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1 임상병리검사과학회지 : 35 권제 1 호, 47-51, 2003 농촌노인환자의혈청생화학적성분분석 원광보건대학임상병리과 남원의료원임상병리과 1 원광대학교생명과학부 2 김종호 오금자 1 박영순 2 Biochemical Components in Serum of Rural Aged Patients Kim, Chong Ho., Oh, Geum Ga 1., Park, Young Soon 2 Dept. of Clinical Pathology, Wonkwang Health Science College Dept. of Clinical Pathology, Namwon Medical Center 1 Dept. of Lift Science, Wonkwang University 2 We determined the concentrations of total protein, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, creatinine blood urea nitrogen (BUN) in the sera of 158 rural aged patients (patients over sixty years old residing in country areas) to analyze the distributions of patients that showed abnormal levels of these biochemical components in their sera. The concentrations of biochemical components were compared with reference values. The distribution of patients showing low levels of total protein, albumin, or both of them was 22.5%, 24.1%, 19.6% respectively. The distribution of patients showing high levels of AST, ALT, cholesterol, creatinine, BUN was 36.7%, 41.8%, 16.4%, 42.45%, 5.8%, 17.1%, respectively. High levels of AST ALT were found in 31.5% of the patients of (51 out of 158). The distributions of patients showing high levels of both creatinine BUN was in 8.2% (22 out of 158). 6.9% of the patients (11 out of 158) displayed high levels of both AST cholesterol. In conclusion, we expect that a high frecuency of rural aged patients have, are developing, or will develop liver disease or hyperglycemia. Key Words: Rural aged patient, Biochemical component 1)I. 서 론 인간의수명연장에의하여노인인구가증가하고있다. 특히산업사회의발달로인하여젊은층의농업인구는감 교신저자 : 김종호, ( 우 ) 전북익산시신룡동 번지원광보건대학임상병리과 Tel : chkim@wkhc.ac.kr 이논문은 2003 년도원광보건대학학술연구비지원과 2003 년도원광대학교연구비지원에의하여연구되었음 소한데반하여노인층의농촌인구는급증하고있다. 이는경제기획원인구및주택센서스보고 ( ) 에 1980년도의노령화지수는 15.7% 이었으나 1999년도의농촌노령화지수가 58.6% 로급상승된것으로보고한자료가이현상을나타내고있다. 이와같이농촌노인인구가급증함에따라건강관리를위한보건환경은비례하여개선되고있지않다. 혈액의생화학적물질의변화는질병에따라변화가일어나기때문에정상환자의혈액내생화학적물질의참고치와환자의혈액농도를비교함으 47

2 로써질병을진단하는데환자의혈액물질농도를활용하고있다. 혈액내존재하는대부분의단백질들은간세포에서합성되고 aspartate aminotransferase(ast), alanine aminotransperase(alt), alkaline phosphatase(alp) 의효소는간세포에다량존재하기때문에간질환진단을위하여 total protein, albumin, AST, ALT, ALP등의검사를실시하고 (King과 Amstrong, 1934; Deritis 등, 1956; Reitman 과 Frankel, 1957; Wroblewski, 1958; Gutman, 1959; Chaney와 Marbach, 1962; Joachim 등, 1964; Hallen과 Laurell, 1972; Laurell, 1972; Bromhult 등, 1974; Gr와 Ulshen 1975; Kindmark, 1976; Bromhult 등, 1977). creatinine과 urea nitrogen(un) 등은신장을통하여요로배설되기때문에신장질환을진단하기위하여 creatinine, urea nitrogen(un) 검사를실시한다 (Bjornsson, 1979; Espinel과 Gregory, 1980; Del Greco와 Krumlovsky, 1981; Morgan, 1982). 심근경색증이나동맥경화증과같은환자의혈액에 AST나 cholesterol과같은물질이상승하는것으로알려졌기때문에이들질환을진단하기위하여 AST와 cholesterol등을검사한다 (Levy, 1981; Tietz, 1986). 