190 Hye Jong Oh and Cheol Won Choi. Relationship of hs-crp Levels in Non-diabetic Obesity Adults ORIGINAL ARTICLE Korean J Clin Lab Sci. 2018;50(2):190-196 https://doi.org/10.15324/kjcls.2018.50.2.190 pissn 1738-3544 eissn 2288-1662 Relationship of the hs-crp Levels with FBG, Fructosamine, and HbA 1 c in Non-diabetic Obesity Adults Hye Jong Oh, Cheol Won Choi Department of Biomedical Laboratory Science, Hanlyo University, Gwangyang, Korea 당뇨병이없는비만성인의 hs-crp 수준과 FBG, Fructosamine 및 HbA 1 c 와의관련성 오혜종, 최철원 한려대학교임상병리학과 Obesity has been reported to be a cluster of risk factors in the pathological ecology, In particular, there is increasing evidence that inflammation-related factors are associated with diabetes. This study examined the relationship between the hs-crp level and FBG, fructosamine, and HbA 1c in 4,734 non-diabetic adults aged 20 years or older, who were approved by the National Health and Nutrition Survey in 2015. The results showed that the FBG, fructosamine, and HbA 1c levels increased with increasing BMI; the hs-crp levels were the highest in the obese group, and HOMA-IR, an index of insulin resistance, was also significantly higher in the obese group. The hs-crp level was the highest in obese adults. The levels of FBG, fructosamine. and HbA 1c, which are involved in blood glucose control, increased with increasing hs-crp level. The FBG, fructosamine, and HbA 1c levels increased significantly with increasing hs-crp level after adjusting for various related variables. These results suggest that the obesity-induced increase in hs-crp is a risk factor for diabetes mellitus in non-diabetic adults. Therefore, proper dietary habits and regular exercise should prevent diabetes by preventing obesity in non-diabetic adults. Key words: FBG, fructosamine, HbA 1c, hs-crp, Obesity Corresponding author: Hye Jong Oh Department of Biomedical Laboratory Science, Hanlyo University, 94-13 Hallyeodae-gil, Gwangyang-eup, Gwangyang 57764, Korea Tel: 82-61-760-1126 Fax: 82-61-761-6709 E-mail: ecrips75@hanmail.net 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. Copyright 2018 The Korean Society for Clinical Laboratory Science. All rights reserved. Received: April 9, 2018 Revised: April 25, 2018 Accepted: April 29, 2018 서론체질량지수 (body mass index, BMI) 는신장과체중을이용하여지방의양을추정하는비만측정법으로체지방률을잘반영하며, BMI에따라질환의이환율및사망률과의관련성이입증되어있는비만지표이다 [1]. 비만은제2형당뇨병발생의가장잘알려진위험인자이며, 인슐린저항성으로인한고혈당증에의해당뇨병을유발하는것으로알려져있다 [2]. 당뇨병이없는성인에서도본인이인지를못하는사이에고 혈당이지속적으로유지되어유병기간이길어질수록인슐린분비저하와함께혈당조절이불량해진다 [3]. 고혈당에의한당뇨병유병인구는세계적으로급격히증가추세에있으며, 국제당뇨병연맹 (international diabetes federation, IDF) 에서는 2035년까지세계인구 10명중 1명이당뇨병에걸리게되어유행병 (epidemic) 상태를넘어당뇨병범유행을예상하고있다 [4]. 우리나라도당뇨병의유병률은 2016년에남자성인 8명중 1명 (12.9%), 여자성인은 10명중 1명 (9.6%) 이당뇨병을앓고있어전체성인의 10% 를육박하는것으로보고되었다 [5].
