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1 Original Article Korean J Health Promot 2014;14(4): pissn: eissn: 제주지역무증상성인의대장용종위험요인 나연자 1, 엄미라 1, 공미희 1,2, 김현주 1,2 1 제주대학교병원가정의학과, 2 제주대학교의학전문대학원제주대학교병원가정의학교실 Risk Factors of Colorectal Polyps in Jeju Island Yeoun Ja Na 1, Mira Um 1, Mi Hee Kong 1,2, Hyeon Ju Kim 1,2 1 Department of Family Medicine, Jeju National University Hospital, 2 Department of Family Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea Background: The incidence of colorectal polyps have been reported to be increasing in those aged years who consume fast food, have low physical activity, and use alcohol and cigarettes. We analyzed the characteristics and risk factors of colorectal polyps in asymptomatic adults in Jeju Island. Methods: Data on 1700 individuals who underwent a screening colonoscopy from 1 July, 2010 to 30 June, 2012 were analyzed based on age, gender, body mass index (BMI), blood pressure, blood tests, and behavioral habits including alcohol use, smoking, and exercise. Results: The prevalence of colorectal polyps, including adenomatous and hyperplastic, is 43.1% and is higher in males (P<0.001). The prevalence according to age group shows increasing by age (P for trend<0.001). The most common histologic type of polyp is adenomatous in the <50 years and >50 years age groups, 27.3% and 45.3% respectively. And the percentage of adenomatous polyps has shown an increasing trend along with increasing number and size of polyps (P for trend<0.001). BMI, waist circumference (WC), fasting blood sugar, and triglyceride were higher in males with polyps than males in the control group. BMI and WC were higher and HDL-cholesterol was lower in females with polyps. The incidence of colorectal polyps was higher in male and female smokers (P<0.001 and P=0.035 respectively). Conclusions: Our results showed that older age, male gender, obesity, and smoking are risk factors for colorectal polyps. The prevalence of colorectal adenomatous polyps is 27.3% in <50 yrs, 33.4% in the 40s. For early detection and treatment, we recommend a screening colonoscopy for those with risk factors. Korean J Health Promot 2014;14(4): Keywords: Colorectal polyp, Prevalence, Risk factors 서 론 대장암은서구에서는암사망률 2위를차지할정도로발생빈도가높고, 2011년국내암사망통계에따르면여성의암사망률 3위를차지할정도로우리나라에서도급격히 Received:March 26, 2014 Accepted:November 26, 2014 Corresponding author:hyeon Ju Kim, MD, PhD Department of Family Medicine, Jeju National University Hospital Jeju National University School of Medicine, 15 Aran 13-gil, Jeju , Korea Tel: , Fax: fmhjukim@hanmail.net This research was supported by the 2014 scientific promotion program funded by Jeju National University 빈도가증가하고있는실정이다. 