또당뇨병의진단을위하여혈액 glucose를분석한다 (Jarrett과 Keen, 1976). 따라서본연구에서는 60세이상농촌인구의건강상태를연구하기위하여간질환진단을위하여분석하는것으로알려진 total protein, albumin, AST, ALT를분석하고신장질환을진단하기위하여실시하는 creatinine, blood urea nitrogen(bun) 를분석하였다. 또당뇨병진단을위하여실시하는혈액 glucose를분석하였다. 각분석한결과가정상참고치를벗어난환자들의분포를비교하였다. II. 재료및방법 농업을주업으로하는농촌환자중처음내원한 60세이상되는환자 (n=158) 들의혈청 total protein(tp), albumin(al), AST, ALT, Cholesterol(Chol), Creatinine(Cre), BUN, Glucose(Glu) 를분석하고참고치 (Tietz, 2001) 와비교하였다. Total protein(tp) 을분석하기위하여사용된 Biuret 시약을제조하기위하여, 1급이상의시약인 NaOH, CuSO 4, 5H 2 O, sodium potassium tartrate, KI을사용하였고 albumin의분석은 bromcresol green(bcg) 색소결 합법에의하여분석하였으며표준시약으로 bovine serum albumine을사용하였다 (John, 1982; Tietz, 1986). AST와 ALT분석에사용된시약은 Retiman Frankel법 (Reitman과 Frankel, 1957) 을응용한 Kit시약 (Inwha pharm. Co. Ltd) 을사용하였고 cholesterol 분석은 cholesterol oxidase 법으로분석하였다 (Huang 등, 1975; Noma와 Nakayama, 1976). 혈청 creatinine의분석은 Jaffe반응을이용한분석방법 (Taussky와 Kurzmann, 1954; Owen 등, 1954; Taussky, 1961; Heinegard와 Tiderstrom, 1973; Cook, 1975; Bulter, 1979) 을이용하였고 BUN 분석은 urease-berthelot 법 (Tietz, 1986) 에의하여분석하였으며 glucose(glu) 분석은 glucose oxidase 법 (Tietz, 2001) 에의하여분석하였다. 분석에사용한시약들은 1급이상의시약을사용하였다. III. 결 과 60세이상되는노인환자의건강상태를연구하기위하여간질환을진단하기위하여참고자료로활용하는 total protein, albumin AST, ALT, ALP를분석하고건강인의참고치와비교한후참고치를벗어난환자들을총노인환자에대한백분율 (%) 로표현하여비교하였다. 총노인환자들중 total protein이감소한환자는 22.5% 이었고 albumin이감소한환자는 24.1% 이었으며 total protein과 Freuency, % TP Al TP Al AS T ALT AS T ALT Biochemical components Fig. 1. The frequency (%) of rural aged patient showed high level of Total protein(tp), Albumin(Al), both total protein albumin(tp AL), aspartate aminotransferase(ast), alanine aminotransferase(alt), both AST ALT. Fig. 1. The frequency (%) of rural aged patient showed high level of Total protein(tp), Albumin(AI), both total protein albumin(tp AL), aspartate aminotransferase (AST), alanine aminotransferase(alt), both AST ALT. 48

3 Frequency, % Chol AST Chol AST Cre BUN Cre BUN Biochemical components Fig. 2. The frequency (%) of rural aged patient showed high level of cholesterol(chol), aspartate aminotransferase(ast), both cholesterol AST, Creatinine(Cre), Blood urea nitrogen(bun) both Cre BUN Fig. 2. The frequency (%) of rural aged patient showed high level of cholesterol(chol), aspartate aminotransferase(ast), both cholesterol AST, Creatinine(Cre), Blood urea nitrogen(bun) both Cre BUN. Abnormal 42% Normal 58% Fig. 3. The frequency (% ) of rural aged patient show ed hyper glycemia(abnormal) Fig. 3. The frequency (%) of rural aged patient showed hyper glycemia(abnormal). albimin이동시에감소한환자는 19.6% 이었다 (Fig. 1). AST 활성도가상승한노인환자는 36.7% 이었고 ALT가상승한환자는 41.8% 이었으며 AST와 ALT가동시에상승한환자는 31.5% 이었다 (Fig. 1). 