Korean J Clin Lab Sci. Vol. 50, No. 2, June 2018 191 당뇨병환자에서혈당조절지표로공복혈당 (fasting blood glucose, FBG) 과프록토사민 (fructosamine), 당화혈색소 (glycated hemoglobin, HbA 1 c) 가이용되는데, FBG는당뇨병을진단하는혈당변동지표로공복시체내포도당을측정한다 [6]. Fructosamine 은당화혈색소단백이외의생체모든당화단백을나타내고, 알부민의반감기에영향을받아과거 2 3 주의혈당상태를반영한다 [7]. HbA 1c는당화로인하여혈색소에당이비가역적으로결합한형태로과거 2 3 개월동안의혈당상태를반영하며 [8], 이들지표는당뇨병의관리및당뇨병합병증발생의예측인자로사용되고있다 [6]. 전향적연구결과에의하면제2형당뇨병의발생에염증반응이중요한역할을하는것으로보고되었다 [9]. 이러한반응에급성상반응물질의대표적인혈장단백인고감도 C-반응성단백질 (high sensitivity C-reactive protein, hs-crp) 이이용되고있다 [10]. hs-crp는각종염증반응및염증성질환의활성도를측정하는표지자로허혈성심질환이나 BMI 및인슐린저항성등과도관련이있다고보고되었다 [11]. 이전연구는단독적으로 hs-crp와심혈관질환및당뇨병 [12], 생활습관 [13] 과비교하는연구가많이진행되어왔다. 하지만당뇨병이없는성인을대상으로 hs-crp와혈당조절지표인 FBG, fructosamine, HbA 1 c 세가지모두를구분하여비교한연구는거의없다. 따라서본연구는대표성있는국가표본조사자료인국민건강영양조사자료를이용하여당뇨병이없는비만성인의 hs-crp와혈당조절지표들과의관련성에대하여알아보고자시행하였다. 재료및방법 1. 연구대상본연구는질병관리본부주관으로시행된국민건강영양조사제6기 3차년도 2015년원시자료를승인받아이용하였다. 연구대상은 20세이상성인 7,380명중당뇨병환자와결측치를포함하거나자료가불충분한대상자를제외한 4,734명을최종분석대상자로선정하였다. 자료조사는질병관리본부에서주민등록주소자료를표본추출틀로 192개표본조사구를추출하여 3,800가구의가구원전체를대상으로 2015년 1월부터 12월까지실시하였으며, 건강설문조사와검진조사를이동검진센터에서실시하였다 [14]. 2. 연구방법 1) 연구대상자의특성연구대상자의일반적인특성으로성별은 20세이상성인남성과여성으로구분하였으며, 연령은실제생년월일을기준으로구분하였다. 생활습관에대한내용으로음주여부는 예 와 아니오 로구분하였으며, 흡연여부는최근 1개월동안하루에담배한개피이상을피우는대상자를현재흡연, 피우지않는대상자를현재비흡연으로구분하였다. 운동여부는하루 30분이상을규칙적으로실시하는대상자를운동하는사람, 그렇지않은대상자를운동하지않는사람으로구분하였으며, 대상자의당뇨병에대한가족력과건강검진수진여부를구분하여조사하였다. 2) 신체계측및혈액검사신장및체중은신발을벗은상태에서자동신장측정기 (seca225, Hamburg, Germany) 로측정하였고, BMI는체중을신장의제곱으로나눈값 [ 체중 ( kg )/ 신장 2 (m 2 )] 으로 BMI가 18.5 kg/m 2 미만을저체중, 18.5 25.0 kg/m 2 미만을정상, 25.0 kg/m 2 이상을비만으로구분하였다 [15]. 혈압은대상자들을최소 5분이상안정시킨후우측상박부에서수은혈압계로수축기혈압과이완기혈압을각각 3회측정하여평균값을사용하였다. 혈액검사는채혈시검사당일 8시간이상공복상태를확인하여정맥혈을채혈하였다. 혈액검사지표로 FBG, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) 은 Hitachi Automatic Analyzer 7600-210 (Hitachi, Tokyo, Japan) 자동화학분석기로측정하였으며, HbA 1 c는 High Performance Liquid Chromatography (Tosoh G8, Tokyo, Japan) 고속액체크로마토그래피법으로측정하였다. hs-crp는 Cobas Immunoturbidimetry (Roche, Bayern, Germany) 면역비탁법으로측정하였고, Fructosamine 은 HbA 1 c를이용하여수식에의해계산하였다 [16]. Fructosamine= (HbA 1 c-1.61) 58.82. 인슐린저항성은 homeostasis model assessment of insulin resistance (HOMA-IR) 를이용하여측정하였다 [17]. HOMA-IR=[ 공복혈당 (mg/dl)] [ 공복인슐린농도 (uu/ml)]/405 3. 통계분석자료의통계처리는통계프로그램 (SPSS version 18.0, Chicago, USA) 을이용하였다. 연구대상자의일반적특성과혈액검사에대한분포는빈도와백분율또는평균과표준편차로
