08. 원저 KJM hwp

Size: px

Start display at page:

Download "08. 원저 KJM hwp"

진기 마
6 years ago
Views:

1 대한내과학회지 : 제 93 권제 3 호 음주가한국인성인의혈청항헬리코박터항체전환에미치는영향에대한연구 건국대학교의학전문대학원내과학교실 권현경ㆍ이선영ㆍ김지혜ㆍ이상표ㆍ김정환ㆍ성인경ㆍ박형석ㆍ심찬섭 Effect of Alcohol Consumption on Seroconversion in Helicobacter pylori-seronegative Koreans Hyun Gyung Kwon, Sun-Young Lee, Ji Hye Kim, Sang Pyo Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, and Chan Sup Shim Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea Background/Aims: Helicobacter pylori (H. pylori) seroconversion may develop in seronegative adults. Although a positive correlation has been reported between alcohol consumption and seroconversion in Korea, an inverse correlation has been reported in other countries. The aim of this study was to investigate the risk factors for seroconversion in Korea. Methods: We included Korean adults who were H. pylori-negative negative in their annual serum immunoglobulin G and pepsinogen assays, and in upper gastrointestinal endoscopy. Subjects with a history of H. pylori eradication or gastrectomy were excluded. The criteria for heavy alcohol consumption were 15 drinks/week for males and 8 drinks/week for females. Results: Of 267 H. pylori-seronegative subjects, 26 (9.7%) exhibited seroconversion at a mean follow-up time of 39.0 ± 19.1 months. Seroconversion was positively correlated with alcohol consumption (p = 0.001), nonsteroidal anti-inflammatory drug use (p = 0.015), a higher body mass index (p = 0.033), a longer follow-up period (p = 0.038), and a greater number of follow-up tests (p = 0.004). Heavy drinking (odds ratio 6.754, 95% confidence interval , p = 0.003) and social drinking (odds ratio 4.360, 95% confidence interval , p = 0.033) were independent risk factors for seroconversion. During follow-up, subjects with seroconversion had higher serum levels of pepsinogen II (12.0 ± 7.8 ng/ml) than others (9.1 ± 5.3 ng/ml) (p = 0.038). Conclusions: Alcohol consumption is related to seroconversion in Koreans. H. pylori transmission might be prevented by reducing alcohol consumption and controlling drinking habits. (Korean J Med 2018;93: ) Keywords: Alcohol drinking; Drinking; Helicobacter pylori; Seroconversion Received: Revised: Accepted: Correspondence to Sun-Young Lee, M.D., Ph.D. Department of Internal Medicine, Konkuk University School of Medicine, Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: , Fax: , sunyoung@kuh.ac.kr * This study was supported by the Korean National Research Foundation (NRF 2016R1D1A1B ). Copyright c 2018 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 - The Korean Journal of Medicine: Vol. 93, No. 3, 서 론 대상및방법 우리나라는헬리코박터파일로리균의감염률이높은동아시아국가로서, 만 40세미만성인의 60% 에서는혈청항헬리코박터항체검사가음성으로보고되지만, 그이후에는항체음성자와양성자의비율이역전된다 [1]. 