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2 大韓癩學會誌 : 第 44 卷, 第 1號 2011 Korean Leprosy Bulletin, Vol. 44, No. 1 December, 2011 한국한센복지협회연구원 김종필, 김연실, 이래환 Abstract The Study of Anemia in Persons affected leprosy Jong Pill Kim, Yeon Sil Kim, Rea Hwan Lee Institute for Leprosy Research, Korean Hansen Welfare Association The anemia still remains the most common hematologic disorder in the the world despite improvements in general health and nutrition. Recently, the prevalence of anemia was reported 7.7% in years and 16.0% in 70 years or older in male and was reported 11.9% in years and 19.5% in 70 years or older in female. This study was aimed at assessing the prevalence of anemia in the persons affected leprosy aged over 60 years. For evaluation of anemia, including prevalence, typing, and cause, hemoglobin, MCV(mean corpucular volume), RDW (red blood cell distribution width), ferritin, iron, TIBC, reticulocyte count, and etc were checked. The prevalence of anemia was 42.8%(male 43.6%, female 42.2%), the proportion of the anemia classified by MCV was 11.8%(microcytic), 50.9%(normocytic), and 37.3%(macrocytic). Our results was higher than other past reports. So we will consider about the evaluation of higher prevalence of anemia in persons affected leprosy, and management plan for anemia in them by the in depth studies. Key Words; anemia, prevalence, persons affected leprosy

3 : 김종필, 김연실, 이래환 최근영양섭취의개선등의요인으로인하여과거에비해빈혈의유병률은많이감소하였기는하다고알려져있으나, 빈혈은여전히많이존재한다고알려져있다 13). 빈혈의원인은매우다양하다고알려져있지만, 철분부족에의한철결핍빈혈 (iron deficiency anemia, IDA) 이가장흔한원인으로알려져있다. 이러한빈혈로인하여피곤하고, 일의능력이떨어지며, 감염에대한저항력이저하되고기억력같은지적인능력이감소하는것으로알려져있다 46). 또한빈혈이있는집단에서그렇지않은집단에비해우울증의위험이더높고, 치매의위험역시높다는보고가있으며, 사망률의위험역시증가하였다는보고가있다 711). 그러므로빈혈을치료하는것은물론이고예방하는것이국민건강상매우중요하다고하겠다. 60세이상의노인에서빈혈의유병률은 23.9% 에달하였다고세계보건기구는발표하였다 12). 최근우리나라의빈혈의유병률은남자에서 60~69 세에서 7.7%, 70세이상에서 16.0% 이고, 여자에서는 세에서 11.9%, 70세이상에서 19.5% 로보고되었다 13). 한편우리나라의한센사업자의경우 2010 년말통계자료 14) 에의하면평균나이가 70 세이고, 60세이상이 83% 에달하고있어이들에대한빈혈유병에대해조사해볼필요가있다고사료된다. 이에저자들은이에 60세이상한센사업대상자의빈혈유병률을조사하여분석한자료를보고한다. 대상및방법 2009 년 3월부터 2011 년 9월까지한국 한센복지협회연구원중앙이동진료반검진을통해정착농원거주한센사업대상자중 60세이상인자를대상으로연구를실시하였다. 이들대상자에대해빈혈의판단, 원인등을파악하기위해혈색소, 평균적혈구용적 (mean corpucular volume, MCV), 적혈구분포계수 (red blood cell distribution width, RDW), 혈청페리틴 (Ferritin), 혈청철(iron), 총철결합능 (total iron binding capacity, TIBC), 망상적혈구수 (reticulocyte count) 등을검사하였다. 그과정은대상자에게서일차검사시에는혈색소, MCV, RDW 등을먼저검사하여이에서유의한소견( 빈혈판정) 이있는경우에는이차검체를확보하여 Ferritin, iron, TIBC, reticulocyte count 등을검사하였다. 빈혈은세계보건기구의판단기준 15) 에따라, 혈색소가 15세이상남자는 13 g/dl 미만일때, 15세이상의성인여자는 12 g/dl 미만일때로정의하였으며, 대적혈구증은 MCV (mean corpucular volume) 가 100fL 을넘을때, 소적혈구증은 MCV 가 80 fl 미만일때로정의하였다. 기타빈혈에분류및원인에대한분석은 Table 1 3, Fig 1 등에따라구분하였다 16,17). Table 1. Classification of degree of anemia 15-16) Classification Overall Mild Moderate Severe Blood Hemoglobin Female : less than 12.0 g/dl Male : less than 13.0 g/dl Female : g/dl Male : g/dl Female & Male : g/dl Female & Male : less than 8.0 g/dl * 교신저자 : 김종필전자우편 : dr_jpkim@hotmail.com 주소 : 경기도의왕시오전동산86 한국한센복지협회 ( )