192 Hye Jong Oh and Cheol Won Choi. Relationship of hs-crp Levels in Non-diabetic Obesity Adults 분석하였다. 체질량지수에따른일반적특성및혈액검사는 chi-square, ANOVA 분석을사용하였고, hs-crp와 FBG, fructosamine, HbA 1 c와의평균비교는공분산분석 (analysis Table 1. Characteristics of study population (N=4,734) Variable Category N(%) or Mean±SD Sex Male 2,022 (42.7) Female 2,712 (57.3) Drinking Drinker 613 (12.9) Non-drinker 4,121 (87.1) Smoking Current smoker 1,800 (38.0) Non-smoker 2,934 (62.0) Exercise Yes 1,183 (25.0) No 3,551 (75.0) Family history of diabetes Yes 717 (15.1) No 4,017 (84.9) Status of health checkup Yes 2,965 (62.6) No 1,769 (37.4) Age (year) 50.2±16.6 Height (cm) 162.6±9.3 Weight (kg) 63.3±12.2 Waist circumference (cm) 82.3±9.8 BMI (kg/m 2 ) 23.8±3.4 SBP (mmhg) 118.5±17.1 DBP (mmhg) 75.1±10.1 All values are given as n (%) or mean±standard deviation. Abbreviations: BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure. of covariance, ANCOVA) 을시행하였다. ANCOVA 분석에서보정전 hs-crp와 FBG, fructosamine, HbA 1 c와의평균비교는 Crude값으로제시하였으며, ANCOVA 의보정변수는 chisquare와 ANOVA 분석에서통계적으로유의한변수를사용하여 Model 1은성별, 연령, 신장, 허리둘레, BMI를보정하였고, Model 2는 Model 1과흡연여부, 운동여부, 건강검진수진여부, 수축기혈압, HOMA-IR, TC, TG, HDL-C을추가보정하였다. 모든통계량의유의수준은 P<0.05로하였다. Table 2. Blood test of study population (N=4,734) Variable Reference interval Mean±SD FBG (mg/dl) (70 110) 96.8±15.9 Fructosamine ( mol/l) (205 285) 231.2±29.5 HbA 1c (%) (<6.5) 5.5±0.5 hs-crp (mg/dl) (0.1 1.0) 1.23±2.2 HOMA-IR (<2.0) 2.05±2.32 TC (mg/dl) (130 200) 191.5±35.1 TG (mg/dl) (35 150) 133.9±104.6 HDL-C (mg/dl) (>40) 51.4±12.8 LDL-C (mg/dl) (<130) 114.8±31.5 Abbreviations: FBG, fasting blood glucose; hs-crp, high sensitivity C-reactive protein; HOMA-IR, homeostasis model assessment of insulin resistance; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol. Table 3. General characteristics in accordance with the BMI level (N=4,734) BMI Variable Category <18.5 (kg/m 2 ) 18.5 24.9 (kg/m 2 ) 25.0 (kg/m 2 ) P-value Sex Male 56 (27.6) 1,190 (40.5) 772 (48.3) <0.001 Female 144 (72.4) 1,746 (59.5) 826 (50.8) Drinking Drinker 22 (10.2) 363 (12.3) 231(14.3) 0.088 Non-drinker 178 (89.8) 2,573 (87.7) 1,367 (85.7) Smoking Current smoker 61 (30.1) 1,041 (35.4) 698 (43.6) <0.001 Non-smoker 139 (69.9) 1,895 (64.6) 900 (56.4) Exercise Yes 40 (19.4) 773 (26.3) 374 (23.3) 0.015 No 160 (80.6) 2,163 (73.7) 1,224 (76.7) Family history of diabetes Yes 25 (11.7) 430 (14.6) 268 (16.6) 0.079 No 175 (88.3) 2,506 (85.4) 1,330 (83.4) Status of health checkup Yes 104 (52.0) 1,832 (62.4) 1,029 (64.5) 0.003 No 96 (48.0) 1,104 (37.6) 569 (35.5) Age (year) 42.1±18.7 49.4±16.8 52.6±15.4 <0.001 Height (cm) 162.5±7.7 162.5±9.0 162.8±9.9 0.536 Weight (kg) 46.2±4.9 58.8±8.2 73.6±11.6 <0.001 Waist circumference 65.9±4.0 78.3±6.8 91.6±7.4 <0.001 SBP (mmhg) 110.1±15.6 116.3±17.1 123.5±16.1 <0.001 DBP (mmhg) 70.8±8.0 73.6±9.6 78.2±10.5 <0.001 Abbreviation: See Table 1.
