KJFPpISSN 2233-9019 eissn 2233-9116 Original Article 한국성인에서고립성저 high-density lipoprotein 콜레스테롤혈증과인슐린저항성간의독립적인상관관계 : 국민건강영양조사자료활용 (2008~2011) 이은준, 김도현, 이지연 *, 이덕철 * 연세대학교의과대학세브란스병원가정의학교실 low high-density lipoprotein cholesterolemia is independently related to insulin resistance among Korean adults: Using Korean National Health and Nutrition Examination Survey data (2008~2011) Eun-Joon Lee, Do-Hyun Kim, Jee-Yon Lee *, Duk-Chul Lee * Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine Background: Low high-density lipoprotein cholesterol () is an independent risk factor for cardiovascular disease and one of the components of metabolic syndrome. In Korea, low has the biggest proportion in all kinds ofis the most prevalent type of dyslipidemia and sustains high prevalence with increasing prevalence of metabolic syndromeis becoming more prevalent as rates of metabolic syndrome increase. Recent large-scale population study studies suggests that isolated low is also associated with an increased risk of coronary heart disease. Methods: 24,499 participants aged 19 years and older from who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) during between 2008~2011 were included in this study, excluding lipid-lowering drug users, cardio-cerebrovascular patients and cancer patients. Low was defined by serum <40mg/dL in men and <50mg/dL in women. Subjects were divided into 3 groups according to lipid levels and analysis of covariance was used to explore the differences of in fasting glucose, HbA1c, fasting insulin and insulin resistance among between groups. Association between lipid levels and insulin resistance was analyzed by multiple logistic regression analysis. Results: The odds ratio for diabetes mellitus for isolated low was 1.31 (95% CI 1.12~1.54). The three groups showed statistically significant differences in insulin resistance, fasting insulin, fasting glucose and HbA1c (P). low was independently associated with increased insulin resistance risk (oodds ratio 1.38 [95% CI 1.23~1.56]). Conclusion: low with an independent association with insulin resistance should be screened for and managed to prevent progression to cardiovascular disease or metabolic syndrome. Keywords: low holesterol; insulin resistance; HOMA-IR 서론한국의이상지질혈증유병률은지속적인증가추세를보이고있다. 