Journal of Korean Academy of Oral Health 2015 September 39(3):207-213 http://dx.doi.org/10.11149/jkaoh.2015.39.3.207 Original Article 성인당뇨환자의비외과적치주치료에의한구강건강상태개선에따른삶의질변화 최윤영 1, 이재영 1, 이희영 2, 진보형 1 1 서울대학교치의학대학원예방치학교실, 2 서울특별시광진구보건소 Assessment of the quality of life and oral health status in diabetic patients Yoon Young Choi 1, Jae-Young Lee 1, Heeyoung Lee 2, Bo-Hyoung Jin 1 1 Department of Preventive & Social Dentistry, School of Dentistry, Seoul National University, 2 Gwang-Jin Gu Public Health Center, Seoul, Korea Received: August 25, 2015 Revised: September 11, 2015 Accepted: September 16, 2015 Corresponding Author: Bo-Hyoung Jin Department of Preventive & Social Dentistry, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongro-gu, Seoul 03080, Korea Tel: +82-2-740-8783 Fax: +82-2-765-1722 E-mail: jjbh@snu.ac.kr *This study was supported by the Health Promotion Fund, Ministry of Health & Welfare, Republic of Korea (#13-15). Objectives: The aim of this study was to investigate changes in the quality of life and oral health status in diabetic patients as a result of non-surgical periodontal treatments. Methods: In total, 55 diabetic patients who visited the health care center at our institution participated in this study. The patients were divided randomly into 3 groups as follows: scaling and root planning (SRP), professional maintenance care (PMC), and control (CT). The patients were asked to answer the Short- Form-36 Health Survey (SF-36) to evaluate their quality of life, and two examiners evaluated the patients oral health status before and after the periodontal treatments. To evaluate the oral health status, the current number of teeth, DMFT index, bleeding on probing rate (BOP), pocket depth (PD), and calculus index (CI) were used. Statistical analyses were conducted using SPSS with appropriate sampling weights to adjust for the stratified sample design. Results: In both the SRP and PMC groups, the BOP and CI decreased after the treatment (P<0.05). In the SRP group, physical functioning and the mental health score increased (P<0.05). Conclusions: According to the results, non-surgical periodontal treatment in diabetic patients is effective in increasing the health-related quality of life. Key Words: Diabetes, Non-surgical periodontal treatment, Oral health, Quality of life, SF-36 서론 삶의질 (quality of life, QOL) 이란자신의삶에대한객관적인정도뿐만아니라주관적인인식과평가에의한만족의정도로서, 개인의복지혹은행복의정도를뜻한다. 