1) 따라서대장암의조기진단및예방이주요한관심사가되고있다. 그러나일반인구에서 50세이전의대장암선별검사는일반적으로추천되고있지않으며, 전세계적으로도비용- 효과측면을고려하여대변잠혈검사및대장내시경검사권고안이각나라마다다양한실정이다. 2-4) 대장암은전구병변인선종성대장용종에서진행한다는 adenoma-carcinoma sequence ( 샘종-암화과정 ) 가인정되고있어서 5) 대장암의전구병변인선종성대장용종을조기에발견하여제거하는것이대장암의예방에있어서매우중요하며, 일부증식성대장용종도암으로발전할수있다는연구들이발표되었다. 7-9) 대장암및대장용종의발생위험요인으로는흡연, 음주,

2 142 Korean J Health Promot Vol. 14, No. 4, 2014 비만, 신체활동, 가족력, 식이습관, 유전적요인등이제시되고있으며, 대장암의 75% 에서는유전질환, 가족력, 염증성장질환등이동반되지않는것으로보고되었다. 6,10-16) 여러연구들에서연령증가와대장선종및대장암발생의연관성은잘알려져있으며, 최근 50대미만의성인에서용종및선종발생이증가하고있어 50대미만의무증상성인에서조기검진의필요성을뒷받침하는결과가보고되었다. 17) 이러한병변의조기발견및제거는대장암의 2차예방으로서중요하며, 이들의위험요인을집중관리하여대장용종의발생을막는 1차예방이더욱중요한점이라할수있다. 10) 기존연구의경우질환자를대상으로하거나소규모연구가많아본연구에서는무증상성인을대상으로한대규모연구를통해제주지역을대표할수있는건강한성인에서대장용종의연령별유병률및임상적특징, 위험요인등에대해알아보고자하였다. 1. 연구대상자 방 법 2010년 7월 1일부터 2012년 6월 30일까지 2년간제주지역한대학병원건강증진센터를방문하여대장내시경검사를시행받은만 20세이상의성인중에서과거용종이발견되어추적관찰을위해대장내시경을시행한경우, 선종이발견되어내시경적제거시술을받은과거력이있거나, 대장암으로인해대장절제수술을받은경우를제외한 1,700명 ( 남자 1,067명, 여자 633명 ) 의수검자를대상으로대장용종에대한분석을시행하였다. 2. 연구방법 모든대상자에서자가기입식설문지와의사의면담을통해과거와현재병력, 복용중인약물, 음주, 흡연과운동을포함한생활습관을조사하였다. 음주는주 3회이상평균음주여부를기준으로비음주군과음주군으로설정하였고, 현재흡연여부에따라비흡연군과흡연군으로분류하였으며, 하루에 30분이상주 3회이상의규칙적운동여부에따라운동군과비운동군으로분류하였다. 신체검사는모든대상자가가벼운검진가운만착용한상태에서신장, 체중을측정한후체질량지수 (body mass index) 는체중 (kg) 을신장 (m) 의제곱으로나누어계산하였고, 허리둘레는숨을내쉰뒤장골능과 12번째늑골사이의둘레를측정하였다. 수축기및이완기혈압은자동혈 압측정계 FT-700R (JAWON MEDICAL Co. Ltd., Seoul, Korea) 을이용하였다. 검사실검사는 8시간이상공복상태로정맥혈을채혈하여공복혈당, 총콜레스테롤, 중성지방, 고밀도콜레스테롤을측정하였다. 3. 대장내시경검사및병리조직검사모든수검자는검사전일저녁은유동식만먹도록한후검사전일밤과검사새벽장정결제를 2 L씩나누어복용하도록하였고, 항문에서부터말단회장까지전대장내시경검사를시행하였으며, 발견된모든용종은내시경겸자를사용하여조직검사를시행하였다. 4. 통계분석연구군의일반적특성은연속형변수를성별에따라연령을보정한공분산분석 (analysis of covariance) 을이용하여분석하였고, 연령별용종분포경향을알아보기위해선형대선형결합 (linear by linear association), 위험요인의비교위험도는다변량로지스틱회귀분석 (multiple logistic regression analysis) 을이용하였다. 자료의분석에사용한프로그램은 SPSS for windows (version 18.0, SPSS Inc., Chicago, IL, USA) 를이용하였고, 통계적유의수준은 0.05 미만으로하였다. 결과 1. 연구대상자의일반적특성 1,700명의수검자중에서남성은 1,067명 (62.8%), 여성은 633명 (37.2%) 이었고, 선종이나증식성용종이확인된대장용종의유병률은 43.1% 였으며, 남성은 50.9%, 여성은 29.9% 로남성에서대장용종의유병률이높았다. 남녀모두용종군에서체질량지수, 허리둘레가높았으며, 남성은용종군에서공복혈당과중성지방이높고, 여성의경우용종군에서고밀도콜레스테롤은낮게나타났다 (Table 1). 2. 대장용종과선종의연령별분포증식성용종과선종을포함군용종군의평균연령은 50.98± 10.15세, 비용종군의평균연령은 46.28±10.12세였으며, 20대부터 70세이후까지의연령별대장용종및선종분포를살펴본결과연령이증가할수록유병률이증가하는경향

