25

서 론

, , ,

2

[1]. 2001 NCEP-ATP III Panel

,

[2].

(nonalcoholic fatty liver disease,

NAFLD) , ,

[3].

[4].

NAFLD ,

1980

[5]. NAFLD

(simple steatosis)

, (non-

alcoholic steatohepatitis, NASH) ,

2 ,

[6-8].

,

NAFLD ,

3-24%[9], 29%

[10], 9-26%

NAFLD [11-12].

NAFLD , 2

,

[3]. NHANES III

, , ,

2

2 [9].

,

[13]

, [14]

NAFLD

.

(alanine aminotransferase;

SGPT) NAFLD NASH

NAFLD

90% [15].

SGPT

(aspartate aminotransferase;

SGOT)

대사증후군과 알라닌 아미노전이효소와의 관련성: 국민건강영양조사 제3기(2005년)

한미아 류소연 박종 강명근 김기순

조선대학교 의과대학 예방의학교실 조선대학교 내성세포연구센터

원 저

26

83% [16]. NAFLD

SGPT

[17].

Hispanic Health and Nutrition Examination Survey

2,999 20

SGPT (>43

IU/L) 4.1

[18]. SGOT SGPT 40 IU/L

1.2-4.23

2.88-3.20

[11].

NAFLD

[22] .

2005

(The Third Korea National Health and Nutrition

Examination Survey; KNHANES , 2005)

SGPT

NAFLD

.

대상 및 방법

1. 대상

2005

19

5,278

HBsAg , SGOT/SGPT 2

, SGOT SGPT 160 IU/L ,

,

40g , 20g

953 4,325

.

2. 방법

SGPT 40 IU/L SGPT

NCEP/ATP

III [2], -

. (

90 , 80 ), (

130/85 mmHg ),

( 150 mg/dL),

( < 40 mg/dL, < 50 mg/dL),

( 110 mg/dL )

3

.

, , , ,

, .

3. 자료분석

SPSS ver. 12.0 . SGPT

, .

19-44 , 45-64 , 65

.

, .

SGPT

,

SGPT .

p-value 0.05 .

연구성적

1. 성에 따른 대사증후군과 SGPT 증가와의 관련성

27.9%(242

), 26.6%(84 ) , SGPT

13.7%(242 ), 3.3%(84 ) .

SGPT ,

SGPT 9.0%

26.0% , ,

, ,

SGPT

.

SGPT 2.0%, 6.8%

, , ,

, ,

SGPT

27

(Table 1).

, , , ,

SGPT .

4.60(95% CI=3.40-6.23)

, , ,

,

Men(N=1,764) Women(N=2,561)

Total Elevated SGPT Total Elevated SGPT

Metabolic syndrome

No 1,271(72.1) 114( 9.0)*

1,880(73.4) 38(2.0)*

Yes 493(27.9) 128(26.0) 681(26.6) 46(6.8)

Abdominal obesity

No 1,291(73.2) 121( 9.4)*

1,474(57.6) 20(1.4)*

Yes 473(26.8) 121(25.6) 1,087(42.4) 64(5.9)

High blood pressure

No 976(55.3) 106(10.9)*

1,803(70.4) 45(2.5)*

Yes 788(44.7) 136(17.3) 758(29.6) 39(5.1)

High triglyceride

No 1,106(62.7) 79( 7.1)*

2,009(78.4) 51(2.5)*

Yes 658(37.3) 163(24.8) 552(21.6) 33(6.0)

Low HDL-cholesterol

No 926(52.5) 93(10.0)*

913(35.7) 22(2.4)*

Yes 838(47.5) 149(17.8) 1,648(64.3) 62(3.8)

High blood glucose

No 1,508(85.5) 197(13.1) 2,308(90.1) 64(2.8)*

Yes 256(14.5) 45(17.6) 253( 9.9) 20(7.9)

Values are expressed as frequency(%)

* p<0.05

Table Table Table Table 1. 1. 1. 1. Association between the metabolic syndrome and the elevated alanine aminotransferase level by sex

Men(N=1,764) Women(N=2,561)

Crude OR

(95% C.I.)

Adjusted OR

(95% C.I.)

Crude OR

(95% C.I.)

Adjusted OR

(95% C.I.)