이러한삶의질에서인간의가장기초적인욕구중하나인건강이상당히중요한부분을차지한다는것은명백한사실이며, 삶의질을높이기위하여의료기술을포함한여러기술이존재하고발전을거듭해왔다. 또한, 현대복지국가는대부분사회구성원의삶의질을향상시키는것을 목표로하고있으며, 우리나라의경우도마찬가지로, 삶의질에대한국민들의관심또한높아지고있다. 그러나경제협력개발기구 (OECD) 가최근발표한 2015 더나은삶지수 (better life index 2015) 에따르면, 우리나라는 OECD 가입국을포함한 36개국중 27위로하위권에머물렀다 1). 삶의질을결정하는요소중건강측면을고려해볼때, 질병의치료자체뿐만아니라전반적인건강관련삶의질향상이매우중요하며, 이는만성질환에있어서특히그러하다. 당뇨병은대표적인만성질환으로, 인슐린의분비량이부족하 Copyright 2015 by Journal of Korean Academy of Oral Health This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. JKAOH is available at http://www.jkaoh.org pissn 1225-388X / eissn 2093-7784
208 J Korean Acad Oral Health 2015;39:207-213 거나정상적인기능이이루어지지않는대사질환의일종이다. 서구화된식습관과편리한생활양식변화이면에당뇨병을포함한각종대사질환이현대사회에서큰문제가되고있는것이다. 당뇨병은심혈관및뇌혈관질환등각종합병증의직ㆍ간접적원인이며, 개인과국가차원의꾸준한관리가필요한질환이다 2). 세계당뇨병연맹 (International Diabetes Federation, IDF) 에서발표한자료에의하면, 2013년기준전세계성인인구의약 8.3% 인약 3억 8천만명이당뇨병을보유하고있으며향후 25년이내에그수는 5억 9천만명으로증가할것으로예상된다 3). 우리나라의경우 30 세이상성인의당뇨병유병률은 11.9%, 남자 13.6%, 여자 10.3% 로보고되었으며 4), 이는세계평균을상회하는것으로추정된다. 또한, 대한당뇨병학회자료에의하면, 당뇨병유병률은 2001년 8.6% 에서 2010년 10.1% 로증가했으며이추세로는 2020년에는당뇨환자수가 424만명, 2050년에는 591만명에이를것으로전망된다 5). 2012년기준전세계적으로연간 150만명이당뇨병으로사망하였으며, 주요사망원인중당뇨병은 8위를차지하였고 6), 우리나라의경우암을제외한주요만성질환중당뇨병이사망원인 3위를기록하였다 7). 이에비해당뇨환자의질병인지율은 72.7%, 치료를받고있는사람은 61.4% 로 8), 예방가능한사망이지속적으로발생한다할수있다. 이러한당뇨병의 6번째주요합병증인치주조직병은치주조직의만성적인감염으로, 심각한경우에는치아상실을초래하며 9), 성인에있어서는치아발거원인질환중가장큰비중을차지한다. 당뇨환자의치주조직병유병률은매우높고그형태또한심각한경우가많으며 10), 치주조직병은당뇨환자의혈당조절능력저하와도밀접한연관이있다 11,12). 그러나환자가정기적으로치과에내원할경우, 이러한치주조직병을예방하거나조기에발견하여치료할수있을뿐아니라, 치과에서의정기적인치주조직관리는당뇨환자의혈당조절을개선시킬수있다고보고된바있다 13,14). 당뇨병과치주조직병은적극적으로관리하지않으면오랜기간삶의질을악화시켜심각한사회적문제를야기한다 15). 구강건강과전신건강이삶의질에미치는영향에관한연구에따르면 16), 구강건강과전신건강의악화로인해자신감이결여되고일상생활에도지장이생기며, 따라서육체적으로뿐만아니라정신적으로도건강한생활을할수없게된다. 현재까지구강건강이삶의질에미치는영향과당뇨병을포함한전신질환이삶의질에미치는영향에대한많은연구가행해졌 으나, 이세가지항목을동시에평가하여상호연관성을규명한연구는매우적으며, 구강건강개선에따른건강관련삶의질의변화를중심으로치료개입전후를비교분석한연구는전무하다. 따라서고령화사회에서중요한문제로대두되고있는당뇨병과치주조직병, 그리고삶의질에대한보다면밀한연구가필요한실정이다. 이에본연구는당뇨환자의비외과적치주치료에의한구강건강상태개선이삶의질에미치는영향을파악하여, 이들의상호연관성을규명함으로써, 궁극적으로는당뇨환자의구강건강관련삶의질향상에기여할수있는바탕을마련하고자시행되었다. 1. 연구대상 연구대상및방법 본연구는 2013년 6월부터 2014년 6월까지서울시광진구보건소성인당뇨환자를대상으로시행되었다. 연구선정기준과제외기준 (Table 1) 에따라총 75명의 44-85세환자를대상으로하였고, 전문가구강건강관리군 (professional maintenance care, PMC 군 ), 스케일링및치근면활택술군 (scaling and root planing, SRP 군 ), 대조군 (control, CT군 ) 에같은비율로무작위배정하였으며, 중도탈락자를제외한 55명 ( 남성 28명, 여성27명 ) 에대한전후비교분석이이루어졌다. 