대한임상건강증진학회지제 8 권제 1 호 2008 Korean J Health Promot Dis Prev Vol. 8, No. 1, 2008 [ 원저 ] 건강검진수진자에서혈중 γ-glutamyltransferase와염증지표와의상관성 이정규, 김영주, 이상엽, 김윤진 부산대학교병원가정의학과 - 요약 - 연구배경 죽상경화증의발생에낮은수준의염증이중요한역할을하는것으로알려지면서염증지표인고민감도 C-반응성단백 (high-sensitive C-reactive protein, hscrp) 이심혈관계질환의예측인자로제시되었다. 또한 γ-glutamyltransferase(ggt) 가산화스트레스를반영하며 hscrp와연관성이있다는보고가있다. 이에저자등은 GGT와염증지표인 hscrp와의상관성을조사하였다. 방 법 2006년 6월부터 10월까지부산의일개대학병원건강증진센터를방문한 1,618명을대상으로하였다. 혈청 GGT 농도에따라 4분위수로나누고각군에서허리둘레, 체질량지수, 혈압, hscrp 에대해분산분석법으로비교하였다. GGT와 loghscrp 와의상관관계는부분상관계수를이용하여분석하였다. 결 과 체질량지수, 복부둘레, 수축기혈압및이완기혈압은각 4분위수에서모두유의한차이를나타내었다. loghscrp 는 50 percentile미만인군과이상인군에서유의한차이가있었다. GGT는 loghscrp (r=0.172, P<0.01) 와약하지만유의한양의상관관계를나타내었다. 지질성분중에는중성지방 (r=0.431), 총콜레스테롤 (r=0.221), 저밀도지단백콜레스테롤 (r=0.183) 은유의한양의상관관계, 고밀도지단백콜레스테롤 (r=-0.165) 은유의한음의상관관계가있었다. 연령, 음주량, 체질량지수, 복부둘레, 수축기혈압및이완기혈압을보정한후 GGT와 loghscrp(r=0.071, P=0.005) 는약하지만유의한양의상관관계가있었다. 결 론 본연구에서혈청 GGT 농도와 hscrp 와는통계적으로유의한상관관계를보였지만그상관성은낮아서임상적으로 GGT와염증지표간의직접적인연관성을찾을수는없었다. 향후 GGT가죽상경화증에미치는영향에관한전향적연구가필요하다. ( 대한임상건강증진학회지 2008;8(1):17~23) 중심단어 gamma-glutamyltransferase, C-반응성단백, 염증, 죽상경화증 5 서론 최근우리나라에서도경제성장및생활습관의서구화로인해심혈관계위험과관련된질환의유병률이증가하고있다. 2006년우리나라사망원인통계결과에의하면악성신생물에이어서뇌혈관질환및심장질환이사망원인중 2, 3위를차지하고있으며, 허혈성심질환에의한사망률은인구 10만명당남자 30.5명, 여자 27.9명이다. 1) 죽상경화증의발생에낮은수준의염증이중요한역할을 교신저자 : 김영주부산대학교병원가정의학과 주소 : 부산광역시서구아미동 1-10 부산대학교병원가정의학과의국 전화 : 051-240-7834 E-mail : joo-dr@hanmail.net 접수일 : 2008년 1월 18일 채택일 : 2008년 3월 19일 하는것으로알려지면서염증지표인고민감도 C-반응성단백 (high-sensitive C-reactive protein, 이하 hscrp) 이심혈관계질환의예측인자로제시되었다. 2,3) hscrp는심근경색, 뇌졸중, 말초혈관질환의발생을예측할수있으며많은심혈관계질환의위험인자들과상관성이있다. 4,5) 혈중 γ-glutamyltransferase(ggt) 는간질환이나알코올섭취의지표로널리알려져있지만최근에정상범위내에서약간증가된 GGT는사망률증가, 심근경색및뇌졸중의발생과유의한연관성이있다는보고가있다. 6,7) 또한 GGT와심혈관계질환의위험인자들인비만 8), 고지혈증 9), 고혈압 10), 2형당뇨병 11), 대사증후군 12) 과의연관성이밝혀지면서 GGT가산화스트레스를반영하며, 심혈관계질환의예측인자인 hscrp와연관성이있다는보고 13,14) 가있었다. 하지만국내에서는이에 17
[ 건강검진수진자에서혈중 γ-glutamyltransferase 와염증지표와의상관성 ] 대한기초자료나연구가아직부족한실정이다. 이에본연구에서는 GGT와염증지표인 hscrp와의상관관계를분석하여 GGT와심혈관계질환의연관성을알아보고자하였다. 방법 1. 연구대상 2006년 6월부터 10월까지 5개월간부산의일개대학병원건강검진센터를방문한수진자를대상으로하였다. 총 2665 명중병력청취, 신체검사및혈액검사등을시행하여혈중 aspartate aminotransferase (AST), alanine transferase (ALT), GGT가 100이상인경우, 백혈구수 10.0 10 3 / μl를초과하는경우, 급성감염과관련된증상을호소한경우, B형간염, anti-hcv Ab. 양성인경우, 암이있거나암의과거력이있는경우, 당뇨병, 고혈압, 류마티스관절염, 허혈성심질환, 심근경색, 뇌경색등과같은각종염증성질환의과거력이있거나현재약물을복용하고있는경우를제외한총 1618명이연구대상자에포함되었다. 