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ORIGINAL ARTICLE Korean Circ J 8;38:152-16 Print ISSN 1738-55 / On-line ISSN 1738-5555 Copyright c 8 The Korean Society of Cardiology 성별에따른혈청요산농도와대사증후군의연관성 대구가톨릭대학교의과대학순환기내과학교실, 1 의학통계학교실 2 홍승표 1 이영수 1 배경륜 1 정진욱 1 김소연 1 이진배 1 류재근 1 최지용 1 김기식 1 장성국 1 신임희 2 Relationship Between Serum Uric Acid Level and Metabolic Syndrome According to Gender Seung Pyo Hong, MD 1, Young Soo Lee, MD 1, Kyung Ryun Bae, MD 1, Jin Wook Chung, MD 1, So Yeon Kim, MD 1, Jin Bae Lee, MD 1, Jae Kean Ryu, MD 1, Ji Yong Choi, MD 1, Kee Sik Kim, MD 1, Sung Gug Chang, MD 1 and Im Hee Shin, PhD 2 1 Departments of Cardiology and 2 Biostatistics, Catholic University of Daegu College of Medicine, Daegu, Korea ABSTRACT Background and Objectives: Hyperuricemia is known to be a risk factor for atherosclerosis, as is gender. The variables related to metabolic syndrome (MS), as well as other cardiovascular risk factors such as serum uric acid (), differ according to gender. The aim of this study was to evaluate the relationship between and the variables of MS according to gender. Subjects and Methods: We randomly recruited 675 subjects (373 men and 2 women), who underwent health screening. The subjects were divided into four groups according to quartiles. We compared each quartile of the with the incidence of MS. The variables included body mass index (BMI), hypertension, fasting blood glucose (FBS), high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and the MS score. Results: The incidence of MS in men was significantly increased compared to women, and the incidence of MS was increased according to the values in women. The MS scores tended to increase according to the values in both genders. The incidence of high BMI, high blood pressure, and high TG were correlated with the values in both genders. However, HDL-cholesterol was correlated with MS scores in women, and fasting glucose was not correlated with MS in either gender. Conclusion: The variables of the MS might be independently associated with values in both genders. In addition, the incidence of MS in women might be significantly increased according to the values. However, large scale follow-up studies will be required to confirm these possibilities. (Korean Circ J 8;38:152-16) KEY WORDS: Uric acid; Metabolic syndrome; Gender. 서 론 대사증후군은복부비만, 고혈압, 고중성지방혈증, 저고밀도지단백콜레스테롤혈증, 내당능장애등이포함되는여러심혈관질환의위험요소를가지는대사이상의군집 (cluster) 으로정의되고있다. 