항암화학요법을 받는 암 환자의 고혈당 예측요인

Abstract

This study is a retrospective cohort study attempted to identify the predictive factors for hyperglycemia in patients receiving chemotherapy. The subjects of the study were 134 patients diagnosed with cancer and receiving chemotherapy at K University Hospital in D Metropolitan City, and data collection was conducted from July 1, 2021 to March 21, 2022.

Data analysis were conducted using SPSS WIN 28.0 for frequency, percentage, average, standard deviation, t-test, χ²-test, and logistic regression. The result of the study are as follows.

1. Hyperglycemic patients were 41 (30.59%) among 134 patients undergoing chemotherapy.

2. Variables that had significant differences between normal and hyperglycemic groups were gender (p=.017), age (p<.001), education (p=.003), comorbities (p=.011), intake of hypertension medication (p=.038), intake of appetite stimulant (p=.045), exercise status (p<.001), the number of exercises (p<.001), exercise time (p<.001), weekly exercise volume (p<.001), fat (p=.020), protein (p=.006), dietary fiber (p=.002), water (p=.049), ash (p=.008), vitamin A (p<.001), vitamin D(p=.002), vitamin E (p=.001), vitamin K (p=.002), vitamin C (p=.016), thiamine (p=.022), riboflavin (p<.001), niacin (p=.009), vitamin B6 (p=.025), folic acid (p=.001), biotin (p=.003), calcium (p=.001), phosphorus (p=.001), potassium (p<.001), magnesium (p=.009), iron (p=.009), zinc (p=.006), cholesterol (p=.012), total fatty acid (p=.039), polyunsaturated fatty acid (p=.005), isorucin (p=.032), lucine (p=.026), and glycine (p=.028).

3. Gender (CI=7.24-745.49, OR=73.48), education (CI=4.02-201.59, OR=28.46), exercise time of 30 minutes or more and less than 60 minutes (CI=0.00-0.06, OR=0.01), 60 minutes or more and less than 90 minutes (CI=0.00-0.05, OR=0.01), and 90 minute or more (CI=0.00-0.42, OR=0.03), weekly exercise of more than 2000kcal (CI=0.01-0.77, OR=0.06), fat (CI=1.02-1.14, OR=1.08) and protein (CI=0.82-0.95, OR=0.88) among daily nutrient intake, seaweed (CI=0.85-0.99, OR=0.92) among daily intake by food groups were confirmed as significant predictive factors by logistic regression results.

In conclusion, it was confirmed with the study subjects that gender and education among their general characteristics, exercise time per session and weekly exercise volume among the exercise-related factors, and fat, protein, and seaweed intake among dietary-related factors are important predictive factors, so these factors should be reflected in managing hyperglycemia in chemotherapy patients.

Therefore, additional studies are needed to recognize the importance of hyperglycemia in chemotherapy patients through the result of this study and to find other factors that may affect hyperglycemia through further studies. Based on these results, it is expected to be used as an important basic data for the development of integrated nursing intervention in order to mediated hyperglycemia in clinical practice, reducing the risk of developing hyperglycemia in chemotherapy patients.

본 연구는 항암화학요법을 받는 환자의 고혈당 발생에 대한 예측요인을 파악하기 위해 시도된 후향적 서술적 조사연구이다. 연구 대상은 D광역시 소재 K대학 병원에 암으로 진단받고 항암화학요법을 실시하는 환자 134명을 대상으로 하였고, 자료수집은 2021년 7월 1일에서 2022년 3월 31일까지 이루어졌다.

자료 분석은 SPSS WIN 28.0 Program을 이용하여 빈도, 백분율, 평균, 표준편차, t-test, χ²-test, Logistic regression을 이용하여 분석하였고, 본 연구의 결과는 다음과 같다.

1. 항암화학요법 환자 134명 중 고혈당은 41명(30.6%)으로 나타났다.

2. 정상혈당군과 고혈당군 간 유의한 차이가 나타난 변수들은 성별(p=.017), 연령(p<.001), 최종학력(p=.003), 동반질환(p=.011), 혈압강하제 복용 유무(p= .038), 식욕촉진제 복용유무(p=.045), 운동여부(p<.001), 운동횟수(p<.001), 운동시간(p<.001), 운동량(p<.001), 지방(p=.020), 단백질(p=.006), 식이섬유(p=.002), 수분 (p=.049), 회분(p=.008), 비타민A(p<.001), 비타민D(p=.002), 비타민E(p=.001), 비타민K(p=.002), 비타민C(p=.016), 티아민(p=.022), 리보플라빈(p<.001), 니아신(p=.009), 비타민B6(p=.025), 엽산(p=.001), 비오틴(p=.003), 칼슘(p=.001), 인(p=.001), 칼륨(p<.001), 마그네슘(p=.009), 철(p=.001), 아연(p=.006), 콜레스테롤(p=.012), 총지방산(p=.039), 다불포화지방산(p=.005), 이소루신(p=.032), 루신(p=.026), 글리신(p=.028)으로 나타났다.

3. 로지스틱 회귀분석 결과 성별(CI=7.24-745.49, OR=73.48), 최종학력(CI= 4.02-201.59, OR=28.46), 운동시간 30분 이상 60분 미만(CI=0.00-0.06, OR= 0.01), 60분 이상 90분 미만(CI=0.00-0.05, OR=0.01), 90분 이상(CI= 0.00-0.42, OR=0.03), 운동량 2000kcal/주 이상(CI=0.01-0.77, OR=0.06), 일일 영양소 섭취량 중 지방(CI=1.02-1.14, OR=1.08), 단백질(CI=0.82-0.95, OR=0.88), 일일 식품군별 섭취량 중 해조류(CI=0.85-0.99, OR=0.92)가 유의한 예측요인으로 확인되었다.

결론적으로 연구대상자의 일반적 특징 중 성별과 최종학력, 운동 관련 요인 중 운동시간, 운동량, 식이 관련 요인 중 지방, 단백질, 해조류 섭취량이 중요 예측요인임이 확인되었으므로 항암화학요법 환자의 고혈당을 관리함에 있어 이러한 요인들을 반영해야 할 것이다. 따라서 본 연구 결과를 통해 항암화학요법 환자의 고혈당에 대한 중요성을 인식하고 반복적인 연구를 통해 고혈당에 영향을 줄 수 있는 요인을 찾아내는 추가 연구가 필요하다. 이러한 결과들을 토대로 임상에서 고혈당을 중재하기 위한 통합적 간호 중재 개발의 중요한 기초자료로 사용되어 항암화학요법 환자의 고혈당 발생 위험이 줄어드는 계기가 되기를 기대한다.