으며 26이상인군은 ±27.09 mg/dl로서 BI가높을수록혈당농도가유의하게높은것으로나타났다 (Table 5). Table 5. Comparison of glucose level by BI BI ean± ean± Triglyceride (mg/dl) ean <150 a 90 (94.7%) 5 (5.3%) ~200 b 71 (86.6%) 11 (13.4%) a,b,c<d 201~249 c 83 (79.8%) 21 (20.2%) d 43 (62.3%) 26 (37.7%) χ 2 (p)= *** (.000) F=8,252***(.000) ***p<.001 <23 a 172 (93.0%) 13 (7.0%) ~25 b 86 (77.5%) 25 (22.5%) 102, a<b<c 26 c 29 (53.7%) 25 (46.3%) χ 2 (p)= *** (.000) F= *** (.000) ***p<.001 Table 6. ultiple linear regression analysis Dependent Independent Total Variable Variable B S.E p-value B S.E p-value B S.E p-value Glucose (Constant) age triglyceride cholesterol BI R 2 =.200 R 2 =.089 R 2 =.092 Pearson s Linear Correlation Coefficient: r(p) **p<.01, ***p<.001 Glucose in pregnant women 207

4 5) 각변수간의상관관계혈당, 트리글리세리드, 총콜레스테롤, BI, 연령간의상관성을알아보기위하여피어슨의선형상관계수를이용하였다. 임산부의혈당을향상시키는요인을살펴보면, 전체대상자에서는연령 (b=.775), BI (b=4.018) 가증가할수록임산부의혈당은상승되는것으로나타났다. 특히 BI 가가장혈당을상승시키는요인으로나타났다. 이를군별로다시분류했을때, 혈당농도가 120 mg/dl 미만인그룹에서는연령 (b=.617), 트리글리세리드 (b=-.035) 가유의한영향을주는것으로나타났으며, 트리글리세리드가높아질수록콜레스테롤농도가높아지는상관성을나타냈다 (Table 6). 고찰 임신성당뇨라함은임신중처음으로발견한혈당장애로정의하였고 (Diabetes care, 1998) 임신성당뇨병이나당뇨병환자가임신중그릇된당뇨관리는태아에미치는영향이크며사망률이높다는것이보고되면서연구가활발히진행되어왔다 (Duccan, 1882). 당뇨병산모의신생아가비당뇨병산모에비해선천성기형이증가하는것은잘알려져있으며 (ills, 1982; Berra, 1990; Buchanan, 1994; Correa, 2008), 임신성당뇨의발생은가족력이나, 비만, 고혈압, 과거력등이있다고하였다 (American Diabetes Association, 2003; Bennett 등, 2005). 미국산부인과학회는 (ACOG, 1986) 30세이상, 과체중아출산경험, 당뇨병의가족력이있는경우, 요당이나올경우및임신전 BI가 27.3이었을경우에임신성당뇨위험요인으로규정하였다. 본연구에서도 BI가 23미만인군의혈당평균농도가 94.96±15.53 mg/dl이었고, 23~25인군은 102,15±22.22 mg/dl이었으며, 26이상인군은 ±27.09 mg/dl로서 BI가높을수록혈당농도가유의하게높은것으로나타났다. 우리나라는서구식생활습관과식이에따라당뇨병의유병률이빠르게진행되고있는데우리나라의임산부중당뇨병임산부가차지하는비율이급속히증가하고있으며임산부들의체질량지수가증가하고비만도가증가할수록당 뇨병임산부의수가빠르게늘것이라고추측하고있다. 홍등 (2001) 도비만도가당뇨병발생의중요위험인자라고하였고그중복부비만이중요인자라고하였으며비만도를나타내는체질량지수가증가함에따라임신성당뇨병이유의하게증가하는것으로보고하였다. 본연구에서도트리글리세리드가 150 mg/dl 이상인군에서는 150 mg/dl 이하인군보다 120 mg/dl 이상의혈당농도를나타냈으며평균차이를비교한결과트리글리세리드가 250 mg/dl 이하의군에서는평균혈당은 100 mg/dl 이하인데비해트리글리세리드가 250 mg/dl 이상인군은혈당이 ± mg/dl 으로유의하게높은것으로나타났다. 즉, 트리글리세리드에따른임산부의혈당농도는트리글리세리드가증가할수록유의하게높아지는것으로나타났다. 국내에서는 4,367명의산모를대상으로한연구에서임신성당뇨는 3.0% 로보고하였고 (Lee 등, 2001), 당뇨산모에서출생한신생아들은거대아, 저혈당증, 저칼슘혈증, 황달, 호흡곤란증후군이발생한다고하며 (Kim, 2008: Ferencz, 1990; Warrell, 2003) 우리나라의경우고위험군에속하므로모든산모를대상으로선별검사로하여야한다는보고가있다 (etzger, 2007). 현재전세계적으로임신성당뇨병진단을위해어떤검사를시행할것인지의견의일치를보이고있지않은데제5차임신성당뇨병국제회의에서는위험군별로나누어서검사할것을권고하고있다. 위험군을기준으로선별검사를하는경우임신성당뇨의 50% 만을진단할수있다고한다 (Homko 등, 2001). 한국인임산부에서임신성당뇨는결코드문질환이아니므로앞으로경제적발전과사회적환경의변화로비만한여성이점차증가한다면서양인임산부에서관찰되는유병률보다오히려더높을것이라예측할수있다. 추후여러변수를조사하여혈당을상승시키는요인을찾아야할것이며검사방법을더욱개발해야할것으로사료된다. 참고문헌 1. Albareda, Caballero A, Badell G, Piquer S, Ortiz A, de Leiva A. Diabetes and abnormal glucose tolerance in women with previous gestational diabetes. Diabetes Care. 2003, 26: Glucose in pregnant women