1) 여러심혈관질환의위험요소를지닌 Received: June 13, 7 Accepted: August 25, 7 Correspondence: Young Soo Lee, MD, Department of Cardiology, Catholic University of Daegu College of Medicine, 56-6 Daemyeong 4-dong, Nam-gu, Daegu 75-718, Korea Tel: 82-53-6-41, Fax: 82-53-621-3166 E-mail: mdleeys@ cu.ac.kr 대사증후군은관상동맥질환의유병률증가와양의상관관계가있으며, 당뇨병보다관상동맥질환의예측인자로더욱중요시되고있다. 2) 최근들어대사증후군과여러인자에대한연구가보고되고있는데, 혈청요산농도와대사증후군의상관관계에대해서도보고되고있다. 몇몇연구에서는한국인에서혈청요산농도가대사증후군의인자들과통계적으로유의한독립적인상관관계가있다고보고하고있다. 3) 혈청요산농도와대사증후군의상관관계에서성별에따른혈청요산농도차이가대사증후군의성별에대한차이와의연관성에대해관심이높아지고있는데, 이러한이유는심혈관질환에서혈청요산농도의남녀차이가대사증후군의남녀차이에영향을줄수있다는보고에근거를두고있다. 4) 이에저 152

Seung Pyo Hong, et al. 153 자들은국내성인건강검진수진자를대상으로하여남녀에따른혈청요산농도와대사증후군의인자들과의상관관계를알아보고자하였다. 대상및방법 대상 6 년 3월 1일부터 6 년 6월 31일까지대구가톨릭대학병원에서건강검진을시행받았던성인총 675 명을대상으로하였다. 이중남녀의구성은성인남자 373 명, 성인여자 2명이었고과거력상당뇨병과고혈압을진단받은환자는제외하였다. 방법 대사증후군의정의 The National Education Cholesterol Program Adult Treatment Panel (NCEP-ATP) III 를중심으로정의하였으나 6) 비만의기준은 American Academy of Clinical Endocrinology (AACE) clinical criteria 를이용하여 7) 체질량지수 25 kg/m 2 진단기준으로정의하였다. 대사증후군의진단기준은다음과같다. 1) 체질량지수 25 kg/m 2, 2) 고중성지방혈증 ( 1 mg/dl), 3) 저고밀도지단백콜레스테롤농도 ( 남자 < mg/dl, 여자 < mg/dl), 4) 고혈압 ( 1/85 mmhg), 5) 공복고혈당 ( 1 mg/dl) 등이상 5개항목중에서 3개항목이상을만족할때대사증후군으로진단하였다. 혈청요산농도와대사증후군인자의연관성을평가하기위해상기진단기준 1) 에서 5) 항목중만족하는항목의개수의합을 score of metabolic syndrome 으로정의하였다. 사회력, 신체계측및혈압흡연력, 키, 체중, 수축기와이완기혈압을측정하였고흡연력은설문지를통해기록하였다. 혈압은 Hypertension Detection and Follow-up Program protocol 에 5) 따라대상자가 5분이상안정후표준화된수은혈압기를이용하여측정하였다. 수축기혈압 1 mmhg, 이완기혈압 9 mmhg 를넘는경우에는안정후 2회혈압을다시측정하여평균값으로정하였다. 키, 체중은자동측정기를이용하였고, 체질량지수 (Body mass index) 는측정된키와체중을이용하여계산 (kg/m 2 ) 으로구하였다. 혈액검사대상자들은 12시간이상금식을확인후공복상태에서정맥혈을채혈하여혈청요산농도, 공복혈당농도, 총콜레스테롤농도, 혈청중성지방농도, 고밀도지단백콜레스테롤농도, 저밀도지단백콜레스테롤농도를측정하였다. 혈청요산농도는 Uricase EMST method (Hiatchi 747 automatic analyzer, Hitachi, Tokyo, Japan) 를이용하여측정하였다. 통계분석통계분석은윈도우즈용 SPSS program (ver. 12., Chicago, IL, USA) 을이용하였다. 통계결과는평균 ± 표준편차또는 95% 신뢰구간으로표시하였다. 혈청요산농도와대사증후군위험인자와의연관성을분석하기위하여대상자를혈청요산농도에따라사등분하여 4군으로분류하였다. 각군의값의비교는 one-way analysis of variance (ANOVA) test 를이용하였고, 교차비는 χ 2 -test 를이용하여검정하였으며, 혈청요산농도에따른남녀의비교는 unpaired t-test 를이용하였다. 혈청요산농도와성별에따른대사증후군의위험인자의상관관계는 pearson 의상관계수를이용하였으며, 혈청요산농도에따른비교위험도는 multiple logistic regression analysis 를이용하여분석하였다. P 값이.5 미만인경우를통계적으로유의한것으로판정하였다. 결과 대상군의임상적특징총대상군 675 명은성별에따라연령, 체질량지수, 흡연율, Table 1. Characteristics of the study population Total p N 675 373 2 Age (yrs) 46.9±.5 46.1±9.5 47.8±11.6.37 BMI (kg/m 2 ) 23.6±3.1 23.9±3. 23.2±3.2.1 Smoking (%) 193 (28.6%) 18 (48.4%) 13 (4.3%) <.1 Systolic BP (mmhg) 125.8±18.5 127.3±18.7 124.