2. 연구방법연구대상자에게문진을통해현병력, 과거병력, 음주력, 흡연력을조사하였다. 음주력은하루음주량과주당음주횟수를물어보고일일평균음주량을구하였고, 통계분석을위해음주를하지않는다고대답한사람을비음주자로하였으며, 적어도주 1회이상음주를하는경우음주자로정의하였다. 신장과체중은가벼운실내복을입은상태에서전자식신체계측기 HM-300(Fanics co. Ltd, Busan, South Korea) 을이용하여신장은 0.1cm, 체중은 0.1kg까지측정하였다. 측정된키와체중을바탕으로체질량지수 ( kg /m 2 ) 를산출하였다. 혈압은자동혈압기 (BP-203 RVⅡ, colin corp., Aichi, Japan) 로수축기혈압과이완기혈압을 1회계측한수치를기록하였다. 복부둘레측정은다수의훈련된전공의가세계보건기구 (WHO) 의지침에따라호기상태에서늑골최하단부와골반장골능사이의가장가는부위를줄자로직접측정하였고, 0.1cm까지기록하였다. 8시간이상공복상태에서혈액을채취하여일반혈액검사, 생화학검사, 지질검사등을시행하였다. 간효소치, GGT, 지질성분은 Hitach 7600 chemical analyzer(hitachi co., Ltd, Tokyo, Japan) 를사용하여효소비색법 (enzymatic colorimetric method) 으로측정하였다. 공복혈당은포도당산화효소법 (LX-20, Beckman Coulter, USA) 으로측정하였다. hscrp 는 FDA로부터승인된 N High Sensitivity CRP (Dade Behring GmbH, Marburg, Germany) 키트시약과 Behring Nephelometer 100 analyzer (Messer Griesheim GmbH, Frankfurt, Germany) 를이용하여비탁법으로측정하였다. 검출한계는 0.0175mg/dL 까지였다. 검출되지않은 CRP 값은 0.002mg/dL 로기록하였다. 3. 통계분석모든통계분석은 SPSS version 12.0 for windows 한글판을이용하였다. 남녀간의연령, 허리둘레, 체질량지수, 혈압, GGT, 지질성분, hscrp 등은 two-sample t-test로비교하였다. hscrp는정규분포를따르지않아 hscrp 의로그변환수치 ( 이하 loghscrp) 를사용하였다. 연구대상자를혈청 GGT 농도에따라 4분위수로나누고각각의군에서연령, 허리둘레, 체질량지수, 혈압, hscrp, 공복혈당, 지질성분등에대해분산분석법 (ANOVA) 과 Dunnett T3 사후검증으로비교하였다. GGT 농도와 loghscrp, 연령, 체질량지수, 복부둘레, 혈압, 공복혈당, 지질성분등과의상관관계는 Pearson 상관계수및연령, 체질량지수, 복부둘레, 혈압등을보정한후부분상관계수를이용하여분석하였다. 유의수준은 p-value<0.05 로정의하였다. 결과 1. 연구대상자의기본적특성총연구대상자 1618명중남자는 728명, 여자는 890명이었다. 평균연령은 45.6±10.5세였다. 평균연령및체질량지수, 복부둘레등은남자가유의하게더높았다. 수축기혈압과이완기혈압모두남자가높았으며, 지질성분중총콜레스테롤, 중성지방은남자가, 고밀도지단백콜레스테롤은여자가유의하게높았다. GGT는남자가유의하게높았으며, hscrp 는유의한차이가없었다 ( 표 1). 2. GGT 의각 4분위수간의염증지표및대사지표의비교연구대상자들에서 25 percentile에해당하는혈청 GGT 농도의절단점은 13.22 IU/L 이었으며, 50 percentile과 75 percentile에해당하는절단점은 19.71 IU/L 와 31.91 IU/L 이었다. 연령은 25 percentile 미만인군이유의하게낮았다. 체 18
[Association of γ-glutamyltransferase and Inflammatory Markers in Health Screeners at a Health Promotion Center] Table 1. Baseline characteristics of study subjects by gender.* Variable Men Women (n=728) (n=890) Age (years) 46.2 ± 10.6 45.1 ± 10.4 BMI (kg/m 2 ) 23.8 ± 2.6 22.8 ± 2.8 Abdominal circumference (cm) 84.2 ± 7.0 75.7 ± 7.4 Systolic BP (mmhg) 122.0 ± 16.5 113.4 ± 15.5 Diastolic BP (mmhg) 75.9 ± 10.7 69.9 ± 9.7 AST (IU/L) 46.2 ± 10.6 45.1 ± 10.4 ALT (IU/L) 26.3 ± 13.6 20.6 ± 6.1 γ-gtp(iu/l) 35.8 ± 20.1 18.0 ± 11.9 