1) 이상지질혈증에있어기존에는저밀도지단백콜레스테롤 (lowdensity lipoprotein, LDL-C) 과중성지방 (triglyceride, TG) 의중요성이주로강조되어왔으나, 최근관상동맥질환의독립적위험인자의하나인저 혈증 2) 에대한대규모연구중다른지질이 상을동반하지않은고립성저혈증의경우에도복합성저 혈증과비슷한수준의관상동맥질환위험연관성이있다는것이밝혀졌다. 3) 한국성인의이상지질혈증은저, 고TG의특성을보이고있으며, 4) 이는당뇨병성이상지질혈증의특성으로알려져있다. 5, 6) 그중고TG혈증유병률은 2005년이후큰변동이없는반면, 1) 저 혈증은한국의이상지질혈증에서가장높은유병률, 4) 그리 Received February 27, 2015 Revised July 27, 2015 Accepted September 17, 2015 Corresponding Author Duk-Chul Lee Tel: +82-2-2228-2330, Fax: +82-2-362-3742 E-mail: FAITH@yuhs.ac Copyright 2015 The Korean Academy of Family Medicine This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 794 www.kafm.or.kr
이은준외. 한국성인에서고립성저 high-density lipoprotein 콜레스테롤혈증과인슐린저항성간의 독립적인상관관계 : 국민건강영양조사자료활용 (2008~2011) KJFP 고대사증후군과동반한가장큰증가추세를보이면서 1998년부터 2007년까지 10년간한국의지속적인대사증후군유병률증가의주원인중하나로보고되었다. 7) 이러한저혈증의유병률, 심혈관계질환과의연관성, 8) 대사증후군요소로서의중요성등을고려할때, 한국인에서고립성저혈증단독에대한연구는중요한의미가있을것으로생각된다. 특히심혈관계질환과대사증후군에서공통적으로중요성을갖는인슐린저항성과관련한고립성저에대한연구는각질환의예방전략에있어중요한참고가될수있을것으로기대된다. 본연구에서는최근중요성이강조되고있으나충분한연구가되어있지않은한국성인의고립성저혈증에주목하여, 관련위험요인분석을통해고립성저혈증의적절한관리의필요성을살펴보고자하였다. 저혈증은 8시간이상공복자중 ( 전환식적용 ) 이남성 40mg/dL 미만, 여성 50mg/dL 미만인경우로정의하였으며, 고립성저혈증은저혈증이면서고LDL-C이나고TG를동반하지않는경우로, 복합성저 혈증은저혈증이면서 LDL-C 160mg/dL 이상또는 TG 200mg/dL 이상또는그두가지를모두동반한경우로정의하였다. 9) 방법 1. 연구대상 2008~2011년에시행된 4기, 5기의국민건강영양조사참여자중 19세이상성인총 24499명 ( 각연도당 6420명, 6918명, 5623명, 5538명 ) 을대상으로하였다. 2. 자료수집 1) 사회경제적상태및생활습관대상자들의나이, 성별, 음주, 흡연상태, 운동상태, 영양섭취, 거주지역, 교육정도, 가구수입, 결혼상태를이용하였다. 음주는 1주일동안의음주빈도로, 운동상태는중등도이상신체활동실천율로, 흡연은비흡연군, 과거흡연군, 현재흡연군으로구분하였다. 영양섭취상태는 24시간회상법을통해총칼로리섭취량과지방섭취량을분석하였다. 교육정도는초등학교졸업이하, 중학교졸업이하, 고등학교졸업이하, 대학교졸업이상으로분류하였고, 가구수입은 4개범위로분류하였다. 2) 검진조사및생화학적검사고혈압진단기준은 sbp 140mmHg 또는 dbp 90mmHg 또는고혈압약복용중으로정의하였고, 당뇨진단기준은현재당뇨약복용중또는공복혈당 126mg/dL 이상또는 HbA1c 6.5% 이상 인경우로정의하였다. 생화학적검사는 8시간이상금식후자동분석기로측정된총콜레스테롤,, LDL-C, TG, 공복혈당수치를사용하였다. 4개년도모두 Hitachi Automatic Analyzer 7600 (Hitachi/Japan) 이사용되었다. 인슐린은 1470 WIZARD gamma- Counter (PerkinElmer/Finland) 를, 당화혈색소는 HLC-723G7 (Tosoh/Japan) 를사용하여분석하였다. 수치의경우, 국민건강영양조사에서기존전환식재검증을실시, 이상검체제외후도출한최종전환식 {2008~2011년전환식 : ( 전환식적용 HDL)=0.872 ( 원자료 HDL)+2.460, 2012 년전환식 : ( 전환식적용 HDL)=0.952 ( 원자료 HDL)+1.096} 을적용한 HDL콜레스테롤전환자료 ( 변수명 :HE_HDL_st) 를사용하였다. 인슐린저항성과췌장베타세포의기능을양적으로예측하기위한인슐린저항성수치인 homeostatic model assessment-insulin resistance(homa-ir) 는 {(HOMA-IR)=fasting glucose(mg/dl) x fasting insulin(mu/l)/405} 계산식을이용하였다. 3. 