4 Anemia MCV < 80 fl MCV fl MCV > 100 fl Microcytic Normocytic Macrocytic RBC < 5 x 10 6 /mm 3 RDW > 16% RBC > 5 x 10 6 /mm 3 RDW normal Iron deficiency Chronic disease Evaluate iron studies Thalassemia Chronic disease Renal insufficiency Bone marrow disorder Hemolytic process Sickle cell disease Folate deficicncy Vitamin B12 deficiency Alcoholism Liver disease Hypothyroidism Hereditary spherocytosis Evaluate RDW and reticulocyte count Fig 1. Approach to the laboratory evaluation of anemia. MCV mean corpuscular volume; RBC= red blood cell count; RDW= red blood cell distribution width index 17). Table 2. Differentiating Anemia of Chronic Disease and Iron Deficiency Base on Iron Studies 17). Parameter Serum iron Total iron-binding capacity % Saturation of transferrin Serum ferritin Cause of Anemia Chronic Disease Normal Iron Deficiency Table 3. Differentiating Anemia Based on Reticulocyte Count and RDW. Reticulocyte Count Normal RDW Increased RDW 2% 2% Thalassemia Chronic disease Hemolytic anemia Iron deficiency RDW = Red blood cell distribution width index 결과 검사에참여한대상자는총 560명으로 남자가 224 명( 평균나이 70.3 세, 표준편차 8.56), 여자가 336 명( 평균나이 70.7 세, 표 준편차 8.72) 이었다. 대상자중빈혈의유 병률은 60~69 세에서는남자 22.4%, 여자 33.8% 로, 70세이상에서는남자 47.6%, 여 자 46.0% 로조사되었다 (Table 4, Fig 2). Table 4. Prevalence of anemia(<60 years old) Age our results(%) Kim et al(%)13) 60~69 yr male feamle yr male feamle

5 : 김종필, 김연실, 이래환 이중 65 세이상대상자( 전체 498 명, 남자 195 명, 여자 303 명) 에대한빈혈유병율은 전체가 42.8%( 남자 43.6%, 여자 57.8%) 이었고, 경한경우는 34.3%( 남자 39.0%, 여자 31.4%), 중등도가 7%( 남자 4.6%, 여 자 8.6%), 심한경우는 0.4%( 남자 0%, 여자 0.7%) 로조사되었다. Fig 2. Prevalence of anemia(<60 years old) Table 5. Prevalence of mild, moderate, and severe anemia based by hemoglobin (<65 years old) Age overall anemia (%) mild anemia (%) moderate anemia (%) severe anemia (%) our results Tettamant et al 16) our results Tettamant et al 16) our results Tettamant et al 16) Fig 3. Prevalence of mild, moderate, and severe anemia(<65 years old)

이차검사가완료할수있었던대상자는 110명에서 MCV 에서의한분류에의하면, 소혈구증이 11.8%(13 예), 정구성은 50.9% (56 예), 대적혈구증이 37.3%(41 예) 로조 사되었으며 (Table 6, Fig 4), 추정되는 원 인으로는철결핍성이 22.7%(25 명), 만성 질환으로추정되는경우가 9.1%(10 명), 용혈성으로추정되는경우가 5.

6 이차검사가완료할수있었던대상자는 110명에서 MCV 에서의한분류에의하면, 소혈구증이 11.8%(13 예), 정구성은 50.9% (56 예), 대적혈구증이 37.3%(41 예) 로조 사되었으며 (Table 6, Fig 4), 추정되는 원 인으로는철결핍성이 22.7%(25 명), 만성 질환으로추정되는경우가 9.1%(10 명), 용혈성으로추정되는경우가 5.5%(6 명), 나머지 62.7%(69 명) 에서는원인미상등 으로조사되었다 (Table 7, Fig 5). Table 7. Classification of anemia based by presumed causes type n % Iron deficiency Chronic disease Hemolysis Unexpained total 110 Table 6. Classification of anemia based by mean corpucular volume type n % Microcytic(MCV < 80 fl) Normocytic(MCV fl) Macrocytic(MCV > 100 fl) total 110 Fig 5. Classification of anemia based by presumed causes 고찰 Fig 4. Classification of anemia based by mean corpucular volume 빈혈은개발도상국이든개발국가이든관 계없이여전히전세계적인문제로남아있 다 18). 빈혈은노인에서도흔한문제이다. 노인에서의빈혈은대체로 에이차적으로일어나고 1/3은영양결핍 1/3은만성염증 이나신질환, 그리고 1/3은원인을잘모른 다고하였다 19). 약 10년전에 60세이상의연령에서의 빈혈의유병률은남녀각각 10.2%, 14.1% 이었고, 대부분은정구성빈혈이었다 은 20). 김등 60세이상의노인을대상으로한 2008 년도의한연구에서빈혈의유병률은남자에