한국인에서만 40세를기준으로항체양성자가급격히많아진다는사실은성인에서새로운감염이드물지않다는것을시사한다 [2,3]. 성인에서발생하는헬리코박터파일로리균의새로운감염은대부분이무증상이며, 구강대구강감염이흔한것으로알려져있다 [4-6]. 또한, 성인에서의감염은소아와달리직계가족에의한수직감염보다는다른성인에의한수평감염이흔하며, 식수나술등의음료, 음식물, 애완동물, 치과시술이나상부위장관내시경검사등을통해서전염되는것으로추정된다 [4,7,8]. 혈청전환이란혈청항헬리코박터파일로리항체검사가음성으로보고되었던사람이추적검사시양성소견을보이는현상으로, 감염자와함께거주하고있거나상부위장관내시경검사를받은후에혈청전환될가능성이높아진다 [9,10]. 성인간의전염에대한구체적인증거로는감염자에게서발견된헬리코박터파일로리균의 DNA와검사한내시경기기에묻은균의 DNA, 이후에동일한내시경으로검사를받은수진자의위에새로감염된균의 DNA 구조가완벽하게일치했다는보고가있다 [11]. 성인이되어새롭게감염된후에발생한혈청전환에대한증거로는헬리코박터파일로리균에의한감염력이없고혈청검사도음성이었던젊은여성이치과시술을받은후에속쓰림증이심해서내시경검사를한결과를요약한보고가있다 [12]. 당시채취한위점막에서헬리코박터파일로리균의급성감염이진단되었으며, 이여성은 2개월후에혈청항헬리코박터 IgG가양성으로혈청전환된소견을보였다. 음주는한국인성인에서는혈청전환을유발하는위험인자로보고되었으나 [9], 일본이나그리스연구에서는상반되는결과가보고되었다 [10,13]. 이에한국인성인에서의혈청전환과음주간의연관성을조사하고자본연구에서는헬리코박터파일로리균에대한감염력이없고혈청항체검사에서음성을보인한국인성인들의추적검사결과를조사하여, 혈청전환되는비율과혈청전환자의특징을분석하였다. 나아가서항체전환의위험성이음주량에따라서차이가있는지도함께분석하였다. 대상이후향적코호트연구는 2010년부터 2014년사이에병원을방문한만 18세이상의한국인중에서혈청항헬리코박터파일로리 IgG 검사에서음성소견을보인수진자를대상으로진행되었다. 혈청항체검사를시행한날, 혈청펩시노겐 (pepsinogen, PG) 검사와상부위장관내시경검사를함께받지않은경우는연구에서제외하였으며, 과거에헬리코박터파일로리제균치료를받은사람과위절제술을받은사람도연구대상에서제외하였다. 이외에도정기적으로같은방법으로혈청항헬리코박터파일로리항체검사, 혈청펩시노겐검사, 상부위장관내시경검사를추적검사하지않은사람은대상에서제외하였다. 이연구는본원윤리위원회의승인을받은후에진행되었다 (IRB 승인번호 : KUH ). 사회력과병력에대한조사미국 National Institute on Alcohol Abuse and Alcoholism 기준에따라음주력은 1) 거의마시지않음 (no drinking), 2) 보통 (social drinking), 3) 많이마심 (heavy drinking) 의세단계로분류하였으며, 심한음주자 (heavy drinker) 는남성에서는일주일에 15잔이상, 여성에서는 8잔이상을마실때로정의하였다. 이기준에준하여마신지두시간후에혈중알코올농도를 0.08 g/dl까지상승시키는음주량을기준으로, 알코올함유량이 5% 인맥주는 350 ml를 1잔으로정의하였다. 도수가 12% 인와인은 150 ml가 1잔에해당했으며, 도수가 40% 인보드카나위스키는 40 ml가 1잔에해당하였다. 최근 3개월안에복용한약물에대해조사하였으며, 아스피린이나진통소염제중비스테로이드성항염증제 (nonsteroidal anti-inflammatory drugs, NSAIDs) 처럼흔한복용약물은별도로기재하였다. 또한, 고혈압이나당뇨등치료를필요로하는질환에대해서도조사하였다. 혈청검사항헬리코박터파일로리 IgG는한국인성인에서유용성이검증된 Chorus H. pylori IgG (DIESSE Diagnostica Senese, Siena, Italy) 와 Vidas H. pylori IgG (BioMérieux, Marcy-l Etoile, France) 로측정하였으며, 민감도와특이도는각각 100% 와 75.4%, 89.7% 와 85.5% 였다 [14]. Chorus H. pylori IgG 검사에서항체수치가 12 AU/mL 이상이거나 Vidas H. pylori IgG