통계분석국민건강영양조사의특성을고려하여 1차추출단위 ( 조사구 ), 층화변수, 가중치를고려해분석하였다. 만 19세이상성인을대상으로하였고, 이중고지혈증약복용중인자, 심뇌혈관질환자, 암환자는제외하였다. 지질수치에따라정상 혈증, 고립성저 혈증, 복합성저혈증의세군으로나누어각군사이의공복혈당, 당화혈색소 (HbA1c), 공복 insulin, HOMA-IR의차이를비교하기위해 ANCOVA를시행하였다. 저혈증에따른당뇨병유병률과 HOMA-IR의연관성을파악하기위해다중로지스틱회귀분석을시행하여교차비와 95% 신뢰구간을구하였다. 당뇨병, HOMA-IR의교차비는연령, 성별, 음주, 흡연, 운동상태, BMI, 총열량섭취량, 거주지, 교육정도, 가구수입, 결혼상태, 수축기혈압을보정하여산출하였다. 모든통계분석은 SPSS ver. 18.0 프로그램을사용하였으며, P-value <0.05인경우통계적으로유의한것으로간주하였다. 결과 1. 연구대상자들의일반적특성연구대상자 24499명의평균연령은정상 군에서 42.55 ±0.18세, 고립성저군에서 47.04 ±0.32세, 복합성저군에서 50.95 ±0.39세로나타났다. 고립성저 혈증의유병률은 20.2%( 남성 11.6%, 여성 26.8%) 로, 전체저혈증유병률 29.7% 중 67.9% 를차지했다. 고립성저 군에서주 1회이하음주, 비음주자의비율은정상군이나 www.kafm.or.kr 795
KJFP Eun-Joon Lee, et al. low high-density lipoprotein cholesterolemia is independently related to insulin resistance among Korean adults: Using Korean National Health and Nutrition Examination Survey data (2008-2011) 복합성저군보다높은경향을보였다. 정상 혈증에서복합성저혈증으로갈수록운동상태, 교육정도, 가구수입이낮은경향을보였다. (Table 1) 2. 그룹에따른심혈관질환위험요소및대사증후군인자와의관계 수치를정상, 고립성저, 복합성저의세군으로나누어 ANOVA test와 chi-square test를사용해심혈관질환위험요소와대사증후군인자를살펴보았다. 고혈압과당뇨의유병률, 그리고 BMI, 허리둘레가정상군에서고립성저군, 복합성저군으로갈수록유의하게증가하는양상을보였다 (P). 공복혈당, 공복인슐린, HbA1c, HOMA-IR 또한정상군, 고립성저군, 복합성저군의순서대로증가하는양상으로세군간에통계적으로유의한차이를보였다 (P). (Table 1) 고립성저과인슐린저항성의관계를밝히기위해연령, 성별, 음주, 흡연상태, 운동상태, 총열량섭취량, 거주지, 교육정도, 가구수입, 결혼상태, BMI, 수축기혈압을보정한후 ANCOVA 분석을시행하여얻은결과들은다음과같다. (Figure 1) 공복혈당 (mg/dl) 은정상 혈증, 고립성저혈증, 복합성저 혈증에서각각 95.06±0.27, 98.48±0.41, 102.94±0.82 (P), 당화혈색소 (%) 는 5.77±0.03, 6.07±0.04, 6.44±0.07 (P ), 공복인슐린 (miu/ml) 은 9.76 ±0.09, 10.67 ±0.18, 11.35±0.23 (P), HOMA-IR은 2.25±0.03, 2.68±0.05, 2.93±0.08 (P) 로세군간에유의한차이를보였다. 3. 그룹에따른인슐린저항성, 당뇨의위험연령, 성별보정후 그룹에따른당뇨의위험은고립성저, 복합성저에서각각 1.40(95% CI 1.21~1.61), 2.31(95% CI 1.97~2.71) 로증가하였다. 운동상태, 음주, 흡연상태, Table 1. Characteristics between participants according to high density lipoprotein cholesterol level Variable level low Low + High LDL-C Subject numbers 17215 4945 2339 Demographic characteristics Age(years) 42.55± 0.18 47.04± 0.32 50.95± 0.39 Gender(n, %) Male Female Alcohol use(n, %) None 1/week >1/week 8438(49.0) 8777(51.0) 3817(22.5) 8706(51.2) 4467(26.3) 1235(25.0) 3710(75.0) 1894(38.9) 2510(51.5) 467(9.6) 975(41.7) 1364(58.3) 873(37.7) 1014(43.7) 431(18.6) Exercise status(n, %) 9143(53.8) 2406(49.5) 1111(48.0) Smoking(n, %) None Past Current Total caloric