3 Yeoun Ja Na, et al. Risk Factors of Colorectal Polyps in Jeju Island 143 Table 1. General characteristics of subjects Characteristics Male (n=1,067) Female (n=633) Polyps a (n=543) No (n=524) Polypsc (n=189) No (n=444) Height, cm ± ± ± ± Weight, kg 73.14± ± ± ±7.96 <0.001 BMI, kg/m ± ± ± ±3.12 <0.001 WC, cm 88.81± ± ± ±8.38 <0.001 SBP, mmhg ± ± ± ± DBP, mmhg 77.76± ± ± ± FBS, mg/dl 99.92± ± ± ± TC, mg/dl ± ± ± ± TG, mg/dl ± ± ± ± HDL, mg/dl 49.80± ± ± ± Abbreviations: BMI, body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBS, fasting blood sugar; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol. Values are presented as means±sd. a Polyps: containing adenomatous and hyperplastic colorectal polyps. b Calculated by ANCOVA adjusted by age. Table 2. Age distribution of colorectal polyps and adenoma Age, y Polyps a Adenoma N (%) N (%) (9.1) < (9.1) < (28.3) 76 (19.9) (41.0) 176 (33.4) (49.6) 206 (41.2) (58.1) 122 (51.7) (63.6) 20 (60.6) Total 732 (43.1) 602 (35.4) Values are presented as number (%). a Polyps: containing adenomatous and hyperplastic colorectal polyps. b Calculated by linear by linear association for trend test. Table 3. Characteristics of colorectal polyps Characteristics Number (%) < 50yr 50yr Pathology 362 (38.9) 438 (57.0) Adenomatous 254 (27.3) 348 (45.3) Hyperplastic 127 (13.6) 144 (18.7) Cancer 1 (0.1) 1 (0.1) Carcinoid tumor 3 (0.3) 1 (0.1) Non-specific 78 (8.4) 94 (12.2) Number (53.2) 169 (38.5) 2 90 (24.9) 123 (15.4) 3 32 (8.9) 56 (12.8) 4 20 (5.5) 31 (7.1) 5 27 (7.5) 60 (13.7) Size, mm < (27.4) 98 (22.3) (60.4) 276 (62.9) (12.2) 65 (14.8) Values are presented as number (%).

4 144 Korean J Health Promot Vol. 14, No. 4, 2014 Table 4. Multivariate logistic regression analysis of colorectal polyps according to risk factors Age, per year BMI, per 1kg/m 2 Smoking b Alcohol c Exercise d Male Female OR (95% CI) P a OR (95% CI) P a ( ) < ( ) ( ) ( ) ( ) < ( ) ( ) ( ) ( ) ( ) Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index. a Calculated by multiple logistic regression analysis. b Smoking: current smoker. c Alcohol: use greater than three times per week, d Exercise: over 30min in a day and over three times per week. 