운동학학술지제 19 권제 3 호 http://kak.co.kr http://e-ajk.org DOI : http://dx.doi.org/10.15758/jkak.2017.19.3.61 한국성인의근감소증과류마티스관절염및골관절염의관련성 : 국민건강영양조사 2008-2011 * 윤정교 김정훈 ** 최윤형 *** 가천대학교 ABSTRACT Jeonggyo Yoon Junghoon Kim Yoonheyong Choi. Associations of Sarcopenia with Rheumatoid Arthritis and Osteoarthritis in Korean Adults: the Korea National Health and Nutrition Examination Survey 2008-2011. The Journal of Kinesiology, 2017, 19(3): 61-70. [PURPOSE] This study aimed to investigate the associations of sarcopenia with rheumatoid arthritis and osteoarthritis in the general population of Korean adults. [METHODS] We analyzed the data for 11,466 adults aged 40 years from the Korea National Health and Nutrition Examination Survey 2008-2011. Dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass. Sarcopenia was defined when the appendicular skeletal muscle index was less than the sex-specific average minus the two standard deviations in the young reference group(age, 20-39 years). Survey logistic regression analysis was used to assess the association of sarcopenia with rheumatoid arthritis and osteoarthritis. [RESULTS] Sarcopenia status was dose-dependently associated with a higher risk of rheumatoid arthritis, after adjustment for potential confounders(p-trend=.002, odds ratio [OR], 2.14; 95% confidence interval [CI], 1.13, 4.05 in sarcopenia group vs. high muscle mass group). However, a higher risk of osteoarthritis was observed in pre-sarcopenia group compared with the high muscle mass group(or, 1.45; 95% CI, 1.03, 2.05), but not in sarcopenia group. [CONCLUSIONS] We found that sarcopenia status was associated with rheumatoid arthritis, and pre-sarcopenia status was associated with osteoarthritis. Our findings suggest that maintaining a skeletal muscle could be beneficial in preventing musculoskeletal disorders, including rheumatoid arthritis and osteoarthritis. Key words : sarcopenia, skeletal muscle mass, rheumatoid arthritis, osteoarthritis, KNHANES 주요어 : 근감소증, 골격근량, 류마티스관절염, 골관절염, 국민건강영양조사 서론 통계청자료에따르면우리나라고령인구의비율은 2015년 12.8% 에서, 2025년에는 20% 로지속적으로증가할것으로예상되고있다 (Statistics Korea, 2016). 평균수명의향상에따른노인인구의증가는만성질환의증가를초래하며, 그로인한사회 경제적인부담과건강관련삶의질 (Quality of life) 의저하는중요한문제로대두되고있다 (Lee, 2014). 노화에따른대표적인신체의변화로골격근 (skeletal muscle mass) 과근력 (muscle strength) 의감소를들수있다 (Goodpaster et al., 2006). 골격근의양 은 40대이후연간약 0.8%(10년에약 8%) 감소하며 (Mitchell et al., 2012), 70대이후의노인에서는더급격한근감소현상이관찰되어 10년동안약 15% 까지감소하는것으로보고되고있다. 이러한노화에따른신체조성및기능의변화를근감소증 (sarcopenia) 이라정의하며 (Mitchell et al., 2012), 이는노인의보행기능의감소, 장애및낙상위험의증가와같은신체기능장애 (functional impairment) 와관련이있는것으로보고되고있다 (Janssen et al., 2002; Rantanen., 2003; Landi et al., 2012). 뿐만아니라, 최근의많은역학연구에서근감소증이대사기능장애및노인성만성질환과같은동반질환의원인으로주목을받고있다 (Biolo et al., 2014). 그리고이는근감소증과 tumor necrosis * 이논문은 2014년도가천대학교교내연구비지원에의한결과임.(GCU-2014-5094) ** 교신저자 : junghoonkim@gachon.ac.kr *** 교신저자 : yoonchoi@gachon.ac.kr
