Journal of agricultural medicine and community health (농촌의학ㆍ지역보건)

Korean Society for Rural Medicine and Community Health (한국농촌의학지역보건학회)
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The Association between HbA1c and the Biological Exposure Index for Heavy Metals in Community

지역사회 주민의 당화혈색소와 중금속 생체표지자와의 관련성

  • Min, Young-Sun (Department of Occupational and Environmental Medicine, Soonchunhyang University Cheonan Hospital) ;
  • Lee, Kwan (Department of Preventive Medicine, Dongguk University College of Medicine)
  • 민영선 (순천향대 천안병원 직업환경의학과) ;
  • 이관 (동국의대 예방의학교실)
  • Received : 2022.09.20
  • Accepted : 2022.09.22
  • Published : 2022.09.30
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Abstract

Objectives: The prevalence of diabetes mellitus was approximately 16% in populations of over age 30 years, and deaths from diabetes mellitus became the sixth most prevalent cause of death by disease. To assess the relationship between HbA1c and heavy metal level in blood and urine, targeted residents were evaluated in a vast steel industrial complex. Methods: We selected 414 subjects for analysis after applying the following exclusion criterion: 18 persons with diabetes mellitus. They took part in a questionnaire survey and underwent blood and urinary assessments. HbA1c and lead (Pb) level were measured in blood and, cadmium (Cd), inorganic arsenic (iAs) and mercury (Hg) were evaluated in urine. Two subgroups were divided by HbA1c 6.5%. Each subgroup was divided by 10th, 20th, 30th, 40th, 50th, 60th, 70th, 80th and 90th percentile levels of biological exposure index of the heavy metals for logistic regression. Results: Odd ratios have a tendency to increase as they go from the 90th to the 10th percentile of cadmium. However, lead, arsenic and mercury did not have significant relationships with HbA1c. In correction of age, region, gender and smoking history, a higher distribution in the subgroup with cadmium above 0.8318 ㎍/g creatinine (30th percentile) was demonstrated in the subgroup with HbA1c levels above the 6.5%, with an odds ratio of 5.26 (95% C.I. ; 1.44~19.17). Conclusion: This study found a significant correlation between urinary levels of cadmium and HbA1c in correction of several factors. It is meaningful that this outcome may be used as a basis for a study to establish the acceptable limit of urinary cadmium in Korea.

당뇨병 발생에는 생활습관이나 생활환경과 관련된 다양한 원인들이 있는데 최근 연구에서 중금속에 많이 노출된 사람에서 당뇨병 발생 및 당뇨병의 악화가 늘어났다는 역학적 연구가 많이 발표되고 있다. 이에 국내 대규모 철강공업단지를 가진 일개 도시 지역 주민을 대상으로 당화혈색소와 체내 중금속의 상관성을 파악하고자 하였다. 2008~2009년 연구대상 총 414명에 대한 설문조사와 생체시료를 채취하였다. 설문은 성별, 연령, 인구학적 특성, 흡연, 음주, 직업, 당뇨진단 유무 등의 항목으로 구성하였다. 혈액을 채취하여 HbA1c, 혈중 납 농도를 측정하였고, 소변을 채취하여 요중 카드뮴, 무기비소, 수은 농도를 측정하였다. HbA1c는 6.5%기준으로 미만군과 이상군으로 분류하였다. 각 중금속별 10분위수부터 90분위수 농도에 해당하는 기준으로 미만군과 이상군 등 두 군을 분류하였다. 당뇨관련검사 결과 HbA1c 6.5% 기준으로 이상군은 남자 14(9.9%)명, 여자 17(6.2%)명이었다. 혈중 납의 기하평균 농도는 2.48 (1.80) ㎍/dl, 요중 카드뮴의 기하평균농도는 1.20 (2.26) ㎍/g creatinine, 요중 무기비소의 기하평균농도는 12.08 (1.80) ㎍/g creatinine, 요중 수은의 기하평균농도는 1.63 (2.23) ㎍/g creatinine 이었다. 연령, 지역, 성별, 흡연으로 보정하였을때 요중 카드뮴 농도 30분위수 이상군이 미만군에 비하여 교차비 5.26(95% 신뢰구간 : 1.44~19.17)으로 유의하게 높았다. 납, 무기비소, 수은은 HbA1c(6.5% 기준) 변수와의 교차분석에서 유의한 분포 차이는 없었다. 여러 요인을 보정하고도 요중 카드뮴과 HbA1c의 유의한 양의 상관관계를 파악하였고, 특히 유의한 상관관계를 보인 요중 카드뮴 농도의 특정 컷오프 값을 찾아내어 이를 통해 우리나라에 적합한 생물학적 노출값 설정의 참고자료로 활용될 수 있다는 점에서 의의가 있다고 생각한다.

Keywords

Acknowledgement

This work was supported by the Soonchunhyang University Research Fund.

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