Fasting plasma glucose (mg/dl) 89.2 ± 14.4 85.7 ± 9.9 Total cholesterol (mg/dl) 252.4 ± 62.4 236.9 ± 27.9 Triglycerides (mg/dl) 133.9 ± 71.7 94.3 ± 54.1 HDL-cholesterol (mg/dl) 52.3 ± 11.5 60.5 ± 13.3 hscrp (mg/dl) 0.13 ± 0.32 0.10 ± 0.29 Smoking status - no. (%) None-smoker Ex-smoker Current smoker 187 (25.7) 247 (33.9) 294 (40.4) 845 (94.9) 13 ( 1.5) 32 ( 3.6) Alcohol status - no. (%) Non-drinker Drinker 138 (19.0) 590 (81.0) 555 (62.4) 335 (37.6) *Plus-minus values are means ± SD. P >0.05 by two sample-t test between men and women. BMI: body mass index, BP: blood pressure, AST: aspartate transferase, ALT: alanine transferase, γ-gtp: gamma-glutamyl transferase, HDL: high-density lipoprotein, hscrp: high-sensitivity C-reactive protein. 질량지수, 복부둘레, 수축기혈압및이완기혈압은각 4분위수에서모두유의한차이를나타내었다. loghscrp 는 50 percentile 미만인군과이상인군에서유의한차이가있었다. 지질성분중총콜레스테롤, 중성지방, 저밀도지단백콜레스테롤은 GGT 농도가높은군에서유의하게높았으며, 고밀도지단백콜레스테롤은 50 percentile 이상인군에비해서 50 percentile 미만인군, 25 percentile 미만인군이유의하게낮았다 ( 표 2). 3. GGT 농도와염증지표및대사지표간의상관성 연구대상자들의 GGT는 loghscrp (r=0.172, P<0.01) 와약하지만유의한양의상관관계를나타내었다. GGT는신체계측치중복부둘레 (r=0.438) 와는뚜렷한양의상관관계가있었고, 체질량지수 (r=0.284), 수축기혈압 (r=0.279) 및이완기혈압 (r=0.293) 과는유의한양의상관관계를나타내었다. 지질성분중에는중성지방 (r=0.431) 이뚜렷한양의상관관계를나타내었고, 총콜레스테롤 (r=0.221), 저밀도지단백콜레스테롤 (r=0.183) 은유의한양의상관관계, 고밀도지단백콜레스테롤 (r=-0.165) 은유의한음의상관관계가있었다 ( 표 3). 연령, 음주량, 체질량지수, 복부 Table 2. Comparison of variables by Quartiles of serum GGT.* Serum GGT class (Percentile, number) I(<25,430) Ⅱ(25~50,367) Ⅲ(50~75,412) Ⅳ(>75,409) Age 42.8±10.3 a 46.7±10.8 b 47.0±10.2 b 46.2±10.1 b BMI (kg/ m2 ) 22.2± 2.5a 22.8± 2.7 b 23.7± 2.7 c 24.3± 2.6 d AC (cm) 74.2± 6.8a 77.6± 7.8 b 81.6± 7.6 c 84.7± 7.3 d SBP (mmhg) 111.2±14.7 a 115.4±15.8 b 119.0±15.8 c 123.7±17.1 d DBP (mmhg) 68.5± 9.4 a 71.1±10.0 b 74.0±10.1 c 76.8±11.0 d loghscrp (mg/ dl ) -3.222±1.198a -3.055±1.320 a -2.717±1.286 b -2.594±1.132 b FPG (mg/dl) 83.9± 7.4a 85.6± 8.1 b 88.1±12.3 c 91.5±17.08 d TC (mg/dl) 190.0±31.4a 196.3±33.8 b 203.6±31.9 c 211.4±33.2 d TG (mg/dl) 79.4±37.3a 96.0±46.5 b 120.2±61.2 c 152.7±82.6 d HDL (mg/dl) 60.8±13.0a 58.1±13.2 b 54.1±12.3 c 54.1±12.9 c LDL (mg/dl) 112.3±26.8a 118.7±28.6 b 125.9±28.2 c 129.4±29.8 c *Plus-minus values are means ± SD. P<0.001 by oneway analysis of variances among groups. a,b,c,d The same letters indicate non-significant difference between