Journal of Hospice and Palliative Care

  • 제18권2호
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  • Pages.120-127
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  • 2015
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  • 2765-3072(pISSN)
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  • 2765-3080(eISSN)
한국호스피스완화의료학회 (Korean Society for Hospice and Palliative Care)
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말기암환자에서 혈중 비타민 D 농도와 생존기간과의 관련성

Relationship between Vitamin D Level and Survival in Terminally III Cancer Patients

  • 최선영 (가톨릭관동대학교 국제성모병원 가정의학과) ;
  • 최윤선 (고려대학교 구로병원 가정의학과) ;
  • 황인철 (가천대학교 길병원 가정의학과) ;
  • 이준영 (고려대학교 의학통계학과)
  • Choi, Sun Young (Department of Family Medicine, Catholic Kwandong University College of Medicine, International ST. Mary's Hospital) ;
  • Choi, Youn Seon (Korea University College of Medicine, Guro Hospital) ;
  • Hwang, In Cheol (Gachon University of Medicine and Science, Gil Medical Center) ;
  • Lee, June Young (Department of Biostatistics, Korea University College of Medicine)
  • 투고 : 2015.01.29
  • 심사 : 2015.05.04
  • 발행 : 2015.06.01
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초록

목적: 국내 말기암환자를 대상으로 혈중 vitamin D 농도를 측정하고, 생존기간과의 관련성에 대하여 확인해 본다. 방법: 2012년 5월부터 15개월 동안, 국내 일개 병원의 말기암환자 96명을 대상으로 후향적 의무기록 조사를 시행하였다. Vitamin D 결핍에 영향을 미치는 요인들을 파악하기 위해 단순 로지스틱 회귀분석과 다중 로지스틱 회귀분석을 실시하였고, vitamin D가 생존기간에 미치는 영향을 파악하기 위해 다변수 분석으로 Cox's proportional hazard regression analysis를 실시하였다. 결과: 대상자의 평균 연령은 $67.06{\pm}13.77$세였고, 모든 대상자가 ECOG PS 3점 이상이었으며 혈중25(OH)D 농도는 평균 $8.60{\pm}7.16ng/ml$였다. 3명(3.1%)만이 vitamin D 충분상태(혈중 25(OH)D 농도${\geq}30ng/ml$)였으며, 5명은 vitamin D 상대적결핍상태(혈중 25(OH) 농도 20~30 ng/ml)였고, 13명(13.5%)은 vitamin D 결핍(혈중 25(OH)D 농도 10~20 ng/ml), 75명(78.1%)은 vitamin D 중증결핍상태(혈중 25(OH)D<10 ng/ml) 였다. 혈중 빌리루빈 농도가 1.2 mg/dl 이상인 경우 vitamin D 중증결핍과 관련이 있었다(Odds ratio, OR=5.041; P=0.039). 혈중 빌리루빈 농도가 높을수록 혈중 vitamin D 농도가 낮았으며, 고빌리루빈혈증인 환자는 vitamin D 중증결핍에 속할 위험이 더 크고(OR=18.476, P<0.05), 중앙생존기간도 유의하게 짧았다. Vitamin D 중증결핍인 경우 추정된 중앙생존기간은 짧았으나 통계적 유의성은 없었다. 다변량 분석결과에서 vitamin D 중증결핍은 사망의 위험인자가 아니었다. 결론: 말기암환자에서 혈중 vitamin D 결핍은 매우 심각하였으나, vitamin D 중증결핍이 생존기간에 영향을 미치지는 않았다.

Purpose: We aimed to investigate how serum vitamin D levels are related to survival of terminally ill cancer patients. Methods: From May 2012 through June 2013, a retrospective chart review was performed on 96 hospice patients. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with severe vitamin D deficiency and Coxcy and Coxional hazard analyses were used to evaluate effects on survival. Results: The mean vitamin D level in patients was $8.60{\pm}7.16ng/ml$. Vitamin D was severely deficient (<10 ng/ml) in 75 patients (78.2%), deficient (10~20 ng/ml) in 13 patients (13.5%), relatively insufficient (21~29 ng/ml) in five patients (8.3%) and sufficient ((t ng/ml) in three patients (3.1%). Hyperbilirubinemia (${\geq}1.2g/dl$) was the only factor associated with severe vitamin D deficiency according to the multiple logistic regression analysis (Odds ratio, OR=18.48, P<0.05). Although hyperbilirubinemia showed a strong association with survival (Hazard ratio, HR=2.25, P<0.01), no association was found between severe vitamin D deficiency and survival (HR=1.15, P>0.05) in Cox's proportional hazard analysis. Conclusion: Although serum vitamin D levels were severely low in terminally ill cancer patients, we found no association between severe vitamin D deficiency and patient survival.

키워드

참고문헌

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