을보였다 (P for trend <0.001, Table 2). 3. 대장용종의임상적특성 50세를기준으로대장용종의조직학적특징을분석한결과선종이 50대미만과 50대이상모두에서각각 27.3%, 45.3% 로높은분포를차지하였고, 용종의개수가많을수록, 크기가클수록선종이증가하였다 (Table 3). 또한본연구에포함된수검자들에서대장암으로확인된경우는 50세이상과미만모두에서단2명으로전체의 0.1% 에해당하였고, 그외유암종은 0.3%, 비특이적염증소견등이약 10% 를차지하였다. 발견된용종의개수는 1개, 크기는 5-9 mm인경우가가장많았다. 4. 위험요인분석대장용종의위험요인들에대한다변량로지스틱회귀분석에서는남녀모두연령과비만, 흡연이통계적으로의미있는결과를보였다 (Table 4). 고찰 대장암은서구에서는폐암다음으로흔하며높은사망률을보이는암으로, 최근우리나라에서도식생활의서구화로인해대장암의발생및이로인한사망률도증가하고있다. 4,10,17) 대장선종은대장암의전구병변으로잘알려져있고증식성용종에서도일부악성화가능성이제시되고있어 7-9) 본연구에서는선종과증식성용종이확인된수검자들을대장용종군으로설정하여분석하였다. 본연구결과대장용종의유병률은이미잘알려진것처럼남성에서 50.9% 로여성의유병률 29.9% 보다높게나타났으며, 4) 연령증가에따라용종및선종유병률역시증가하는경향을보였고, 이는 2010년 Chung 등 17) 의연구에서 30대 10.4%, 40대 22.2%, 50대 32.8% 보다도더높 은유병률을보여주었다. 기본적특성에있어용종군에서체질량지수, 허리둘레등이높아비만과관련성을보였으며, 남성용종군은공복혈당, 중성지방이높게나타났으며, 여성용종군에서는고밀도콜레스테롤이낮게나타났다. 생활습관에따른분석에서는남녀모두흡연군이의미있게위험도가높은것으로나타나본연구에서는남성, 연령, 비만, 흡연이대장용종의위험인자로생각된다. 현재까지알려진대장용종발생의위험요인으로는흡연, 음주, 비만, 신체활동저하및고지방식, 저섬유식등이제시되고있다. 6) 이러한위험요인들에대한연구들로 2008년 Kim 등 13) 은고령및현재흡연이선종위험도를높이는것으로보고하였고, 2009년 Lee 등 6) 의연구에서용종군이비용종군에비해나이, 흡연량, 음주량이모두유의하게높았으나다중로지스틱회귀분석상으로는유의한차이를보이지않았으며, 2010년정수진등의연구에서는저위험성선종및진행성선종의위험도는남성과흡연군에서높았고진행성선종의경우대장암가족력이용종위험도를높이는것으로나타났다. 17) 또한 2011년 Sanchez 등 14) 은최소한일주일에 1시간이상의신체활동이대장선종의위험을낮춘다고발표하였다. 본연구에서는용종위험요인들에대해남녀전체를대상으로다변량로지스틱회귀분석을시행했을때남자, 고령, 비만, 흡연이의미있는위험인자로나타났으나알코올섭취와운동은통계적으로의미있는결과를보여주지는못하였는데 10-15) 이것은연구들마다흡연의정의, 알코올섭취유무의기준, 신체활동유무의기준시간을다르게설정하였기때문에정확한비교가어려울수있다. 대장용종의특성을살펴보았을때용종의개수및크기에있어 1개인경우와5-9 mm 크기가가장흔하였고개수와크기가증가함에따라선종의개수역시증가하는경향을보였다. 50대미만과이상을구분하였을때물론 50대이상에서높은유병률을보였지만, 50대미만에서도 27.3% 의상당한유병률을확인할수있었고연령대별로

5 Yeoun Ja Na, et al. Risk Factors of Colorectal Polyps in Jeju Island 145 세분화하였을때 30대가전체유병률의 28.3%, 40대는 41.0% 를차지하고있었고, 이들용종의대부분은선종으로확인되었는데이는건강에대한관심이높아지면서 30-40대젊은연령층에서도검진목적으로대장내시경을많이시행하였고그로인해조기진단이가능해졌다고평가할수있는부분이다. 본연구는일개대학병원에서시행된단면연구로서대표성이떨어지고, 실제수검자들이제주지역에거주하는지에대해정확한파악을하지못했다는점에있어서지역특이성을입증할수없다는한계를가지고있으나비교적대규모연구이며제주도전지역에걸쳐수진자가분포하여제주지역을대표할수있는연구로서의미가있다. 또한질환자나증상이있어검사를한경우가아닌무증상성인을대상으로한연구로서건강한성인에서의대장용종의유병률및위험인자에대해전반적으로파악해볼수있었다. 일부연구들에서대장용종의위험요인에대한분석에서는남성, 흡연만이의미있게나타났거나, 17) 신체활동증가가용종위험을줄인다는보고 14) 등이있었으나이러한위험요인들과대장용종의상관성을분석한많은연구들에서와마찬가지로본연구에서도일관성있는결과를보여주지는못하였다. 하지만 2012년소화기학회의대장암선별및대장용종진단검사가이드라인에서는평균위험군에서대장암및대장용종진단검사는 50세부터시작할것을권고하고있으나 4) 본연구의결과에비추어 50대미만의무증상성인에서라도비만, 흡연을비롯한위험요인들을가지고있는경우라면조기대장내시경검사를시행하는것이권장할만하다고생각된다. 향후각지역의대학병원, 건강관리협회및여러기관들에서시행된연구데이터를모아지역별대장용종유병률, 위험요인분석을통합한다면범국가적이고지역특이적인결과및새로운가이드라인을도출해낼수있을것으로생각된다. 