3 - Hyun Gyung Kwon. et al. Seroconversion and drinking - 검사에서 test value 가 1.0 AU/mL 이상인경우는양성으로, Chorus H. pylori IgG 검사에서 8 AU/mL 미만이거나 Vidas H. pylori IgG 검사에서 0.75 AU/mL 미만인경우는음성으로정의하였다. 혈청전환은위검사에서음성으로보고되었던사람이추적검사시양성소견을보일때로정의하였다. 대조군은혈청전환을보이지않은대상자로하였다. 펩시노겐검사는 latex enhanced turbidimetic immunoassay (HBi Co., Anyang, Korea) 를이용하여 PG I의수치, PG II의수치, PG I/II 비를각각조사하였다. 위체부위축 (gastric corpus atrophy) 에대한정의는기존연구에준하여 PG I/II 비가 3.0보다작고, PG I 수치가 70 ng/ml 보다작을때로정의하였다 [15]. 내시경검사상부위장관내시경검사는혈청검사와같은날, GIF-H260 (Olympus, Tokyo, Japan) 혹은 EG-2990i (Pentax, Tokyo, Japan) 기기를이용해서시행하였다. 전정부의소만측부터투영된점막하혈관상이보이면위축성위염 (chronic atrophic gastritis), 전정부의대만측에여러개의선상발적이보이면표재성위염 (chronic superficial gastritis), 전정부에다발성의융기된미란이보이면미란성위염 (erosive gastritis), 불규칙한다발성의흰융기나함몰된발적상이보이면화생성위염 (metaplastic gastritis), 무색상의작은점막하융기가규칙적으로배열된소견이보이면결절성위염 (nodular gastritis) 으로각각진단하였다 [16]. 또한, 위나십이지장에점막이결여된점막하염증소견이보이면소화성궤양 (peptic ulcer disease), 하부식도에직선의발적상이보이면미란성식도염 (erosive esophagitis) 으로진단하였다. 그밖의내시경소견들은별도로기재하였다. 추적검사첫진단시와동일한방법으로같은날에혈청항헬리코박터파일로리항체검사, 혈청펩시노겐검사, 상부위장관내시경검사를시행하였다. 또한, 병력청취를통해서추적기간동안에음주력, 흡연력, 약물력에변경사항이있었는지를함께조사하였다. 혈청전환자에서는항체가가처음으로음성에서양성수치로전환된날을추적검사일로정의하였으며, 혈청전환을보이지않은경우는가장최근에검사한날을추적검사일로정의하였다. 통계분석연속형변수는 Student s t-test로분석해서평균 ± 표준편차 (standard deviation) 로표시하였으며, 범주형변수는 chi-square test나 fisher s exact test로분석해서빈도 (%) 로표시하였다. 첫진단시의검사소견과추적검사소견에대한비교는 signed-rank test로분석하였다. 혈청전환에독립적으로영향을미치는유의한위험인자를찾기위해서로지스틱회귀분석을시행하였으며, 결과는 odds ratio (OR) 와 95% confidence interval (CI) 로표시하였다. 또한, 단변량분석 (univariate analysis) 에서유의성을보인변수들은다변량분석 (multivariate analysis) 을통해독립변수로서의유의성을입증하였다. 모든통계는 PASW Statistics version 17.0 (SPSS Inc., Chicago, IL, USA) 으로분석하였으며, 유의수준은 p-value < 0.05로하였다. 결과혈청전환율 2010년부터 2014년사이에혈청검사에서음성을보인한국인성인 335명중, 제균치료의과거력이있는 68명은대상에서제외하였다. 남은 267명의혈청음성자가연구에포함되었으며, 추적기간중에혈청전환을보인사람은 26명 (9.7%) 이였다. 혈청전환여부를판단하기까지추적한평균관찰기간은 39.0 ± 19.1개월이었으며, 평균검사횟수는 2.5 ± 0.8회였다. 혈청전환을보인대상자의특징혈청전환군은대조군에비해서음주량이많았고 (p = 0.001), 비스테로이드성항염증제의복용력이많았다 (p = 0.015). 또한, 높은체질량지수를보였고 (p = 0.033), 추적관찰기간이길었으며 (p = 0.038), 추적검사횟수가많았다 (p = 0.004). 혈청전환군과대조군은나이, 성별, 흡연력, 병력, NSAIDs 이외의약물복용력에는차이를보이지않았다 (Table 1). 혈청펩시노겐과내시경검사소견항체음성자로진단된첫검사당시에측정한혈청 PG I, PG II, PG I/II 비를비교한결과, 혈청전환군과대조군간의유의한차이는없었다 (Table 2). 첫진단당시의내시경소견도양군간에차이가없었다

4 - 대한내과학회지 : 제 93 권제 3 호통권제 682 호 Table 1. Baseline characteristics of the H. pylori-seronegative subjects Variables All subjects Subjects without Subjects with (n = 267) seroconversion (n = 241) seroconversion (n = 26) p-value Age (years) 49.9 ± ± ± Sex (male) 165 (61.8) 147 (61.0) 18 (69.2) BMI (kg/m 2 ) 24.5 ± ± ± Cigarette-smoking status Non-smoker 139 (53.6) 128 (63.2) 11 (42.3) Past smoker 80 (3.0) 70 (29.0) 10 (38.5) Current smoker 48 (18.6) 43 (17.8) 5 (19.2) Alcohol consumption None 86 (32.2) 78 (32.4) 8 (30.8) Social drinking 165 (61.8) 153 (63.5) 12 (46.2) Heavy drinking a 16 (6.0) 10 (4.1) 6 (23.1) Comorbidity Hypertension 55 (20.6) 51 (21.2) 4 (15.4) Diabetes mellitus 20 (7.5) 18 (7.5) 2 (7.7) Other comorbidity 10 (3.7) 9 (3.7) 1 (3.8) Medication Aspirin 24 (9.0) 23 (9.5) 1 (3.8) NSAIDs 27 (10.1) 23 (9.5) 4 (15.4) Other medication 56 (21.0) 47 (19.5) 9 (34.6) Follow-up (months) 36.0 ± ± ± Number of anti-h. pylori IgG assays performed 2.46 ± ± ± Continuous values are presented as mean ± standard deviation, and categorical values are presented as percentage (%). BMI, body mass index; NSAIDs, nonsteroidal anti-inflammatory drugs. a The criteria for heavy drinking were 15 drinks/week for males and 8 drinks/week for females based on the National Institute for Alcohol Abuse and Alcoholism guidelines. One drink is equal to 350 ml beer (5% [v/v] alcohol), 150 ml wine (12% [v/v] alcohol), or 40 ml whiskey or vodka (40% [v/v] alcohol). Table 2. Serum pepsinogen data and upper gastrointestinal endoscopic findings Variables Subjects without seroconversion (n = 241) Subjects with seroconversion (n = 26) p-value Serum pepsinogen assay Pepsinogen I level (ng/ml) 51.1 ± ± Pepsinogen II level (ng/ml) 9.3 ± ± Pepsinogen I/II ratio 5.7 ± ± Endoscopy finding Erosive esophagitis 47 (19.5) 9 (34.6) Erosive gastritis 84 (34.9) 13 (50) Chronic superficial gastritis 85 (35.3) 6 (23.1) Chronic atrophic gastritis 88 (36.5) 13 (50) Metaplastic gastritis 9 (3.7) Nodular gastritis 2 (0.8) Peptic ulcer disease 5 (2.1) 2 (7.7) Continuous values are presented as mean ± standard deviation, and categorical values are presented as percentage (%)

5 - 권현경외 7 인. 항체전환과음주 - Table 3. Significant risk factors for seroconversion in H. pylori-seronegative subjects Univariate analyses Multivariate analyses Significant variables OR (95% CI) p-value OR (95% CI) p-value Longer follow-up ( ) ( ) Number of serological tests ( ) ( ) Higher BMI ( ) ( ) No drinking 1 1 Social drinking ( ) ( ) Heavy drinking a ( ) ( ) No intake of NSAIDs 1 1 Intake of NSAIDs ( ) ( ) OR, odds ratio; CI, confidence interval; BMI, body mass index; NSAIDs, nonsteroidal anti-inflammatory drugs. a The criteria for heavy drinking were 15 drinks/week for males and 8 drinks/week for females based on the National Institute for Alcohol Abuse and Alcoholism guidelines. One drink is equal to 350 ml beer (5% [v/v] alcohol), 150 ml wine (12% [v/v] alcohol), or 40 ml whiskey or vodka (40% [v/v] alcohol). Table 4. Significance of alcohol drinking for seroconversion Males Females Without seroconversion With seroconversion p-value Without seroconversion With seroconversion p-value (n = 147) (n = 18) (n = 94) (n = 8) No drinking 24 (16.3) 