±18.1.24 Diastolic BP (mmhg) 75.8±14. 76.1±15.2 75.4±12.3.472 Total cholesterol (mg/dl) 194.2±36.8 198.4±34.8 189.±38.6 <.1 HDL-cholesterol (mg/dl) 56.8±13.8 53.2±12.6 61.2±14. <.1 Triglyceride (mg/dl) 123.9±84.3 142.7±89.5.7±71. <.1 LDL-cholesterol (mg/dl) 132.4±37.2 138.±35.2 125.4±38.6 <.1 Fasting glucose (mg/dl) 95.8±39.9 97.2±47.2 94.1±28.5.315 Serum uric acid (mg/dl) 5.5±1. 5.83±1.39 4.8±.95 <.1 BMI: body mass index, BP: blood pressure, HDL: high density lipoprotein, LDL: low density lipoprotein

154 Serum Uric Acid and Metabolic Syndrome 혈압, 혈청고밀도지단백콜레스테롤농도, 혈청중성지방농도, 공복혈당농도, 혈청요산농도를각각비교하였다 (Table 1). 대상군의남성에서체질량지수, 흡연율, 수축기및이완기혈압, 혈청중성지방농도, 공복혈당이의미있게여성보다높았으며, 여성에서평균연령, 고밀도지단백콜레스테롤농도가남성보다높았다. 혈청요산농도는남성에서 5.83±1.39 mg/dl 로여성의 4.8±.95 mg/dl 보다통계적으로유의하게높았다 (p<.5). 혈청요산농도와대사증후군의인자와의상관관계혈청요산농도와대사증후군인자의상관관계를고려하였을때, 혈청요산농도와체질량지수, 고밀도지단백콜레스테롤농도, 중성지방농도, 수축기혈압이통계적으로의미있는상관관계를보였다. 남녀로나누었을경우에는체질량지수, 수축기혈압과중성지방농도는통계적으로의미있는상관관계를보였지만, 고밀도지단백콜레스테롤농도는통계적으로상관관계가없었다 (Table 2 and 3). Table 2. Pearson s correlation coefficients for the relationship between variables of metabolic syndrome and serum uric acid in total person Table 3. Pearson s correlation coefficients for the relationship between variables of metabolic syndrome and serum uric acid in men and women BMI HDL-C TG FBS SBP () BMI HDL-C TG FBS SBP DBP.234 -.239 -.311 -.31 -.139 -. BMI -.266 -.317 -.66 -.75 -.17 HDL-C - -.418 -.19 -.7 -. TG - -.57 -.59 -.2 FBS SBP BMI HDL-C TG.239 ) -.87 ).241* (.181) (-.7) (.143)* FBS.57 (-.92) ) -.313 ).37.46 () (-.171) (.2) (.99) ) -.3.37 () (-.485) (.23) () SBP.3* (.124)*.62 (.69).1 (-.2).4 (.167).78 (-.24) () -.21 (-.22) () DBP.7 (-.2) -.9 (.46) -.3 (-.52).19 (-.52) -.6 (-.29).758 (.714) DBP () *p<.5, p<.1. : serum uric acid, BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, TG: triglyceride, FBS: fasting blood sugar, SBP: systolic blood pressure, DBP: diastolic blood pressure Table 4. Relationship between variables of metabolic syndrome and serum uric acid quartiles in men Quartiles of serum uric acid 1 2 3 4 - -.17 -.11 - -.738 DBP - *p<.5, p<.1. : serum uric acid, BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, TG: triglyceride, FBS: fasting blood sugar, SBP: systolic blood pressure, DBP: diastolic blood pressure range (mg/dl) 1.9-4.8 4.9-5.7 5.8-6.6 6.7-.2 N 89 86 1 97 Age (yrs) 48.2±.1 46.5±.5 44.5±7.8 45.5±9.4 <.47 BMI (kg/m 2 ) 23.3±2.8 23.2±2.5 24.1±3. 25.±3.2* <.1 SBP (mmhg) 123.5±19.7 129.