혈청 γ-glutamyltransferase수치와 뇌졸중과의 관련성 연구

Abstract

[한글]

이 연구는 전향적 연구 설계를 통하여 혈청 γ-glutamyltransferase 수치와 뇌졸중으로 인한 사망률간의 관련성을 알아보고자 하였다.연구 대상자는 국민건강보험공단에 가입한 건강보험가입자 가운데 1992년부터 1995년의 건강 검진 수검자 중 피부양자인 남녀 총 412,653명 가운데 1995년 혈청 γ-glutamyltransferase 검사를 시행한 203,971명을 대상으로 하였고, 자기기입식 설문지를 바탕으로 2년마다 정기검진을 실시하여 2003년 12월까지 8년간 추적되었다.뇌졸중은 제 9 차와 제 10 차 개정된 국제질병분류(ICD, International Classification of Disease)코드를 기준으로 만들어진 한국질병사인분류를 참고하였으며, 허혈성 뇌졸중, 출혈성 뇌졸중, 허혈성 뇌졸중과 출혈성 뇌졸중 및 기타 뇌졸중을 합친 총 뇌졸중으로 하여 크게 세 분류로 나누었다.혈청 γ-glutamyltransferase 수치의 뇌졸중에 대한 사망 상대위험비는 뇌졸중 위험인자인 나이, 혈압, 흡연, 체질량 지수, 공복 혈당, 총 콜레스테롤, 음주를 모두 통제한 후, Cox‘s proportional hazard model을 이용하여 분석하였다.그 결과 혈청 γ-glutamyltransferase 수치가 높아짐에 따라 남자는 허혈성 뇌졸중, 출혈성 뇌졸중, 총 뇌졸중으로 인한 사망위험이 증가했으며, 여자의 경우 혈청 γ-glutamyltransferase 수치 상승이 출혈성 뇌졸중 사망위험과는 관련성이 없었으나, 허혈성 뇌졸중, 총 뇌졸중으로 인한 사망위험은 증가했다.뇌졸중은 발생 후 손상된 뇌조직과 그 기능을 완전히 회복할 수 없으므로 이러한 결과를 통해 뇌졸중으로 인한 사망을 예방하고자 하며, 사망률보다 보건학적으로 더 의미 있는 뇌졸중의 발생률을 나타내는 혈청 GGT 수치에 대한 연구가 더욱 필요하다.

[영문]Background : There is evidence fro, recent studies that γ-glutamyltransferase (GGT) is likely to be associated with cardiovascular disease (CVD). However, few studies to date with sufficient sample size and follow-up investigated the association of GGT and CVD mortality.Objectives : To examine the relationship between GGT and ischemic stroke, hemorrhagic stroke and total stroke and to see if GGT is a significant predictor of outcomes independent of other biomarkers.Material and methods : An eight-year prospective cohort study was carried out with a sample of 52,616 Korean men and 151,355 Korean women who were the dependents of the insured of health insurance plan coverage from the National Health Insurance Corporation and who went through medical exams in 1995. The deaths from ischemic stroke, hemorrhagic stroke and total stroke, obtained from the National Statistical Office were used as a main outcome measure.To assess the independent effects of serum GGT on stroke mortality, multivariate Cox''s proportional hazards models were used, controlling age, body mass index, blood pressure, fasting glucose, total cholesterol, smoking and alcohol consumption. The subjects of each gender were classified into four groups according to their serum GGT concentrations, into quartiles(Q1,Q2,Q3 and Q4).Results : During the 8 years, 1,477 ischemic , 450 hemorrhagic and 396 total stroke deaths occurred for men and 1,493 ischemic , 365 hemorrhagic and 574 total stroke occurred for women.After adjustment for age and other traditional risk factors and according to Cox proportional-hazards models, serum GGT level had an independent positive associations with ischemic, hemorrhagic and total stroke for men and ischemic and total stroke for women. However, hemorrhagic stroke were not associated with elevation of serum GGT for women. For men, compared with the level <17 U/L(Q1), the adjusted relative risks(95% confidence interval) of total stroke, ischemic stroke and hemorrhagic stroke for serum GGT level of >=47 U/L were 1.67(1.43-1.96), 1.44(1.09-1.91) and 2.14(1.57-2.92), respectively. For women, compared with the level <11 U/L(Q1), the adjusted relative risks(95% confidence interval) of total stroke and ischemic stroke for serum GGT level of >=22 U/L(Q4) were 1.41(1.22-1.62) and 1.66(1.24-2.22), respectively. These associations were consistent regardless of the level of obesity, blood pressure, fasting glucose, total cholesterol, smoking and alcohol consumption.Conclusion : This study suggests that an increase in serum GGT concentration is associated with increased risk of mortality risk from total stroke, ischemic stroke and hemorrhagic stroke in men and from total stroke and ischemic stroke in women and that these associations are independent of alcohol consumption and hypertension.