간 기능 수치(GPT. GOT등) 올라 간 자 에게 지질 저하제(Statin)를 처방 해야 하는 이유 > 임상 응용 정보

간 기능 수치(GPT. GOT등) 올라 간 자 에게 지질 저하제(Statin)를 처방 해야 하는 이유

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간 기능 수치(GPT. GOT등) 올라 간 자 에게 
 
지질 저하제(Statin)를 처방 해야 하는 이유</TD></TR>
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S-GPT,  S-GOT 등 간 기능 수치가 높은 자들이 
 
지질 저하제(Statin)를 복용하면 
 
순환기 질환 합병증도 예방할 뿐 아니라
 
간 기능 수치도 정상화 시켜주며
 
신장 기능까지 개선해 준다는 놀라운 사실이 최초로 밝혀졌다
 
 
지금까지는  간 기능 수치가 조금이라도 나쁘면 
 
지질 저하제 Statin의 처방을 금기 시 해왔다
 
 
특히 비만 자나 당뇨병자나 대사증후군자 중에서
 
비 알코올성 지방간을 지닌 자들이 매우 많을 뿐 아니라
 
비 알코올성 지방간은 그 자체가 심장병 합병증을 
 
유발하는 병태를 지니고 있다
 
이제 이러한 자들에게 Statin을 처방 할 수 있게 된 것이다
 
 이는 주로 비만 자나 당뇨병자에게 많은 
 
비 알코올성 지방간(NAFLD)을 지닌 자들을 대상으로 한
 
3년간의 임상 실험을 통해 입증된 결과 이다
 
 
본 연구는 런던 의대와 그리스 데살노니카 의대 연구팀의 연구 결과이며
 
영국 의학 전문지(Lancet)를 통해 발표된 것이다
 
 
<IMG src="/_dimg/1%20nASH.bmp"> 
[그림] 비알코올성 지방 간(NAFHD) 는 국민의 30% 이상에게 발견되며
이들의 간 기능 수치(GPT. GOT)는 정상 보다 높다. 이를 치료하지 않으면 지방간(Fatty Liver), 지방 간염 (NASH) 간경변(Cirrhosis)으로 악화하며 심장 질환을 합병하게 된다</TD></TR>
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간 기능 수치 높았던 자들 89%가 정상 수치로 개선 </TD></TR>
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고지혈증을 지닌 관상 동맥 질환 자 1,600명을 대상으로 하고
 
S-GPT(ALT),  S-GOT(AST) 등 간 기능 수치가 
 
정상 수준보다 3배를 넘지 않는 
 
중등도의 간 기능 수치 이상 자들을 대상으로 하였다
 
 
이들에게 지질저하제 Statin 계 약물을  3년간 투약하면서
 
심장병, 뇌졸중 등 합병증 발생 현황을 비교하고
 
아울러 간 기능 수치 변화 여부를 비교하였다
 
 
그 결과 아래 표에서 처럼 환자의 87%가 간 기능 수치가 정상화 되었다
 
한편 Statin을 투약하지 않은 환자들은 간 기능 수치가 더욱 악화 되었다
 
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Statin 투약 (3년간) </TD>
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Statin 투약 안 한 자 </TD></TR>
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S-GPT(ALT)  (IU) </TD>
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57---37</TD>
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-35%</TD>
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 </TD>
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56---63</TD>
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+12%</TD></TR>
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S-GOT(AST) (IU)</TD>
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49---26</TD>
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-47%</TD>
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 </TD>
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49---55</TD>
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+12%</TD></TR>
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GGT        (IU)</TD>
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70---38</TD>
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-40%</TD>
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68---79</TD>
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+16%</TD></TR>
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정상수치: S-GPT ---40 이하 
             S-GOT---40 이하 
             GGT------여자 45이하 남자 65이하 </TD></TR></TBODY></TABLE></TD></TR>
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신장 기능도 함께 개선</TD></TR>
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Statin 투약 자는 나빴던 간 기능 수치가 정상화 되었을 뿐 아니라
 
아래 표에서 처럼 신장 기능(여과 율)도 개선 되었다
 
Statin을 투약하지 않은 자는 신장 여과 율이 더 악화 되었음을 볼 수 있다
 
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Statin 투약(3년간)</TD>
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Statin 투약 안 함</TD></TR>
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신장 여과 율 eGFR
(ml/min/1.73m2)</TD>
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59à70</TD>
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+19%</TD>
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68-à64</TD>
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-6%</TD></TR></TBODY></TABLE></TD></TR>
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Statin 투약 안 하면 심장병 합병증 발병 율 3배</TD></TR>
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간 기능 수치가 나쁜 자들이 Statin 투약을 안 한 경우
 
