대한진단검사의학회지제 29 권제 4 호 2009 Korean J Lab Med 2009;29:286-92 DOI 10.3343/kjlm.2009.29.4.286 Original Article Clinical Chemistry 여성에서갑상샘기능과심혈관계질환의위험인자와의관계 나은희 이정규 한국건강관리협회서울지부 The Relationship between Thyroid Function and the Risk Factors of Cardiovascular Disease at Female Medical Checkups Eun Hee Nah M.D. and Jeong Gyu Lee, M.T. Korea Association of Health Promotion, Seoul, Korea Background : Thyroid hormones play an important role in regulating lipid and glucose metabolism. Thus this study was conducted to investigate the relationship between the thyroid hormone (FT4) or thyroid stimulating hormone (TSH) and the cardiovascular risk factors and metabolic syndrome in the individuals with subclinical thyroid dysfunction. Methods : The female health examinee with normal range of FT4 were classified into three groups according to the level of TSH; euthyroid group (n=4,410), subclinical hypothyroidism group (n=438) and subclinical hyperthyroidism group (n=66). Age, blood pressure, BMI, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lipoprotein(a), and high-sensitivity C-reactive protein (hscrp) levels of serum specimens were compared among the groups and association of FT4 or TSH with these parameters. Results : Fasting glucose was significantly higher in subclinical hyperthyroidism than in euthyroid and subclinical hypothyroidism groups (P=0.031), and total cholesterol was higher in subclinical hypothyroidism than in subclinical hyperthyroidism (P=0.011). But the other factors showed no difference among the groups. The level of TSH increased as triglyceride increased, while FT4 decreased as BMI or triglyceride increased. The FT4 also lowered when fasting glucose was above 126 mg/dl. TSH was not related with the metabolic syndrome, but the possibility of the syndrome was 1.3 times higher in the lowest quartile of the normal range of FT4 than in its highest quartile. Conclusions : For the interpretation of FT4, its reference interval needs to be divided into 4 quartiles, which can be used as one of the predicting factors of the metabolic syndrome. (Korean J Lab Med 2009;29:286-92) Key Words : Subclinical thyroid dysfunction, FT4, Cardiovascular risk factors, Metabolic syndrome 서 론 건강검진에서갑상샘기능이상은드물지않게발견된다. 