groups based on Dunnett T3 multiple comparison test. BMI: body mass index, AC: abdomonal circumference, SBP: systolic blood pressure, DBP: diastolic blood pressure, hscrp: high-sensitivity C-reactive protein, FPG: fasting plasma glucose, TC: total cholesterol, TG: triglyceride, HDL: high-density lipoprotein, LDL: low-density lipoprotein. Table 3. Cross-table of the correlations of measured parameters. GGT(IU/L) loghscrp(mg/dl) GGT(IU/L) 1.000 loghscrp(mg/dl) 0.172 1.000 Age 0.070 0.113 Body mass index (kg/m 2 ) 0.284 0.214 Abdominal circumference (cm) 0.438 0.256 Systolic BP (mmhg) 0.279 0.146 Diastolic BP (mmhg) 0.293 0.159 Fasting plasma gluceose (mg/dl) 0.232 0.116 Total cholesterol (mg/dl) 0.221 0.077 Triglyceride (mg/dl) 0.431 0.169 High density lipoprotein (mg/dl) -0.165-0.156 Low density lipoprotein (mg/dl) 0.183 0.090 Data are expressed as correlation coefficient, measured by Pearson correlation analysis. P<0.01 for all variance. hscrp: high-sensitivity C-reactive protein. BMI: body mass index, BP: blood pressure. 둘레, 수축기혈압및이완기혈압등의심혈관계위험인자들을보정한후 GGT와 loghscrp(r=0.071, P=0.005) 는약하지만유 19
[ 건강검진수진자에서혈중 γ-glutamyltransferase 와염증지표와의상관성 ] Table 4. Correlations between serum GGT and loghscrp after correction for age, alcohol consumption, body mass index, abdominal circumference, systolic and diastolic blood pressure. GGT(IU/L) loghscrp(mg/ dl ) GGT(IU/L) 1.000 loghscrp(mg/dl) 0.071* 1.000 Data are expressed as partial correlation coefficient, controlled for age, body mass index, abdominal circumference, systolic and diastolic blood pressure. hscrp: high-sensitivity C-reactive protein. *P=0.005. 의한양의상관관계가있었다 ( 표 4). 고찰 우리나라에서도생활습관의서구화, 비만인구의증가, 사회의노령화등으로심혈관질환, 뇌혈관질환, 말초동맥질환등의죽상경화증과연관성이있는질병의유병률이증가되고있다. 많은연구들이죽상경화증의기전, 예방및치료를위해시행되었으나아직까지심혈관질환은여전히전세계적인사망의주요원인이되고있다. 심혈관질환의전통적인위험인자로는 45세이상의연령, 조기관상동맥질환의가족력, 현재의흡연, 고혈압, 낮은고밀도지단백콜레스테롤등 15) 이있으며, 이들중수정가능한위험인자 (modifiable risk factor) 의선별검사가권고되고있다. 최근에는염증지표인 hscrp 가심혈관질환의예측인자이고죽상경화증과관련된질환의독립적인위험인자임이보고되었다. 또한알코올섭취및간질환에서증가되는 GGT가심혈관질환의위험인자인비만, 고지혈증, 당뇨병, 대사증후군과연관성이있음이밝혀지면서미국인 13) 과일본인 14) 을대상으로한 GGT와 hscrp의연관성에관한이전의보고가있으나, 적절한국내연구는미비한실정이다. 따라서건강검진수진자를대상으로 GGT와 hscrp 의연관성을알아보는것은의미있는연구로사료된다. 다수의혈청인자들이비전통적인심혈관질환의위험인자로제시되었다. 