연구대상자의성별및연령분포에유의한차이가없었으며 (P>0.05), 그구성은 Table 2와같았다. Table 2. Distribution of age and sex for each groups (N=55) Variable Total (%) SRP (N=19) PMC (N=20) CT (N=16) Sex* Male 28 (50.9) 9 (47.4) 10 (50.0) 9 (56.3) Female 27 (49.1) 10 (52.6) 10 (50.0) 7 (43.7) Age 69.58±8.01 67.90±8.79 69.60±8.08 71.56±6.92 Range 44 to 85 50 to 85 44 to 82 58 to 84 P-value 0.867 0.410 SRP, scaling and root planing; PMC, professional maintenance care; CT, control. *Values represented number (%). Values represented mean±standard deviation. P-value was determined by chi-square test for categorical variables and one-way ANOVA test for continuous variables. Table 1. Inclusion/exclusion criteria for participants Inclusion criteria 1. Pocket depth 4 mm 2 or more sites 2. Non-smoker 3. No change in the courses of treatment Maintain oral anti-diabetic drug 3 months before and during the study Exclusion criteria 1. 18 teeth 2. Systemic disease (ex. SLE, HIV, AIDS etc.) 3. No periodontal treatment received 3 months before the study 4. Chronic liver disease including Hepatitis 5. BMI (Body Mass Index) 40 6. Pregnancy 7. Current abuse of alcohol or drugs 8. HbA 1C < 6.5% 17)
209 최윤영외 성인당뇨환자의비외과적치주치료에의한구강건강상태개선에따른삶의질변화 2. 연구방법본연구는서울대학교치의학대학원연구윤리심의위원회의승인 (Institutional Review Board No. S-D20130016) 후실시되었으며, 연구에대한설명후참여에동의한환자들을대상으로구강건강검사및삶의질에관한설문조사를행하였다. 무작위임상시험 (randomized clinical trial) 으로서, 연구기준에부합되는환자들을대상으로 3군 (PMC군, SRP군, CT군 ) 으로무작위배정하여 PMC군, SRP군에대하여비외과적치주치료프로그램을시행하고, 삶의질및구강건강상태변화를분석하였다. 구강검사및비외과적치주치료는치과의사 2인에의해시행되었으며, 검사및치주치료시행전구강검사기준및치료술식에대한모의훈련과현장지도를하였다. 이후조사자간일치도검정을시행한결과 Kappa index는 0.976 (P<0.05) 로산출되었다. 표본수산출을위해효과크기 0.3545 18), 통계적검정력 0.95, 탈락률 10% 미만으로 Power and Sample Size Effect Size Calculation Program (Heinrich-Heine-Universität, Düsseldorf, Germany) 을이용하였으며, 적정연구대상환자수는각군당 25 명, 총 75명으로산출되었다. 2.1. 구강건강검사모든군에있어서연구시작시와 12주차에훈련받은치과의사 2인에의한구강건강검사를시행하였다. 제3대구치를제외한모든치아를대상으로세계보건기구 (World Health Organization, WHO) 영구치우식경험도검사기준 19) 에따라치아건강상태 (DMFT Index) 를측정하였다. 치주조직검사를위해상악우측제1대구치, 상악우측중절치, 상악좌측제1대구치, 하악좌측제1대구치, 하악좌측중절치, 하악우측제1대구치의총 6개치아를대상으로협설면의근심, 원심및중앙부를포함한여섯부위의치주낭깊이 (pocket depth, PD) 를측정하였다. 또한모든치아의근, 원, 협, 설측치은연을탐침하여출혈지수 (bleeding on probing, BOP) 의산술평균으로개인탐침시출혈지수를산출하였다. 마지막으로 Greene과 Vermillion 이 제안한간이구강위생환경지수 20) 중치석지수측정방법에의거하여, 치석지수 (calculus index, CI) 를측정하였다. 2.2. 