한국인 성인에서 관상동맥질환과 혈중 Retinol-Binding Protein 4 농도와의 연관성 = The Relationship between Serum Retinol-Binding Protein 4 Levels and Coronary Artery Disease in Korean Adults

국문 초록 (Abstract)

배경: 혈중 RBP-4는 새로이 밝혀진 아디포카인으로 최근 인슐린저항성과 대사증후군과의 연관성이 밝혀져 있다. 저자들은 한국인 성인에서 혈중 RBP-4 농도와 관상동맥질환과의 연관성에 관해서 분석하였다. 방법: 순환기내과에 흉통을 주소로 내원하여 관상동맥 조영술을 시행 받은 235명의 대상자(평균 연령 58세)에서 enzyme-linked immunosorbent assay를 이용하여 혈중 RBP-4 농도를 측정하였다. 모든 환자들에서 관상동맥 조영술을 시행하였고, 관상동맥질환의 중증도는 정상군, 단일혈관질환군, 두혈관질환군, 세혈관질환군으로 분류하였다. 모든 환자에서 신체계측, 공복혈당, 지질 농도 등을 측정하였다. 대사증후군 여부는, 허리둘레 대신 체질량지수를 적용한 AHA/NHLBI 진단기준으로 분석하였다. 결과: 관상동맥 조영술상 정상군은 101명(43.0%), 단일혈관질환군은 82명(34.9%), 두혈관질환군은 31명(13.2%), 세혈관질환군은 21명(8.9%)이었다. 관상동맥 협착을 가진 대상자들에서 정상군보다 높은 평균 연령(60.5±10.0 years), 공복 혈당(123.3±45.0 mg/dL), 낮은 고밀도 지단백 콜레스테롤 농도(49.0±13.2 mg/dL)를 보였으나, 혈중 RBP-4 농도는 관상동맥질환군과 정상군 사이에 의미있는 차이를 보이지 않았다. 협착된 혈관 수에 따른 각 변수들의 평균 수치를 비교하였는데, 정상군에서 세혈관질환군으로 갈수록 평균 연령, 공복 혈당 농도가 증가하였으나, 협착된 혈관 수에 따라서 혈중 RBP-4 농도는 의미있는 차이를 보이지 않았다. 각 대사성 지표들 중 중성지방 농도만이 혈중 RBP-4와 의미있는 연관성을 보였다(r=0.177, P=0.007). 결론: 한국인 성인에서 관상동맥질환 여부에 따른 혈중 RBP-4 농도는 협착된 혈관의 수나 질환 여부에 따라 차이가 없어서 동맥경화증에 미치는 영향은 적은 것으로 생각되나 대규모의 연구를 통한 결론이 내려져야 할 것이다.

다국어 초록 (Multilingual Abstract)

Background: A recently discovered adipokine, retinol-binding protein-4 (RBP-4), is reportedly associated with insulin resistance and metabolic syndrome. This study was performed to analyze the relationship between serum RBP-4 levels and coronary artery disease (CAD) in Korean adults. Methods: In 235 subjects (mean age 58 years) in whom coronary artery angiograms were performed due to complaints of chest pain, serum RBP-4 levels were measured by enzyme-linked immunosorbent assay. Coronary artery angiograms were performed in all subjects and the severity of CAD was assessed by the number of stenotic vessels. The presence of metabolic syndrome was defined by AHA/NHLBI criteria with body mass index substituted for waist circumference. Results: Coronary angiogram showed that 101 subjects (43%) had normal coronary vessel, 82 subjects (34.9%) had 1-vessel disease, 31 subjects (13.2%) had 2-vessel disease and 21 subjects (8.9%) had 3-vessel disease. Subjects with coronary artery stenosis showed a higher mean age (60.5±10.0 years), fasting glucose (123.3 mg±45.0 mg/dL) and lower mean value for high-density lipoprotein cholesterol (HDL-C) level (49.0±13.2 mg/dL), although serum RBP-4 levels were not significantly different between those with and without CAD. Mean age and fasting glucose level increased significantly as the number of stenotic vessels increased, although serum RBP4 level showed no significant differences among the different groups. Among the metabolic parameters, only serum triglyceride levels showed a significant correlation with serum RBP-4 levels. Conclusion: There was no difference in mean serum RBP-4 levels between subjects with or without coronary artery disease in Korean adults. Further studies are warranted to draw a clear conclusion on the effect of RBP-4 on atherosclerosis. (Korean Diabetes J 33:105-112, 2009)

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