Korean J Clin Lab Sci. Vol. 50, No. 2, June 2018 193 결과 1. 연구대상자의일반적특성연구대상자에대한일반적특성은 Table 1과같다. 전체연구대상자는 4,734명으로남성이 2,020명 (42.7%), 여성은 2,712 명 (57.3%) 이었다. 생활습관에서현재음주는 613명 (12.9%) 이었고, 현재흡연은 1,800명 (38.0%) 이었으며, 현재운동은 1,183명 (25.0%) 이었다. 당뇨병가족력이있는대상자는 717명 (15.1%) 이었고, 건강검진수진자는 2,965명 (62.6%) 이었다. 연령은평균 50.2±16.6세이었고, 신장은 162.6±9.3 cm, 체중은 63.3±12.2 kg이었으며, 허리둘레는 82.3±9.8 cm, BMI는 23.8±3.4 kg/m 2 이었다. 수축기혈압은 118.5±17.1 mmhg 이었고, 이완기혈압은 75.1±10.1 mmhg이었다 (Table 1). 2. 연구대상자의혈액검사연구대상자의혈액검사결과는 Table 2와같다. FBG는평균 96.8±15.9 mg/dl 이었고, fructosamine은 231.2±29.5 mol/l, HbA 1 c는 5.5±0.5%, hs-crp는 1.23±2.2 mol/l 이었다. 혈중지질과관련된혈액검사지표중 TC는 191.5± 35.1 mg/dl, TG는 133.9±104.6 mg/dl, HDL-C은 51.4± 12.8 mg/dl, LDL-C은 114.8±31.5 mg/dl이었다 (Table 2). 보이지않았다 (Table 3). 4. BMI에따른혈액검사대상자의 BMI 수준에따른혈액검사를비교한결과는 Table 4와같다. FBG, fructosamine, HbA 1 c, HOMA-IR, TC, TG, HDL-C, LDL-C는 BMI가증가할수록평균값이증가하여통계적으로유의한차이를보였다 (P<0.001). hs-crp는 18.5 kg/m 2 미만군에서 1.14±2.8 mg/dl, 18.5 25.0 kg/m 2 미만군에서 1.06±2.1 mg/dl, 25.0 kg/m 2 이상군은 1.57±2.4 mg/dl로 25.0 kg/m 2 이상군에서가장높았으며, HOMA-IR은 18.5 kg/m 2 미만군에서 1.06±0.6, 18.5 25.0 kg/m 2 미만군에서 1.60±1.4, 25.0 kg/m 2 이상군은 3.02±3.2 로 25.0 kg/m 2 미만군에서가장높아비만한성인에서인슐린저항성이높음을보여주며, BMI 수준에따라통계적으로유의한차이를보였다 (P<0.001)(Table 4). 5. hs-crp 에따른 FBG와의평균비교 hs-crp 수준에따른 FBG와의평균비교는 Table 5와같다. hs-crp 수준에따른 FBG의평균값은성별, 연령, 신장, 허리둘레, BMI를보정한경우 (Model 1), hs-crp가 1.0 미만군은 3. BMI에따른일반적특성전체대상자의 BMI 수준에따른일반적특성을비교한결과는 Table 3과같다. BMI 수준에따라 18.5 kg/m 2 미만, 18.5 25.0 kg/m 2 미만, 25.0 kg/m 2 이상세집단으로나누어분석한결과성별, 흡연여부, 운동여부, 건강검진수진여부, 연령, 체중, 허리둘레, 수축기혈압, 이완기혈압에서통계적으로유의한차이를보여 BMI 세집단간의차이가있음을알수있었다. 그밖의음주여부, 당뇨병가족력, 신장은 BMI 수준에유의한차이를 Table 5. FBG compared with the average of hs-crp levels hs-crp level Crude Model 1* Model 2** <1.0 (mg/dl) 95.5±0.27 96.1±0.26 96.3±0.25 1.0 3.0 (mg/dl) 100.0±0.45 98.4±0.44 97.1±0.43 >3.0 (mg/dl) 101.0±1.81 100.1±1.72 100.0±1.66 P-value <0.001 <0.001 0.037 Values are Mean±Standard Error. Abbreviation: *Adjusted for sex, age, height, waist circumference, BMI, **Adjusted for Model 1 plus smoking, exercise, status of health checkup, systolic BP, HOMA-IR, TC, TG and HDL-C. Table 4. Blood test in accordance with the BMI level (N=4,734) Variable BMI <18.5 (kg/m 2 ) 18.5 24.9 (kg/m 2 ) 25.0 (kg/m 2 ) P-value FBG (mg/dl) 89.3±7.9 94.9±15.0 101.2±17.0 <0.001 Fructosamine ( mol/l) 218.1±17.3 227.5±27.0 239.6±32.8 <0.001 HbA 1c (%) 5.32±0.2 5.48±0.4 5.68±0.5 <0.001 hs-crp (mg/dl) 1.14±2.8 1.06±2.1 1.57±2.4 <0.001 HOMA-IR 1.06±0.6 1.60±1.4 3.02±3.2 <0.001 TC (mg/dl) 173.8±30.5 189.5±34.1 197.4±36.2 <0.001 TG (mg/dl) 82.9±44.0 117.1±86.4 168.9±127.2 <0.001 HDL-C (mg/dl) 58.9±12.7 53.3±12.9 47.0±11.3 <0.001 LDL-C (mg/dl) 95.7±27.4 112.9±30.4 120.6±32.5 <0.001 Abbreviation: See Table 2.