삶의질에관한설문조사모든군에서연구시작시와 12주차에삶의질에관한설문조사를시행하였는데, Ware와 Sherboune 21) 가개발한설문도구를 Koh 등 22) 이번역한한국어판 The Short-Form-36 Health Survey (SF-36) 을사용하였다. SF-36는크게기능수준, 안녕수준, 전반적인건강평가의 3개영역으로구성되어있으며, 세부적으로총 9개의하부영역, 즉, 신체적기능 (Physical Functioning, PF), 사회적기능 (Social Functioning, SF), 신체적역할 (Role-Physical, RP), 감정적역할 (Role- Emotion, RE), 정신건강 (Mental Health, MH), 활력 (Vitality, VT), 통증 (Bodily Pain, BP), 일반건강 (General Health, GH), 건강상태변화 (Health Change, HC) 의총 36개문항으로구성되어있다 (Table 3). 각문항의응답은 Likert 척도를이용하여건강에가장나쁜영향을미치는내용 1점에서최고 5점까지산출되었으며, 점수화된각문항을각영역별로합산하여 100점만점으로환산하였다. 2.3. 비외과적치주치료 (1) 스케일링 / 치근면활택술 (scaling and root planing, SRP): SRP군에서는초기구강건강검사자료를바탕으로 1주차에치은연상치석제거를, 3주차에치근면활택술을시행하였다. 12주차에구강건강검사를재시행하고, 추가적인관리가필요한경우치료를행하였다. (2) 전문가구강건강관리 (professional maintenance care, PMC): PMC군에서는초기구강건강검사자료를바탕으로 1주차에전문가잇솔질 ( 와타나베법 ) 을전악에 15-30분간시행하였다. 2 주차에초음파, 수기구를이용한치은연상치석제거를시행하고, 상태에따라치은연하치석제거를시행하였다. 이후 3주차부터 5 주차까지, 필요한경우는 8주차까지 1주간격으로지속적으로 15 Table 3. Composition of SF-36 Scale Contents (low score/high score) Number of items Functioning Physical Functioning Limitation in taking a bath or putting on clothes/no limitation in physical movement 10 Social Functioning Limitation in social activity resulting from physical or emotional status/no limitation in social activity 2 Role-Physical Limitation in daily life resulting from physical health status/no limitation in daily life 4 Role-Emotional Limitation in working or daily life resulting from emotional problem/no limitation in working or daily life 3 Well-being Bodily Pain Severe pain/no pain 2 Vitality Feeling tired all the time/energetic all the time 4 Mental Health Being anxious or depressed all the time/being happy and quiet all the time 5 Overall Health Evaluation General Health Regarding personal health as getting worse/regarding personal health as excellent 5 Health Change 1 SF-36, The Short-Form-36 Health Survey.
210 J Korean Acad Oral Health 2015;39:207-213 분에서 30분간전문가잇솔질을시행하였다. 12주차에구강건강검사를재시행하고추가적인관리가필요한경우치료를행하였다. 3. 통계분석획득한자료는전산입력하여통계적유의수준 0.05 상에서 PASW 통계패키지 Version 21.0 (SPSS Inc. Chicago, IL, USA) 를이용하여분석하였다. 각조사항목의전후비교를위해정규성검정후구강건강상태는 Kruskal-Wallis test, Wicoxon signed rank test, Mann- Whitney test를통하여임상시험전후를비교하여검정하였고, 삶의질은정규성검정후 paired t-test, one-way ANOVA test, Tukey post-hoc test로검정하였다. 연구성적 1. 구강건강상태구강건강상태분석결과는 Table 4와같았다. SRP군, PMC군, 및 CT군사이의초기구강건강검사결과, 잔존치아수, DMFT, PD, BOP, CI에서유의한차이가없었다 (P>0.05). PD가 4 mm 이상인부위의수는, SRP군에서는 4.42에서 4.32, PMC군에서는 4.85에서 4.45, CT군에서는 3.88에서 6.75로 (P<0.05) 변화하였으며, 세군간에서통계적으로유의한차이가있었다 (P<0.05). 