심혈관질환을진단하기위하여참고자료로사용하는 AST와 cholesterol를분석한환자들중 cholesterol이상승한환자는 16.4% 이었고 cholesterol과 AST 모두상승한환자는 6.9% 이었으며신장질환을진단하기위하여참고자료로사용하는 creatinine 과 BUN를분석한결과 creatinine 이상승한환자는 15.8% 이었고 blood urea nitrogen이상승한환자는 17.1% 를나타내었으며 creatinine과 blood urea nitrogen 모두상승한환자는 8.2% 이었다 (Fig. 2). 또노인환자들중고혈당을나타내는환자는 42.4% 를나타냈다 (Fig. 3). Total protein이나 albumin이감소한환자들중 total protein 과 albumin이동시에감소한환자는 75.6% 이었고 AST 또는 ALT가상승한환자들중 AST와 ALT가동시에상승한환자는 70.8% 이었으며 creatinine이나 blood urea nitrogen 이상승한환자들중이들모두상승한환자는 33.3% 이었다. IV. 고찰 혈청내존재하는생화학물질들의농도변화는질병을진단하는데유용하게활용된다. 특히 AST, ALT, ALP, 등의활성도가상승하는것은간세포성질환이나폐쇄성질환의가능성을나타내며 (Deritis 등, 1956; Clermont와 Chalmers, 1967; Ellis 등, 1978). BUN과 creatinine의상승은어떤원인에의한신장기능저하를나타낸다 (Owen 등, 1954; Morgan, 1982). AST와 cholesterol의증가는심혈관질환을의심하며 (Levy, 1981; Tietz, 1986), blood glucose 의증가는당뇨병을의심한다 (Genuth, 1973; Jarrett과 Keen, 1976). 농촌노인환자의 20~40% 가간질환진단에활용하는검사물질들이비정상인참고치를나타냈고, 1 6~37% 의환자들이심혈관질환의진단에활용하는검사물질들이비정상참고치를나타냈다. 또고당혈증으로나타난환자는 42.4% 로나타났으며신장질환을진단하는참고물질인 creatinine과 blood urea nitrogen은각각 15.8% 와 17.1% 를나타냈다. 이결과는어떤질환의원인으로간기능저하나심혈관질환이농촌노인들에게심각하다는것을나타낸다. 뿐만아니라이들의질환빈도가다른장기의질환보다다발할수있음을추이할수있다. 또고혈당을나타내는빈도가높은것은농촌의생활습관이나식생활의변화로인하여혈당이상승하고있음을의미한다. 이는보건복지부환자조사 1999년통계에나타난것처럼외래입원환자의 27.6% 가 54세이상의노인환자라는점을생각할때농촌노인인구의건강관리에더욱관심을가져야한다. V. 결론 60 세이상농촌노인환자들의혈청임상생화학적물 49

4 질들을분석하고혈청참고치를벗어난환자들의분포를조사하기위하여내원한노인환자들의혈청 total protein, albumin, cholesterol, glucose, AST, ALT, creatinine, urea nitrogen 등을분석하였다. Total protein 이나 albumin이감소한환자들의분포와 AST, ALT등이증가한환자들의분포가 20~40% 에달하였고, cholesterol이증가한환자는 15.2%, hyperglycemia 환자의분포가 41.8% 를나타내었으며, creatinine이나 blood urea nitrogen이증가한환자는각각 12.5% 와 17.5% 를나타낸것은농촌노인환자들의간질환환자와고혈당환자가많이분포한다고할수있다. 참고문헌 1. Bjornsson TD. Use of serum Concentrations to determind rinal function. Clin Pharmacokinet 4: , Bromhult J, Friedel E, Sunblad L. Studies in alkaline phosphatase isoenzymes relation to g-glutamyl transferase lactate dehydrogenase isoenzymes. Clin Chim Acta. 76: , Butler AR. The Jaffe reaction. Identification of the coloured species. Clin Chim Acta 59: , Chaney AL, Marbach EP. Modified reagents for determination of urea ammonia. Medicine 8: , Clermont RJ, Chalmers TC. The transminase tests in liver disease. Medicine 46: , Cook JG. Factors influencing the assay of creatinine. Ann Clin Biochem 12: , Del Greco F, Krumlovsky FA. Role of the laboratory in mangement of acute Chronidc renal failure. Ann Clin Lab Sci 11: , DeRitis F, Coltori M, Giusti C. Diagnostic value pathogenic significanceof transminase activity changes in liver hepatitis. Minerva Med 47: , Ellis G, Goldberg DM, Spooner RJ. Serum enzyme tests in diseases of the liver biliary tree. Am J Ciln Pathol 70: , Espinel CH, Gregory AW. Differential diagnosis of acute renal failure. Clin Nephroll 13:73-77, Genuth SM. Plasma insulin glucose profiles in normal, obese, diabetic person. Ann Intern Med 79: , Gr RJ, Ulshen MH. Clinical physiological