정신분열병 환자의 인슐린저항성 결정인자 = A determinant of insulin resistance in patients with schizophrenia

국문 초록 (Abstract)

목적: 정신분열병 환자는 일반인에 비해 비만 및 당대사 장애의 발생 위험이 높은 것으로 알려져 있으며 정신분열병 치료를 위해 사용하는 항정신병 약물은 체중증가를 유발할 수 있기 때문에 그 위험이 더욱 높아지게 된다. 그러나 항정신병 약물의 영향을 받지 않은 상태에서 정신분열병 환자의 인슐린저항성 유발인자에 대한 연구는 드물다. 따라서 본 연구에서는 항정신병 약물의 영향을 받지 않은 상태의 정신분열병 환자를 대상으로 인슐린저항성에 영향을 미치는 인자를 알아보고자 하였다. 방법: DSM-IV 기준에 의해 정신분열병을 처음 진단받은 환자 또는 이미 진단받고 추적관리하고 있는 환자 중 최소한 6주 이상 항정신병 약물을 투여 받지 않은 환자 19명(남:녀=4:15)과 이들과 성별, 나이를 맞춘 정상 대조군을 19명 선정하여 이들의 체질량지수 및 체지방률을 측정하고 인슐린저항성 관련 위험인자를 비교하였다. 또한 각 군에서 인슐린저항성지표(HOMA-IR)와 신체계측, 임상적 특성의 연관성을 알아보았다. 결과: 양 군 간의 체질량지수, 허리둘레 및 체지방률은 차이는 없었다. 또한 정신분열병 환자군에서 중성지방의 농도가 높았지만 혈압, 혈당, 당화혈색소, 인슐린, HOMA-IR, 총콜레스테롤, HDL-콜레스테롤 및 LDL-콜레스테롤 값의 차이는 없었다. 정상 대조군에서는 나이(r=0.685, p=0.002), 허리둘레(r=0.617, p=0.014)가 인슐린저항성지표인 HOMA-IR과 관련이 있었지만 정신분열병 환자에서는 24시간 소변 유리코티졸 수치가 연관성이 있었다(r=0.797, p=0.002; β=0.646, p=0.023). 결과: 본 연구를 통하여 항정신병 약물의 영향을 받지 않은 상태에서 정신분열병 환자의 인슐린저항성의 위험인자는 정상 대조군과 별 차이가 없었으나 인슐린저항성을 결정하는 주된 위험인자는 정상 대조군과는 달리 정신분열병 환자에서 증가하는 코티졸임을 알아냈다.

다국어 초록 (Multilingual Abstract)

Background/Aims: As compared with the general population, patients with schizophrenia have a higher risk of obesity and glucose metabolism impairment. Moreover, some antipsychotic drugs add to this risk owing to side effects such as weight gain. However, few reports exist regarding the pathophysiology of insulin resistance in drug-naive or drug-free schizophrenic patients. Therefore, the aim of the present study was to investigate the factors that contribute to insulin resistance in antipsychotic drug-naive and drug-free schizophrenic patients. Methods: Nineteen (4 men, 15 women) drug-naive or drug-free subjects with schizophrenia and nineteen age- and sex-matched controls were recruited for participation in this study. We measured weight, height, waist circumference, biochemical profiles, body fat percentage, and calculated body mass indices (BMI) in all patients. Furthermore, we correlated HOMA-IR, a marker for insulin resistance, with anthropometric measures and clinical characteristics. Results: There were no significant differences in BMI, waist circumference, or body fat percentage between the two groups. In addition, there were no differences in blood pressure, glucose, HbA1c, insulin, HOMA-IR, total cholesterol, HDL-cholesterol, or LDL-cholesterol; however, triglyceride levels and 24 hr urine free cortisol levels were higher in schizophrenic patients. There was also a significant correlation between HOMA-IR and both age and waist circumference in the control group. Additionally, HOMA-IR was significantly correlated with 24 hr urine free cortisol levels in schizophrenic patients. Conclusions: The study shows that risk factors for insulin resistance in drug-naive or drug-free schizophrenic patients do not differ from those of the control group; however, the major determinant of insulin resistance in schizophrenia patients was that of increased cortisol levels. (Korean J Med 75:673-679, 2008)

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