요약 연구배경 : 대장선종은대장암의전구병변으로서식생활의서구화및운동부족, 음주및흡연등의위험요인증가로최근 30-40대젊은연령에서도용종및선종발생증가가보고되어왔다. 본연구는제주지역무증상성인에서대장용종의임상적특징및위험요인에대해알아보고자하였다. 방법 : 2010년 7월 1일부터 2012년 6월 30일까지 2년간제주지역한대학병원건강증진센터를방문하여대장내시경검사를시행받은만 20세이상의성인중에서과거용종이발견되어추적관찰을위해대장내시경을시행하거나, 내시경적제거술을받은과거력또는대장암으로인해 대장절제수술을받은경우를제외한 1,700명의수검자를대상으로대장용종에대한분석을시행하였다. 결과 : 1,700명의수검자중에서선종이나증식성용종이확인된대장용종의유병률은 43.1% 였으며, 남자는 50.9%, 여자는 29.9% 로남자에서높았으며연령이증가할수록유병률이높게나타났다. 용종군에서체질량지수허리둘레가통계적으로의미있게높았으며, 남자의경우용종군에서공복혈당과중성지방이높고, 여자의경우용종군에서고밀도콜레스테롤은낮았다. 다변량분석에서는연령, 비만, 흡연이남녀모두통계적으로대장용종의의미있는위험요인으로나타났다. 대장용종의조직학적특징을분석한결과선종이 50대미만과 50대이상모두에서각각 27.3%, 45.3% 로높은분포를차지하였고, 용종의개수가많을수록, 크기가클수록선종이증가하는결과를보였다. 결론 : 본연구의결과제주지역의무증상성인중 50세미만에서도대장선종의유병률이 27.3% 에해당하였고, 특히 40대의경우선종이 33.4% 로높게나타났다. 용종의위험요인으로는연령, 남성, 비만, 흡연이통계적으로의미있게나타나 50대미만의무증상성인에서도이러한위험요인을가지고있는경우선택적으로조기대장내시경검사를고려해보는것이좋겠다. 중심단어 : 대장용종, 유병률, 위험인자 REFERENCES 1. Korea National Statistical Office. Annual Report on the cause of death statistics;2011.[accessed 24 December, 2012].Available from: 2. Ross WA. Colorectal cancer screening in evolution: Japan and the USA. J Gastroenterol Hepatol 2010;25 Suppl 1:S Lee SH, Lee KS, Lee JY, Ji JH, Park JK, Park YS, et al. Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps. Korean J Gastroenterol 2006;48(6): Lee BI, Hong SP, Kim SE, Kim SH, Kim HS, Hong SN, et al. Korean guidelines for colorectal cancer screening and polyp detection. Korean J Gastroenterol 2012;59(2): Jackman RJ, Mayo CW. The adenoma-carcinoma sequence in cancer of the colon. Surg Gynecol Obstet 1951;93(3): Lee HM, Lee S, Lim JK, Seo JW, Lee KS, Baek SC et al. Relationship of colorectal polyps and the risk factors including obesity, age, alcohol and smoking. Chonnam Med J 2009;45(3): Kearney J, Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, et al. Diet, alcohol, and smoking and the occurrence of hyperplastic polyps of the colon and rectum (United States). Cancer Causes Control 1995;6(1): Morimoto LM, Newcomb PA, Ulrich CM, Bostick RM, Lais CJ, Potter JD. Risk factors for hyperplastic and adenomatous polyps: evidence for malignant potential? Cancer Epidemiol

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전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II)

전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) 전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) - i - - ii - - iii - - iv - - v - - vi - - vii - - viii - - ix - -