±18.2 125.1±18.4 131.5±17.7* <.12 DBP (mmhg) 75.1±15.7 78.4±15.3 72.3±11.4 79.±17.3 <.7 HDL-C (mg/dl) 54.4±13.4 54.8±14.5 52.7±11.2 51.4±11.3 <.229 TG (mg/dl) 1.6±69.9 121.6±67.5 1.5±7.3 184.±121.7* <.1 FBS (mg/dl) 99.2±29.3 6.1±89.9 91.±14.7 93.9±18.3 <.142 *p<.5 compared to 1 st Quartiles, p<.5 comparted to 2 nd Quartiles, p<.5 comparted to 3 rd Quartiles. : serum uric acid, BMI: body mass index, SBP: systolic blood pressure, DBP: diastolic blood pressure, HDL-C: high density lipoprotein-cholesterol, TG: triglyceride, FBS: fasting blood sugar p

Seung Pyo Hong, et al. 155 성별에따른혈청요산농도와대사증후군의인자와의연관성성별에따라공복시혈청요산농도를백분위에의거하여 4군으로분류하여각군과대사증후군의인자와의연관성을고려하였을때, 남성의경우혈청요산농도가증가함에따라체질량지수, 수축기및이완기혈압, 중성지방농도는통계적으로유의하게증가하였으나, 고밀도지단백콜레스테롤 농도는감소하는경향을보였다 (Table 4). 여성의경우혈청요산농도가증가함에따라고밀도지단백콜레스테롤농도는의미있게감소하였고, 체질량지수와중성지방농도는혈청요산농도가증가함에따라통계적으로유의하게증가하였다 (Table 5). 남녀모두에서혈청요산농도의증가에따른공복혈당의농도는유의한차이를보이지않았다. Table 5. Relationship between variables of metabolic syndrome and serum uric acid quartiles in women Quartiles of serum uric acid 1 2 3 4 range (mg/dl).5-3.4 3.5-4. 4.1-4.5 4.6-8.8 N 73 76 7 83 Age (yrs) 45.6±11.7 44.4±9.6 48.3±11.9 52.6±11.7 <.1 BMI (kg/m 2 ) 22.2±2.6 23.2±4.3 22.9±2.5 24.2±2.7*.1 SBP (mmhg) 122.9±15.9 124.5±17.5 121.7±.9 126.6±17.9.367 DBP (mmhg) 76.9±12.4 75.5±13.2 72.2±11.2 76.5±12..95 HDL-C (mg/dl) 62.7±12.8 63.9±14.5 57.5±13. 6.6±14.8.34 TG (mg/dl) 87.1±86.3 85.5±52.3 7.6±61.3 1.7±73.8*.4 FBS (mg/dl) 97.9±46.8 91.7±12. 93.3±18.8 93.6±24.7.575 *p<.5 compared to 1 st Quartiles, p<.5 comparted to 2 nd Quartiles, p<.5 comparted to 3 rd Quartiles. : serum uric acid, BMI: body mass index, SBP: systolic blood pressure, DBP: diastolic blood pressure, HDL-C: high density lipoprotein-cholesterol, TG: triglyceride, FBS: fasting blood sugar p p<.1 47.4 p=.2 Incidence of obesity (%) 34. 24.7.9.6 Incidence of obesity (%) 24.2 13.7 23.7 18.6 38.6 127/373 22/89 18/86 41/1 46/97 No. of Pt. Fig. 1. Relationship between obesity and serum uric acid () quartiles. 73/2 /73 18/76 13/7 32/83 Incidence of increased blood pressure (%) p<.1.6 21.3 29.1 28.7 42.3 114/373 19/89 25/86 29/1 41/97 No. of Pt. 56/2 15/73 15/76 14/7 22/83 Fig. 2. Relationship between increased blood pressure and serum uric acid () quartiles. Incidence of increased blood pressure (%) p=.16 18.5 6.8 19.7. 26.5