변화량에있어서는각치료군과 CT군에서유의한차이를나타내었다 (P<0.05). BOP에있어서, SRP군에서는 17.05% 에서 10.96% (P<0.05), Table 4. Changes of oral health status SRP group PMC group CT group P-value* PD baseline 4.42±2.73 4.85±3.30 3.88±2.87 12 wks 4.32±2.95 4.45±4.14 6.75±4.57 0.004 P-value 0.920 0.135 0.011 BOP baseline 17.05±13.23 22.25±15.96 20.84±16.85 12 wks 10.96±8.51 5.73±5.70 21.24±14.86 0.001 P-value 0.004 0.010 0.807 CI baseline 2.89±3.28 1.70±1.78 1.94±1.95 12 wks 1.05±1.81 0.60±0.88 2.25±2.15 0.082 P-value 0.010 0.005 0.654 Teeth (N) baseline 25.26±2.90 24.25±3.57 24.69±3.16 0.621 DMFT baseline 4.89±4.61 8.25±6.71 5.38±4.50 0.128 DMFT, Decayed, Missing, Filled Teeth; PD, Pocket depth 4 mm sites; BOP, Bleeding on probing rate; CI, Calculus index. The data was presented by mean and standard deviation. *P-value was determined by Kruskal-Wallis test for continuous variables (P<0.05). P-value was determined by Wilcoxon signed rank test for continuous variables (P<0.05). P-value was determined by Mann-Whitney test with control group (P<0.05). P-value was determined by Mann-Whitney test with SRP group (P<0.05). Table 5. Changes of SF-36 score Scale SRP PMC CT Baseline 12 wks P-value Baseline 12 wks P-value Baseline 12 wks P-value Functioning 75.74±18.13 79.42±16.58 0.332 83.50±13.46 85.90±11.55 0.399 83.38±9.77 80.63±13.87 0.328 Physical functioning 70.79±26.84 78.95±22.83 0.030* 83.75±16.93 81.25±16.93 0.574 79.06±21.15 75.31±30.14 0.414 Social functioning 86.18±19.50 90.13±18.90 0.517 90.63±19.82 96.25±12.23 0.154 89.84±18.38 93.75±13.69 0.312 Role-physical 64.47±16.54 67.43±12.25 0.375 71.56±13.97 72.19±18.97 0.874 67.58±16.33 66.41±14.77 0.767 Role-emotional 81.14±32.02 81.14±31.65 1.000 87.72±25.29 93.75±18.11 0.317 97.40±5.01 86.98±24.72 0.091 Well-being 79.21±11.09 81.91±9.70 0.168 84.46±12.94 86.71±11.10 0.432 86.20±9.03 84.79±7.71 0.533 Bodily Pain 84.21±13.72 85.53±11.23 0.630 86.88±14.89 85.00±14.40 0.659 88.28±10.67 87.50±12.91 0.817 Vitality 78.95±16.95 77.30±14.32 0.583 81.25±14.90 86.88±13.44 0.149 81.25±13.31 76.56±17.75 0.188 Mental health 74.47±16.99 82.89±14.84 0.013* 85.25±14.46 88.25±13.89 0.365 89.06±11.72 90.31±10.08 0.684 Overall Health evaluation 60.39±10.87 58.16±10.86 0.315 59.75±9.42 56.88±7.90 0.089 60.78±12.64 57.97±13.11 0.471 General health 52.37±9.48 49.21±12.16 0.204 53.25±11.50 51.25±9.58 0.456 54.38±19.74 48.75±12.85 0.254 Health change 68.42±18.34 67.11±16.78 0.663 66.25±14.68 62.50±12.83 0.186 67.19±15.05 67.19±19.83 1.000 SF-36, The Short-Form-36 Health Survey. *P-value was determined by one-way ANOVA test for continuous variables (P<0.05). P-value was determined by paired-t test for continuous variables (P<0.05).