62 한국성인의근감소증과류마티스관절염및골관절염의관련성 : 국민건강영양조사 2008-2011 factor-alpha (TNF-α), interleukin-1 (IL-1) 그리고 interleukin-6(il-6) 와같은염증사이토카인 (Morley et al., 2001) 과의관련성을통해설명이가능하다. 또한, Chang & Lin(2016) 은메타분석연구를통해근감소증그룹에서근감소증에해당하지않는그룹에비해사망률이더높아진다고보고하고있다. 따라서근감소증의예방은계속적으로증가하는노인인구의신체적자립과삶의질향상그리고노인성만성질환의예방을위한효과적인전략이라할수있을것이다. 노화와관련된대표적인근골격계질환으로류마티스관절염과골관절염 ( 퇴행성관절염 ) 이있다 (Hur et al., 2008). Kwon et al.(2012) 은한국인의류마티스관절염유병률이 50대에서 2.23%, 60대에서 3.16%, 70세이상에서 5.28% 로나이에따라서증가하는것으로보고하였다. 골관절염유병률또한 50대에서 4.7%, 60대에서 14.0%, 70세이상에서 26.1% 로증가하는것으로나타났다 (Korea Centers for Disease Control and Prevention, 2015). 이두질환모두선행연구에따르면질환발병에있어 TNF-α, IL-1 그리고 IL-6 등공통된여러염증사이토카인이나타난다고보고되고있다 (Guerne et al., 1989; Schlaak et al., 1995; Maggio et al., 2006). 그러나유사한증상과는달리류마티스관절염과골관절염의근본적인원인과발병기전은다르다고보고되고있다. 류마티스관절염은관절을둘러싸고있는활막에염증이생겨관절의변형이나장애를초래하는자가면역성만성관절질환이다 (Alamanos & Drosos, 2005). 그리고골관절염은퇴행성질환으로관절사이에있는연골이닳아없어지면서통증과손상이발생하는질환으로노인인구에서가장흔하게발생하는만성관절질환이다 (Anderson & Loeser, 2010). 특히, 류마티스관절염의발병요인에대해서아직까지명확하게알려지지않았기에많은연구가필요한부분이다. 근감소증은근력과신체기능의감소뿐아니라염증사이토카인의증가와도관련이있으며, 이러한근감소증으로인한근기능의저하로나타나는만성적인염증은류마티스관절염과골관절염의위험요인으로작용할수있을것이다. 이와관련하여몇몇임상관련환자-대조군연구에서는류마티스관절염이나골관절염환자들에서관절부위통증외에도전신골격근의감 소와관절변형, 신체장애등이복합적으로나타나는것으로보고하였고근감소증과관절염 ( 류마티스관절염, 골관절염 ) 간의관련성에대하여보고하였다 (Kramer et al., 2012; Doğan et al., 2015). 그러나지금까지소규모의임상연구를바탕으로실시한몇몇선행연구가보고되고있을뿐, 일반적인인구집단에서의근감소증과류마티스관절염및골관절염대한연구는보고되지않았다. 따라서본연구에서는국민건강영양조사 2008-2011 자료를이용하여일반적인한국성인에있어서근감소증과류마티스관절염및골관절염의관련성을규명하는것을연구의목적으로하였다. 연구방법 연구대상본연구는국민건강영양조사 (The Korea National Health and Nutrition Examination Survey, KNHANES) 자료를활용하였으며, Dual energy X-ray absorptiometry(dxa) 를이용한골격근의평가가이루어진 2008년-2011년도의자료를분석자료로선정하였다. 전체조사참여자 37,753명중골격근의평가를위한 DXA 측정에참여한 20세이상의성인 19,130명중, 20 세-39세의젊은성인그룹은근감소증의진단을위한기준집단 (N=5,944) 으로분류하고 (Baumgartner et al., 1998; Janssen et al., 2002), 40세이상의중년및노인그룹을본연구대상자 (N=13,186) 로선정하였다. 연구대상자중, DXA 측정의결손값을가진 452명과관절염및류마티스관절염데이터의결손값을가진 70명을분석대상에서제외하였다. 그리고가구소득, 교육수준, 흡연, 음주, 유산소성신체활동, 근력운동, 체질량지수 (Body Mass Index; BMI), 고혈압유무, 당뇨병유무등의보정변수에대한자료중결손값을가지는대상자를추가로제외한 11,466명을최종분석대상으로하였다. 본연구에서사용한모든국민건강영양조사자료는질병관리본부연구윤리심의위원회의승인을받아실시되었다 (IRB No: 2008-04EXP-01-C, 2009-01CON-03-2C, 2010-02CON-21-C, 2011-02CON-06-C).