156 Serum Uric Acid and Metabolic Syndrome 성별에따른혈청요산농도와대사증후군인자의독립적인연관성대사증후군의각인자가독립적으로대사증후군의진단기준에만족하는빈도와혈청요산농도와의연관성을비교해보았을때, 비만, 고혈압과고중성지방농도는남성에서여성보다통계적으로유의하게증가되어있었으며 (p<.5), 남녀모두에서혈청요산농도가높은군에서비만, 고혈압과 고중성지방농도의빈도가의미있게증가되어있다 (Figs. 1, 2 and 3). 낮은고밀도지단백콜레스테롤농도의경우, 여성에서남성보다빈도가의미있게증가되어있으며 (p<.5), 여성의경우에는혈청요산농도가증가함에따라낮은고밀도지단백콜레스테롤농도의빈도가통계적으로유의하게증가되었다 (p<.5) (Fig. 4). 공복고혈당의빈도는남성에서여성보다높았다 (p<.5) (Fig. 5). Incidence of high triglyceride (%) 6 p<.1 35.1 41.6 53.6 22.5 22.9 19.8. 14.6 8.2 6.6 131/373 /89 17/86 42/1 52/97 No. of Pt. 44/2 16/73 5/76 14/7 19/83 Fig. 3. Relationship between high triglyceride and serum uric acid () quartiles. Incidence of high triglyceride (%) 6 p=.6 p=.678 p=.17 Incidence of low HDL (%).5 13.5 9.3.9 8.2 Incidence of low HDL (%).2 12.3 14.5 31.4 22.9 39/373 12/89 8/86 11/1 8/97 No. of Pt. 61/2 59/73 11/76 22/7 19/83 Fig. 4. Relationship between low high-density lipoprotein (HDL) cholesterol and serum uric acid () quartiles. Incidence of fasting hyperglycemia (%) p=.5 13.4 19.1.9 5.9 /373 17/89 18/86 6/1 9/97 Fig. 5. Relationship between fasting hyperglycemia and serum uric acid () quartiles. 9.3 Incidence of fasting hyperglycemia (%) No. of Pt. p=.465 8.6 8.2.5 4.3.8 26/2 6/73 8/76 3/7 9/83

Seung Pyo Hong, et al. 157 Score of metabolic syndrome 3 2 1 1.23 p<.5 p<.5 1.28 1. 1. 1.61 Score of metabolic syndrome 3 2 1.89 p<.5 p<.5 p<.5.94.75 1.21.49 Fig. 6. Relationship between score of metabolic syndrome and serum uric acid () quartiles. Table 6. Multiple analysis of the association between uric acid and metabolic syndrome Quartiles of serum uric acid Q1 Q2 Q3 Q4 Total 1 (reference) 1.175 (.925-1.493)* 1.426 (1.134-1.793) 1.76 (1.366-2.132) 1 (reference) 1.37 (.754-1.426)* 1.384 (1.27-1.865)* 1.784 (1.299-2.353) 1 (reference) 1.496 (1.4-2.229)* 1.613 (1.89-2.39)* 1.851 (1.268-2.72) Age and low density lipoprotein-cholesterol were used as covariates. *p<.5, p<.1 Incidence of metabolic syndrome (%) p=.639 11.5 11.1.5 11.9 16.5 48/373 11/89 9/86 12/1 16/97 No. of Pt. 27/2 2/73 4/76 7/7 14/83 Fig. 7. Relationship between metabolic syndrome and serum uric acid () quartiles. Incidence of metabolic syndrome (%) p=.11 8.9 2.7 5.3. 16.9 성별에따른혈청요산농도와대사증후군유병률의상관관계 Score of metabolic syndrome 은남성에서여성보다높았으며 ( 남성 : 1.23±1.9, 여성 :.86±1.4, p<.1), 남녀모두에서혈청요산농도가증가함에따라 Score of metabolic syndrome 이증가하였다 (Fig. 6). 또한연령과저밀도지단백콜레스테롤농도를고려한다변량회귀분석에서도대사증후군의인자가혈청요산농도가증가함에따라유의하게양의상관관계를보였다 (Table 6). 대사증후군인자가 3개이상만족하는것으로정의되는대사증후군의유병률은남성에서여성보다높은경향을보였으며 ( 남성 : 12.9%, 여성 : 8.9%, p=.67), 여성에서만혈청요산농도가증가할수록대사증후군의유병률이통계적으로유의하게증가하였다 (Fig. 7). 여성의경우폐경에따른혈중요산농도와대사증후군의유병률의차이는폐경전에비해폐경후대사증후군의유병 률이더증가하였으며 (p<.5), 폐경전여성의경우에서혈중요산농도와대사증후군의유병률과통계적으로유의성이없었으나 (p=.858), 폐경후여성의경우에서는혈청요산농도와대사증후군의유병률이통계적으로유의하였다 (p=.8) (Fig. 8). 고찰 본연구의결과에의하면대사증후군의인자들은남녀모두에서혈청요산농도와유의한양의상관관계를보였다. 대사증후군의유병률은여성보다남성에서높았으나, 혈청요산농도의증가에따른대사증후군의유병률은여성에서만통계적으로유의한양의상관관계를보였다. 일반적으로대사증후군의유병률은남성보다여성에서높은것으로보고되고있다. Regitz-Zagrosek 등 4) 은남성보