아래 표에 나타나 있는 바와 같이
 
Statin 투약을 한 자들에 비해 심장병 합병증 발생율이 3배나 높았다
 
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 </TD>
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Statin 투약 (3년간)</TD>
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Statin 투약 안 함</TD></TR>
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심장병 합병증 발생</TD>
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9.7%</TD>
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30%</TD></TR>
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환자 100명당 합병증 발생</TD>
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3.2명</TD>
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10명</TD></TR>
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총콜레스테롤 mol/L</TD>
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6.36-4.16</TD>
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-35%</TD>
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6.41-6.21</TD>
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-3%</TD></TR>
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LDL mol/L</TD>
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4.37-2.46</TD>
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-44%</TD>
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4.45-4.24</TD>
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-5%</TD></TR>
<TR style="HEIGHT: 27.85pt; mso-yfti-irow: 5">
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Triglyceride mol/L</TD>
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2.2-1.49</TD>
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-32%</TD>
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2.13-1.98</TD>
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-7%</TD></TR>
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HDL mol/L </TD>
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0.96-1.03</TD>
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+8%</TD>
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0.98-0.96</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 2cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; HEIGHT: 27.55pt; BORDER-TOP: #ffffff; BORDER-RIGHT: black 1pt solid" width=76>
-3%</TD></TR></TBODY></TABLE></TD></TR>
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<TD class=tbl2-subtitle>
간 기능 수치 개선되면서
 
지질 저하 작용은 더욱 강해져</TD></TR>
<TR style="HEIGHT: 35.15pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes">
<TD class=tbl2-contents>
간 기능 수치가 나빴던 자들에게 Statin을 투약했을 때
 
87% 환자의 간 기능 수치가 정상 수준으로 개선 되었을 뿐 아니라
 
정상 수준까지 개선된 자들은
 
정상 수준까지 개선되지 못한 자들보다 지질저하 작용이 더 우수했다
 
 
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<TBODY>
<TR style="HEIGHT: 75pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes">
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 </TD>
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간 기능 수치
정상수준으로까지
개선된 자</TD>
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 </TD>
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정상 수준에
미치지 못한 자</TD></TR>
<TR style="HEIGHT: 45pt; mso-yfti-irow: 1">
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LDL 콜레스테롤 
mmol/L</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 139.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; HEIGHT: 45pt; BORDER-TOP: #ffffff; BORDER-RIGHT: black 1pt solid" width=186>
2.43</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ffffff; PADDING-LEFT: 5.4pt; WIDTH: 40.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #eaf1dd; HEIGHT: 45pt; BORDER-TOP: #ffffff; BORDER-RIGHT: black 1pt solid" width=54>
 </TD>
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2.51</TD></TR>
<TR style="HEIGHT: 25.5pt; mso-yfti-irow: 2; mso-yfti-lastrow: yes">
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LDL 콜레스테롤 저하 목표 : 2.60mmol/L 이하 (1mmol=38.7mg)</TD></TR></TBODY></TABLE></TD></TR>
<TR style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<TD class=tbl2-subtitle>
발병 빈도 높은 비 알코올성 지방간</TD></TR>
<TR style="HEIGHT: 35.15pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes">
<TD class=tbl2-contents>
비 알코올성 지방간은
 
비만 자, 당뇨병자 대사증후군을 지닌 자들에게 매우 많다
 
본 임상에서도 당뇨병자 중 71%가 비 알코올성 지방간이고
 대사증후군 환자 중 56%가 비 알코올성 지방간을 지니고 있음이 밝혀졌다 
 
술로 인한 지방간은 술을 중단하면 곧 사라진다
 
그러나 비 알코올성 지방간은 난치 성이다
 
한국인의 30%이상이 비 알코올성 지방을 지니고 있고
 
간 기능 수치가 올라간 자들이 많다
   
GPT GOT 수치가 올라간다는 것은 간 세포가 파괴됨을 의미한다
 
따라서 즉시 대처해야 하만 하는 증상이다
 
특히 비 알코올성 지방간이 있는 자는 
간염으로 악화되는 것보다는 심장병 합병증으로 악화되는 경우가 더 많다
 
따라서 Statin 복용은 필수 이다 </TD></TR></TBODY></TABLE>
<TABLE class=tbl2>
<TBODY>
<TR style="mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes">
<TD class=tbl2-ref1>
근거</TD>
<TD class=tbl2-ref2>
2010 Nov. 24 the Lancet  <A href="http://dx.doi.org/10.1016/S0140-6736(10)61272-X" target=doilink>doi:10.1016/S0140-6736(10)61272-X</A>
Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (<A name=hit1></A>GREACE) Study: a post-hoc analysis 
Vasilios G Athyros MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff1">a</A>, Konstantinos Tziomalos MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff2">b</A>, Thomas D Gossios MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff3">c</A>, Theodora Griva MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff1">a</A>, Panagiotis Anagnostis MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff4">d</A>, Konstantinos Kargiotis MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff1">a</A>, Efstathios D Pagourelias MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff3">c</A>, Eleni Theocharidou MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff1">a</A>, Prof Asterios Karagiannis MD<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff1">a</A>, Dr Dimitri P Mikhailidis FRCPath<A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#aff5">e</A>, and for the GREACE Study Collaborative Group<A name=bfn1></A><A href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-51J670C-1&_user=780460&_coverDate=11%2F23%2F2010&_alid=1556351784&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=4886&_sort=d&_st=13&_docanchor=&view=c&_ct=13&_acct=C000037458&_version=1&_urlVersion=0&_userid=780460&md5=b01a62ea559ca53f4ad7d44cee5df8d1&searchtype=a#fn1">‡</A>
<A name=aff1></A>a Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
<A name=aff2></A>b First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
<A name=aff3></A>c First Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
<A name=aff4></A>d Endocrinology Clinic, Hippokration Hospital, Thessaloniki, Greece
<A name=aff5></A>e Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London, London, UK</TD></TR></TBODY></TABLE>
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