이들에포함되는것으로는 homocysteine과 fibrinogen, plasminogen activator inhibitor-1(pai-1), D-dimer, thrombin/antithrombin Ⅲ complex 등의응고지표, amyloid A, interleukin (IL), matrix metalloprotease (MMP), adhesion molecule, C-reactive protein(crp) 등의염증지표가있으며대부분은아직까지임상에서사용하지않으며, 그예측도도확정되지않았다. 16) 이들중 CRP는다양한기능을가진급성면역계반응물질로서 interleukin-6의분비에의해간에서주로생성되며, adhesion molecule 과 PAI-1 의발현을촉진시키고, 백 혈구와보체계를활성화시키며, 죽상경화반 (atherosclerotic plaque) 의내피세포와민무늬근세포 (smooth muscle cell), 큰포식세포 (macrophage), 지방세포 (adipocyte) 에서발견된다. 17-19) 통상적인측정법에서 CRP의증가는급성감염증이나염증에서나타나지만, 고민감도법 (high-sensitivity assay) 으로측정되어진 hscrp는비교적건강한무증상의성인에서심근경색과뇌졸중의강력하고독립적인예측인자로고혈압과고콜레스테롤혈증의효과와유사하다. 20,21) GGT는알코올섭취와간담도질환의진단에광범위하게이용되었지만역학연구에서심혈관질환의이환및사망률의생화학적위험인자로서의가능성이발견되었다. 22) 따라서혈청 GGT수준을단계화하여단기적, 장기적으로심혈관계질환의예후를예측하는데도움을줄수있으며, 고전적인선별검사법에 GGT 측정을추가함으로써예방적중재가필요한심혈관질환의고위험자를선별하고, 적극적인치료노력을기울이는데도움을줄수있다. 7) GGT와심혈관질환과의연관성에대한기전은아직정확히밝혀지지않았으나다음과같은가설이제시되고있다. 첫째, 혈중에순환하는 GGT가죽상판 (atheromatous plaques) 에서일부기원하고둘째, 죽상판이광범위하게발생하는위험요소들과 GGT가연관성이있을것등이다. 23) GGT가죽상경화증에기여하는산화스트레스와관련되는기전은몇몇연구들에서다음과같이제시하고있다. GGT는대부분의세포들에서항산화제인 glutathione의세포외이화작용을담당하는효소로작용하여세포내항산화방어체계를유지하는데중추적인역할을한다. 24-26) 자유라디칼의생산은 glutathione 의고갈과 GGT의발현을일으키고따라서혈청내 GGT의활성도를증가시킨다. GGT의증가는산화스트레스의반응이므로증가된혈청 GGT는낮은수준이지만지속적인산화스트레스를받고있는위험군을감별하는데도움을줄수있다. 혈청 GGT의활성도는실질적인일중변동 (circadian difference) 이없이매우안정되어있으며일간변동 (day-to-day variation) 은거의무시할수준이다. 27) 이는일중어느시간에나측정할수있는기회를제공하므로죽상경화증의고위험군을선별하는데좀더간편한수단을제공할수있다. 본연구에서는최근산화스트레스의생화학적지표로제시된혈청 GGT 수준과심혈관질환의독립적인위험인자인 hscrp와의연관성을살펴보았다. GGT 수준에따라서 4분위수로나누었을때혈청 GGT가 50 percentile 미만인군과그이상인군에서 hscrp 는유의한차이가있었다. 체질량지수, 복부둘레, 수축기혈압, 이완기혈압, 공복혈당, 총콜레스테롤및중성지방은각 4분위수에서모두유의한차이를나타내었는데이는비록정상 GGT군과증가된 GGT군만을비교한연구이지만 Yamada 등 28) 의연구와일치하였다. 20
[Association of γ-glutamyltransferase and Inflammatory Markers in Health Screeners at a Health Promotion Center] GGT는신체계측치중복부둘레와는뚜렷한양의상관관계가있었고, 체질량지수, 수축기혈압및이완기혈압과는유의한양의상관관계를나타내어 Luttmann 등 7) 의연구와유사한결과를보였다. 또한연령, 음주량, 체질량지수, 복부둘레, 수축기혈압및이완기혈압을보정한후 GGT와 loghscrp 는약하지만통계적으로유의한양의상관관계가있었다. 하지만통계적으로유의하다할지라도상관관계가너무작아서임상적으로유의한상관관계가있다고보기에는어려움이있다. 이는 Saijo 등 14) 의연구에서뚜렷한양의상관관계를보인결과와는차이점이있는데이는이들의연구가연구대상자가공무원으로국한된점, hscrp 가아닌 CRP와의상관관계를확인한점등에서본연구와구별된다할수있다. hscrp 가 CRP보다죽상경화증에관계된염증상태를더잘반영한다는관점에서볼때본연구결과혈청 GGT는 hscrp 와임상적으로유의한상관관계를찾을수없으며, 이는여러죽상경화증에연관된질환들과의관련성이입증된 GGT가낮은수준의염증이아닌다른기전으로죽상경화증과관련됨을시사한다고볼수있다. 본연구의제한점으로는첫째, GGT에영향을줄수있는식이습관이나약물사용력, 지방간유무등에대한조사가미흡한점이다. 하지만 GGT, AST 및 ALT가 100이상으로상승되어과도한알코올섭취나간담도질환의가능성이있는경우는제외하였고또한만성간염, 간경화가있는사람을제외하여 GGT에미치는영향을최소화하고자노력하였다. 