Metabolic syndrome 3.55(2.69-4.70) 4.60(3.40-6.23) 3.51(2.26-5.44) 3.49(2.07-5.90)

Abdominal obesity 3.32(2.51-4.39) 3.94(2.94-5.29) 4.54(2.73-7.56) 4.33(2.49-7.51)

High blood pressure 1.71(1.30-2.25) 2.30(1.71-3.10) 2.11(1.36-3.28) 1.73(1.01-2.98)

High triglyceride 4.28(3.20-5.71) 4.32(3.20-5.83) 2.44(1.55-3.82) 2.13(1.33-3.41)

Low HDL-cholesterol 1.93(1.46-2.55) 1.95(1.47-2.59) 1.58(0.96-2.59) 1.45(0.88-2.40)

High blood glucose 1.41(0.99-2.02) 1.88(1.28-2.76) 3.01(1.79-5.06) 2.39(1.36-4.18)

OR, odds ratio; C.I., confidence interval.

Adjusted for age(continuous variable), marital status(single, with spouse, widowed divorced separated), education status( elementary

school, middle school, high school, college), health insurance(community health insurance, employer-provided health insurance, medical aid,

uninsured), smoking(nonsmoker, current smoker) and exercise(none, regular).

Table Table Table Table 2. 2. 2. 2. Odds ratios for the elevated alanine aminotransferase level according to presence of the metabolic syndrome by sex

28

.

3.49(95% CI=2.07-5.90)

, ,

,

(Table 2).

2. 연령에 따른 대사증후군과 SGPT 증가와의

관련성

19-44 12.4%,

45-64 36.5%, 65 49.6% , SGPT

19-44 8.0%(165 ), 45-64 8.0%(124 ),

65 5.2%(37 ) . SGPT

, 19-44

SGPT 5.5%

25.8% , ,

, , ,

SGPT

. 45-64

SGPT 4.4%

14.3% ,

, , ,

SGPT

. 65

SGPT 2.8%

7.7% ,

,

SGPT (Table 3).

, , , ,

SGPT

. 19-44

4.57

(95% CI=3.13-6.67) ,

, ,

. 45-64

3.92(95% CI=2.64-5.82)

Age 19-44 years (N=2,065) Age 45-64 years (N=1,555) Age 65 years (N=705)

Total Elevated SGPT Total Elevated SGPT Total Elevated SGPT

Metabolic syndrome

No 1,809(87.6) 99( 5.5)*

987(63.5) 43( 4.4)*

355(50.4) 10( 2.8)*

Yes 256(12.4) 66(25.8) 568(36.5) 81(14.3) 350(49.6) 27( 7.7)

Abdominal obesity

No 1,586(76.8) 83( 5.2)*

840(54.0) 42( 5.0)*

339(48.1) 16( 4.7)

Yes 479(23.2) 82(17.1) 715(46.0) 82(11.5) 366(51.9) 21( 5.7)

High blood pressure

No 1,746(84.6) 103( 5.9)*

822(52.9) 41( 5.0)*

211(29.9) 7( 3.3)

Yes 319(15.4) 62(19.4) 733(47.1) 83(11.3) 494(70.1) 30( 6.1)

High triglyceride

No 1,629(78.9) 65( 4.0)*

1,007(64.8) 47( 4.7)*

479(67.9) 18( 3.8)*

Yes 436(21.1) 100(22.9) 548(35.2) 77(14.1) 226(32.1) 19( 8.4)

Low HDL-cholesterol

No 967(46.8) 61( 6.3)*

619(39.8) 45( 7.3) 253(35.9) 9( 3.6)

Yes 1,098(53.2) 104( 9.5) 936(60.2) 79( 8.4) 452(64.1) 28( 6.2)

High blood glucose

No 1,987(96.2) 153( 7.7)*

1,291(83.0) 88( 6.8)*

538(76.3) 20( 3.7)*

Yes 78( 3.8) 12(15.4) 264(17.0) 36(13.6) 167(23.7) 17(10.2)

Values are expressed as frequency(%)

* p<0.05

Table Table Table Table 3. 3. 3. 3. Association between the characteristics of the study population and the elevated alanine aminotransferase level by age

29

, ,

,

. 65

3.43

(95% CI=1.59-7.42)

,

(Table 4).

고 찰

NAFLD

, , ,

, Mallory

[19], ,

, , ,

[20].

NAFLD

NAFLD

NAFLD

[12].

,

.

.

.

[21].

( , , ,

, )

[23].

SGPT ( , ,

)

[24].

NAFLD

SGPT NAFLD

[9,17,25-27].