158 Serum Uric Acid and Metabolic Syndrome Incidence of metabolic syndrome (%) p=.858 5.5 3.8 7.5 4.9 5.7 /182 2/53 4/53 2/41 2/35 Pre-menopause Post-menopause Fig. 8. Relationship between metabolic syndrome and serum uric acid () quartiles according to menopause. Incidence of metabolic syndrome (%) No. of Pt. p=.8 14.2 17.2 25. 17/1 / /23 5/29 12/48 다여성에서대사증후군의유병률이높다고보고하고있고, 우리나라의경우에도유병률이성인남자 19.9%, 여자 23.7% 로여성에서의유병률이높게보고되고있다. 8) 하지만본연구의결과에서는외국과국내의보고와달리대사증후군의유병률이여성보다남성에서높은결과를보였다. 이러한결과의차이는대사증후군의연령에따른유병률의차이에서찾을수있다. 대사증후군의연령에따른유병률은여성에서는 대에서 대에이를때급증하는양상을보이면서지속적으로증가하는반면, 남자는 ~ 대에정점을형성하다이후줄어드는경향을보인다. 그러므로 대까지는남성에서여성보다빈도가높지만 대이후에는여성에서남성보다빈도가높게나타난다. 8) 본연구에서대사증후군의유병률이여성에비해남성에서높은결과를보이는이유는본연구에서선별된대상의평균연령이 46.9 세 ( 남성 : 46.1 세, 여성 : 47.8 세 ) 이므로남성에서높은유병률을보이는것으로생각된다. 또한본연구에서는대사증후군의기준중비만에대한기준을체질량지수로하였다. Park 등 8) 의국내연구에따르면남녀의체질량지수는남성에서 23.1, 여성에서 23.3 으로비슷한소견을보였으나복부둘레는남성에서 82.9 cm, 여성에서 78.6 cm으로복부비만의국내기준 9) 인남성 9 cm, 여성 8 cm와비교시여성에서비만에가까운결과를보였다. 이러한결과를고려해보았을때본연구에서도대사증후군의비만정의를복부둘레를기준으로한다면남녀에서대사증후군의유병률의결과가달라질수있는가능성이있겠다. 향후복부둘레를비만기준으로이용한대사증후군의유병률연구가필요할것으로보인다. 혈관내피세포에영향을준다고알려진혈청요산은항산화성질을가진퓨린대사물질로고혈압, 당뇨병, 만성심질환을가진고위험군에서심혈관계질환의위험도를 3~5배증가시킨다. ) 이러한혈청요산의심혈관질환에대한위험도증가는대사증후군의유병률증가와양의상관관계가있다는보고들이있다. Yoo 등 11) 의연구에따르면혈청요산농도는고혈압, 인슐린저항성및대사증후군발생위험인 자들과통계적으로유의한독립적인상관관계가있었으며, 또한정상범위의혈청요산농도라할지라도혈청요산농도의증가에비례하여대사증후군의위험성이증가한다고보고하고있다. 본연구의결과에서는혈청요산농도의증가에따른대사증후군의유병률은여성에서만통계적으로유의한양의상관관계를보였다. 이러한성별의차이는우선성별에따른혈청요산농도의차이에서고려해볼수있다. 혈청요산농도는남성의상한치는 7. mg/dl, 여자는 6. mg/dl 로여성이폐경이되어남성들의혈청요산농도와비슷해질때까지거의변화가없다. 이렇게여성들이낮은혈청요산농도를유지하는이유는콩팥의세관에서요산의분비후재흡수를저하시키는여성호르몬때문이라고생각된다. 12) 폐경후의여성은여성호르몬의감소로인해혈청요산의농도가증가되고, 12) 인슐린저항성, 복부비만, 고지혈증, 고혈압의유병률도증가된다. 4) 일반적으로혈청요산의농도증가는혈관의질소산화물의활성도를저하시키고항산화성물질을생산함으로써심혈관에서혈관확장기능의저하를일으키고혈관평활근과혈관내피세포기능의저하를일으킴은 13) 물론, 혈소판응집및부착을더잘일으켜심혈관계질환에영향을준다고보고되고있다. 14)15) 폐경후의여성호르몬의감소와더불어혈청요산농도증가의상관관계가대사증후군의유병률에영향을준다고직접적으로결론을내릴수는없다. 하지만본연구에서는여성의평균연령이 47.8±11.6 세인점을감안할때, 국내의폐경주변기여성의평균연령이 48.5 세 ( 본연구에서의폐경평균연령 : 49.1 세 ) 이었으므로 16) 폐경기전후로의여성호르몬변화와혈청요산의변화가여성에서의혈청요산과대사증후군유병률의상관관계에있어영향이있을것으로보인다. Park 등 8) 의국내연구에따르면 세이후의여성에서대사증후군의유병률이급격히증가하는소견을보였다. 본연구에서도폐경전여성과폐경후여성의대사증후군의유병률을비교해보았을때폐경후의여성에서유병률이높게나타났다. 하지만여성호르몬의감소에따른영향과혈청요산으로인한영향의상관관계에대해서는향후더연구가필요하리라본다.

