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Journal of the Korean Academy of Family Medicine 1996;17(1):91-101.
Published online January 1, 1996.
Risk Factors of Cerebral Infarction Among Koreans.
Sang Woo O, Byung Wook Do, Sung Sunwoo, Yun Mi Song, Tae Woo Yoo
뇌경색증 발병의 관련요인
오상우, 도병욱, 선우성, 송윤미, 유태우
여수전남병원 가정의학과
Abstract
Background
: Stroke is the second common cause of death in Korea. It may cause severe and irreversible damages to human health. Risk factors and prevention of stroke have been interested by many physicians and patients. There are many studies about rick factors of stroke in the world. but there are no reliable epidemiologic studies abut risk factors of stroke in Korea. So this study was designed to investigate the risk factors of cerebral infarction. Especially, we focused on the lipid profile in cerebral infarction.

Methods : 102 cases were selected among patients who confirmend by Brain CT of MRI as cerebral infarction at one University Hospital and one City Hospital. Age-sex matched 102 patients, who were not diagnosed as stroke by CT or MRI, were selected as a contral group. Information was taken by charts review. Adjusted odds ratios for individual risk factors were calculated by multiple logistics regression anaysis.

Results : Average total cholesterol level was 216.1mg/dl in the case group and 190.7mg/dl in the control group. A patient who had cerebral infarction had almost 2.5 times more likely to have hypercho-lesterolemia(cholesterol>200mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 2.48, 95% confidence interval, CI : 1.27~4.8, p<0.01). HDL-cholesterol average was 39.4mg/dl in the case group and 46.6mg/dl in the control group. A patient who had cerebral infarction had almost 0.5 times more likely to have not hypoHDL-cholesterolemia(HDL-cholesterol<35mg/dl in male, HDL-cholesterol<45mg/dl in female) than a patient who did not have a stroke(adjusted odds ratio is 0.46, 95% CI:0.23~0.92, p<0.05). LDL-cholesterol average was 147.8mg/dl in the case group and 114.5mg/dl in the control group. A patient who had cerebral infarction had almost 3.1 times more likely to hane hyperLDL-cholesterolemia(cholesterol>130mg/dl) than a patient who did not have a stroke(adjusted odds ratio is 3.07, 95% CI:1.59~5.96, p<0.01). Triglyceride average was 144.4mg/dl in the case group and 149.0mg/dl in the control group. There was not statistically significant diference between two groups. In concerning with other risk factors, obesity was not statistically significant risk factor. Hypertension and Diabetes Mellitus were statistically significant(two p-value are all less than 0.01). Its adjusted odds ratio were 5.24(95% CI:2.8~10.22) and 5.32(95% CI:2.14~13.21)

Conclusion : Hypercholesterolemia, HypoHDL-cholesterolemia, hyperLDL-cholesterolemia, Hyper-tension, and Diabets Mellitus were significant risk factors for cerebral infaction. But Triglyceride and Obesity were not statistically signficant risk factors.
초록
연구배경 : 뇌졸증의 예방과 치료에 대하여 지금까지 많은 관심과 접근이 이루어져 왔으나 이의 위험요인에 관한 국내자료는 거의 전무한 상태였다. 이에 뇌졸증 중에서 뇌경색증 환자를 대상으로 그 관련요인에 관한 국내자료를 얻고자 환자·대조군 연구를 시행하였다.

방법 : 1992년부터 1994년초까지 일개 대학병원과 일개 시립병원에서, 뇌컴퓨터단층촬영이나 자기공명영상을 통해 뇌경색증으로 진단받은 102명을 환자군으로 정했다. 상기검사에서 정상 또는 뇌경색증 외의 질환으로 진단받은 환자 102명을 1:1로 환자군과 짝짓기하여 대조군으로 정했다. 의무기록지의 검토를 통하여 성별, 나이, 비만도, 고혈압, 당뇨병, 혈중지질농도 등을 조사하였다. 이들을 분석하여 각각의 정정교차비를 선형 로짓모델을 이용한 다변량 분석법을 이용하여 구하였다.

결과 : 전체환자군의 총콜레스테롤농도 평균치는 216.1mg/dl이었고 대조군의 평균치는 190.7mg/dl이었다. 혈중 총콜레스테롤농도가 200mg/dl이상인 경우를 고콜레스테롤혈증이라고 보았을 때, 다른 관련요인들을 고려한 정정교차비는 2.48(95% 신뢰구간:1.27~4.84)이었다(P<0.01). 고비중 지단백 콜레스테롤은 환자군 전체의 평균치는 39.4mg/dl이고 대조군 전체의 평균치는 46.6mg/dl이었다. 남자환자의 경우 35mg/dl, 여자환자의 경우 45mg/dl를 농도의 고비중 지단백 콜레스테롤 기준치로 삼았을 때 정정교차비는 0.46(95% 신뢰구간:0.23~0.92)전체의 평균치는 114.5mg/dl이었다. 저비중 지단백 콜레스테롤은 130mg/dl를 기준으로 나눌때 정정교차비는 3.07(95% 신뢰구간:1.59~5.96)로 나왔다(P<0.01). 중성지방의 경우 환자군의 평균치는 144.4mg/dl였고 대조군의 평균치는 149.0mg/dl로 이들간의 차이는 통계적으로 유의하지 않았다. 다른 관련요인들의 영향을 고려하였을 때 전체적으로 비만여부(BMI25기준)는 통계적으로 유의한 위험인자는 아니었다. 고혈압의 정정교차비는 5.24(95% 신뢰구간 : 2.68~10.22)였고(P<0.01), 당뇨병의 정정교차비는 5.32(95% 신뢰구간 : 2.14~13.21)로 나타났다(P<0.01)

결론 : 본 연구에서 총콜레스테롤, 고비중 지단백 콜레스테롤, 저비중 지단백 콜레스테롤, 고혈압, 당뇨병은 뇌경색증과의 관련성이 인정되었으나 증성지방, 체질량지수는 관련성이 인정되지 않았다.


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