194 Hye Jong Oh and Cheol Won Choi. Relationship of hs-crp Levels in Non-diabetic Obesity Adults Table 6. Fructosamine compared with the average of hs-crp levels hs-crp level Crude Model 1* Model 2** <1.0 (mg/dl) 228.0±0.51 229.2±0.48 229.7±0.48 1.0 3.0 (mg/dl) 239.1±0.84 236.1±0.81 234.6±0.82 >3.0 (mg/dl) 242.5±3.33 239.1±3.12 241.4±3.18 P-value <0.001 <0.001 <0.001 Abbreviation: See Table 5. Table 7. HbA 1c compared with the average of hs-crp levels hs-crp level Crude Model 1* Model 2** <1.0 (mg/dl) 5.48±0.01 5.50±0.01 5.51±0.01 1.0 3.0 (mg/dl) 5.67±0.01 5.62±0.01 5.60±0.01 >3.0 (mg/dl) 5.73±0.05 5.67±0.05 5.70±0.06 P-value <0.001 <0.001 <0.001 Abbreviation: See Table 5. 96.1±0.26 mg/dl, 1.0 3.0 미만군은 98.4±0.44 mg/dl, 3.0 이상군은 100.1±1.72 mg/dl 로 hs-crp 수준이증가할수록 FBG의평균값도유의하게증가하였다 (P<0.001). Model 1 에서흡연여부, 운동여부, 건강검진수진여부, 수축기혈압, HOMA-IR, TC, TG, HDL-C 을추가보정한경우 (Model 2), 1.0 미만군은 96.3±0.25 mg/dl, 1.0 3.0 미만군은 97.1±0.43 mg/dl, 3.0 이상군은 100.0±1.66 mg/dl로 hs-crp 수준이증가할수록 FBG의평균값도통계적으로유의하게증가하였다 (P<0.001)(Table 5). 6. hs-crp 에따른 fructosamine 과의평균비교 hs-crp 수준에따른 fructosamine 과의평균비교는 Table 6과같다. hs-crp 수준에따른 fructosamine의평균값은성별, 연령, 신장, 허리둘레, BMI를보정한경우 (Model 1), hs-crp가 1.0 미만군은 229.2±0.48 mol/l, 1.0 3.0 미만군은 236.1±0.81 mol/l, 3.0 이상군은 239.1±3.12 mol/l 로 hs-crp 수준이증가할수록유의하게증가하였다 (P< 0.001). Model 1에서흡연여부, 운동여부, 건강검진수진여부, 수축기혈압, HOMA-IR, TC, TG, HDL-C을추가보정한경우 (Model 2), 1.0 미만군은 229.7±0.48 mol/l, 1.0 3.0 미만군은 234.6±0.82 mol/l, 3.0 이상군은 240.0±3.12 mol/l 로 hs-crp 수준이증가할수록 fructosamine 은통계적으로유의하게증가하였다 (P<0.001)(Table 6). 7. hs-crp 에따른 HbA 1c와의평균비교 hs-crp 수준에따른 HbA 1 c와의평균비교는 Table 7과같다. hs-crp 수준에따른 HbA 1c의평균값은성별, 연령, 신장, 허리둘레, BMI를보정한경우 (Model 1), hs-crp가 1.0 미만군은 5.50±0.01%, 1.0 3.0 미만군은 5.62±0.01%, 3.0 이상군은 5.67±0.05% 로 hs-crp 수준이증가할수록 HbA 1c는유의하게증가하였다 (P<0.001). Model 1에서흡연여부, 운동여부, 건강검진수진여부, 수축기혈압, HOMA-IR, TC, TG, HDL-C을추가보정한경우 (Model 2), 1.0 미만군은 5.51± 0.01 %, 1.0-3.0 미만군은 5.60±0.01 %, 3.0 이상군은 5.70± 0.06 % 로 hs-crp 수준이증가할수록 HbA 1 c는통계적으로유의하게증가하였다 (P<0.001)(Table 7). 