211 최윤영외 성인당뇨환자의비외과적치주치료에의한구강건강상태개선에따른삶의질변화 PMC군에서는 22.25% 에서 5.73% (P<0.05), CT군에서 20.84% 에서 21.24% 로변화하였으며, 세군간에통계적으로유의한차이가있었다 (P<0.05). 변화량에있어서는각치료군과 CT군, 그리고두치료군사이에서유의한차이를보였다 (P<0.05). CI에있어서, SRP군에서는 2.89에서 1.05 (P<0.05), PMC 군에서는 1.70에서 0.60(P<0.05), CT군에서는 1.94에서 2.25 로변화하였고, 세군간에유의한차이가있었다 (P<0.05). 또한변화량에있어서 SRP군과 CT군에서유의한차이를나타내었다 (P<0.05). 2. 삶의질변화삶의질분석결과는 Table 5에제시한바와같았다. 초기설문조사결과, 안녕수준중정신건강항목이외의모든항목에서세군간차이가없었다. 초기정신건강항목에서 SRP군의삶의질지수는 74.47±16.99, CT군에서는 89.06±11.72로통계적으로유의하게차이를나타내었다 (P<0.05). 비외과적치주치료전후비교결과, SRP 군의기능수준하위항목중신체적기능항목에서 70.79±26.84에서 78.95±22.83 로 (P<0.05) 변화하였으며, 안녕수준하위항목중정신건강의삶의질지수가 74.47±16.99에서 82.89±14.84로 (P<0.05) 변화하였다. 또한기능수준의하위항목중사회적기능, 신체적역할그리고안녕수준중신체통증항목에서삶의질지수가증가하였다 (P>0.05). PMC 군에서는기능수준하위항목중사회적기능, 신체적역할, 감정적역할항목과안녕수준중활력, 정신건강항목에서삶의질지수가증가하였다 (P>0.05). 고안 오늘날고도로발전한의료기술에의해질병의치료율이높아지고인간수명이연장됨에따라단순한의식주를벗어난삶의질에대한관심이높아지고있다. 따라서질병치료와개선에중점을두는기초의학과임상의학뿐아니라, 생물로서의인간이아닌사회적존재로서의인간을중시하여연구하는학문인사회의학의중요성이강조되고있다. 이러한사회적분위기속에서삶의질에관한연구는기하급수적으로증가하였고, 이와함께다양한삶의질측정도구가개발되었다. 미국의경우, 1960년대부터삶의질에대한개념이생명보존과수명연장에서생의의미를찾는사회지표로변화하였으며 23), 국내에서는 1980년대 Noh 24) 에의한삶의질측정도구개발을시작으로삶의질에관한연구가꾸준히진행되고있다. 그리하여개발된다양한건강관련, 구강건강관련삶의질측정도구중, 본연구에서는 Ware와 Sherboune 21) 이개발하고 Koh 등 22) 이한국어판으로번역한 The Short-Form-36 Health Survey (SF-36) 를평가도구로채택하였다. SF-36은국내외인구집단을대상으로전반적인건강상태를측정하기위한임상연구에서널리사용되어도구의신뢰도와타당도가검증된바있으며 21), 현대사 회의대표적만성질환인당뇨환자의삶의질을평가하기위한여러연구에서사용되었다 25). 본연구에서는단순히당뇨환자의건강관련삶의질을측정하는데에그치지않고, 당뇨병의주요합병증의하나인치주조직병의비외과적치주치료에따른구강상태개선과삶의질변화의연관성을파악하는데에중점을두었다. 연구결과, 참여자 75명중비외과적치주치료프로그램을끝까지참여한사람은 55명이며, 중도탈락자가 20명 (26.67%) 으로약간높은탈락률을보였다. 본연구참여자의특성상환자연령대가높아총연구기간인 12주동안다참여하지못하여, 연구참여자가자발적인의지로연구참여가중단되는사례가높은편이었다. 그럼에도비외과적치주치료에의한확연한구강건강개선을확인할수있었으며, 스케일링 / 치근면활택술과전문가구강관리를시행한군에서탐침시출혈지수와치석지수가통계적으로유의하게감소하였다. 또한통계적으로유의하지는않았으나, 이미알려진바와같이비외과적치주치료시행군에서치주낭깊이가감소하였다. 이에따른당뇨환자의삶의질변화분석결과, 스케일링 / 치근면활택술군에서기능수준, 안녕수준의삶의질지수가유의하게증가하였다. 이는객관적인구강건강개선이환자가느끼는주관적인삶의질향상으로이어졌다고해석할수있으며, 구강건강이삶의질에긍정적으로작용한다고보고한연구결과 26) 를뒷받침하는것으로사료되었다. 반면, 비외과적치주치료를시행한후삶의질지수변화를분석한연구에따르면 27), 치주치료에따른구강건강개선이구강건강관련삶의질증가로이어진비당뇨환자에반해, 당뇨환자에서는그러한결과를보이지않았다. 이는당뇨병이라는만성질환자체와그로인해나타나는합병증의무게가치주조직병개선에따른삶의질향상효과를감소시키기때문이라여겨진다. 앞서언급한연구에서사용된삶의질측정도구는구강건강관련삶의질을측정하는 OHIP-49 (Oral Health Impact Profile-49) 인데비하여, 본연구에서는전반적건강관련삶의질을측정하는 SF-36을사용하였다는데에의의가있다. 즉, 당뇨환자에있어서구강건강개선이단순한구강건강관련삶의질이아닌, 전반적인건강관련삶의질을증가시키는지여부를파악할수있는연구라는점에서더욱의미있다할수있다. 본연구에서는스케일링 / 치근면활택술군에서기능수준하위항목중신체적기능항목, 그리고안녕수준하위항목중정신건강항목에서삶의질지수가유의하게증가하였다. 당뇨환자의신체적기능에관한연구에따르면 28), 폐활량, 근육강도, 평상시걷는양, 총에너지소모량등신체적기능면에서정상인에비해뒤떨어지는경향을보였다. 또한당뇨환자에있어서우울증등정신건강문제가정상인에비해높게나타난다고보고된바있다 29). 따라서본연구에서얻은비외과적치주치료로인한당뇨환자의신체적기능과정신건강개선결과는상당히주목할만하다. 특히우울증은고령화사회에서큰문제가되고있는치매전단계인경도인지장애의위험요소라여겨지는점에서, 당뇨환자의정신적측면에영향을미칠수있는요인을파악하는일은매우중요하다.