그러 Received : Fubruary 13, 2009 Manuscript No : KJLM09-027 Revision received : May 19, 2009 Accepted : June 26, 2009 Corresponding author : Eun Hee Nah, M.D. Korea Association of Health Promotion, 1097 Hwagok 6-dong, Gangseo-gu, Seoul 157-704, Korea Tel : +82-2-2601-7161, Fax : +82-2-2696-4500 E-mail : cellonah@hanmail.net 나, 확연한갑상샘기능저하증이나기능항진증보다도, 혈중갑상샘호르몬은정상범위내에있고갑상샘자극호르몬만증가하거나감소하는무증상갑상샘기능저하증이나무증상갑상샘기능항진증이더흔하다 [1]. 이는여성에서더자주발견된다 [2]. 한편, 갑상샘호르몬 (free thyroxine, FT4) 은지질대사와당대사에중요한역할을하고있으며, 특히갑상샘기능저하증때혈중지질농도와혈압에영향을미치는것으로알려져있다 [3, 4]. 그러나혈중갑상샘호르몬수치가정상인무증상갑상샘기능저 286
Thyroid Function Test and Cardiovascular Risk Factors 287 하증인경우는상반된결과, 즉갑상샘호르몬이혈중지질이상과연관이있다는결과 [5] 와연관이없다는결과 [6] 가보고된바있다. 이에본연구에서는무증상갑상샘기능이상을보이는여성을대상으로, 갑상샘호르몬또는갑상샘자극호르몬 (thyroid-stimulating hormone, TSH) 과심혈관계질환의위험요소및대사증후군과의연관성을밝히고, 이들의대사적특징을알아보고자하였다. 대상및방법 1. 대상 2007년 4월부터 2008년 3월까지건강증진센터에서임상계측, 일반화학검사및갑상선기능검사를포함한면역혈청검사를받은 20세이상의여성에서, TSH와 FT4가정상인 4,410명을정상갑상샘기능군으로, FT4는정상이나 TSH가증가한 438명을무증상갑상샘기능저하군으로, FT4는정상이나 TSH가감소한 66 명을무증상갑상샘기능항진군으로구분하여연구대상으로하였다. 2. 무증상갑상샘기능이상및정상갑상샘기능군의대사적특징조사 롤, 리포지단백 (a)[lipoprotein(a): Lp(a)], 고감도 C-반응성단백질 (high sensitivity C-reactive protein, hscrp) 을 Hitachi 7600 (Hitachi, Nakai, Japan) 으로측정하였다. 총콜레스테롤, HDL콜레스테롤, 중성지방, 혈당은아산시약 (Asan Inc., Hwaseong, Korea) 을사용하여효소법으로, LDL콜레스테롤은 Daiichi 시약 (Daiichi Pure Chemicals Co., Tokyo, Japan) 을사용하여효소법으로, Lp(a) 와 hscrp는 Daiichi 시약을사용하여혼탁면역법으로측정하였다. hscrp의측정범위는 0.03-30 mg/dl이었고, 참고범위는 0.3 mg/dl 미만으로하였다. TSH와 FT4는전기화학발광면역분석법 (electrochemiluminescence immunoassay) 을이용하여 MODULAR ANALY- TICS E170 (Roche Diagnostics, Indianapolis, IN, USA) 으로측정하였다. TSH와 FT4의참고치는건강검진센터를내원한 19 세부터 79세까지의성인여성의검사결과를 Shapiro-Wilk test 로정규성을검정한후 2.5 percentile과 97.5 percentile에해당하는결과를참고치의상, 하한으로선정하였다. TSH의참고범위는 0.27-4.2 μiu/ml, 최소측정농도는 0.005 μiu/ml, 검사간변이계수는 1.1-3.0%, 검사일간변이계수는 3.2-7.2% 였다. FT4의참고범위는 0.8-1.9 ng/dl이었으며, 최소측정농도는 0.023 ng/dl, 검사간변이계수는 1.4-2.0%, 검사일간변이계수는 2.7-3.6% 였다. 4. 통계분석 혈압측정은최소 5분이상안정을취한후표준혈압계를사용하여상완에서수동으로측정하였다. 정상혈압이아닌경우는좀더안정을취한후재측정하였고, 만약재측정값이처음값과 10 mmhg 이상차이가날때는한번더측정하여근접한 2회측정값의평균치로정하였다. 체질량지수 (Body Mass Index, BMI) 는체중 (kg)/ 신장 2 (m 2 ) 의공식에의해계산하였다. 대사증후군의판정은 National Cholesterol Education Panel (NCEP) 기준 [7] 에따라공복혈당이 100 mg/dl 이상, 혈압이 130/85 mmhg 이상, 중성지방이 150 mg/dl 이상, HDL콜레스테롤은 50 mg/dl 미만인경우, 체질량지수가 25 kg/m 2 를초과하는경우중 3가지이상해당하는경우로하였다. 3. 혈액화학및면역혈청검사혈액화학검사는 10시간공복후채혈한혈액의혈청에서공복혈당, 중성지방, 총콜레스테롤, HDL콜레스테롤, LDL콜레스테 정상갑상샘기능군, 무증상갑상샘기능저하증군, 무증상갑상샘기능항진증군사이의임상적및대사적차이를알아보기위해일원분산분석 (one-way ANOVA) 을하였으며, 각군간의차이를알기위해사후분석으로다중비교를하였다. TSH 및 FT4와심혈관계질환의위험인자와의연관성을알기위해다중선형회귀분석을하였다. TSH 및 FT4와대사증후군발생과의관계를알아보기위해로지스틱회귀분석을하였다. 정상범위의 FT4를사분위하였으며, TSH를 7개범위로나누었다. 즉, TSH가증가한경우를, 4.3-10 μiu/ml와 10 μiu/ml 이상인경우로, TSH 의정상범위를사분위로세분화했으며, 마지막으로 TSH가 4.3 μiu/ml 미만인경우로구분하였다. 통계프로그램은 SPSS version 11.5 (SPSS Inc., Chicago, IL, USA) 를이용하였고, P< 0.05를통계적으로유의한것으로하였다. 결과 20세이상의여성건강검진자 4,953명중, 갑상샘기능항진증
288 나은희 이정규 이 23 명 (0.5%), 갑상샘기능저하증이 16명 (0.3%) 이었고, 본연구의대상이된무증상갑상샘기능항진증이 66명 (1.3%), 무증상갑상샘기능저하증이 438명 (8.8%) 으로, 무증상갑상샘기능이상이 504명 (10.1%) 이었고, 갑상샘기능이정상인경우가 4,410명 (89.0%) 이었다. 1. 무증상갑상샘기능이상의임상적및대사적특징정상군과무증상갑상샘기능이상군에서 FT4를비교했을때, FT4는무증상갑상샘기능항진증군에서 1.406±0.24 ng/dl로가장높았고, 정상군에서 1.198±0.15 ng/dl, 무증상갑상샘기능저하증군에서 1.127±0.16 ng/dl로가장낮았다 (P<0.001) (Table 1). 정상군과무증상갑상샘기능이상군에서공복혈당과총콜레스테롤을비교했을때, 공복혈당은무증상갑상샘기능항진증군에서 94.7±20.7 mg/dl로정상갑상샘기능군의 90.3±14.0 mg/ dl이나, 무증상갑상샘기능저하증군의 89.8±15.4 mg/dl보다더높았다 (P=0.031) (Table 1). 총콜레스테롤은무증상갑상샘기능저하증군에서 181.4±32.9 mg/dl로, 정상갑상샘기능군의 178.7±33.1 mg/dl와의미있는차이는없었으나, 무증상갑상샘기능항진증의 170.3±31.7 mg/dl과비교하면의미있게더높았다 (P=0.011) (Table 1). 그러나연령, 체질량지수, 혈압, HDL콜레스테롤, LDL콜레스테롤, 중성지방, Lp(a), hscrp는세군사이에차이가없었다. 2. 갑상샘기능과심혈관계질환위험요소와의관계 연령대에따른 TSH의차이는없었다. 다중선형회귀분석에의한 TSH와심혈관계질환위험요소와의관계분석시, 연령및다른인자들과의교란효과를제거했을때 TSH는중성지방이높을때더높았다 (P=0.008) (Table 3). 그러나체질량지수, 혈압, 공복혈당, 총콜레스테롤, LDL콜레스테롤, HDL콜레스테롤과는연관성이없었다. FT4는연령대에따라차이를보였으며, 20대와 30 대가 40대이후보다의의있게더높았다 (P<0.001) (Table 2). 연령의교란효과를제거했을때 FT4는체질량지수가높을수록, 공복혈당이정상인경우보다당뇨병진단기준이상인경우에, 그리고중성지방이높을수록더낮았다 (Table 4). 그러나혈압, 총콜레스테롤, LDL콜레스테롤, HDL콜레스테롤과는연관성이없었다. Table 2. Mean FT4 according to age Age N Mean FT4 P value 20-29 557 1.223±0.165 <0.001 30-39 1,930 1.209±0.155 40-49 750 1.173±0.155 50-59 939 1.175±0.158 60-69 608 1.182±0.162 70-130 1.171±0.162 Total 4,914 1.194±0.159 Table 1. Difference of variables among euthyroid and subclinical thyroid dysfunction groups Subclinical hyperthyroidism (n=66) Euthyroid (n=4,410) Subclinical hypothyroidism (n=438) P value* TSH (μiu/ml) 0.050±0.08 1.978±0.89 5.912±2.32 <0.001 FT4 (ng/dl) 1.406±0.24 1.198±0.15 1.127±0.16 <0.001 Age (yr) 47.1±12.8 43.7±12.9 43.8±13.3 BMI 22.6±3.0 22.7±3.2 22.5±3.2 Systolic BP (mmhg) 119.7±15.8 116.7±16.1 117.6±15.9 Diastolic BP (mmhg) 71.0±9.4 69.2±10.3 70.1±9.9 Fasting glucose (mg/dl) 94.7±20.7 90.3±14.0 89.8±15.4 0.031 T. Cholesterol (mg/dl) 170.3±31.7 178.7±33.1 181.4±32.9 0.029 LDL-C (mg/dl) 106.3±28.9 113.1±31.9 115.7±31.9 HDL-C (mg/dl) 53.6±10.9 54.4±9.2 54.4±8.8 Triglyceride (mg/dl) 86.0±48.4 91.1±57.9 95.2±52.0 Lp(a) (mg/dl) 13.4±12.6 16.1±18.1 15.9±17.4 hs-crp (mg/dl) 0.09±0.14 0.15±0.63 0.13±0.26 *P value derived from one-way ANOVA that used to evaluate differences in the 3 groups; P<0.05 from the posthoc comparisons (Dunnett t) of the investigated variables between euthyroid and subclinical hyperthyroidism. Abbreviations: BP, blood pressure; BMI, body mass index; T. cholesterol, total cholesterol; LDL-C, LDL-cholesterol; HDL-C, HDL-cholesterol; Lp(a), lipoprotein(a); hscrp, high sensitivity C-reactive protein;, not significant.
Thyroid Function Test and Cardiovascular Risk Factors 289 Table 3. TSH levels according to the levels of each cardiovascular risk factor BMI TSH (mean±sd) P value <23 2.331±1.825 23 to <25 2.479±4.000 25 to <30 2.359±2.880 30 3.766±2.086 BP SBP <130 or DBP <85 2.289±1.528 SBP 130 or DBP 85 2.354±1.779 Fasting glucose <100 2.413±3.140 100-125 2.149±1.468 126 2.961±7.495 T. Cholesterol 200> 2.379±2.830 200-240 2.497±4.441 >240 2.316±1.479 LDL-C 100 2.272±2.332 100 to 130 2.392±2.563 130 2.576±4.602 Triglyceride 0.008 <150 2.283±1.586 150 2.463±1.586 HDL-C 50 2.399±3.428 <50 2.400±2.539 Abbreviations: See Table 1. 3. 갑상샘기능과대사증후군과의관계 TSH와대사증후군과는연관성이없었던반면, 혈청 FT4와대사증후군은연관성이있었다. 정상범위의 FT4를사분위로나눈후, 각범위에서대사증후군발생을비교했을때, 가장낮은사분위에서의발생위험이가장높은사분위에서보다 1.3배더높았다 ( 교차비 : 0.732, 95% 신뢰구간 : 0.548-0.979) (Table 5). FT4의가장낮은사분위와가장높은사분위에서의대사증후군구성요소와의관계를비교해보면, 비만은연령의교란효과를제거했을때, FT4가가장낮은범위의경우가가장높은경우에서보다 1.4배더발생위험이높았다 ( 교차비 : 0.70, 95% 신뢰구간 : 0.57-0.86) (Table 6). 고혈압의경우는, FT4가가장낮은사분위의경우에발생위험이더높았으나연령의교란효과를제거하면발생위험의차이는없었다. 고혈당은연령의교란효과를제거했을때가장높은사분위의경우에발생위험이 1.6배더높았으나 ( 교차비 : 1.56, 95% 신뢰구간 : 1.20-2.03) (Table 6), 고중성지방혈증은가장낮은사분위에서발생위험이 1.8배더높았고 ( 교차비 : 0.54, 95% 신뢰구간 : 0.41-0.71) (Table 6), HDL Table 4. FT4 levels according to the levels of each cardiovascular risk factor BMI FT4 (mean±sd) P value <23 1.217±0.212 <0.001 23 to <25 1.182±0.201 25 to <30 1.187 0.363 30 1.151 0.188 BP SBP <130 or DBP <85 1.197 0.159 SBP 130 or DBP 85 1.186 0.158 Fasting glucose <0.001 <100 1.201 0.248 100-125 1.219 0.238 126 1.176 0.184 T. Cholesterol <200 1.209 0.268 200-240 1.179 0.162 >240 1.185 0.171 LDL-C 100 1.227 0.328 100 to 130 1.191 0.187 130 1.180 0.166 Triglyceride <0.001 <150 1.199 0.158 150 1.156 0.158 HDL-C 50 1.201 0.180 <50 1.204 0.351 Abbreviations: See Table 1. Table 5. Independent associations between FT4 level and metabolic syndrome FT4 (ng/dl) People (N) MS (%) Abbreviations: Q, quartile; MS, metabolic syndrome; OR, odds ratio; CI, confidence interval. 콜레스테롤감소는가장낮은사분위에서 1.3배더발생위험이높았다 ( 교차비 : 0.77, 95% 신뢰구간 : 0.64-0.91) (Table 6). 고 혈중 FT4는정상범위내에있고, TSH만증가하거나감소하는무증상갑상샘기능저하증이나무증상갑상샘기능항진증에서, FT4는무증상갑상샘기능저하증, 정상갑상샘기능군, 무증상갑상샘기능항진증의순으로높았다. 무증상갑상샘기능저하증과 찰 OR (95% CI) for MS P value Q1 (0.800-1.088) 1,185 12.4 1 0.204 Q2 (1.089-1.190) 1,339 10.5 0.927 (0.716-1.200) 0.564 Q3 (1.191-1.300) 1,149 9.2 0.883 (0.668-1.165) 0.378 Q4 (1.301-1.900) 1,138 7.8 0.732 (0.548-0.979) 0.035
290 나은희 이정규 Table 6. Prevalence and odds ratios (95% confidence interval) for each component of metabolic syndrome according to serum FT4 quartiles Variables Q1 (lowest) Q2 Q3 Q4 (highest) Prevalence (%) 26.9 22.3 18.8 18.1 Obesity OR (95% CI) 1 0.78 (0.65-0.94)* 0.63 (0.52-0.77)* 0.60 (0.49-0.78)* OR (95% CI) 1 0.84 (0.70-1.02) 0.73 (0.59-0.89)* 0.70 (0.57-0.86)* Prevalence (%) 24.0 22.5 20.5 19.9 Increased OR (95% CI) 1 0.92 (0.76-1.10) 0.81 (0.67-0.99)* 0.79 (0.65-0.96)* BP OR (95% CI) 1 1.07 (0.87-1.31) 1.05 (0.84-1.30) 1.01 (0.81-1.26) Prevalence (%) 11.0 11.5 11.2 13.1 Increased OR (95% CI) 1 1.06 (0.83-1.35) 1.02 (0.79-1.32) 1.22 (0.95-1.57) Fasting glucose OR (95% CI) 1 1.22 (0.94-1.57) 1.27 (0.97-1.66) 1.56 (1.20-2.03)* Prevalence (%) 15.9 12.5 9.9 8.1 Increased OR (95% CI) 1 0.76 (0.61-0.94)* 0.59 (0.46-0.75)* 0.47 (0.36-0.61)* Triglyceride OR (95% CI) 1 0.83 (0.66-1.04) 0.68 (0.53-0.87)* 0.54 (0.41-0.71)* Prevalence (%) 32.2 32.3 31.2 26.5 Decreased OR (95% CI) 1 1.00 (0.85-1.18) 0.95 (0.80-1.13) 0.76 (0.63-0.90)* HDL-C OR (95% CI) 1 1.01 (0.85-1.19) 0.96 (0.81-1.14) 0.77 (0.64-0.91)* *P<0.05 in logistic regression analysis; Non-adjusted; Age-adjusted. Abbreviations: See Table 5. 혈중지질과의관계는연구자에따라차이가있는것같다. 즉, Kvetny 등 [8] 은 50 세이하의남성을대상으로한연구에서무증상갑상샘기능저하증때중성지방과 C-반응성단백질이증가하며, Busselton연구 [9] 에서는정상갑상샘기능인경우보다총콜레스테롤이증가하였으나연령과성별의교란효과를제거했을때는이차이가미미하다고보고한반면, Bell 등 [6] 은 18-75세여성을대상으로한연구에서무증상갑상샘기능저하증인여성들에서혈중지질이상은없었다고하였다. 본연구에서도정상갑상샘기능군과비교했을때무증상갑상샘기능저하증에서의혈중지질의의미있는차이는없었다. 무증상갑상샘기능저하증과혈중지질간의이같은보고에따른차이는연구대상자들의연령, 성별과관계가있으리라생각되었다. 무증상갑상샘기능항진증때의공복혈당은정상갑상샘기능군에비해더높았다. 이같은차이는갑상샘기능항진증때관찰된내당능장애 [10] 와관련있을것으로보인다. 이의기전으로는, 갑상샘기능항진때췌장에서의인슐린분비감소 [11] 와글루코오스신합성의감소 [12] 를들수있다. Yavuz 등 [13] 은무증상갑상샘기능항진증에서도비슷한소견이관찰된다고하였다. TSH는체질량지수, 혈압, 총콜레스테롤, LDL콜레스테롤, 중성지방과같은심혈관계질환위험인자들과양의상관관계를보였다. 그러나, 연령및다른위험인자들의교란효과를제거하면, 중성지방만이 TSH와양의상관관계였다. 이에반해 FT4는연령, 체질량지수, 총콜레스테롤, LDL콜레스테롤및중성지방과음의상관관계에있었다. 그러나, 연령및다른인자들의교란효 과를제거하면, 체질량지수, 공복혈당및중성지방만이 FT4와음의상관관계를보였다. TSH의 7개범위에서대사증후군발생의위험도는차이가없었다. 이에반해, FT4 수치는연령이증가함에따라감소하므로연령의교란효과를제거한후, 정상범위의 FT4의사분위에따른대사증후군발생의위험성을비교했을때, 가장낮은사분위가가장높은사분위에비해 1.3배더높았다. Park 등 [14] 은 TSH와 FT4가정상인정상갑상샘기능을가진폐경기여성을대상으로한연구에서, 높은사분위의 TSH 를가진사람이낮은사분위의 TSH를가진사람에비해대사증후군발생이더높다고하였다. 그러나본연구에서는 20세이상의 FT4가정상인정상갑상샘기능자와무증상갑상샘기능이상자를대상으로한연구이므로단순비교는적당치않다. 한편, 여성고령자에서 TSH 수치가높은경우에관상동맥질환의위험도가높다 [15] 고알려져있는데, 이는죽상경화증에서분비된염증성싸이토카닌이 TSH 분비에영향을미치기때문인것으로설명된다 [16]. 그러나 TSH는다발성혈관질환과는연관이있으나, 관상동맥질환과는관련이없다는상반된결과 [17] 도보고된바있다. 본연구는협심증환자를대상으로한연구가아니고, 대부분이외형상건강한검진자를대상으로한것이므로 TSH 와관상동맥질환간의관련성을밝히지는못하였다. 그러나, 본연구의결과로미루어보아 TSH보다는 FT4가심혈관계질환의위험인자및대사증후군발생과관계가있는것같다. 정상범위에서의갑상샘호르몬은인슐린감수성을증가시키는물질을자극하며 [18, 19], 카테콜라민의지방분해를도와서내장