2 (11.1) (57.4) 6 (75.0) Social drinking 113 (76.9) 10 (55.6) 40 (42.6) 2 (25.0) Heavy drinking a 10 (6.8) 6 (33.3) 0 0 Variables are shown as frequencies (%). a The criteria for heavy drinking were 15 drinks/week for males and 8 drinks/week for females based on the National Institute for Alcohol Abuse and Alcoholism guidelines. One drink is equal to 350 ml beer (5% [v/v] alcohol), 150 ml wine (12% [v/v] alcohol), or 40 ml whiskey or vodka (40% [v/v] alcohol). 혈청전환에영향을미치는독립변수혈청전환군과대조군간에차이를보인음주량, 비스테로이드성항염증제복용력, 체질량지수, 추적관찰기간, 추적검사횟수를회귀분석으로통계처리한결과, 독립인자로서의유의성은음주력에서만관찰되었다 (Table 3). 심한음주자는비음주자에비해서혈청전환율이 6.754배높았으며 (95% CI , p = 0.003), 보통음주자는비음주자에비해서혈청전환율이 4.360배높았다 (95% CI , p = 0.033). 여성대상자중에는심한음주자가없어서성별로재분석한결과, 여성에서는음주력과혈청전환간의연관성을보이지않았다 (Table 4). 반면, 남성에서는음주량이많을수록혈청전환될가능성이높았다 (p = 0.002). 추적혈청펩시노겐과내시경검사소견추적검사에서혈청전환군의평균 PG II 수치는대조군에비해서유의하게높았다 (Table 5). 내시경검사상유일하게 미란성위염에서만차이를보였으며, 혈청전환군에서미란성위염의유병률이대조군에비해서높았다 (p = 0.045). 혈청전환군 26명중혈청전환진단당시에상부위장관증상을호소한사람은 8명이었으며, 증상은속쓰림 2명, 식도이물감 2명, 조기포만감 1명, 우상복부불편감 1명, 흉부작열감 1명, 삼킴곤란 1명, 조기포만감 1명으로식도부터우상복부증상까지비전형적이고다양하였다. 나머지 16명은기존에호소하는증상이사라지는등무증상상태로, 혈청전환에따른상부위장관증상의발현이나특징적인내시경소견은없었다. 혈청전환군 26명중 15명은 3회이상의추적검사를받았으며, 이중 7명은혈청검사가음성에서양성으로변하기전에중간값에해당되는판정보류 (equivocal) 과정을거쳐서혈청전환된것이확인되었다. 다른 3명은혈청전환된이후에검사가다시음성으로전환된소견을보였다. 추적내시경검사시김자 (Giemsa) 염색까지시행받은혈청전환자 2명은양성소견을보여서혈청검사가위양성이아닌실제

6 - The Korean Journal of Medicine: Vol. 93, No. 3, Table 5. Follow-up test data by seroconversion status Follow-up tests a Subjects lacking seroconversion (n = 241) Subjects exhibiting seroconversion (n = 26) p-value Serum pepsinogen assay Pepsinogen I level (ng/ml) 54.7 ± ± Pepsinogen II level (ng/ml) 9.1 ± ± Pepsinogen I/II ratio 6.7 ± ± Endoscopy finding Erosive esophagitis 55 (22.8) 10 (38.5) Erosive gastritis 99 (41.1) 16 (61.5) Chronic superficial gastritis 69 (28.6) 8 (30.8) Chronic atrophic gastritis 116 (48.1) 12 (46.2) Metaplastic gastritis 9 (3.7) Peptic ulcer disease 8 (3.3) Continuous values are presented as mean ± standard deviation and categorical values are presented as percentage (%). a Follow-up testing featured serum levels of pepsinogen and upper gastrointestinal endoscopy performed at the time of seroconversion. For subjects without seroconversion, the latest data are presented. 감염이라는것이증명되었다. 고찰이연구를통해서혈청항헬리코박터파일로리 IgG 검사상음성소견을보인한국인 10명중한명은 3년후에항체가전환된다는사실을확인할수있었다. 또한, 음주량이혈청전환을유발하는독립적인위험인자로서, 음주여부만으로도혈청전환의위험성이 4배나높아지며, 일주일에 15잔이상의술을마실경우에는혈청전환의위험성이 7배로높아진다는사실도확인하였다. 한국인성인에서혈청항헬리코박터파일로리 IgG 음성자의 10% 가 3년안에양성자로변한다는것은 10년후에는더많은음성자가혈청전환을보일수있다는것을간접적으로시사한다. 즉, 성인들도헬리코박터파일로리전염으로부터자유롭지못하다는것을시사한다. 