고찰본연구는국민건강영양조사자료를이용하여당뇨가없는성인 4,734명을대상으로 hs-crp와혈당조절지표들과의관련성을평가하였다. 본연구에서 BMI가증가할수록혈당변동지표인 FBG와 2 3 주전의중기적인혈당조절지표인 fructosamine, 2 3 개월전의장기적인혈당조절지표인 HbA 1 c가증가하였다. hs-crp는비만군에서가장높은수치를보였으며, 인슐린저항성의지표인 HOMA-IR 도비만군에서통계적으로유의하게증가하였다. 또한, hs-crp의수준을구분하여혈당조절지표들과의관련성을확인한결과, hs-crp가증가할수록 FBG, fructosamine 및 HbA 1c가증가됨을확인하였고, 여러관련변수를보정한후에도 hs-crp가증가할수록 FBG, fructosamine 및 HbA 1 c가통계적으로유의하게증가하였다. 당뇨병의위험요인에는당뇨병의가족력, 고혈압, 연령및생활습관등이있으나, 제2형당뇨병을발병시키는대표적인원인으로비만이잘알려져있다 [18]. 비만은각종질병의원인이될수있으며, 정상체중이라도복부비만이있는경우당뇨병의위험성이매우증가하게된다. 이는지방세포의염증성세포가활성화되어결국비만으로인해염증반응을야기시켜인슐린의기능을떨어뜨리는것으로보고하고있다 [19]. 비만이동반된염증반응의변화는말초혈액내단핵구의수및활동성이증가하며, 전염증성사이토카인 (proinflammatory cytokine) 의농도가상승한다 [20]. 비만과염증과의연관성은비만인의지방세포에서분비되는여러가지염증성물질 (proinflammatory cytokine, IL-6, TNF- ) 이간에서 hs-crp 의생성을자극한다는연구결과 [21] 와 Ford 등 [22] 의연구에서도비만환자에서염증지표인 hs-crp가증가한다고보고하고있다. 본연구에서도 hs-crp 는체질량지수가 18.5 kg/m 2 미만군에서 1.14±2.8 mg/dl, 18.5 25.0 kg/m 2 미만군에서 1.06±2.1 mg/dl, 25.0 kg/m 2 이상군은 1.57±2.4 mg/dl로
Korean J Clin Lab Sci. Vol. 50, No. 2, June 2018 195 25.0 kg/m 2 이상군에서가장높은결과를보였다. 이러한 hs-crp와 BMI와의유의한관계는인슐린의작용이체지방과관계가있음을의미한다. 비만환자의지방세포에는인슐린저항성에영향을미치는 leptin, resistin, adiponectin, TNF, IL-6과같은다양한염증성물질을분비하는것으로알려져있으며 [23], 비만으로야기된대사적염증반응이인슐린저항성에있어서주된역할을한다는것이다 [24]. 본연구에서도인슐린저항성의지표인 HOMA-IR은체질량지수가 18.5 kg/m 2 미만군에서 1.06±0.6, 18.5 25.0 kg/m 2 미만군에서 1.60±1.4, 25.0 kg/m 2 이상군은 3.02±3.2로 25.0 kg/m 2 이상군에서가장높은결과를보였다. 제2형당뇨병환자의 hs-crp 값과인슐린저항성과의관련성연구에서제2형당뇨병환자에서정상범위라할지라도상대적으로증가되어있는 hs-crp는인슐린저항성증가와관련성을시사하며, 당뇨병이없는성인에서도 hs-crp 는비만의정도와인슐린저항성과강하게연관되어있다고보고되었다 [25,26]. 현재염증반응의표지자와인슐린저항성과의관계를설명하는가설은만성화된염증이인슐린저항성의유발인자로작용하거나, 개인이갖고있는기저질환에의해 hs-crp 합성을자극하여결국에는제2형당뇨병을유발할수있다는것이다 [27,28]. 또한고혈당으로인한당화 (Glycation) 의증가로체내단백질이손상을받아최종당화산물을형성시킨다 [6,7]. 최종당화산물은산화스트레스를유발하여특히, 신체대사가활발한콩팥의토리, 안구의망막세포, 췌장의베타세포에영향을주며, 당화에의한베타세포의영향은인슐린저항성을증가시키는연결고리임을보고하고있다 [29]. 