212 J Korean Acad Oral Health 2015;39:207-213 삶의질은개인의주관적인인식에의해서뿐만아니라사회경제적요인, 국가별차이, 국가내사회계급에따라달라지며, 문화적영향을크게받는것으로알려져있다 30). 본연구에서는이러한변수들을고려하지않고비교적소수의연구대상자를중심으로시행한결과로, 추후자료수집환경등을개선한추가적인연구가필요하다고사료되었다. 또한비외과적치주치료중에서도전문가구강관리군에비해스케일링 / 치근면활택술군에서만유의한결과를나타낸부분에있어서도표본수증가, 내원횟수조절등다각적방법으로접근하여원인을파악할필요가있다고사료되었다. 주관적안녕, 행복, 만족등개인의신체적, 정신적, 사회적, 경제적측면에서의삶의질향상을위해, 본연구결과는성인당뇨환자의비외과적치주치료에의한구강건강상태개선에따른삶의질향상을위한기반을마련하는데에유용한기초자료로활용될수있을것이다. 결론 성인당뇨환자의구강건강상태개선이삶의질에미치는영향을파악하고이들의상호연관성을규명하고자임상실험과설문조사를시행하였으며, 다음과같은결론을얻었다. 1. 스케일링 / 치근면활택술군에서비외과적치주치료후기능수준의하위항목중신체적기능, 그리고안녕수준의하위항목중정신건강항목에서삶의질지수가통계적으로유의하게증가하였다 (P<0.05). 2. 스케일링 / 치근면활택술군에서비외과적치주치료후기능수준하위항목중사회적기능, 신체적역할, 감정적역할, 그리고안녕수준과그하위항목인신체적통증항목에서삶의질지수가증가하였으나, 통계적으로유의하지는않았다 (P>0.05). 3. 전문가구강관리군에서비외과적치주치료후기능수준과그하위항목인사회적기능, 신체적역할, 감정적역할, 그리고안녕수준과그하위항목인활력, 정신건강항목에서삶의질지수가증가하였으나, 통계적으로유의하지는않았다 (P>0.05). 이상의결과는성인당뇨환자에있어서비외과적치주치료에의한구강건강상태개선이성인당뇨환자의전반적건강관련삶의질을향상시키는데에효과적이라할수있다. 감사의글 연구자료수집에도움을주신서울특별시광진구보건소임옥용과장님과임상병리과및구강보건실관계자여러분께감사드립니다. References 1. Organization for Economic Cooperation and Development (OECD). Better Life Index [Internet]. [cited 2015 Aug 21]. Available from: http://www.oecdbetterlifeindex.org/#/11111111111. 2. Pickup JC, Williams G. Textbook of diabetes. 3rd ed. Malden, Mass: Blackwell Science;2003. 3. International Diabetes Federation (IDF). Diabetes Atlas [Internet]. [cited 2015 Aug 21]. Available from: http://www.idf.org/diabetesatlas/update-2014. 4. Ministry of Health & Welfare. Korea Health Statistics 2013. Seoul:Ministry of Health & Welfare;2014:54. 5. Korean Diabetes Association. Korean Diabetes Research Report 2012. Seoul:Korean Diabetes Association;2013. 6. World Health Organization (WHO). The 10 leading causes of death in the world 2000 and 2012 [Internet]. [cited 2015 Aug 21]. Available form: http://www.who.int/mediacentre/factsheets/fs310/en/. 7. Statistics Korea. Cause of death statistics 2013 [Internet]. [cited 2015 Jul 24]. Available from: http://kostat.go.kr/wnsearch/search. jsp. 8. Kim YA. Diabetes Management Status among Adults in Republic of Korea, 2008-2012. Seoul:Korea Centers for Disease Control and Prevention;2014:3. 