윤정교, 김정훈, 최윤형 63 측정항목및방법골격근의평가와근감소증의진단골격근의평가를위해 DXA 로측정된자료를이용하였다. 뼈와지방을제외하고측정된총사지근육량 (appendicular skeletal muscle mass; ASM) 을체중 (body weight) 으로나눈후 100을곱한값을산출하여 (ASM/body weight 100) 골격근지표 (skeletal muscle mass index; SMI) 로사용하였다 (Janssen et al., 2002). 성별에따라측정한골격근지표 (SMI) 가젊은성인으로구성된기준집단 (20-39세) 의평균값 2 standard deviation(sd) 미만인경우를 sarcopenia 그룹 ( 남 : <27.18%, 여 : <21.30%) 으로정의하였다. 또한, 평균값 SD 미만인경우는 pre-sarcopenia 그룹 ( 남 : 27.18-30.13%, 여 : 21.30-23.76%) 으로정의하였으며, 평균값에서 ±SD 범위는 normal muscle mass 그룹 ( 남 : 30.13-36.03%, 여 : 23.76-28.68%), 평균값 +SD 보다클경우 high muscle mass 그룹 ( 남 : 36.03%, 여 : 28.68%) 으로각각분류하였다. 류마티스관절염과골관절염의진단류마티스관절염과골관절염의유병여부는자가보고설문을통하여평가하였다. 각각의질환에대해서 살아오면서류마티스관절염 ( 골관절염 ) 을의사로부터진단받은적이있습니까? 라는질문에 의사에게진단을받았음 으로응답한대상자를류마티스관절염및골관절염환자로정의하였다. 인구사회학적특성및건강관련요인교육수준은초졸이하, 중졸, 고졸, 대졸이상으로 4 그룹으로구분하였고, 가구소득수준은국민건강영양조사각조사연도별 4분위수로구분하였다. 흡연은비흡연자, 과거흡연자, 현재흡연자로구분하였으며, 음주빈도는금주, 주 1회이하, 주 2-3회, 주 4회이상으로분류하였다. 유산소성신체활동은적어도 10분이상의중강도및고강도의신체활동실천유무, 주당실천횟수 ( 빈도, 0-7회 ) 및지속시간 ( 시간 / 분 ) 을각각조사하여, 주당신체활동량 ( 빈도 분 / 주 ) 으로환산하였다. 그리고, 한국인을위한신체활동가이드라인에기초하여유산소성신체활동은주 150분미만 (low) 과이상 (high) 으로, 근력운동은주 2회미만 (low) 과주 2회이상 (high) 으로각각분류하였다 (Ministry of Health and Welfare, 2013). 고혈압의판정을위해공복시측정한수축기혈압과이완기혈압을사용하였다. 혈압은 3회측정한데이터를사용하여수축기와이완기혈압의최저치를각각사용하였다. 수축기혈압 140mmHg 이상또는이완기혈압 90mmHg이상, 또는혈압을낮추기위한약물을복용하고있다고응답한경우고혈압으로진단하였다. 당뇨병은 8시간이상금식후측정한공복혈당이 126mg/dL 이상이거나혈당을조절하고있는약물을복용하고있거나또는인슐린을사용하는경우당뇨병으로판정하였다. 자료처리본연구의모든자료처리는 IBM SPSS Statistics ver. 23.0 을사용한복합표본설계분석모듈을사용하였으며, 해당표본의자료분석을위해국민건강영양조사에서제시한층화변수 (Kstarata) 와집락변수 (PSU), 연관성분석가중치 (weight) 를적용하여분석계획파일을생성하였다. 나이, BMI, SMI 와같은연속형변수는가중치를적용한평균값 (weighted mean) 과표준오차 (standard error; SE) 로제시하였고, 성별, 가구소득, 교육수준, 흡연, 음주빈도, 신체활동의명목형변수는가중치를적용한비율 (weighted %) 로제시하였다. 근감소증의판정기준에따라분류된각그룹의인구사회학적변수및건강행태의차이를비교하기위해서범주형변수는 Chi-square test, 연속형변수는선형회귀분석 (Linear regression) 을이용한트렌드분석 (trend analysis) 을실시하였다. 근감소증과류마티스관절염및골관절염의관련성을평가하기위해로지스틱회귀분석 (Logistic Regression) 을실시하였다. 로지스틱회귀분석은 high muscle mass 를기준범주 (reference) 로설정하여각그룹의류마티스관절염과골관절염에대한오즈비 (odds ratio; OR) 와 95% 신뢰구간 (confidence interval; CI) 을산출하였다. 또한, 근감소증과류마티스관절염및골관절염유병의양-반응관련성 (dose-response relationship) 을평가하기위해서로지스틱회귀모형을이용한트렌드분석 (trend analysis)