intake(kcal) Total fat intake(g) Socioeconomic characteristics Living place(n, %) Urban area Rural area Education level(n, %) graduate elementary school graduate middle school graduate high school graduate college Household income(n, %) Low(<733 USD) Low-medium(733-1429 USD) Medium-high(1429-2381 USD) High( 2380.95 USD) 9248(54.2) 3660(21.5) 4148(24.3) 2059.96±10.41 43.66±0.38 13390(77.8) 3825(22.2) 3562(20.9) 1776(10.4) 6292(37.0) 5393(31.7) 2874(17.1) 4239(25.0) 4831(28.5) 4989(29.5) 3494(71.6) 698(14.3) 687(14.1) 1801.69± 15.58 34.36± 0.59 3638(73.6) 1307(26.4) 1687(34.6) 566(11.6) 1497(30.7) 1126(23.1) 1203(24.7) 1243(25.5) 1282(26.3) 1139(23.4) 1297(55.8) 401(17.3) 625(26.9) 1918.80± 24.52 35.24± 0.83 1691(72.3) 648(27.7) 922(39.8) 300(12.9) 654(28.2) 441(19.0) 627(27.4) 598(25.0) 572(21.5) 491(21.5) P value * 796 www.kafm.or.kr
이은준외. 한국성인에서고립성저 high-density lipoprotein 콜레스테롤혈증과인슐린저항성간의 독립적인상관관계 : 국민건강영양조사자료활용 (2008~2011) KJFP level Variable low Low + High LDL-C P value * Marital status(n, %) Married Unmarried 14198(82.5) 3009(17.5) 4459(90.2) 484(9.8) 2199(94.1) 137(5.9) Clinical characteristics Hypertension(n, %) 2172(12.7) 995(20.3) 621(26.7) Diabetes(n, %) 701(4.1) 400(8.1) 253(10.8) Metabolic parameters BMI(kg/m 2 ) 23.21±0.03 24.07± 0.06 25.53± 0.08 WC(cm) 79.83±0.12 81.74± 0.18 87.13± 0.23 SBP(mmHg) 116.59± 0.18 116.40± 0.31 123.79± 0.43 DBP(mmHg) 76.68±0.13 74.84± 0.20 80.19± 0.29 Fasting glucose(mg/dl) 94.95±0.19 96.59±0.35 106.47±0.74 Insulin(mIU/mL) 9.65±0.07 10.94± 0.16 12.54± 0.26 HbA1c(%) 5.84±0.02 6.02± 0.04 6.63± 0.07 HOMA-IR 2.31±0.21 2.68± 0.46 3.38± 0.10 Data are presented as mean±standard error or proportion (%). * P values for continuous variables were calculated by ANOVA test using generalized linear model and P values for nominal variables were calculated by chi-square test. Low in the absence of a high LDL-C or high TG level. Low : <40mg/dL for males and <50mg/dL for females. High LDL-C: LDL-C 160mg/dL, High TG: TG 200mg/dL Figure 1. Insulin resistance according to groups by ANCOVA analysis Number 1, 2 and 3 of transverse axis mean normal, isolated low and combined low, respectively. Data are presented as mean±standard error. Data were adjusted for age, gender, alcohol status, smoking status, exercise status, total calorie intake, living place, education