9. Löe H. Periodontal disease-the sixth complication of diabetes mellitus. Diabetes Care 1993;16:329-334. 10. Tomar SL, Lester A. Dental and other health care visits among U.S. adults with diabetes. Diabetes Care 2000;23:1505-1510. 11. Saito T, Shimazaki Y, Kiyohara Y, Kato I, Kubo M, Iida M, et al. The severity of periodontal disease is associated with the development of glucose intolerance in non-diabetics:the Hisayama Study. J Dent Res 2004;83:485-490. 12. Taylor G. Periodontal treatment and its effects on glycemic control, 1999. Oral Surg Oral Med Oral Pathol 1999;87:311-316. 13. Committee on Research, Science, and Therapy, American Academy of Periodontology. Diabetes and periodontal disease. J Periodontol 2000;71:664-678. 14. Grossi SG, Skrepcinski FB, DeCaro T, Robertson DC, Ho AW, Dunford RG, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J Periodontol 1999;68:713-719. 15. Deen D. Metabolic syndrome: Time for action. Am Fam Physician 2004;69:2875-2882. 16. Inglehart M, Bagramian R. Oral health-related quality of life. Chicago: Quintessence Books 2002;99-109. 17. Lee JY. Oral health status and systemic health change of diabetic patients according to the method of non-surgical periodontal treatment application [master s thesis]. Seoul:Seoul National University;2015. [Korean]. 18. Gaikwad SP, Gurav AN, Shete AR, Desarda HM. Effect of scaling and root planing combined with systemic doxycycline therapy on glycemic control in diabetes mellitus subjects with chronic generalized periodontitis: a clinical study. J Periodontal implant Sci 2013; 43:79-86. 19. World Health Organization. Oral health surveys basic method. 5th ed. Geneva:World Health Organization;2013:87. 20. Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13. 21. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-483. 22. Koh SB, Jang SJ, Kang MG, Cha BS, Park JK. Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean J Prev Med 1997;30:251-266. 23. Freed MM. Quality of life the physician s dilemma. Arch Phys Medicine Rehabil 1984;65:109-111. 24. Noh YJ. Analysis of quality of life of middle-aged adults dwelling in Seoul [doctorate thesis]. Seoul:Yonsei University;1988. [Korean]. 25. Nehra M, Selmira B, Sabina N, Nurka P. Quality of life of people with diabetes mellitus type 2. HealthMED 2012;6:1076-1080.
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