: 김종필, 김연실, 이래환 서 10.8%, 여자에서 13.6% 이라고보고하였다 21). 2010 년도김등의보고 13) 에따르 면, 2005 년도에서 60~69 세에남녀각각 9.2%, 11.8% 이고대적혈구증은남녀각각 1.6%, 1.2% 로소적혈구증은남녀각각 0.8%, 1.0% 로, 70세이상에서는남녀각 각 17.1%, 20.

7 : 김종필, 김연실, 이래환 서 10.8%, 여자에서 13.6% 이라고보고하였다 21) 년도김등의보고 13) 에따르 면, 2005 년도에서 60~69 세에남녀각각 9.2%, 11.8% 이고대적혈구증은남녀각각 1.6%, 1.2% 로소적혈구증은남녀각각 0.8%, 1.0% 로, 70세이상에서는남녀각 각 17.1%, 20.5% 이고대적혈구증은남녀 각각 2.9%, 2.5% 로소적혈구증은남녀 각각 0.6%, 0% 로보고하였고, 2009 년에는 세에남녀각각 7.7%, 11.9% 이고 대적혈구증은남녀각각 0.8%, 0.3% 로소 적혈구증은남녀각각 0.4%, 1.1% 로, 70세 이상에서는남녀각각 16.0%, 19.5% 이고 대적혈구증은남녀각각 0.5%, 0.2% 로소 적혈구증은남녀각각 1.6%, 1.1% 로보 고하였다. 이는본연구결과에서 60~69 세에서는남자 22.4%, 여자 33.8% 로, 70 세이상에서는남자 47.6%, 여자 46.0% 로 조사되어과거의국내보고예들 13,19 21) 에 비해더높은수치를보였으며, 국내의보 22 23) 고들 에비해서도높은수치를보인다 (Table 8, Fig 6). Table 8. Comparison of Anemia Prevalence (by WHO criteria, Age > 65) Authors Nation male(%) female(%) our results Korea Myers22) USA Elwood et al. 23) UK Inelmen et al 24) Italy 9 9 Fig 6. Comparison of Anemia Prevalence (by WHO criteria, Age > 65) 또한혈색소수치에따른분류에의한조사결과에서도 Tettamanti 등 16) 의결과에 비해 85세이상의중증빈혈의경우를제 외하고는높게조사되었다. 다른여러연구 에서도빈혈의빈도는나이가들어감에따라 25 27) 증가하는것으로알려져있는데, Ania 등 26) 은 세남녀에서각각 6%, 4% 이 었고, 85세이상에서남녀각각 14%, 13% 임을보고하였는데, 이역시본연구결 과에서높게조사되었다. 본연구에서소적 혈구증이 11.8%, 정구성은 50.9%, 대적 혈구증은 37.3% 로조사되었으며, 추정되는 원인으로는철결핍성이 으로추정되는경우가 22.7%, 9.1%, 만성질환 용혈성으로 추정되는경우가 5.5%, 나머지 62.7% 에 서는원인미상등으로조사되었는데, 이는 노인에서철결핍에의한빈혈이주원인인 소적혈구증보다는대적혈구증이더많다는 점에서도철분영양보다는대구성빈혈을일 으키는엽산이나비타민 B12의부족의가 능성이크다는과거보고 28) 와일치하는것 으로사료된다. 본연구는단지혈청페리 틴, 혈청철이나총철결합능등실험실적 검사만을실시하고원인분석을위한다각