Thyroid Function Test and Cardiovascular Risk Factors 291 비만을감소시킨다 [20]. 하지만갑상샘기능항진증에서는오히려인슐린감수성과지방분해가감소한다 [21, 22]. 인슐린저항성이대사증후군발생의기전으로여겨지고있기때문에 [23], 정상 FT4의가장낮은사분위가가장높은사분위에비해대사증후군발생위험성이더높게나온본연구결과가설명될수있다. 한편, FT4와대사증후군의각구성요소와의연관성을보면, 비만및고중성지방혈증과는음의상관관계에있었고, 고밀도콜레스테롤과는양의상관관계에있었다. 이중고밀도콜레스테롤과 FT4와의양의상관관계는, FT4는내장비만을감소시키며 [20], 복부비만이있는사람에서고밀도콜레스테롤의감소가더많이관찰된다 [24] 는사실로설명된다. FT4와고혈압은연령을고려하지않을때는연관성이있었으나, 연령의교란효과를제거했을때연관성이없어지는것으로보아, 고혈압과 FT4의연관성은연령의효과로생각된다. 본연구에는몇가지제한점이있었다. 첫째, 단면연구였기때문에대사증후군및그구성요소들과 FT4와의인과관계를증명할수없었다. 둘째, 대사증후군의발생기전인인슐린저항성을측정하지못했다. 셋째, 연구대상중에는갑상샘호르몬제를투여받고있는검진자가있을수있는데, 이를배제시키지못했다. 그러나본연구대상이대부분건강한검진자였으며, 대상자수가거의 5,000명이기때문에, 이로인한영향은미미했을것으로생각된다. FT4가정상인정상갑상선기능과무증상갑상샘기능이상증에서심혈관계질환의위험인자및대사증후군과관련이있는것은 TSH보다는 FT4였으며, 정상범위의 FT4에서도가장낮은사분위가가장높은사분위에비해대사증후군의발생위험이더높았다. 그러므로 FT4의정상범위를세분화할필요가있으며, 이는대사증후군발생을예견하고, 이를예방하는데도도움이될것으로생각되었다. 요약배경 : 갑상샘호르몬은지질대사와당대사에중요한역할을하고있으며, 무증상갑상샘기능저하증에서혈중지질이상과관련이있다는보고와, 관련이없다는보고가혼재되어있다. 그러므로무증상갑상샘기능이상에서갑상샘호르몬 (FT4) 또는갑상샘자극호르몬 (thyroid-stimulating hormone, TSH) 과심혈관계질환위험요소및대사증후군과의연관성을알아보고자하였다. 방법 : 여성건강검진자중에서정상갑상샘기능군 (4,410명), 무증상갑상샘기능저하증군 (438명), 무증상갑상샘기능항진증 군 (66명) 사이의연령, 혈압, 체질량지수, 공복혈당, 총콜레스테롤, HDL콜레스테롤, LDL콜레스테롤, 중성지방, 리포지단백 (a) 과고감도 C-반응성단백질을비교하였고, FT4 또는 TSH와심혈관계질환의위험요소및대사증후군과의연관성을알아보았다. 결과 : 공복혈당은무증상갑상샘기능항진증군에서정상갑상샘기능군이나무증상갑상샘기능저하증군과비교해서더높았고 (P=0.031), 총콜레스테롤은무증상갑상샘기능저하증군에서무증상갑상샘기능항진증과비교해서의의있게더높았다 (P= 0.011). 그러나연령, 체질량지수, 혈압, HDL콜레스테롤, LDL 콜레스테롤, 중성지방, Lp(a), hscrp는세군사이에차이가없었다. TSH는중성지방이높은경우에더높았고, FT4는체질량지수가높을수록, 공복혈당이정상인경우보다는 126 mg/ dl 이상인경우에, 중성지방이높을수록더낮았다. TSH와대사증후군발생과는연관성이없었으나, FT4 정상범위의가장낮은사분위인경우에가장높은사분위에비해대사증후군발생의위험이 1.3배더높았다. 결론 : FT4 검사결과해석시정상범위를사분위로세분화할필요가있으며, 이는대사증후군발생을예견하고예방하는데도움이될수있으리라생각되었다. 참고문헌 1. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526-34. 2. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-99. 3. Duntas LH. Thyroid disease and lipids. Thyroid 2002;12:287-93. 4. Fommei E and Iervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab 2002;87:1996-2000. 5. Bauer DC, Ettinger B, Browner WS. Thyroid functions and serum lipids in older women: a population-based study. Am J Med 1998; 104:546-51. 6. Bell RJ, Rivera-Woll L, Davison SL, Topliss DJ, Donath S, Davis SR. Well-being, health-related quality of life and cardiovascular disease risk profile in women with subclinical thyroid disease-a community-based study. Clin Endocrinol (Oxf) 2007;66:548-56. 7. Stone NJ, Bilek S, Rosenbaum S. Recent national cholesterol educa-
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