level, household income, marital status, body mass index and SBP. Mean value of HOMA-IR was 2.25±0.03 for normal, 2.68±0.05 for isolated low, and 2.93±0.08 for combined low (P). Mean values of fasting insulin for the three groups were 9.76±0.09, 10.67±0.18, and 11.35±0.23, respectively(p). Mean values of fasting glucose were 95.06±0.27, 98.48±0.41, and 102.94±0.82, respectively(p). And mean values of HbA1c were 5.77±0.03, 6.07±0.04, and 6.44±0.07, respectively(p). www.kafm.or.kr 797
KJFP Eun-Joon Lee, et al. low high-density lipoprotein cholesterolemia is independently related to insulin resistance among Korean adults: Using Korean National Health and Nutrition Examination Survey data (2008-2011) Table 2. Results of multiple logistic regressions for the presence of diabetes mellitus according to the level(weighted data) Table 3. Results of multiple logistic regressions for the presence of insulin resistance according to the level(weighted data) low Low + High LDL-C low Low + High LDL-C Diabetes mellitus HOMA-IR Model 1 a 1.54(1.12~1.79) 2.64(1.87~2.98) Model 1 a 1.79(1.67~1.98) 3.34(2.99~4.10) Model 2 b 1.40(1.21~1.61) 2.31(1.97~2.71) Model 2 b 1.66(1.49~1.85) 3.24(2.87~3.66) Model 3 c 1.22(1.15~1.42) 1.84(1.56~2.18) Model 3 c 1.33(1.18~1.49) 2.25(1.97~2.55) Model 4 d 1.31(1.12~1.54) 1.85(1.54~2.21) Model 4 d 1.38(1.23~1.56) 2.20(1.91~2.54) Data are presented as Odds ratios and 95% confidence intervals in parentheses a Unadjusted b Adjusted for age and gender c Adjusted for age, gender, exercise status, smoking status, alcohol use status and BMI. d Age, gender, alcohol status, smoking status, exercise status, total calorie intake, living place, education level, household income, marital status, body mass index, SBP. Odds ratios and 95% confidence intervals were calculated using multiple logistic regression. Diabetes mellitus: current oral hypoglycemic agent users or fasting glucose 126mg/dL or HbA1c 6.5% Low in the absence of a high LDL-C or high TG level. Low : <40mg/dL for males and <50mg/dL for females. High LDL-C: LDL-C 160mg/dL, High TG: TG 200mg/dL Data are presented as Odds ratios and 95% confidence intervals in parentheses a Unadjusted b Adjusted for age and gender c Adjusted for age, gender, exercise status, smoking status, alcohol use status and BMI. d