64 한국성인의근감소증과류마티스관절염및골관절염의관련성 : 국민건강영양조사 2008-2011 을실시하였다. 모든로지스틱회귀모형은나이, 성별, 가구소득, 교육수준, 흡연, 음주, 유산소성신체활동, 근력운동, BMI, 고혈압, 당뇨병유무로보정하였다. 본연구의모든통계분석의유의수준은 p<.05로설정하였다. 결과 <Table 1> 은연구대상자의특성을제시하였다. 대상자총 11,466명의평균나이는 54.92±0.18(SE) 세였고 BMI 와 SMI의평균은각각 24.03±0.04(kg/ m2 ), 28.34±0.06( 남 : 31.92±0.07, 여 : 25.02±0.06) 으로나타났다. 전체대상자중 51.77% 는여성이었고고혈압은 40.57%, 당뇨병은 12.55% 로나타났다. 골관절염을앓고있는사람은 13.28% 였으며류마티스관절염은 2.45% 로나타났다. <Table 2> 는근감소증의판정기준에따라분류된각그룹의대상자특성을비교한결과를제시하였다. 근감소증의정도에따라서평균연령및 BMI는유의하게높은것으로나타났다 (p-trend). 또한, 근감소증의정도에따라성별과유산소성신체활동그리고근력운동에서비율차이가유의하게나타났다. 그리고근감소증의정도가심화될수록골관절염과류마티스관절염에서유의한유병비율의차이가관찰되었으며 sarcopenia 그룹에서의골관절염과류마티스관절염은각각 178명 (24.09%), 38명 (5.63%) 로다른그룹에비해가장높게나타났다. <Table 3> 는근감소증과류마티스관절염간의관련성을평가하기위해로지스틱회귀분석을이용해분석한결과를나타냈다. 연령, 성별, 가구소득수준, 교육수준, 흡연, 음주, 신체활동, 근력운동, BMI, 고혈압과당뇨병을보정한후에, 근감소증의정도에따라류마티스관절염의유병오즈비가유의하게증가하는것으로나타났다 (p-trend=.002). high muscle mass 그룹에비교하여 pre-sarcopenia, sarcopenia 그룹에서의류마티스관절염유병오즈비는각각 1.15(95% CI: 0.67, 1.97), 2.14(95% CI: 1.13, 4.05) 였다. Table 1. Participants characteristics (N=11,466) Characteristics Distribution Age (years) 54.92 ±0.18 a) Skeletal muscle mass index (%) 28.34 ±0.06 Body mass index (kg/ m2 ) 24.03 ±0.04 Sex (n (%)) Males 4958 (48.23) b) Females 6508 (51.77) Household income (n (%)) Low 2925 (20.73) Low-middle 2842 (25.47) High-middle 2784 (26.38) High 2915 (27.42) Education level (n (%)) Elementary 4399 (31.35) Middle school 1813 (16.32) High school 3214 (31.54) College 2040 (20.79) Smoking status (n (%)) Never 6789 (54.61) Former 1166 (11.14) Current 3511 (34.25) Alcohol consumption (n (%)) Never 3935 (29.75) Once a week 4962 (44.82) 2-3 times/week 1516 (15.58) 4 times/week 1053 (9.85) Physical activity (n (%)) Low (<150 min/week) 7018 (60.04) High ( 150 min/week) 4448 (39.96) Muscular training (n (%)) Low (<2 days/week) 9230 (78.77) High ( 2 days/week) 2236 (21.23) Osteoarthritis (n (%)) No 9608 (86.72) Yes 1858 (13.28) Rheumatoid arthritis (n (%)) No 11128 (97.55) Yes 338 (2.45) Hypertension (n (%)) No 6468 (59.43) Yes 4998 (40.57) Diabetes (n (%)) No 9917 (87.45) Yes 1549 (12.55) a) Weighted mean±se from survey mean (all such values). b) Weighted percentages from survey frequency (all such values).
