제2형 당뇨병환자에서 인슐린저항성과 뇌혈관 박동성 지수와의 연관성 = Relation between Cerebral Arterial Pulsatility and Insulin Resistance in Type 2 Diabetic Patients

다국어 초록 (Multilingual Abstract)

-Background: Diabetic patients have a 3-fold risk for cerebrovascular disease compared with nondiabetic controls. The aim of the present study was to investigate the association of insulin resistance with pulsatility index (PI) of cerebral arteries in type 2 diabetic patients. Methods: We compared a group of 90 patients with stroke free, type 2 diabetes and an age- and sex- matched control group of 45 healthy subjects without diabetes. Diabetic patients were divided into 3 groups according to the ISI (insulin sensitivity index). We evaluated PI of the middle cerebral artery (MCA) by transcranial Doppler ultrasonography (TCD) and insulin resistance determined by short insulin tolerance test. Results: The PI was significantly higher in diabetic patients than that in healthy controls (P < 0.05), and also higher in patients with insulin resistance than that in insulin sensitive diabetic patients (P < 0.05). The PI of the MCA was significantly correlated with age (r= 0.465, P < 0.01), duration of diabetes (r = 0.264, P = 0.025), hypertension (r = 0.285, P = 0.015) and inversely correlated with insulin resistance (r = -0.359, P = 0.030).Multiple regression analysis was performed with PI as a dependent variable and insulin resistance as an independent variable along with known clinical risk factors. Age (β = 0.393, P < 0.01) and duration of diabetes (β = 0.274, P = 0.043) exhibited a significant independent contribution to PI. Conclusions: PI might be useful markers of the detection of diabetic cerebrovascular changes and insulin resistance, measured with short insulin tolerance test, showed correlations with PI, but age and duration of diabetes contributed independently to the variability in the PI. (J Kor Diabetes Assoc 30:347~354, 2006)

국문 초록 (Abstract)

연구배경: 이번 연구를 통하여 제2형 당뇨병환자를 대상으로 뇌혈관 질환의 지표인 박동성 지수의 증가에 영향을 미치는 인자를 찾고 특히 인슐린저항성과의 연관성을 규명하고자 한다.방법: 뇌경색의 과거 병력이 없는 제2형 당뇨병환자 90명 (남 43명, 여 47명) 및 정상 대조군 45명 (남 24명, 여 21명)을 대상으로 임상적, 생화학적 특성을 조사하였고 단시간 인슐린저항성 검사를 시행하여 인슐린저항성 측정 및 경두개 초음파를 시행하여 박동성 지수를 측정하였다. 결과: 제2형 당뇨병환자의 박동성 지수가 정상 대조군에 비해 컸고 당뇨병환자군에서도 인슐린저항성 그룹이 인슐린감수성 그룹에 비해 박동성 지수가 컸다. 중뇌 동맥의 박동성 지수는 나이, 당뇨병 이환기간, 고혈압의 유무 및 인슐린저항성과 상관관계가 있었다. 다중회귀분석 결과 나이 및 당뇨병 이환기간이 박동성 지수를 결정하는 독립적 위험인자였다.

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