5 American college of obstetricians and gynecologist (ACOG). anagement of diabetes mellitus during pregnancy. ACOG Technical Bulletin. 1986, No. 92. Washington, DC, ACOG. 3. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003, 26(suppl 1): Bennett PH, Knowler WC. Definition, diagnosis, and classification of diabetes mellitus and glucose homeostasis. In: Kahn CR, Weir GC, King GL, Jacobson A, oses AC, Smith RJ. Joslin s Diabetes ellitus. 14th ed. 2005, p Boston, LWW. 5. Berra JE, Khoury J, Cordero JF, Ericksoon JD. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population-based case-control study. Pediatrics. 1990, 85: Browers D, Cohen WR. Obesity and related pregnancy complications in an inner city. Clin J Perinatol. 1999, 19: Buchanan TA, etzger BE, Freinkel N, Bergman RN. Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes. Am J Obstet Gynecol. 1990, 162: Buchanan TA, Kitzmiller JL. etabolic interactions of diabetes and pregnancy. Ann Rev ed. 1994, 45: Correa A, Gilboa S, Besser L, Botto LD, oore CA, Hobbs CA. Diabetes mellitus and birth defects. Am J Obstet Gycecol. 2008, 199: Dabelea D, Snell-Bergeon JK, Hartfield CL, Bischoff KJ, Hamman RF, cduffie RS. Increasing prevalence of gestational diabetes mellitus (GD) over time and by birth cohort: Kaiser Permanente of Colorado GD Screening Program. Diabetes Care. 2005, 28: J. Onpuerperal diabetes. Trans Obstetsoc (London), 1882, 24: Ferencz C, Rubin JD, ccarter RJ, Clark EB. aternal diabetes and cardiovascular malformations: predominance of double outlet right ventricule and truncus arteriosus. Teratol. 1990, 41: Getahun D, Nath C, Ananth CV, Chavez R, Smulian JC. Gestational diabetes in the Unithed States: temporal trends 1989 through Am J Obstet Gynecol. 2008, 198: Homko CJ, Reece EA. To screen or not to screen for gestational diabetes. The clinical quagmire. Clin Perinatol. 2001, 28: Jang HC, Cho NH, JUNG KB. Screening for gestational diabetes mellitus in Korea. Int J Gynecol Obstet. 1995, 51: Kliegman R. Gross T. Perinatal problems of the obese mother and her infant. Obstet Gynecol. 1985, 66: Kim H. Changes in birth rates of low birth weight and premature infants in Korea over the past in 7 years. Korean J Pediatr. 2008, 51: Lee WJ, Ahn SH, Kim HS, Yang JI, Kim YS, Oh JH. Clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance and gestational diabetes mellitus. Korean J Obstet Gynecol. 2001, 44: etzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR. Summary and recommendations of the fifth international workshopconference on gestational diabetes mellitus. Diabetes Care. 2007, 30: ills JL. alformations in infants of diabetic mothers. Teratol. 1982, 25: National Diabetes Date group [editors]. Classification and diagnosis of diabetes mellitus and orther categories of glucose intolerance. Diabetes. 1979, 28: Proceedings of the 4th International Workshop-Conference on Gestational Diabetes ellitus. Chicago, Illinois, USA arch Diabetes Care. 1998, 21: Ryan EA, Imes S, Liu D, canus R, Finegood DT, Polonsky KS. Defects in insulin secretion and action in women with a history of gestational diabetes. Diabetes. 1995, 44: Warrell DA, Cox T, Firth JD, Benz EJ. Oxford Textbook of edicine. 4th ed. p , Oxford University Press, Oxford, UK. 25. 홍은경, 조용욱, 장학철, 박혜경, 조남한. 임신성당뇨환자의산후혈성당뇨병발생과비만의연관성. 당뇨병. 2001, 25:180. Glucose in pregnant women 209

DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%) aged over 30 years or older had diabetes in 2010. Based on fasting g

DIABETES FACT SHEET IN KOREA 2012 Korean Diabetes Association (KDA) / Korea Centers for Disease Control and Prevention (CDC) DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%)