우리나라에서는해마다 % 의항체음성자가양성자로전환되는데, 이는본연구와유사한혈청전환율이다 [3,9]. 이와는대조적으로, 서양연구에서는높은인구밀도를보인군대나감염자가많은병원과같은특수환경을제외하고는혈청전환율이 1년에약 % 로매우낮다 [17,18]. 따라서우리나라처럼대부분의헬리코박터감염자들이제균치료를받지않는환경에서는성인간의전염에대한철저한관리와전감염자에대한제균치료가시급하다. 성인에서의헬리코박터파일로리균에의한새로운감염은대부분이수평감염으로, 구강 대구강감염을막지못하는불량한위생상태에기인하기때문이다 [4,19]. 이번연구결과를바탕으로한국의독특한음주문화가성인간의헬리코박터수평감염을조장한다고주장할수근거들은다음과같다. 첫째, 성인간에관찰되는헬리코박터전염은주로음식물을공유하면서발생하는것으로알려지며, 활동성감염자가많은지역일수록전염될가능성이높기때문이다 [4,20,21]. 둘째, 우리나라에는하나의잔을여러사람에게돌려가며마시게하는독특한음주문화가있어, 감염자가입을대고마신잔을여러사람들이마셔야하는비위생적인환경이조장되기때문이다. 외국과달리유독한국에서만음주력이혈청전환과연관성을보인것은이와같은술잔돌리기문화때문으로추정된다 [9,10,13,17-19]. 셋째, 본연구에서여성들은음주량과혈청전환간의연관성을보이지않았는데, 이는남성과달리여성중에는일주일에 8잔이상을마시는심한음주자가없었기때문이다. 이러한성별간의차이는심한음주자가대부분이남성이며, 음주량이많을수록감염에노출될위험성이높아지기때문에혈청전환율도따라서증가한다는것을의미한다. 즉, 한국인에서만음주량이독립적인위험인자로증명되었다는것은술을많이마실수록헬리코박터에새로감염될위험성이높아진다는것이므로, 우리나라의독특한음주문화인술잔돌리기가구강대구강감염의주요원인일것으로추정된다. 나아가서우리나라의위암검진에는헬리코박터감염에대한진단이누락되어있고, 전감염자에대한제균치료가이루어지

7 - Hyun Gyung Kwon. et al. Seroconversion and drinking - 지않고있으므로, 이에대한정책변화가시급하다 [22,23]. 이연구에서간과하면안되는중요한결과중하나는혈청전환자에서혈청 PG II 수치가상승하였다는것이다. 이는혈청전환이단순한수치상승을보이는비활동성감염이아니라, 위점막을자극하고손상시킬수있는정도의활동성감염으로진행할수있다는것을가리킨다. 만성감염과달리활동성감염기간중에는위점막의자극으로혈청 PG I와 PG II 수치가상승하며, PG I/II 비에는의미를두지않는다 [24]. 위축성및화생성변화가기저부까지진행하는만성감염상태가되어야비로소 PG I 수치와 PG I/II 비가감소하므로, 이번연구결과는혈청전환자가처음부터만성감염소견을보일가능성은희박하다는것을간접적으로알려준다. 또한, 혈청전환자에서추적내시경검사에서미란성위염이증가하였다는것은위점막의자극을대변하며, 이는혈청 PG 수치의증가와도비례해서증가하는소견을보였다. 본연구에서혈청전환자들의대부분은증상을호소하지않았는데, 음주나음식물에의한헬리코박터파일로리균의전염은치과시술이나내시경검사에의한침습적인전염과달리, 적은양의균주가침입하여서서히위내환경에적응해가기때문으로추정된다 [4,9]. 또한, 혈청전환자 26명중 7 명은혈청추적검사시양성도음성도아닌중간값인판정보류로보고된뒤, 1-2년이지나서야양성으로전환되었는데, 이역시전염된균의양이많지않아서항체가오랜기간에걸쳐서천천히소량씩생성되었기때문으로해석된다. 나아가서헬리코박터감염과위염이흔한환경에서는증상을유발할정도의자극적인히스타민분비가드물기에 [25], 서양과는대조적으로우리나라와일본에서는헬리코박터감염으로인한상부위장관증상은적은것으로알려지고있다 [26-28]. 결론적으로한국인성인에서의헬리코박터파일로리균에대한혈청전환율은음주여부및음주량과비례해서증가하므로, 비위생적인음주문화에대한개선과전감염자를제균치료하고자하는의지가필요하다. 나아가서혈청항헬리코박터항체검사가음성으로나와도성인간의수평전염에대한경각심을잃지않고, 음주를통한전염을견제하는태도를지니는것이바람직하다. 요 목적 : 헬리코박터파일로리균에대한혈청전환의위험성은감염된가족과거주하거나상부위장관내시경검사를받으면상승한다. 우리나라에서는음주가혈청전환의위험요인으로알려져있으나, 외국에서는이와상반된연관성을보인다. 이에본연구에서는한국인에서혈청전환을유발하는위험요인을분석하고, 음주량이혈청전환에미치는영향력을조사하였다. 방법 : 혈청항헬리코박터파일로리항체검사에서음성을 보인한국인성인중매년혈청항체에대한추적검사를하면서혈청펩시노겐검사와상부위장관내시경검사를함께받은사람을대상으로하였다. 위절제술이나제균치료를받은사람은대상에서제외하였다. 심한음주자는일주일에 15잔이상을마시는남자와 8잔이상을마시는여자로정의하였다. 결과 : 항체음성자 267명중 26명 (9.7%) 이혈청전환을보였으며, 평균추적기간은 39.0 ± 19.1개월이었다. 혈청전환율은음주량 (p = 0.001), 비스테로이드성항염증제복용력 (p = 0.015), 높은체질량지수 (p = 0.033), 긴추적기간 (p = 0.038), 많은추적검사횟수 (p = 0.004) 와비례해서증가하였다. 이중에서심한음주자 (OR 6.754, 95% CI , p = 0.003) 와보통음주자 (OR 4.360, 95% CI , p = 0.033) 만이혈청전환의독립적인위험인자로밝혀졌다. 추적검사시의혈청펩시노겐 II 수치는혈청전환자 (12.0 ± 7.8 ng/ml) 가대조군 (9.1 ± 5.3 ng/ml) 에비해서높았다 (p = 0.038). 결론 : 한국인에서음주는혈청전환과연관된주요위험인자이다. 이는음주를줄이고비위생적음주습관을개선하는것이한국인성인들사이에서헬리코박터파일로리균의전염을예방하는데도움이될수있다는것을시사한다. 중심단어 : 알코올 ; 음주 ; 헬리코박터파일로리 ; 혈청전환 약 REFERENCES 1. Lee SP, Lee SY, Kim JH, et al. Correlation between Helicobacter pylori infection, IgE hypersensitivity, and allergic disease in Korean adults. Helicobacter 2015;20:

8 - 대한내과학회지 : 제 93 권제 3 호통권제 682 호 Kim JH, Kim HY, Kim NY, et al. Seroepidemiological study of Helicobacter pylori infection in asymptomatic people in South Korea. J Gastroenterol Hepatol 2001;16: Kim N, Lim SH, Lee KH, et al. Seroconversion of Helicobacter pylori in Korean male employees. Scand J Gastroenterol 2005;40: Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000;22: De Schryver A, Van Winckel M, Cornelis K, Moens G, Devlies G, De Backer G. Helicobacter pylori infection: further evidence for the role of feco-oral transmission. Helicobacter 2006;11: Osaki T, Okuda M, Ueda J, et al. Multilocus sequence typing of DNA from faecal specimens for the analysis of intra-familial transmission of Helicobacter pylori. J Med Microbiol 2013;62: Breckan RK, Paulssen EJ, Asfeldt AM, Kvamme JM, Straume B, Florholmen J. The all-age prevalence of Helicobacter pylori infection and potential transmission routes. A population-based study. Helicobacter 2016;21: Kivi M, Johanson ALV, Reilly M, Tindberg Y. Helicobacter pylori status in family members as risk factors for infection in children. Epidemiol Infect 2005;133: Jung JH, Choi KD, Han S, et al. Seroconversion rates of Helicobacter pylori infection in Korean adults. Helicobacter 2013;18: Kikuchi S, Ohgihara A, Hasegawa A, Miki K, Kaneko E, Mizukoshi H. Seroconversion and seroreversion of Helicobacter pylori antibodies over a 9-year period and related factors in Japanese adults. Helicobacter 2004;9: Sugiyama T, Naka H, Yachi A, Asaka M. Direct evidence by DNA fingerprinting that endoscopic cross-infection of Helicobacter pylori is a cause of postendoscopic acute gastritis. J Clin Microbiol 2000;38: Kamada T, Hata J, Manabe M, et al. Can dental treatment be the infection route of H. pylori transmission in adults? Three cases of acute gastric mucosal lesions after dental treatment. Dig Endosc 2007;19: Gikas A, Triantafillidis JK, Apostolidis N, Mallas E, Peros G, Androulakis G. Relationship of smoking and coffee and alcohol consumption with seroconversion to Helicobacter pylori: a longitudinal study in hospital workers. J Gastroenterol Hepatol 2004;19: Lee SY, Moon HW, Hur M, Yun YM. Validation of western Helicobacter pylori IgG