Age, gender, alcohol status, smoking status, exercise status, total calorie intake, living place, education level, household income, marital status, body mass index, SBP. Odds ratios and 95% confidence intervals were calculated using multiple logistic regression. Low in the absence of a high LDL-C or high TG level. Low : <40mg/dL for males and <50mg/dL for females. High LDL-C: LDL-C 160mg/dL, High TG: TG 200mg/dL 성상에서이루어졌던점 10) 에서볼때주목할만하다. 만약전체 BMI, 열량섭취량, 거주지, 교육정도, 가구수입, 결혼상태, 수축기혈압추가보정후의교차비는각각 1.31 (95% CI 1.12~1.54), 1.85 (95% CI 1.54~2.21) 로확인되었다. (Table 2) 그룹에따른인슐린저항성을비교하기위해 HOMA- IR을 4분위수로나눈후, 네번째분위에해당하는군을인슐린저항성이있는것으로정의하고, 다중로지스틱회귀분석을시행하였다. 연령, 성별보정후인슐린저항성의교차비는고립성저, 복합성저에서각각 1.66 (95% CI 1.49~1.85), 3.24 (95% CI 2.87~3.66) 였고, 운동상태, 음주, 흡연상태, BMI, 총열량섭취량, 거주지, 교육정도, 가구수입, 결혼상태, 수축기혈압을추가로보정한후의교차비는각각 1.38(95% CI 1.23~1.56), 2.20 (95% CI 1.91~2.54) 이었다. (Table 2-1) 저혈증의병적특성에대한고립성저혈증의기여도가확인된다면, 고립성저에대한집중적인연구가저 혈증의정복에중요한실마리를제공할수있을것이다. 본연구에서고립성저혈증이있을때심혈관질환위험요소, 대사증후군인자가유의하게증가하는양상이확인되었다. 보정후, 세그룹에따른인슐린저항성, 당뇨의교차비분석에서고립성저은인슐린저항성의위험을 38% 증가시키며, 당뇨의위험을 31% 증가시키는것으로나타났다. 복합성저 군에서는인슐린저항성의위험이 120%, 당뇨의위험이 85% 증가하였다. 이는복합성저혈증뿐만아니라, 다른지질이상을동반하지않는고립성저혈증에서도인슐린저항성, 당뇨발생가능성이유의하게증가한다는가설을뒷받침하는결과이다. 인슐린저항성과관련하여고립성저 혈증에대한외국 고찰 의선행연구, 11) 한국인을대상으로한 TG/ 비와인슐린저 항성의관계에대한선행연구등이있었으나, 10) 예방적접근차원에 본연구의분석결과, 한국성인의고립성저혈증은전체저혈증에서 2/3가넘는큰분율을차지하였으며, 복합성저혈증과마찬가지로고립성저혈증에서도인슐린저항성및당뇨의발생률이독립적으로증가함을확인할수있었다. 분석대상자에서고지혈증약복용자, 심혈관계질환자를제외한것을고려한다면실제유병률은더욱높을것으로예상된다. 고립성저혈증이전체저혈증의큰분율을차지하는현상은, 기존의저혈증연구가주로 TG와의연관 서대표성이확립된한국인집단을대상으로한고립성저 혈증의영향에대한연구는드물었다. 같은아시아인인한국과일본사이에서도 수치가큰차이를보이는만큼, 12, 13) 고립성저혈증에대한연구는특히한국인에서더욱중요할것으로보인다. Sander J. Robins 등 14) 은전향적연구를통해저 또는고 TG와관련된새로운관상동맥질환의발생위험은인슐린저항성이있을때만유의하게증가한다고보고하였다. 인슐린저항성이있을 798 www.kafm.or.kr
이은준외. 한국성인에서고립성저 high-density lipoprotein 콜레스테롤혈증과인슐린저항성간의 독립적인상관관계 : 국민건강영양조사자료활용 (2008~2011) KJFP 15, 16) 때 TG 증가, 감소의발생, 심혈관계질환의위험증가 는잘알려져있으나, 역으로고립성저 혈증이인슐린저항 성에미치는영향이나, TG 와는독립적인고립성저 혈증의 병인에대한보고는거의없는상황이다. 고립성저 혈증의병인에서역할을할것으로생각되는 인자들로는 adiponectin, 17) unacylated ghrelin, 18, 19) resistin 20) 과 retinol binding protein 4(RBP4) 21) 등이있다. Adiponectin 은복부 지방의증가로감소하여간의인슐린저항성에영향을끼치고, 혈중 hepatic lipase 활성을통해 HDL 을저하시키는것 17) 으로생각된다. 혈청 unacylated ghrelin 수치는인슐린저항성, CRP 수치와무관 하게비만환자에서고립성저 혈증과양의상관관계를보 였으며, 18) Resistin 은주로여성에서저, 인슐린저항성과의 강력한연관성을보였고, 20) RBP4 는당뇨발생전인슐린저항성확 인용도로활용될가능성이제시되었다. 