부당경량아로 태어난 소아와 청소년의 대사증후군 유병률 = The Prevalence of Metabolic Syndrome in Children and Adolescents Born Small for Gestational Age

다국어 초록 (Multilingual Abstract)

Purpose : Type 2 diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease, called metabolic syndrome (MS), occur more frequently among individuals who were born small for gestational age (SGA). SGA children with catch-up growth in height and high BMI are the most insulin resistant. We investigated the prevalence of MS and evaluated the risk factors affecting the development of MS in children and adolescents born SGA.
Methods : The study population (n=65) were born less than 10th percentile in body weight for their gestational age and the body weights of the control group (n=34) were more than 10th percentile at birth. The SGA and control subjects divided into prepubertal and pubertal groups. We measured serum lipid levels (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol), fasting sugar levels and insulin levels. Insulin resistance was determined by homeostasis model assessment, fasting insulin glucose ratio and quantitative insulin sensitivity check index.
Results : Systolic blood pressure was significantly higher in the pubertal SGA group than in the control group (113.2±10.3 vs. 98.7±16.4, P=0.001). The prevalence of high triglyceride and high fasting glucose levels were significantly increased in pubertal SGA group than prepubertal SGA group (P< 0.05). Insulin resistance was correlated to systolic blood pressure, triglyceride levels, HDL-cholesterol levels, fasting glucose, insulin levels at fasting and 2 hours after oral glucose tolerance test and body fat mass in SGA group (P<0.05).
Conclusion : We suggest that the monitoring of these risk factors including systolic blood pressure, triglyceride, HDL-cholesterol levels and body fat mass is important for the prevention of MS in children and adolescents born SGA.

국문 초록 (Abstract)

목 적 : 부당경량아는 고지혈증, 인슐린 저항성, 제2형 당뇨병, 심혈관질환 등이 적정체중아 보다 상대적으로 잘 발생하며, 인슐린 저항성이나 고인슐린혈증이 대사장애의 발생 기전에 중요한 역할을 할 것이라고 알려져 있다. 본 연구에서는 부당경량아로 태어난 소아와 청소년에서 대사증후군의 발생빈도를 조사하고, 대사증후군의 발생에 영향을 미치는 인자를 알아보고자 한다.
방 법 : 1989년에서 2000년 사이에 강동성심병원에서 출생한 소아 가운데 재태기간에 비해 출생 체중이 10백분위수 미만인 부당경량아 65명(사춘기 전 30명, 사춘기군 35명)과 재태 기간에 대해 출생체중이 10백분위수 이상인 34명(사춘기 전 18명, 사춘기군 16명)을 대조군으로 하였다.
결 과 : 사춘기 시기의 부당경량아군이 대조군에 비해 수축기 혈압이 높게 나타났다(P=0.001). 중성지방이 110 mg/dL 이상인 경우와 공복 혈당이 110 mg/dL 이상인 경우는 사춘기 이전에 비해서 사춘기군에서 유의하게 높았다(P<0.05). 대사증후군의 위험인자가 1개 이상인 경우는 사춘기 전에는 42.4%, 사춘기 군에서는 61.3%였고 2개 이상인 경우는 각각 7.7%, 29.1%, 3개 이상인 경우는 3.9%, 9.7%, 4개 이상인 경우는 3.9%, 0.0% 였다. 인슐린 저항성은 수축기 혈압, 중성지방, 고밀도지단백 콜레스테롤, 공복 시 혈당, 공복 및 경구 당부 하 후 2시간째에 측정한 인슐린의 농도, 체지방률과 유의한 상관 관계를 보였다(P<0.05).
결 론 : 부당경량아로 태어난 소아에게 수축기 혈압이나 중성지방, 고밀도지단백 콜레스테롤, 체지방률을 지속적으로 추적 관찰하는 것이 대사증후군의 발생을 예방하고 중재하는 데에 필요하다고 생각된다.

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