8 적인검사를시해하지못하였기때문에이 에대한결론에는한계가있다. 또한빈혈 은여러가지영양적결핍이나질병에의하 여발생할수있기때문에식이력, 알코올 섭취를포함한분석이있어야할것으로사 료된다. 또한엄격한채식은비타민 B12의 결핍위험이높고, 알코올과다섭취는엽 산결핍의위험이있고, 위궤양에의한출 혈을일으킬수있다는점 29) 에도관심을가 지고조사하여야할것으로사료된다. 우리사회가급격히고령화사회로접어 들고있는데, 고령화에따라빈혈의유병률 이현저히높아진다는것이다. 따라서건강 한노인인구로유도하기위해서는빈혈에 대한다각도의접근이필요할것으로생각 된다. 특히향후한센사업대상자의높은빈 혈유병에대해그원인과향후관리대책 에대해심도있는연구가진행되어야할 것으로사료된다. 참고문헌 1. Wu AC, Lesperance L, Bernstein H.: Screening for iron deficiency. Pediatr Rev 2002;23: Greydanus DE, Patel DR.: The female athlete. Before and beyond puberty. Pediatr Clin North Am 2002;49: Meier PR, Nickerson HJ, Olson KA, et al.: Prevention of iron deficiency anemia in adolescent and adult pregnancies. Clin Med Res 2003;1: Chaves PH, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated. J Am Geriatr Soc 2002;50: Penninx BW, Pahor M, Cesari M, et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 2004;52: Penninx BW, Guralnik JM, Onder G, Ferrucci L, Wallace RB, Pahor M. Anemia and decline in physical performance among older persons. Am J Med 2003; 115: Thein M, Ershler WB, Artz AS, et al. Diminished quality of life and physical function in community dwelling elderly with anemia. Medicine (Baltimore) 2009; 88: Beard CM, Kokmen E, O'Brien PC, Ania BJ, Melton LJ 3rd. Risk of Alzheimer's disease among elderly patients with anemia:population based investigations in Olmsted County, Minnesota. Ann Epidemiol 1997;7: Chaves PH, Carlson MC, Ferrucci L, Guralnik JM, Semba R, Fried LP. Association between mild anemia and executive function impairment in community dwelling older women:the Women's Health and Aging Study II. J Am Geriatr Soc 2006;54: Chaves PH, Xue QL, Guralnik JM, Ferrucci L, Volpato S, Fried LP. What constitutes normal hemoglobin concentration in

9 : 김종필, 김연실, 이래환 community dwelling disabled older women? J Am Geriatr Soc 2004;52: Zakai NA, Katz R, Hirsch C, et al. A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med 2005; 165: de Benoist B, McLean E, Egli I, et al.: Worldwide prevalence of anaemia Geneva, Switzerland: World Health Organization Press, 2008: Kim SK, Kang HS, Lee JE, et al. : The Prevalence Change of Anemia in the Population Aged 10 Years or Older: 2005 and Clin Pediatr Hematol Oncol 2011;18: KHWA: Current situation and major indicator of Hansen s service programme in Korea. Uiwang, Korea:KHWA WHO: WHO criteria for anemia: WHO Nutritional anemias Tech. Rep. Ser. 503, Tettamanti M, Lucca U, Gandini F et al.: Prevalence, incidence and type of mild anemia in the elderly: the Health and Anemia population based study.): haematologica 2010;95:11: Karnath BM.: Anemia in the Adult Patient. Hosp Physician 2004;40: Sandoval C, Jayabose S, Eden AN. Trends in diagnosis and management of iron deficiency during infancy and early childhood. Hematol Oncol Clin North Am 2004;18: Bross MH, Soch K, Smith Knuppel T. Anemia in older persons. Am Fam Physician 2010;82: Choi CW, Park KH, Yoon SY, et al. Prevalence of anemia in the elderly. Korean J Med 2001;60: Kim HS, Lee BK. Cross sectional study on the prevalence of anemia among rural elderly in Asan. Nutr Res Pract 2008;2: Myers AM, Saunders CR, Chalmers DG. The haemoglobin level of fit elderly people. Lancet Aug 3;2(7562): Elwood PC, Shinton NK, Wilson CI, Sweetnam P, Frazer AC. Haemoglobin, vitamin B12 and folate levels in the elderly. Br J Haematol Nov;21(5): Inelmen E. M., D Alessio M., Gatto M.R.A., Baggio M. B., Jimenez G., Bizzotto M. G., Enzi G. Descriptive analysis of the prevalence of anemia in a randomly selected sample of elderly people living at home: some results of an Italian multi centric study. Aging Clin. Exp. Res. 1994;6: Bross MH, Soch K, Smith Knuppel T. Anemia in older persons. Am Fam Physician 2010;82: Ania BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton LJ 3rd. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc 1997;45: Smith DL. Anemia in the elderly. Am Fam Physician 2000;62:

10 28. Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron deficiency anemia: an overview. J Gen Intern Med 1992;7: Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull 2008;29 Suppl 2:S20 34.

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -