OPINION J Korean Med Assoc 2017 October; 60(10):784-788 pissn 1975-8456 / eissn 2093-5951 https://doi.org/10.5124/jkma.2017.60.10.784 영양, 미용목적의주사 : 홍보된효과와확인된근거 신현영 서남대학교의과대학명지병원가정의학과 Injections for nutrition and cosmetic purposes: promoted effect vs. objective evidence Hyun-Young Shin, MD Department of Family Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea The introduction of intravenous nutritional therapy for cosmetic and health purposes in Korea has been controversial. Because it brings ethical problems of off-label prescribing on the basis of low level of medical evidences for claims of fatigue reduction, detoxification, anti-inflammation effect, skin whitening, antioxidant and anti-aging effects. Despite the lack of clinical studies, the verification of the efficacy and safety of intravenous nutritional therapy and the need to provide objective information to patients are prerequisite for the correct intravenous use. In addition, efforts should be made to prevent the abuse for commercial purposes. Key Words: Placenta extract; Glutathione; Thioctic acid; Fursultiamine; Glycyrrhizic acid 서론 미용, 건강증진을목적으로한영양주사요법이국내에도 입되면서피로개선, 활력증강, 해독작용, 염증완화, 미백효 과, 항산화, 항노화효과등에도움을줄것이라는기대와함 께비급여진료에서의새로운영역으로자리매김해왔다. 하 Received: September 1, 2017 Accepted: September 15, 2017 Corresponding author: Hyun-Young Shin E-mail: shy801117@gmail.com Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 지만부풀려진영양주사의효과와더불어박근혜, 최순실의료농단으로청와대내에서도영양주사들이투여된것으로알려지면서근거수준이낮은영양주사의오프라벨처방에대한윤리적문제가사회적이슈로부상하였다. 이로써보건복지부에서는마늘주사, 백옥주사등의속칭명사용을자제하고정확한성분별명명을사용하도록권고하였고 [1], 대한의사협회에서는 정맥영양주사요법사용권고지침 을발간하면서의료현장에서의정맥영양주사의안전한사용가이드라인을배포하기도하였다 [2]. 널리사용되고있는영양주사들의효과및안전성을확인하여의사와환자에게객관적인정보를제공하는것은올바른주사사용을위해선행되어야하며, 이를위해대표적인영양주사의알려진효과및관련임상데이터를정리해보고자한다. 784 대한의사협회지
Shin HY Injections for nutrition and cosmetic purpose 자하거추출물 자하거가수분해물 ( 일명태반주사 ) 자하거란사람의태반을건조한것을칭하며, 탯줄을포함 하지않은인태반에염산가수분획법을적용한 자하거가수 추출물 과탯줄을포함한인태반에분자분획법과염산가수 분획법을적용하여 2 단계처리한 자하거가수분해물 두종류 로나뉘다. 태반에는성장인자, 성호르몬, 단백질, 미네랄등 성분들이포함되어인체에다양한긍정적인효과에대한기 대로동양의학에서널리사용되어왔다. 형성을막고 reactive oxidative stress를제거하는항산화효과를가진다. 멜라닌생성과정에있어 tyrosinase를억제하여피부톤을밝게하는데기여한다고알려져있다 [10]. 1. 홍보된효과시스플라틴또는유사계열화학요법에의한신경성질환의예방또는약물중독, 알코올중독, 만성간질환에서간기능의개선으로허가받았지만, 피부항노화, 미백효과로인해비욘세주사라고불리기도하며, 기타항산화효과, 피로회복개선등의효과가홍보되고있다. 1. 홍보된효과자하거가수추출물은갱년기장애증상의개선, 자하거가수분해물은만성간질환에있어서간기능개선으로허가받았으나, 이외에도피로회복, 피부항노화, 미백효과및항염증, 통증완화, 연골보호의효과가있다고홍보되고있다. 2. 확인된근거들정맥주사투여시임상적효과에대한근거는확인된바없으며 [3], 인체적용시험에서피하주사투여시만성피로증후군과피로증상완화 [4,5], 노인건강관련삶의질개선 [6] 및동물실험에서항염작용으로인한통증완화효과 [7] 와연골보호효과 [8] 에대한연구가있으나양질의근거로평가된연구는없다 [9]. 2. 확인된근거들 2011년필리핀, 2015년미국, 2016년영국의식품의약품청에서는글루타티온의과장된피부미백효과와근거부족, 안전성에대한문제점관련서한을배포하였다. 경구제제복용, 로션도포시피부미백관련임상연구는일부보고되고있지만 [11,12], 글루타티온의정맥투여시효과와관련된임상연구는없다 [3]. 3. 부작용사례피부발적, 위축, 백반증, 갑상선기능장애, 신장장애, 복통, 아나필락시스성쇼크, 과민반응, 오심, 구토등이보고되었다 [3,13]. 3. 부작용사례쇼크, 과민반응 ( 오한, 발열, 발진 ), 알레르기반응, 오심, 여성형유방, 주사부위동통, 발적등의부작용사례가있다 [9]. 글루타티온 ( 일명백옥주사 ) 글루타티온 (glutathione) 은 cysteine, glycine, glutamate 로구성되며 GSH (reduced glutathione), GSSG (oxidized glutathione) 두가지형태로존재한다. 산화 환원작용을통하여세포안에서의 redox의균형을유지하고, free radical 티옥트산 ( 일명신데렐라주사 ) 티옥트산 (thioctic acid) 또는 alpha-lipoic acid이라불리고미토콘드리아내에너지생산에있어 pyruvate가 acetyl-coa로전환되는과정에서 pyruvate dehydrogenase 복합체에작용하여도움을준다. 그외에도 alphaketoglutarate dehydrogenase 복합체의조효소로작용하여미토콘드리아 TCA cycle 내에서 alpha-ketoacid 분해에작용하고, NADH (nicotinamide adenine dinucleotide hydrate) NADPH (nicotinamide adenine dinucleotide phosphate) 를통한세포내항산화작용, 글루타티온합성증 영양, 미용목적의주사 785
J Korean Med Assoc 2017 October; 60(10):784-788 가유도, 세포내산화 환원관련전사인자 (NF-κB, Nrf2) 조절등의기전이있다 [14]. 1. 홍보된효과허가사항으로는티옥트산의수요가증대되는경우의보급 ( 격심한육체노동시 ), Leigh 증후군 ( 아급성괴사성뇌척수염 ), 중독성 ( 스트렙토마이신, 가나마이신에의한 ) 및소음성 ( 직업성 ) 의내이성난청, 당뇨병다발신경병증의완화에해당되나이외에도피로회복, 피부항노화, 미백효과, 체지방감소등이홍보되고있다. 1. 홍보된효과허가된사항은비타민B1 결핍증의예방및치료, 비타민 B1 수요가증대하여음식으로부터섭취가불충분한때의보급 ( 소모성질환, 갑상성기능항진증, 임부, 수유부, 격렬한육체노동시등 ), 베르니케뇌병증, 각기심장장애, 각종질환 ( 신경통, 근육통, 관절통, 말초신경염, 말초신경마비, 심근대사장애, 변비등의위장운동기능장애, 수술후장관마비 ) 에의한비타민B1 결핍또는대사장애이다. 이밖에도피로회복, 체력증진, 피부항노화에도효과가있다고홍보되고있다. 2. 확인된근거들건강인을대상으로 alpha-lipoic acid를경구투여시항산화수준의변화에대한연구결과는일정하지않다 [15,16]. 경구복용시에체중감량및지질개선효과에대해서일부연구가있지만 [17-19], 정맥투여에관련된연구는비만한중국인 22명을대상으로단기투여시체중감량의효과는없었으나혈중지질개선및인슐린민감성이호전되었다는보고가유일하다 [20]. 3. 부작용사례백반증, 피부위축, 가려움, 발진, 아나필락시스성쇼크, 심계항진, 어지러움, 두통, 식욕부진, 오심, 설사등이보고되었다 [3]. 2. 확인된근거들건강한운동유발피로대상자들에게경구티아민제제를복용하였을때피로경감의효과가있다는보고가있고 [21], 고강도운동을수행하는데있어경구티아민제제가유의한효과가없음을보고한연구도있다 [22]. 이외에정맥주사로푸르설티아민을투여한임상연구는없는것으로확인된다 [3]. 3. 부작용사례어지러움, 두근거림, 호흡곤란, 발진, 주사부위통증, 과민반응등이보고되었다 [3]. 글리시리진 ( 일명감초주사 ) 푸르설티아민 ( 일명마늘주사 ) 푸르설티아민 (fursultiamine; thiamine tetrahydrofurfuryl disulfide) 은 1960년대일본에서개발되었으며친수성인 thiamine의합성 disulfide 유도체로서지용성을가져체내흡수율을높인 vitamin B의활성유도체이다. TCA cycle의 transketolase, pyruvate dehydrogenase, α-ketoglutarate dehydrogenase 조효소로작용하여아미노산과탄수화물대사에작용하여에너지대사를촉진하는역할을한다. 감초뿌리에서추출하여한약재로널리사용되는성분으로 glycyrrhizin, glycine, cysteine의복합체이다. 스테로이드와유사한구조를가진 glycyrrhizin이 18-β-glycyrrhetinic acid로대사되어체내 cortisol에서 cortisone로전환을억제하여 cortisol 수치를증가시키면서스테로이드유사효과를나타내는것으로알려져있다 [3,13]. 1. 홍보된효과허가된사항은두드러기, 습진, 알레르기성피부질환의보조요법, 약물중독의보조요법, 만성간질환의간기능개선이 786 대한의사협회지
Shin HY Injections for nutrition and cosmetic purpose 지만그외에도피로회복, 해독작용, 피부항노화, 항염작용 에효과가있는것으로홍보되고있다. 2. 확인된근거들 오프라벨사용관련임상연구는확인된바없다 [3]. 3. 부작용사례 쇼크, 아나필락시스성쇼크, 심부전, 부정맥, 위알도스테 론증 ( 저칼륨혈증, 혈압상승, 나트륨저류, 부종, 체중증가 ), 전신권태감, 근육통, 발진, 두통, 열감등이보고되었다 [13]. 결론 영양주사의미용, 건강증진의효과에대한임상연구들이 부족한상태에서그효능효과가과학적으로입증되지못한 것인지, 아니면효과가없는것인지에대한의문은여전히 남아있다. 낮은근거수준의경험적효과를바탕으로하는의 료행위에대한논란이있는상태에서, 적어도상업적인목적 을위해서영양주사가남용되지않도록최소한의기준은필 요할것으로보인다. 대한의사협회의권고지침에따라, 영양 주사는환자개별상태에따라질병치료외의보조적인치료 로사용될수있으나대상자에게약물관련작용, 부작용등 의정보가충분히제공될수있도록의료현장에서의노력이 우선되어야할것이다 [2]. 