윤정교, 김정훈, 최윤형 65 Table 2. Participant characteristics by the sarcopenia status. high muscle mass normal muscle mass pre-sarcopenia sarcopenia p-value b) Characteristics N (%) a) N (%) N (%) N (%) Age (years) 54.22 ±0.58 c) 53.88 ±0.20 56.93 ±0.29 60.51 ±0.54 Body mass index (kg/ m2 ) 20.96 ±0.12 23.62 ±0.04 25.47 ±0.08 27.22 ±0.20 Sex (n (%)) Males 311 (45.56) 3319 (50.84) 1101 (43.64) 227 (37.88) Females 511 (54.44) 4012 (49.16) 1583 (56.36) 402 (62.12) Household income (n (%)) Low 240 (22.82) 1740 (18.71) 721 (23.63) 224 (31.51) Low-middle 204 (25.85) 1781 (25.23) 684 (25.28) 173 (28.94) High-middle 189 (26.63) 1862 (27.38) 620 (25.10) 113 (18.56) High 189 (24.69) 1948 (28.67) 659 (25.99) 119 (20.99) Education level (n (%)) Elementary 356 (32.84) 2620 (28.69) 1100 (36.17) 323 (42.94) Middle school 103 (12.36) 1165 (16.45) 434 (16.52) 111 (19.07) High school 245 (35.74) 2172 (33.09) 675 (27.42) 122 (23.85) College 118 (19.06) 1374 (21.77) 475 (19.89) 73 (14.14) Smoking status (n (%)) Never 519 (55.67) 4212 (52.59) 1646 (58.47) 412 (62.45) Former 49 (7.32) 724 (11.10) 315 (12.23) 78 (11.95) Current 254 (37.01) 2395 (36.30) 723 (29.30) 139 (25.60) Alcohol consumption (n (%)) Never 310 (30.45) 2315 (27.44) 1028 (34.05) 282 (40.07) Once a week 339 (44.48) 3266 (45.51) 1115 (43.53) 242 (41.93) 2-3 times/week 100 (14.12) 1035 (16.75) 321 (13.63) 60 (10.77) 4 times/week 73 (10.94) 715 (10.30) 220 (8.79) 45 (7.24) Physical activity (n (%)) Low (<150 min/week) 421 (49.11) 4319 (57.80) 1840 (68.51) 438 (66.46) High ( 150 min/week) 401 (50.89) 3012 (42.20) 844 (31.49) 191 (33.54) Muscular training (n (%)) Low (<2 days/week) 669 (76.31) 5806 (77.59) 2218 (82.05) 537 (82.85) High ( 2 days/week) 153 (23.69) 1525 (22.41) 466 (17.95) 92 (17.15) Osteoarthritis (n (%)) No 719 (90.91) 6319 (88.83) 2119 (81.64) 451 (75.91) Yes 103 (9.09) 1012 (11.17) 565 (18.36) 178 (24.09) Rheumatoid arthritis (n (%)) No 792 (97.25) 7142 (97.91) 2603 (97.30) 591 (94.37) Yes 30 (2.75) 189 (2.09) 81 (2.70) 38 (5.63) Hypertension (n (%)) No 596 (76.28) 4390 (62.55) 1267 (50.12) 215 (37.12) Yes 226 (23.72) 2941 (37.45) 1417 (49.88) 414 (62.88) Diabetes (n (%)) No 770 (93.66) 6457 (88.91) 2221 (84.00) 469 (75.25) Yes 52 (6.34) 874 (11.09) 463 (16.00) 160 (24.75) a) Weighted percentages from survey frequency(all such values). b) p-values were calculated using chi-square tests for categorical variables and trend test based on linear regression for continuous variables according to survey procedures. c) Weighted mean±se from survey mean(all such values).