각종염증성질환의과거력이있거나현재약물을복용하고있는경우도제외하여 CRP에미치는영향도최소화하고자노력하였다. 둘째, 알코올섭취량을조사할때반정량적섭취빈도조사법의하나인간이조사법설문지를이용해간접적으로알코올섭취량을추정한것과셋째, hscrp 를 2회측정하지못한것, 넷째일개대학병원의건강증진센터수진자를대상으로하였기때문에연구결과를일반화하기어렵다는점이다. 하지만이와같은연구의제한점에도불구하고본연구는 GGT와 hscrp의연관성에관한국내연구가매우부족한실정에서기초자료를제공하였다는점에서그의미를찾을수있을것이다. 결론적으로본연구에서혈청 GGT 농도와 hscrp 와는통계적으로유의한양의상관관계를보였으나, 그상관계수가너무작아서임상적으론유의한관련성이있다고보기는어렵다. 앞으로 GGT가낮은수준의염증이외에죽상경화증에영향을미치는기전에대한연구와함께, 이를실제임상에적용가능한고위험군의선별에적용할수있는적절한기준을마련하기위한대규모전향적연구가필요할것으로사료된다. 참고문헌 1. 통계청. 2006년사망원인통계결과. Available from: URL:http:// www.nso.go.kr. 2. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002;105:1135-43. 3. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003;107:363-9. 4. Yamada S, Gotoh T, Nakashima Y, Kayaba K, Ishikawa S, Nago N, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population: Jichi Medical School Cohort Study. Am J Epidemiol 2001;153:1183-90. 5. Laaksonen DE, Niskanen L, Nyyssonen K, Punnonen K, Tuomainen TP, Valkonen VP, et al. C-reactive protein and the development of the metabolic syndrome and diabetes in middle-aged men. Diabetologia 2004;47:1403-10. 6. Whitfield JB. Gamma glutamyl transferase. Crit Rev Clin Lab Sci 2001;38:263-355. 7. Ruttmann E, Brant LJ, Concin H, Diem G, Rapp K, Ulmer H; Vorarlberg Health Monitoring and Promotion Program Study Group. γ-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation 2005;112:2130-7. 8. Daeppen JB, Smith TL, Scuckit MA. Influence of age and body mass index on gamma-glut-amyltransferase activity: a 15-year follow-up evaluation in community sample. Alcohol Clin Exp Res 1998;22:941-4. 9. Nilssen O, Forde OH, Brenn T. The Tromso Study. Distribution and population determinants of gamma-glutamyl transferase. Am J Epidemiol 1990;132:318-26. 10. Yamada Y, Ikai E, Tsuritani I, Ishizaki M, Honda R, Ishida M. The relationship between serum gamma-glutamyl transferase levels and hypertension: common in drinkers and non-drinkers. Hypertens Res 1995;18:295-301. 11. Nakanishi N, Takatorige T, Suzuki K. Daily life activity and risk of developing impaired fasting glucose or type 2 diabetes in middle aged japanese men. Diabetologia 2004;47:1768-75. 12. Kang YH, Min HK, Son SM, Kim IJ, Kim YG. The association of serum gamma glutamyltransferase with components of the metabolic syndrome in the Korean adults. Diabetes Res Clin Pract 2007;77:306-13. 13. Lee DH, Jacobs Jr DR, Association between serum gammaglutamyltransferase and C-reactive protein. Atherosclerosis 21