antibody assays in Korean adults. J Med Microbiol 2015;64: Choi HS, Lee SY, Kim JH, et al. Combining the serum pepsinogen level and Helicobacter pylori antibody test for predicting the histology of gastric neoplasm. J Dig Dis 2014;15: Lee SP, Lee SY, Kim JH, Sung IK, Park HS, Shim CS. Link between serum pepsinogen Concentrations and upper gastrointestinal endoscopic findings. J Korean Med Sci 2017; 32: Menegatti M, Figura N, Farinelli S, et al. Helicobacter pylori seroconversion in asymptomatic blood donors: a five-year follow-up. Dig Dis Sci 2000;45: Rosenstock S, Jørgensen T, Andersen L, Bonnevie O. Seroconversion and seroreversion in IgG antibodies to Helicobacter pylori: a serology based prospective cohort study. J Epidemiol Community Health 2000;54: Fürész J, Lakatos S, Németh K, Fritz P, Simon L, Kacserka K. The prevalence and incidence of Helicobacter pylori infections among young recruits during service in the Hungarian army. Helicobacter 2004;9: Brown LM, Thomas TL, Ma JL, et al. Helicobacter pylori infection in rural China: demographic, lifestyle and environmental factors. Int J Epidemiol 2002;31: Zhang L, Eslick GD, Xia HH, Wu C, Phung N, Talley NJ. Relationship between alcohol consumption and active Helicobacter pylori infection. Alcohol Alcohol 2010;45: Lee SY. New guidelines for Helicobacter pylori treatment: comparisons between Korea and Japan. Korean J Gastroenterol 2014;63: Lee SY. Current progress toward eradicating Helicobacter pylori in East Asian countries: differences in the 2013 revised guidelines between China, Japan, and South Korea. World J Gastroenterol 2014;20: Lee SY. Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection. Korean J Intern Med 2016; 31: Konturek PC, Konturek SJ, Sito E, et al. Luminal Nalphamethyl histamine stimulates gastric acid secretion in duodenal ulcer patients via releasing gastrin. Eur J Pharmacol 2001;412: Triantafillidis JK, Gikas A, Hyphantis T, et al. Helicobacter pylori infection in hospital workers over a 5-year period: correlation with demographic and clinical parameters. J Gastroenterol 2002;37: Lee SP, Lee SY, Kim JH, Sung IK, Park HS, Shim CS. Factors related to upper gastrointestinal symptom generation in 2275 Helicobacter pylori seroprevalent adults. Dig Dis Sci 2017;62: Kawakubo H, Tanaka Y, Tsuruoka N, et al. Upper gastrointestinal symptoms are more frequent in female than male young healthy Japanese volunteers as evaluated by questionnaire. J Neurogastroenterol Motil 2016;22:

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 - -