찾아보기말 : 태반추출물 ; 글루타티온 ; 티옥트산 ; 푸르설티아민 ; 글리시리진 ORCID Hyun-Young Shin, http://orcid.org/0000-0001-7261-3365 REFERENCES 1. Moon SH. White jade, garlic, Cinderella, do not use it as titles of injections. Medical Times. 2017 Mar 28 [cited 2017 Aug 11]. Available from: http://www.medicaltimes.com/users4/ News/newsView.html?ID=1110880&nSection=1&nStart=0&s ubmenu=news&subnum=1&searchkeyword=%b9%e9%bf %C1. 2. Korean Medical Association. Guidelines for the use of intraveous nutritional therapy. Seoul: Korean Medical Association; 2017. 3. National Evidence-based Healthcare Collaborating Agency. Safety and efficacy of intravenous injection for beauty and health promotion purpose. Seoul: National Evidence-based Healthcare Collaborating Agency; 2016. 4. Park SB, Kim KN, Sung E, Lee SY, Shin HC. Human placental extract as a subcutaneous injection is effective in chronic fatigue syndrome: a multi-center, double-blind, randomized, placebo-controlled study. Biol Pharm Bull 2016;39:674-679. 5. Kong MH, Lee EJ, Lee SY, Cho SJ, Hong YS, Park SB. Effect of human placental extract on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women. Menopause 2008;15:296-303. 6. Kong M, Park SB. Effect of human placental extract on health status in elderly Koreans. Evid Based Complement Alternat Med 2012;2012:732915. 7. Lee KH, Kim TH, Lee WC, Kim SH, Lee SY, Lee SM. Antiinflammatory and analgesic effects of human placenta extract. Nat Prod Res 2011;25:1090-1100. 8. Kim JK, Kim TH, Park SW, Kim HY, Kim Sh, Lee Sy, Lee SM. Protective effects of human placenta extract on cartilage degradation in experimental osteoarthritis. Biol Pharm Bull 2010;33:1004-1010. 9. National Evidence-based Healthcare Collaborating Agency. Medical technology evaluation on the efficacy and safety of placenta injection. Seoul: National Evidence-based Healthcare Collaborating Agency; 2010. 10. Sonthalia S, Daulatabad D, Sarkar R. Glutathione as a skin whitening agent: facts, myths, evidence and controversies. Indian J Dermatol Venereol Leprol 2016;82:262-272. 11. Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: a randomized, double-blind, placebo-controlled study. J Dermatolog Treat 2012;23:97-102. 12. Watanabe F, Hashizume E, Chan GP, Kamimura A. Skinwhitening and skin-condition-improving effects of topical oxidized glutathione: a double-blind and placebo-controlled clinical trial in healthy women. Clin Cosmet Investig Dermatol 2014;7:267-274. 13. Song BW. Nutrition injection, cosmetic injection. Seoul: Korea Pharmaceutical Information Center; 2017. 14. Park S, Karunakaran U, Jeoung NH, Jeon JH, Lee IK. Physiological effect and therapeutic application of alpha lipoic acid. Curr Med Chem 2014;21:3636-3645. 15. Sharman JE, Gunaruwan P, Knez WL, Schmitt M, Marsh SA, Wilson GR, Cockcroft JR, Coombes JS. Alpha-lipoic acid does 영양, 미용목적의주사 787
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