66 한국성인의근감소증과류마티스관절염및골관절염의관련성 : 국민건강영양조사 2008-2011 Table 3. OR (95% CI) for rheumatoid arthritis by sarcopenia status. Sarcopenia status N OR (95% CI) high muscle mass 822 1.00 (Reference) normal muscle mass 7331 1.01 (0.64, 1.61) pre-sarcopenia 2684 1.15 (0.67, 1.97) sarcopenia 629 2.14 (1.13, 4.05) p-trend 0.002 Adjusted for age, sex, household income, education level, smoking status, alcohol consumption, physical activity, muscular training, BMI, hypertension, and diabetes. Table 4. OR (95% CI) for osteoarthritis by sarcopenia status. Sarcopenia status N OR (95% CI) high muscle mass 822 1.00 (Reference) normal muscle mass 7331 1.28 (0.93, 1.78) pre-sarcopenia 2684 1.45 (1.03, 2.05) sarcopenia 629 1.33 (0.88, 2.01) p-trend 0.135 Adjusted for age, sex, household income, education level, smoking status, alcohol consumption, physical activity, muscular training, BMI, hypertension, and diabetes. <Table 4> 는근감소증과골관절염간의관련성에대한로지스틱회귀분석결과를나타냈다. high muscle mass 그룹에비교하여 sarcopenia 그룹에서골관절염의오즈비는 1.33(95% CI: 0.88, 2.01) 으로통계적인유의성은관찰되지않았으나 pre-sarcopenia 그룹에서의골관절염의오즈비는 1.45(95% CI: 1.03, 2.05) 로통계적으로유의한차이가나타났다. 그리고트렌드분석결과 p-trend=.135 로근감소증의정도에따른골관절염유병위험의유의한양-반응관련성 (dose-response relationship) 은나타나지않았다. 논의 본연구는국민건강영양조사자료를활용하여우리나라성인의일반적인인구집단에서근감소증과류마티스관절염및골관절염의연관성에대해알아보았다. 그결과, 골격근의감소가심화될수록류마티스관절염의유병위험이유의하게증가했다. 또한 pre-sarcopenia 그룹에서골관절염유병위험은 high muscle mass 그룹에비해높게 나타났다. 따라서본연구의결과는노화에따른골격근의표현형으로나타나는근감소증을예방함으로서근골격계질환으로대표되는류마티스관절염및골관절염의예방에기여할수있을것으로기대된다. 본연구는근감소증의정도에따른류마티스관절염유병위험의양-반응관련성 (dose-response relationship) 을확인한연구이며일반적인인구집단을대상으로실시한첫연구이다. 골격근감소와류마티스관절염에대한몇가지임상관련환자- 대조군연구가보고되어있으나대상자수가한정되어있고일반적인구집단이아닌류마티스관절염환자를대상으로하였다. 예를들어, Doğan, et al.(2015) 은여성류마티스관절염환자에서대조군에비교하여더많은골격근의감소가관찰되었다고보고하였다. 그리고 45세이상의중고령자 189명을대상으로실시한 Giles et al.(2008) 의환자- 대조군단면연구에서는대조군에비교하여류마티스관절염환자에서더많은골격근의감소와비정상적인지방의축적이관찰되었다. 본연구결과에서도근감소증이심화됨에따라 BMI 가유의하게증가하였으며골관절염과류마티스관절염의유병률또한높게나타났다. 이러한선행연구와본연구의결과는류마티스관절염예방을위한신체조성개선에대한중요성을시사하고있다. 노화에따른골격근의감소로인한염증증가의기전과골형성에대한직접적인영향은류마티스관절염및골관절염의원인으로작용할수있을것이다. 골격근에서분비되는마이오카인의일종인 IL-6, interleukin-15 (IL-15), 이리신 (irisin) 등은인슐린분비와내장지방의분해를촉진하고근육내의지방분해를촉진하는역할을하며항염증효과에기여하는것으로보고되고있다 (Pedersen & Febbraio, 2012; Eckardt et al., 2014). 근감소로인한이러한낮은수준의만성적인염증은류마티스관절염및골관절염의병인과병태생리학적기전과일치한다 (Fougere et al., 2016). 또한골격근유래 insulin-like growth factor(igf-1) 과 fibroblast growth factor(fgf-2) 는골의형성과흡수에중요한역할을한다. 이러한근거는몇몇역학연구 (epidemiology study) 를통해근감소증이골밀도및골다공증에위험요인으로작용한다고보고된바있다 (Verschueren et al., 2013). 근감소증이심화됨에따라류마티스관절염과골관절염의유병위험이유의하게증가한본연구결과는
