당뇨병 조절이 혈청지질 변동에 미치는 영향

Abstract

[한글]

당뇨병환자의 조기동맥경화성 변화는 합병증의 발생요인으로 주로 대사장애로 인한 고혈당과 지질대사의 이상이 중요한 역할을 한다고 알려져 있다.

저자는 1980년 10월부터 1981년 7월 사이 연세대학교 의과대학부속 세브란스병원을 방문한 정상대조군 39예와 당뇨병환자군 103예를 대상으로 공복혈당 및 HbAlc와 혈청지질치를 측정하여 다음과 같은 결과를얻었다.

정상대조군과 환자군에서 공복혈당 및 HbAlc는 연령별 성별간에 유의한 차이는 없었으며, 당뇨병 환자군에서 공복혈당과 HbAlc간에 유의한 양의 상관관계를 보였다.

혈청 TC치는 정상대조군과 신환자군간에 유의한 차이는 없었으며, TG는 신환자의 남자환자군에서 대조군에 비해 유의한 증가를 보였다. HDL-C/TC 비는 신환자군 특히 50세 이상의 남자군에서 유의한 감소를 보였다. 혈청지질치와 HbAlc간에 유의한 상관관계는 없었다.

과거부터 치료해온 방법에 따라 분류 관찰한바, 공복혈당은 인슐린군에서 식이요법군에 비해 유의한 증가를, TG는 식이군에 비해 경구혈당강하제군에서 유의한 증가를 보였으며, HDL-C/TC비는 식이군에 비해 경구혈당강하제군에서 유의한 감소를 보였다.

인슐린 치료후 공복혈당 및 HbAlc는 6 ∼ 12주에 정상화 되었으며, TC와 TG는 12 ∼ 24주에 유의한 감소를, HDL-C/TC비는 유의한 증가를 보였다.

경구혈당강하제 치료 6 ∼ 12주후 공복혈당 및 HbAlc는 정상화되었으나 TC 및 TG는 유의한 변화가 없었으며, HDL- C/TC비는 오히려 감소하는 경향을 보였으나 통계적인 의의는 없었다.

이상으로 장기적인 당뇨병의 조절에 따른 혈당 및 HbAle, 혈청지질의 정상화는 당뇨병 환자의 조기동맥경화성 변화를 억제할 수 있을 것으로 기대된다.

[영문]

Fasting blood sugar, HbAlc and lipid values, including total cholesterol, triglyceride and high density lipoprotein cholesterol, were obtained; in 39 normal controls and 34 new diabetics; in the three groups which was classified by previous control methods(diet alone, oral hypoglycemic agent and insulin therapy); in diabetics with or without microangiopathy. The changes of FBS, HbAlc and lipid values also investigated after diabetic control with insulin or oral hypoglycemic agents. The results are summarized as follows.

1. In normal controls and diabetic groups, FBS and HbAlc were not significantly different according to sex and age. There was positive correlation between FBS and HbAlc in 39 normal controls and 34 new diabetics(r=0.54, P<0.01).

2. Serum total cholesterol in new diabetics was not significantly different from that in normal controls. Serum triglyceride was significantly higher in new diabetics, especially in male patients than that in normal controls. HDL-C/TC ratio was significantly lower in new diabetics, especially in eldery male patients than that in normal controls. But, there was no correlation between HbAlc and serum lipid levels.

3. In each group classified by previous control method, FBS was significantly higher in patients on insulin therapy(N=24) than that in those on diet therapy alone(N=20) (0.01<P<0.02). Serum triglyceride was significantly higher in patients on oral hypoglycemic agent therapy(N=17) than that in those on diet therapy alone(0.02<P<0.05). HDL-C/TC ratio was significantly lower in patients on oral hypoglycemic agent therapy than that in those on diet therapy alone. (0.01<P<0.02)

4. In diabetics with microangiopathy(N=48), serum total cholesterol was significantly higher(0.01<P<0.02) and HDL-C/TC ratio was significantly lower(P<0.02) than that in those without microangiopathy.

5. After conventional insulin therapy for intermediate-term(6-12 weeks), FBS and HbAlc were significantly decreased(0.001>P) to the normal range. After conventional insulin therapy for long-term(12-24 weeks), FBS and HbAlc, total cholesterol and triglyceride were significantly decreased(P<0.05) and HDL-C/TC cholesterol ratio was significantly increased(P<0.01).

6. After oral hypoglycemic agent therapy for intermdiate-term(6-12 weeks), FBS and Hbalc were significantly decreased(P<0.02) to the normal range and HDL-C/TC ratio was also decreased, but statistically not significant.

In conclusion, these changes in serum lipid levels in response to long-term diabetes control would favorably alter the predicted risk for the development of premature atherosclerosis in diabetic patients.