근시의 정도에 따른 안압, 뇌척수압 및 사상판경유압력차의 관계

The Relationships of Intraocular Pressure, Cerebrospinal Fluid Pressure, and The Relationships of Intraocular Pressure, Cerebrospinal Fluid Pressure, and

목적: 한국인에서 근시와 안압, 뇌척수압, 사상판경유압력차 간의 관계를 알아보고자 하였다. 대상과 방법: 본 연구는 2008년부터 2012년까지 시행한 국민건강영양조사자료를 바탕으로 19세 이상의 성인 6,933안을 대상으로 젊은 연령군(19-49세, Group 1)과 고령군(≥50세, Group 2)으로 분류하였다. 추정뇌척수압은 ‘cerebrospinal fluid pressure(mmHg)=0.44×신체비만지수(kg/m2)+0.16×이완기혈압(mmHg)-0.18×나이(years)-1.91’ 공식을 사용하였다. 사상판경유압력차는 안압에서 추정뇌척수압수치를 제하여 구하였다. 결과: 전체 환자군에서, 평균추정뇌척수압은 13.7 ± 0.1 mmHg (Group 1: 14.2 ± 0.1 mmHg, Group 2: 11.5 ± 0.1, p<0.01)였고 평균 안압은 14.0 ± 0.1 mmHg (Group 1: 14.0 ± 0.1 mmHg, Group 2: 14.1 ± 0.1, p=0.724)였으며, 평균사상판경유압력차는 0.7 ± 0.1mmHg (Group 1: 0.3 ± 0.1 mmHg, Group 2: 3.0 ± 0.2, p<0.001)였다. 혼란변수를 보정한 후 시행한 다중선형회귀분석에서 근시의 정도와 추정뇌척수압 간의 양의 상관관계를 가졌으며(p<0.001; β: 0.12, spherical equivalent [SE]: 0.03), 이는 안압에서도 마찬가지였다(p<0.001; β: 0.29, SE: 0.05). 결과적으로 근시가 심할수록 높은 사상판경유압력차와 연관이 있었다(p=0.002; β: 0.18, SE: 0.06). Group 1과 Group 2로 나눠 시행한 분석에서 Group 1은 비슷한 연관성을 보였으나(추정뇌척수압: p<0.001; β: 0.12, SE: 0.03; 안압: p<0.001; β: 0.28, SE: 0.05; 사상판경유압력차: p=0.005; β: 0.17, SE: 0.06), Group 2에서는 사상판경유압력차와 근시의 정도와의 관계가 통계적으로 유의하지 않았다(p=0.274; β: 0.18, SE: 0.16). 결론: 한국인에서 공식으로 계산한 사상판경유압력차는 근시의 정도와 연관이 있으며, 이는 근시가 녹내장의 발병과 진행에 영향을 미치는 병리기전에 사상판경유압력차 증가가 기여할 수 있음을 나타낸다.

Purpose: To investigate the relationships between myopia and the three parameters of intraocular pressure (IOP), estimated cerebrospinal fluid pressure (CSFP), and the trans-lamina cribrosa pressure difference (TLCPD). Methods: A total of 6,933 adults (≥19 years of age) who participated in the Korea National Health and Nutrition Examination Survey (2008&#8211;2012). These subjects were divided into two groups: young age group (19&#8211;49 years of age) and old age group (≥50 years of age). The estimated CSFP was calculated as CSFP (mmHg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mmHg) - 0.18 age (years) - 1.91. The TLCPD was calculated by subtracting the CSFP from the IOP. Results: The mean estimated CSFP in the total population was 13.7 ± 0.1 mmHg (young, 14.2 ± 0.1 mmHg; old, 11.5 ± 0.1; p <0.01), the mean IOP in the total population was 14.0 ± 0.1 mmHg (young, 14.0 ± 0.1 mmHg; old, 14.1 ± 0.1; p = 0.724), and the mean TLCPD in the total population was 0.7 ± 0.1 mmHg (young, 0.3 ± 0.1 mmHg; old, 3.0 ± 0.2; p < 0.001). After adjusting for confounding factors, multivariate linear regression analyses revealed significant positive associations between the degree of myopia and the estimated CSFP (p < 0.001; β, 0.12; spherical equivalent [SE], 0.03), as well as IOP (p < 0.001; β, 0.29; SE, 0.05). As a result, a higher TLCPD also showed a significant association with more myopic refractive error (p=0.002; β, 0.18; SE, 0.06). In subgroup analyses, a similar association was shown only in the young age group (estimated CSFP, p < 0.001; β, 0.12; SE, 0.03; IOP, p < 0.001; β, 0.28; SE, 0.05; TLCPD, p = 0.005; β, 0.17; SE: 0.06), while the old age group did not show a significant association between TLCPD and the degree of myopia (p = 0.274; β, 0.18; SE, 0.16). Conclusions: The calculated TLCPD showed an association with high myopia. It was consistent with the potential role of high myopia in the pathogenesis of open-angle glaucoma.