이에당뇨병이없는성인에서도 BMI가증가할수록인슐린저항성및당화반응의영향으로 FBG, fructosamine 및 HbA 1c가증가됨을확인할수있었다. 본연구결과 hs-crp와혈당조절지표들과의연관성은비만과의상호작용으로인한결과로생각된다. BMI와 hs-crp, 혈당조절지표들은각각에서연관성을보였으며, 여러변수를보정한후에도 hs-crp와각각의혈당조절지표들은양의상관관계가유지되었다. 이에당뇨병이없는성인중높은 BMI에서증가된 hs-crp에의해결과적으로당뇨병의주요한병인인인슐린저항성을증가시켜혈당조절지표인 FBG, Fructosamine 및 HbA 1 c가통계적으로유의하게증가한것으로사료된다. 본연구에서는몇가지제한점이있다. 첫째, 단면연구이기때문에 hs-crp와 FBG, fructosamine, HbA 1 c 사이의인과관계를설명할수가없었다. 향후이들의인과관계를확인하기위한추적연구가필요할것으로사료된다. 둘째, 당뇨병이없는성인에서 hs-crp와 FBG, fructosamine 과 HbA 1 c 측정치에영 향을미칠수있는기저질환을배제하지못하였다. 이러한제한점에도불구하고본연구에서는세가지혈당조절지표를제시하여관련성을분석함에연구의의의를가지고있다. 이상의결과로당뇨병이없는성인에서올바른식습관및규칙적인운동으로비만을예방하여염증및당뇨병발생을감소시키는노력이강구되어야할것으로사료된다. 요약 본연구는국민건강영양조사자료를이용하여당뇨병이없는성인 4,734명을대상으로비만성인의 hs-crp와혈당조절지표들과의관련성에대해알아보고자하였다. 연구결과 BMI 가증가할수록혈당조절지표인 FBG와 fructosamine 및 HbA 1 c가증가하였으며, hs-crp는비만군에서가장높은수치를보였고, 인슐린저항성의지표인 HOMA-IR도비만군에서통계적으로유의하게증가하였다. 또한 hs-crp 수준을구분하여혈당조절지표들과의관련성을확인한결과 hs-crp가증가할수록 FBG, fructosamine 및 HbA 1 c가증가됨을확인하였고, 여러관련변수를보정한후에도 hs-crp가증가할수록 FBG, fructosamine 및 HbA 1 c가통계적으로유의하게증가하였다. 결과적으로비만과 hs-crp, 혈당조절지표는각각에서연관성을보여당뇨병이없는성인중높은 BMI에서증가된 hs-crp 에의해당뇨병의주요한병인인인슐린저항성을증가시켜혈당조절지표인 FBG, fructosamine 및 HbA 1 c가통계적으로유의하게증가한것으로사료된다. 이에당뇨병이없는성인에서도올바른식습관및규칙적인운동으로비만을예방하여당뇨병발생을감소시키는노력이강구되어야하겠다. Acknowledgements: None Conflict of interest: None REFERENCES 1. Welborn TA, Knuiman MW, Vu HT. Body mass index and alternative indices of obesity in relation to height, triceps skinfold and subsequent mortality: the Busselton health study. Int J Obes Relat Metab Disord. 2000;24:108-115. 2. Carlsson S, Ahlbom A, Lichtenstein P, Andersson T. Shared genetic influence of BMI, physical activity and type 2 diabetes: a twin study. Diabetologia. 2013;56:1031-1035. doi: 10.1007/ s00125-013-2859-3. 3. Scragg R, Sowers M, Bell C, Third National Health and Nutrition Examination Survey. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the third national health and nutrition exami-
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