Seung Pyo Hong, et al. 159 여러연구들에서혈청요산의대사가제2형당뇨병에중요한역할을하고있다고보고하고있다. 17) 또한혈청요산이대사증후군과의연관성에대해인슐린저항을나타내는인자로서대사증후군의한부분이라는보고도있다. 18) 본연구에서는혈청요산농도와공복혈당의관련성이없었다. 이러한결과는본연구에서선별된군의평균공복혈당이 95.8 ±39.9 mg/dl 로내당능장애소견없이정상공복혈당범위내에있기때문으로사료된다. 여러연구들에서대사증후군, 혈청요산농도, 그리고심혈관질환에대한상관관계에대해보고하고있으나, 대부분이당뇨병, 고혈압등의질병을가진환자를대상으로하였으며일반인을대상으로한연구는부족한상태이다. 또한, 성별에따른혈청요산농도와대사증후군의상관관계에대해서도연구가부족한상태이다. 본연구에서는질병이있는환자가아닌일반성인을대상으로하였으며성별에따른혈청요산농도와대사증후군발생위험인자와의관련성에대해연구하였다. 본연구의제한점으로는첫째, 대사증후군의진단기준에서복부비만을사용하지않고체질량지수를택한점, 둘째, 대상자의항지질제와같은약물의영향이고려되지않은점, 셋째, 대상자의평균연령이 대미만으로낮다는점과여성에서남성보다연령이높다는점, 넷째, 설문지를통하여조사하였기때문에이뇨제등약물의사용, 음주, 흡연, 식생활습관등혈청요산농도의증가또는감소에영향을미치는요소들을완전히배제하지못하였다는점, 마지막으로, 대상인원이 675명으로대규모로이루어지지못했다는점등이다. 결론적으로본연구에서여러가지제한점이있지만, 국내건강한성인에서대사증후군의인자들은남녀모두에서혈청요산농도와의미있는양의상관관계를보였다. 또한대사증후군의유병률은여성보다남성에서높았으나, 대사증후군인자의유병률은여성에서만혈청요산농도와통계적으로유의한양의상관관계를보였다. 향후혈청요산농도가대사증후군에미치는영향에대한전향적인연구가필요할것으로생각된다. 요약 배경및목적고요산혈증은죽상동맥경화증의위험인자로알려져있다. 다른위험인자로성별이알려져있으나성별은고정인자로작용하고있다. 이러한성별의차이는대사증후군의인자와혈청요산과같은심혈관계위험인자에서도나타난다. 이에저자들은국내성인건강검진수진자를대상으로하여혈청요산농도와대사증후군발생위험인자들과의상관관계를알아보고자하였다. 방법 6 년 3월부터 6 년 6월까지본원에서건강검진을 받은성인남자 373 명, 성인여자 2 명등총 675 명을대상으로혈청요산농도를백분위에의거하여 4군으로분류한후성별에따라혈청요산농도에따른대사증후군인자와의관련성과대사증후군의유병률을판정하였다. 결과대사증후군의유병률은여성보다남성에서더높았고. 혈청요산농도가증가함에따른대사증후군의유병률은여성에서만통계적으로유의하게상관관계가있었다 (p=.11). 남녀모두에서혈청요산농도가증가함에따라대사증후군정의에해당하는항목을만족시키는개수의평균수치가증가함을관찰할수있었다. 남녀모두에서혈청요산농도가높아질수록높은체질량지수, 고혈압, 높은중성지방농도를보였다. 하지만혈청고밀도지단백콜레스테롤농도는남성에서보다여성에서더밀접한관계를보였고, 공복혈당의경우관련성이없었다. 결론대사증후군의인자들은남녀모두에서혈청요산농도와독립적인상관관계를보였다. 대사증후군의유병률은여성보다남성에서높았으나, 혈청요산농도의증가에따른대사증후군의유병률은여성에서만통계적으로유의한양의상관관계를보였다. 그러나이들의인과관계를알기위해서는향후전향적연구가필요할것으로생각된다. 중심단어 : 요산 ; 대사증후군 ; 성별. Acknowledgments 본연구는산업자원부지방기술혁신사업 (RTI4-1-1) 지원으로수행되었음. REFERENCES 1) Costa A, Iguala I, Bedini J, Quinto L, Conget I. Uric acid concentration in subjects at risk of type 2 diabetes mellitus: relationship to components of the metabolic syndrome. Metabolism 2; 51:372-5. 2) Alexander CM, Landsman PB, Teutsch SM, Haffner SM. NCEPdefined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age years and older. Diabetes 3;52:12-4. 3) Cha BS, Kim HJ. Metabolic syndrome and cardiovascular disease. Korean Circ J 3;33:645-52. 4) Regitz-Zagrosek V, Lehmkuhl E, Weickert MO. Gender differences in the metabolic syndrome and their role for cardiovascular disease. Clin Res Cardiol 6;95:136-47. 