SGPT

, HBsAg , SGOT/SGPT

2 , SGOT SGPT 160 IU/L

Age 19-44 years (N=2,065) Age 45-64 years (N=1,555) Age 65 years (N=705)

Crude OR

(95% C.I.)

Adjusted OR

(95% C.I.)

Crude OR

(95% C.I.)

Adjusted OR

(95% C.I.)

Crude OR

(95% C.I.)

Adjusted OR

(95% C.I.)

Metabolic syndrome 6.00(4.24-8.47) 4.57(3.13-6.67) 3.65(2.48-5.37) 3.92(2.64-5.82) 2.88(1.37-6.05) 3.43(1.59-7.42)

Abdominal obesity 3.74(2.70-5.17) 5.16(3.58-7.44) 2.46(1.67-3.62) 3.69(2.44-5.58) 1.22(0.63-2.39) 1.46(0.71-3.02)

High blood pressure 3.84(2.73-5.41) 2.03(1.41-2.92) 2.43(1.65-3.58) 2.16(1.45-3.22) 1.88(0.81-4.36) 1.92(0.81-4.51)

High triglyceride 7.16(5.12-9.99) 4.60(3.20-6.61) 3.33(2.28-4.87) 2.98(2.02-4.40) 2.35(1.20-4.57) 2.39(1.21-4.70)

Low HDL-cholesterol 1.55(1.11-2.15) 2.14(1.51-3.04) 1.17(0.80-1.72) 1.42(0.96-2.11) 1.79(0.83-3.85) 2.23(0.99-5.02)

High blood glucose 2.17(1.15-4.12) 1.51(0.76-3.00) 2.15(1.42-3.26) 1.85(1.21-2.83) 2.93(1.50-5.74) 2.79(1.41-5.52)

OR, odds ratio; C.I., confidence interval.

Adjusted for age(continuous variable), marital status(single, with spouse, widowed divorced separated), education status( elementary school,

middle school, high school, college), health insurance(community health insurance, employer-provided health insurance, medical aid,

uninsured), smoking(nonsmoker, current smoker) and exercise(none, regular).

Table Table Table Table 4. 4. 4. 4. Odds ratios for the elevated alanine aminotransferase level according to presence of the metabolic syndrome by age

30

, ,

. SGOT/SGPT 2 90%

[28], NAFLD 4

(160 IU/L)

[29,30]. SGPT

5

SGPT .

SGPT

, ,

.

Tsai 22

SGPT( 41U/L,

31U/L)

, , ,

[17].

[28]

, , ,

, ,

SGPT ( 40 U/L)

SGPT

.

SGPT

, [29].

SGPT NAFLD

.

SGPT

.

SGPT

. NAFLD

SGPT

.

NAFLD SGPT

,

.

,

, ,

, NAFLD

.

SGPT

. SGPT

NAFLD

,

.

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CK, Blumenkehl M. Prospective evaluation of

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Metabolism 2005; 54: 1510-1514

33

Purpose: The aim of this study was to investigate the association between the metabolic syndrome and alanine

aminotransferase(SGPT) levels in Korean adults.

Methods: The study subjects were 4,325 adults aged 19 years without an apparent cause of liver disease from

the Third Korea National Health and Nutrition Examination Survey(2005). The metabolic syndrome was defined using

criteria established by the NCEP/ATP III, while abdominal obesity was assessed based on the Asia-Pacific guidelines.

Subjects with SGPT 40 IU/L were considered to have elevated SGPT levels. Demographic characteristics, waist

circumference, blood pressure, triglyceride, HDL cholesterol, fasting blood sugar were recorded for statistical analysis.

Results: The prevalence of elevated SGPT levels was significantly increase with the presence of the metabolic

syndrome and its components. In multiple logistic regression analyses, odds ratio for the elevated SGPT levels was

significantly high in the subjects with the metabolic syndrome compared to the subjects without metabolic syndrome

after adjusted for socio-demographic characteristics and health-related behavior.

Conclusions: The metabolic syndrome was independently associated with SGPT levels in Korean adults.

: Metabolic Syndrome X, Alanine Aminotransferase(SGPT)

Metabolic Syndrome and Serum Alanine Aminotransferase Levels in Korean Adults : The

Third Korea National Health and Nutrition Examination Survey (KNHANES ), 2005

Mi Ah Han1),2)

, So Yeon Ryu1),2)

, Jong Park1),2)

, Myung Geun Kang1), Ki Soon Kim

1)