abnormality in hepatic function. Pediatr Clin North Am 22: , Gutman AB. Serum alkaline phosphatase activity in diseases of the skeletal hepatobiliary systems. Am J Med 27: , Hallen J, Laurell CB. Plasma Protein Pattern in Cirrhosis of the Liver. Sc. Clin Lab invest, Supple 124:29-97, Heinegard D, Tiderstrom G. Determination of serum creatinine by a direct colorimetric method. Clin Chem Acta 43: , Huang HS, Kuan JC, Guilbault GG. Fluorometric enzymatric determination of total cholesterol in serum, Clin Chem 21: , Jarrett RJ, Keen H. Hyperglycemia diabetes mellitus. Lancet 2: , Jeppsson JO, Laurell CB, Franzen B. Agarose Gel Electrophoresis. Clin Chem 25:629, Joachim GR, Cameron S, Schwartz M, Beckek EL. Selectivity of Protein Excretion in Patients with the Nephrotic Syndrome. J Clin invest 43:2332, John D Bauer. Clinlical Laboratory Methods. 9th. Mosby Co. U.S.A , Kindmark CO. Plasma Protein Pattern in Hepatits A B. In: Peeters, H., Ed. Protides of the Biological Fluids (23rd colloquium 1975). Oxford: Pergamon Press: , King EJ, Amstrong AR. A convenient metho for determing serum bile phosphatase activity. Can Med Assoc J 31: , Laurell CB. Composition Variation of the Gel Electrophoretic Fractions of Plasma, Cerebrospinal Fluid Urine. Sc J Clin Lab invest 124:71,

5 24. Levy RI. Decclining mortality in coronary heart disease. Arteriosclerosis, 1: , Morgan DB. Assessment of renal tubular function damage their clinical significance. Ann Clin Biochem 19: , Noma A, Nakayama K. Polarographic method for rapid microdetemination of cholesterol with cholesterol esterase cholesterol oxidase. Clin Chem 22: , Owen JA, Iggo, Scrett F. The determination of creatinine in plasma or serum, in urine: a critical exmination. Biochem J 58: , Reitman S, Frankel S. A coloric method for determination of glutamic oxaloacetic glutamic pyruvic transaminase. Am J Clin Pathol 28:56-61, Taussky HH. Creatinine creatine in urine serum. In: Stard Methods of Clinical Chemistry, Vol. 3. D.Seligson, Ed. p99-113, Academic Press, New York, Taussky HH, Kurzmann G. A microcolorinetric determination of creatine in urine by the Jaff reaction. J Biol Chem 208: , Tietz NW. Clinical chemistry. p WB. Saunders Co. Philadelphia, Tietz NW. Clinical chemistry. p WB. Saunders Co. Philadelphia, Tietz NW. Clinical chemistry. p WB. Saunders Co. Philadelphia, Wroblewski, F. Clinical significance of alterations in transminase activities of serum other body fluids. Adv Clin Chem 1: , 보건복지부환자조사, 경제기획원인구및주택센서스보고,

<30382EC0C7C7D0B0ADC1C22E687770>

<30382EC0C7C7D0B0ADC1C22E687770> 대한내과학회지: 제 76 권 제 2 호 2009 의학강좌-개원의를 위한 모범처방(Current Clinical Practice) 간기능검사의 이해와 적용 인제대학교 의과대학 일산백병원 내과학교실 김 경 아 Understanding and application of liver function tests Kyung-Ah Kim, M.D. Department of