Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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The Relationship between Opioids Use, Cortisol and DHEAS

마약성 진통제 사용과 Cortisol 및 DHEAS와의 관계

  • Jung, Ji Hoon (Department of Family Medicine, Korea University Guro Hospital) ;
  • Choi, Youn Seon (Department of Family Medicine, Korea University Guro Hospital) ;
  • Kim, Seon Mee (Department of Family Medicine, Korea University Guro Hospital) ;
  • Lee, June Young (Department of Biostatistics, Korea University) ;
  • Kim, Eun Hye (Department of Family Medicine, Korea University Guro Hospital) ;
  • Kim, Jung Eun (Department of Family Medicine, Korea University Guro Hospital) ;
  • Kim, E Yeon (Department of Family Medicine, Korea University Guro Hospital) ;
  • Park, Hee Jin (Department of Family Medicine, Korea University Guro Hospital) ;
  • Yoon, Dong Jin (Department of Family Medicine, Korea University Guro Hospital)
  • 정지훈 (고려대학교 구로병원 가정의학과) ;
  • 최윤선 (고려대학교 구로병원 가정의학과) ;
  • 김선미 (고려대학교 구로병원 가정의학과) ;
  • 이준영 (고려대학교 의과대학 통계학교실) ;
  • 김은혜 (고려대학교 구로병원 가정의학과) ;
  • 김정은 (고려대학교 구로병원 가정의학과) ;
  • 김이연 (고려대학교 구로병원 가정의학과) ;
  • 박희진 (고려대학교 구로병원 가정의학과) ;
  • 윤동진 (고려대학교 구로병원 가정의학과)
  • Received : 2015.01.03
  • Accepted : 2015.04.27
  • Published : 2015.06.01
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Abstract

Purpose: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. Methods: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. Results: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). Conclusion: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

목 적: 치료 불가능한 암환자에서는 암으로 인한 전신적 쇠약 이외에 피로와 에너지 상실, 무력감, 식욕부진 및 통증 등이 공통적으로 나타나는 주요 증상으로 알려져 있으며 이러한 증상은 부신 기능 부전이 있을 때 나타나는 증상과 유사한 점이 많다. 또한 말기암환자의 통증은 중등도 이상이기 때문에 대부분 마약성 진통제로 조절하고 있는 경우가 많다. 본 연구에서는 마약성 진통제와 부신 기능 부전에 대한 관계를 알아보고자 한다. 방법: 2013년 11월부터 2014년 6월까지 7개월 동안, 만 18세 이상의 말기암환자 55명을 대상으로 혈장 cortisol, DHEAS 등을 측정하였다. 또한 환자의 마약성 진통제의 사용 기간 및 용량도 함께 조사하였고 마약성 진통제의 사용 기간 및 용량과 부신 기능을 대표할 수 있는 혈장 cortisol, DHEAS의 농도를 각각 비교하였다. 결과: Cortisol의 평균값은 $20.24{\mu}g/dL$, DHEAS의 평균값은 $44.41{\mu}g/dL$였으며, 상관 분석 결과 DHEAS와 마약성 진통제의 사용 기간 및 용량과의 관계는 통계적으로 유의한 수준의 관련성이 없었고, Cortisol의 경우 마약성 진통제의 사용 기간과는 유의한 관련성이 없었으나, 진통제의 사용 용량이 많을수록 Cortisol의 수치가 유의하게(P-value 0.0322) 상승되었다. 결론: 마약성 진통제의 사용 기간 및 용량에 따른 부신 기능의 저하는 통계적으로 유의한 연관성을 보이지 않았으나 진통제를 사용하고 있는 말기암환자들의 부신 기능을 대표할 수 있는 지표인 DHEAS 값은 대부분 정상 이하로 낮아져 있는 모습을 보였다.

Keywords

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