윤정교, 김정훈, 최윤형 67 이러한앞선선행연구를뒷받침할수있는결과이다. 노화에따른골격근의감소로나타나는만성질환은류마티스관절염과골관절염의원인으로작용할수있다. 실제로본연구에서는근감소증이심화될수록고혈압과당뇨병의유병율이유의하게증가하였다 <Table 2>. 골격근의감소는다양한만성질환과직접적으로관련되어있고만성질환에서기인한염증은류마티스관절염및골관절염의원인과도연결된다. 낮은수준의골격근량은당뇨병, 인슐린저항성, 심혈관질환및조기사망위험과관련이있다 (Kalyani et al., 2014). 이러한대사질환은높은염증수치와관련이있으며, 이는류마티스관절염및골관절염과도연결된다 (Burner & Rosenthal, 2009; Crowson et al., 2013). 예를들어, 아직까지는관련근거의부족으로당뇨병이류마티스관절염의독립된위험요인으로주목받지는못하지만, 많은경우에이두질환은동반질환으로나타난다 (Burner & Rosenthal, 2009). 또한류마티스관절염과심질환은염증과관련된많은기전을공유하는것으로보고되어있다 (Crowson et al., 2013). 류마티스관절염과골관절염은대표적인근골격계질환이지만증상과발병기전이서로다르다 (Schlaak et al., 1995). 골관절염환자의근육량과근력의감소는대표적인증상이자위험요인으로나타난다 (Scott et al., 2012). 본연구에서근감소증과골관절염간의연관성을분석하였으나 sarcopenia 그룹에서유의한결과가관찰되지않았다. 이것은골관절염의다양한발병원인으로설명할수있을것이다. 첫째, 관절의과사용은골관절염의대표적인원인으로들수있다. 예를들어육체노동직업자의경우관절의부상이나관절의물리적인과사용으로골관절염이나타날수있다 (Coggon et al., 2000). 둘째, 비만으로인한체중의증가로관절의부하가증가할경우골관절염이나타날수있다 (Sellam & Berenbaum, 2013). 그러나, 본연구에서는노인성질환으로인한골관절염과다른원인에의한골관절염을명확히구분할수없었다. 실제로, 본연구대상자중골관절염환자는류마티스관절염환자에비해높은유병률을보였다. 그리고 pre-sarcopenia 그룹에서골관절염오즈비 (odds ratio) 가 1.45로 high muscle mass 그룹에비해유의하게높게나타났으며이는여전히노화로인한근감소가골관절염에영향을 줄수있음을시사한다. 본연구의강점으로는첫째, 대표성을가지고있는국민건강영양조사자료를이용하여일반적인한국성인을대상으로분석이이루어졌다는점이다. 두번째, 근감소증을진단하기위하여골격근량을평가하는가장표준적인방법으로알려진 DXA를이용해정확한측정이이루어졌다. 세번째, 근감소증과류마티스관절염그리고골관절염에영향을줄수있는인구사회학적인요인과건강관련행태및질환과관련한요인들을통계적으로통제한점을들수있다. 그러나, 본연구는단면연구로서질환간의선후적인과관계를파악할수없었다. 근감소증으로인해근골격계질환이발생할수있지만, 반대로근골격계질환의발생은신체활동량을감소시키고이동성을제한하기때문에근감소를가속화시킬수있다는가능성을배제할수없다. 따라서향후전향적코호트연구를통한검증이필요할것이다. 또한, 본연구에서종속변수로제시된류마티스관절염과골관절염은자기기입식설문자료를이용했다. 따라서, 개인의질환진행속도나중증도를비교할수없었다. 결론 본연구에서근감소증은류마티스관절염및골관절염의유병위험의증가와관련이있음을확인하였다. 골격근의유지를통한근감소증예방은곧근골격계질환의예방으로이어져노인의신체기능적자립과삶의질의향상에긍정적인영향을줄것으로사료된다. 따라서, 본연구결과를토대로근골격계질환의예방과증상개선을위한근감소증예방프로그램개발등의적용이가능하며, 이를구체적으로적용하기위해서는추가적인중재연구가필요하겠다. 참고문헌 Alamanos, Y., & Drosos, A. A. (2005). Epidemiology of adult rheumatoid arthritis. Autoimmunity
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