21) 본연구에는몇가지제한점이있다. 가장큰제한점은연구설계 가단면연구라는점이다. 한국에서저 혈증의영향을전향 적으로확인한연구는거의보고된바가없는상태로, 인과관계규 명을위해추가적인연구가필요하다. 또한본연구에서사용한이 상지질혈증의기준은 NCEP ATP III 에서제시한기준으로, 인종간 차이가심한 수치및, 수치와밀접한관련이있다 고보고되어있는 TG 수치의판단에있어한국인에게도적절한기 준인지의여부가추후연구를통해확인되어야할것이다. 결론적으로본연구는한국성인에서고립성저 혈증이 인슐린저항성과독립적인상관관계를가진다는것을확인함으로 써, 건강검진등으로우연히알게되지만다른지질이상과동반되 지않아간과되기쉬운고립성저 혈증의중요성을확인하 여적극적인선별검사와관리를통해한발앞선질병예방을도모하 는데그의의가있다하겠다. 앞으로고립성저 혈증환자에 서도인슐린저항성, 당뇨의선별검사와운동, 식이등의생활습관 개선이함께강조되어야할것이며, 저 의병인에대한추가 적인연구가이루어져야할것이다. 요약 연구배경 : 저 HDL 콜레스테롤혈증은심혈관질환의독립적인위험 인자이며대사증후군의요소중하나로알려져있다. 한국에서저 HDL 콜레스테롤혈증은이상지질혈증의가장큰비율을차지하며 대사증후군의증가와함께높은유병률을유지하고있다. 최근의 대규모연구결과에따르면고립성저 HDL 콜레스테롤혈증역시심 혈관질환의위험증가와연관이있는것으로나타났다. 방법 : 국민건강영양조사 2008~2011 년의자료중, 고지혈증약복 용중인자, 심뇌혈관질환자, 암환자를제외한만 19 세이상성인 24499 명을대상으로하였다. 저 HDL 콜레스테롤혈증의기준은남 자 40mg/dL 미만, 여자 50mg/dL 미만으로하였다. 대상을지질 수치에따라세군으로나누어공분산분석을이용해공복혈당, 당 화혈색소, 공복인슐린, 인슐린저항성의차이를알아보았다. 지질 수치와인슐린저항성의연관성은다중로지스틱회귀분석을통해 살펴보았다. 결과 : 한국성인에서당뇨의교차비는고립성저 HDL 콜레스테 롤혈증과복합성저 HDL 콜레스테롤혈증에서각각 1.31(95% CI, 1.12~1.54), 1.85(95% CI, 1.54~2.21) 였으며, 두군모두공복혈 당, 공복인슐린, 당화혈색소, 인슐린저항성에서정상군과유의한 차이를보였다. 인슐린저항성의교차비는고립성저 HDL 콜레스테 롤혈증과복합성저 HDL 콜레스테롤혈증에서각각 1.38(95% CI, 1.23~1.56), 2.20(95% CI, 1.91~2.54) 이었다. 결론 : 심혈관질환과대사증후군으로의진행방지를위하여인슐린 저항성과독립적인상관관계를보이는고립성저 HDL 콜레스테롤 혈증환자의적극적인선별검사, 예방과치료가시행되어야할것 이다. 중심단어 : 고립성저 HDL- 콜레스테롤혈증 ; 인슐린저항성 ; HOMA-IR REFERENCES 1. Korea Centers for Disease Control and Prevention. The Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI), 2013. Seoul: Korea centers for Disease Control and Prevention; 2014. 2. Woodward M, Barzi F, Feigin V, Gu D, Huxley R, Nakamura K, et al. Asia Pacific Cohort Studies Collaboration. Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region. Eur Heart J 2007; 28: 2653-60. 3. Rachel R. Huxley, Federica Barzi, Tai Hing Lam, Sebastien Czernichow, Xianghua Fang, Tim Welborn, et al. Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease. Circulation 2011; 124: 2058-64. 4. Korea Centers for Disease Control and Prevention. The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V), 2010. Seoul: Korea centers for Disease Control and Prevention; 2012. 5. Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nat Clin Prac Endocrinol Metabol 2009; 5: 150 9. 6. Taskinen MR. Diabetic dyslipidaemia: from basic research to www.kafm.or.kr 799
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