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Korean J Health Promot Dis Prev Vol. 8, No. 1, 2008 [Abstract] Association of γ-glutamyltransferase and Inflammatory Markers in Health Screeners at a Health Promotion Center Jeong Gyu Lee, Young Joo Kim, Sangyeoup Lee, Yun Jin Kim Department of Family Medicine, Pusan National University Hospital Background Methods Results Conclusions Key words Low grade inflammation plays a major role in atherosclerosis, and the measurement of inflammatory markers such as high-sensitivity C-reactive protein (hscrp) provide methods for risk prediction and reveal independent risk factors of cardiovascular diseases. Gamma-glutamyltransferase(GGT) may directly take part in atherogenesis and can be used potential biochemical risk indicator of cardiovascular disease. The purpose of our study was to assess the correlation between GGT and hscrp concentration. The study subjects consisted of 1,618 individuals who underwent periodic health examination in a university hospital in Busan from June to October 2006. Body mass index, abdominal circumference, blood pressure, and fasting glucose, lipid profile, general blood test, GGT and hscrp were measured. To quantify the correlation between GGT and hscrp concentration, partial correlation coefficient were presented. Total cholesterol(r=0.221, P<0.01), Triglyceride(r=0.431, P<0.01), loghscrp(r=0.172, P<0.01) showed a significant correlation with GGT level. The GGT was significantly correlated with hscrp level after adjusting for age, body mass index, abdominal circumference and blood pressure. These finding suggest that there was a significant correlation between GGT and hscrp concentration. Therefore, inflammatory status is higher in person who has high level of GGT than a person who has low level. The former is presumed to have a higher risk of atherosclerotic disease thereafter. (Korean J Health Promot Dis Prev 2008 ; 8(1):17~23) gamma-glutamyltransferase, C-Reactive Protein, Inflammation, Atherosclero-sis 6` Address for correspondence : Young Joo Kim Department of Family Medicine, Pusan National University Hospital T e l : 051-240-7834 E-mail : joo-dr@hanmail.net 23