5) Curb JD, Ford C, Hawkins CM, et al. A coordinating center in a clinical trial: the hypertension detection and followup program. Control Clin Trials 1983;4:171-86. 6) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 1;285:2486-97. 7) Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 3;9:237-52.

16 Serum Uric Acid and Metabolic Syndrome 8) Park HS, Oh SW, Kang JH, et al. Prevalence and associated factors with metabolic syndrome in South Korea: from the Korean National Health and Nutrition Examination Survey, 1998. J Korean Soc Study Obes 3;12:1-14. 9) International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Western Pacific Region;. ) Ames BN, Cathcart R, Schwiers E, Hochstein P. Uric acid provides an antioxidant defense in humans against oxidant-and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A 1981;78:6858-62. 11) Yoo TW, Sung KC, Kim YC, et al. The relationship of the Hypertension, insulin resistance, and metabolic syndrome in the serum uric acid level. Korean Circ J 4;34:874-82. 12) Sumino H, Ichikawa S, Kanda T, Nakamura T, Sakamaki T. Reduction of serum uric acid by hormone replacement therapy in postmenopausal women with hyperuricaemia. Lancet 1999;354: 6. 13) Waring WS, Adwani SH, Breukels O, Webb DJ, Maxwell SR. Hyperuricaemia does not impair cardiovascular function in healthy adults. Heart 4;9:155-9. 14) Alderman MH, Cohen H, Madhavan S, Kinlighn S. Serum uric acid and cardiovascular events in successfuolly treated hypertensive patients. Hypertension 1999;34:144-. 15) Sowers JR, Lester MA. Diabetes and cardiovascular disease. Dabetes Care 1999;22(Suppl 3):C14-. 16) Kim JH, Moon HS. Health perception, body image, sexual function and depression in menopausal women according to menopausal stages. J Korean Acad Nurs 6;36:449-56. 17) Jitapunkul S, Chalapraprawat M, Bunnag S, et al. The relationship between glucose and uric acid metabolism: influence of short term allopurinol on glucose metabolism. J Med Assoc Thai 1991;74:8-6. 18) Yun JW, Kang JM, Lee WY, Kim SW. Plasma uric acid concentrations represent the degree of metabolic control and diabetic complications in type 2 diabetes. Korean J Med 3;64: 78-84.