안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 전신 염증인자, 산화 스트레스와의 관련성 = Relationship between Systemic Inflammatory Marker, Oxidative Stress and Body Mass Index in Stable COPD Patient

국문 초록 (Abstract)

연구배경: 만성폐쇄성폐질환은 기도염증으로 인한 기도폐쇄를 특징으로 하는 질환이지만, 질병의 경과 중에 체중감소나 근위축 같은 전신증상을 동반하게 된다. 만성 염증과 산화 스트레스가 만성폐쇄성폐질환의 병인에 중요한 역할을 하므로 신체질량지수의 감소와 관련이 있을 것으로 추측할 수 있다. 연구자 등은 안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 관련된 인자를 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 안정된 만성폐쇄성폐질환 환자 53명(남: 여 =49:4, 평균나이 =68.25±6.32)과 정상 대조군 33명을 대상으로 폐기능 검사를 실시하고 전신염증인자로 혈청 IL-6, TNF-α를 측정하고 산화 스트레스 인자로 혈청 8-iso-prostaglandin F2α와 carbonyl protein을 측정하여 비교하였다. 또한 만성폐쇄성폐질환 환자를 신체질량지수에 따라 다시 3군(<18.5, 18.5-25,>25)으로 나누어 각각의 수치들을 비교하였고 만성폐쇄성 폐질환의 중증도에 따라 신체질량지수를 비교하였다. 결과: 만성폐쇄성폐질환 환자와 정상 대조군의 혈청에서 IL-6, TNF-α, carbonyl protein은 유의한 차이가 없었으며 8-iso-prostaglandin F2α은 각각 456.08±574.12 pg/㎖, 264.74±143.15 pg/㎖로 만성폐쇄성폐질환 환자에서 유의하게 높았다(p<0.05). 만성폐쇄성폐질환에서 신체질량지수의 차이에 따라 혈청IL-6, TNF-α, carbonyl protein 과 8-iso-prostaglan-din F2α 은 유의한 차이를 보이지 않았다. 신체질량지수에 따른 환자의 FEV1은 각각 0.93±0.25ℓ, 1.34±0.52ℓ, 1.72±0.41ℓ로 신체질량지수가 낮을수록 FEV1 값도 감소하는 경향을 보였고 (p=0.002, r=0.42), 최중증 만성폐쇄성폐질환 환자의 신체질량지수는 19.8±2.57로 중등증의 환자의 22.6±3.14에 비해 유의하게 낮았다(p<0.05). 결론: 본 연구에서 안정된 만성폐쇄성폐질환 환자의 신체질량지수는 전신염증인자와 산화 스트레스의 정도와는 관련을 보이지 않았으나 기도폐쇄의 정도와는 관련이 있을 것으로 사료된다. 만성폐쇄성폐질환 환자에서 신체질량지수의 감소와 관련된 인자에 대해서는 추가적인 연구가 필요할 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

Background: The main factors associated with weight loss in patients with COPD are not well known. Since chronic inflammation and oxidative stress play a major pathogenic role in COPD, these factors may be responsible for the patients` weight loss. Therefore, this study measured the body mass index (BMI) in COPD patients and evaluated the variables, such as systemic inflammatory marker, oxidative stress and lung function, that correlate with the BMI. Method: The stable COPD patients (M:F=49:4, mean age=68.25±6.32) were divided into the lower (<18.5), normal (18.5-25) and higher (>25) BMI group. The severity of the airway obstruction was evaluated by measuring the FEV1. The serum IL-6 and TNF-α levels were measured to determine the degree of systemic inflammation, and the carbonyl protein and 8-iso-prostaglandin F2α level was measured to determine the level of oxidative stress. Each value in the COPD patients and normal control was compared with the BMI. Results: 1) Serum 8-iso-prostaglandin F2α in COPD patients was significantly higher (456.08±574.12 pg/㎖) than that in normal control (264.74±143.15 pg/㎖) (p<0.05). However, there were no significant differences in the serum IL-6, TNF-α, carbonyl protein between the COPD patients and normal controls. 2). In the COPD patients, the FEV1 of the lower BMI group was significantly lower (0.93±0.25ℓ) than that of the normal BMI (1.34±0.52ℓ) and higher BMI groups (1.72±0.41ℓ) (p<0.05). The lower FEV1 was significantly associated with a lower BMI in COPD patients (p=0.002, r=0.42). The BMI of very severe COPD patients was significantly lower (19.8±2.57) than that of the patients with moderate COPD (22.6±3.14) (p<0.05). 3). There were no significant differences in the serum IL-6, TNF-α, carbonyl protein and 8-iso-prostaglandin F2α according to the BMI in the COPD patients. Conclusion: The severity of the airway obstruction, not the systemic inflammatory markers and oxidative stress, might be associated with the BMI in stable COPD patients. Further study will be needed to determine the factors associated with the decrease in the BMI of COPD patients. (Tuberc Respir Dis 2006 61: 330-338)

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