The Korean Journal of Nuclear Medicine Technology (핵의학기술)

The Korean Society of Nuclear Medicine Technology (대한핵의학기술학회)
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Factors Influencing the Activation of Brown Adipose Tissue in 18F-FDG PET/CT in National Cancer Center

양전자방출단층촬영 시 갈색지방조직 활성화에 영향을 미치는 요인 분석

  • You, Yeon Wook (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Lee, Chung Wun (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Jung, Jae Hoon (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Kim, Yun Cheol (Department of Nuclear Medicine and Research Institute, National Cancer Center) ;
  • Lee, Dong Eun (Department of Biostatistics Collaboration Team and Research Institute, National Cancer Center) ;
  • Park, So Hyeon (Department of Nuclear Medicine, Korea University Anam Hospital) ;
  • Kim, Tae-Sung (Department of Nuclear Medicine and Research Institute, National Cancer Center)
  • 유연욱 (국립암센터 핵의학과) ;
  • 이충운 (국립암센터 핵의학과) ;
  • 정재훈 (국립암센터 핵의학과) ;
  • 김윤철 (국립암센터 핵의학과) ;
  • 이동은 (국립암센터 의학통계분석팀) ;
  • 박소현 (고려대학교 안암병원 핵의학과) ;
  • 김태성 (국립암센터 핵의학과)
  • Received : 2021.04.23
  • Accepted : 2021.04.30
  • Published : 2021.05.22
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Abstract

Purpose Brown fat, or brown adipose tissue (BAT), is involved in non-shivering thermogenesis and creates heat through glucose metabolism. BAT activation occurs stochastically by internal factors such as age, sex, and body mass index (BMI) and external factors such as temperature and environment. In this study, as a retrospective, electronic medical record (EMR) observation study, statistical analysis is conducted to confirm BAT activation and various factors. Materials and Methods From January 2018 to December 2019, EMR of patients who underwent PET/CT scan at the National Cancer Center for two years were collected, a total of 9155 patients were extracted, and 13442 case data including duplicate scan were targeted. After performing a univariable logistic regression analysis to determine whether BAT activation is affected by the environment (outdoor temperature) and the patient's condition (BMI, cancer type, sex, and age), A multivariable regression model that affects BAT activation was finally analyzed by selecting univariable factors with P<0.1. Results BAT activation occurred in 93 cases (0.7%). According to the results of univariable logistic regression analysis, the likelihood of BAT activation was increased in patients under 50 years old (P<0.001), in females (P<0.001), in lower outdoor temperature below 14.5℃ (P<0.001), in lower BMI (P<0.001) and in patients who had a injection before 12:30 PM (P<0.001). It decreased in higher BMI (P<0.001) and in patients diagnosed with lung cancer (P<0.05) In multivariable results, BAT activation was significantly increased in patients under 50 years (P<0.001), in females (P<0.001) and in lower outdoor temperature below 14.5℃ (P<0.001). It was significantly decreased in higher BMI (P<0.05). Conclusion A retrospective study of factors affecting BAT activation in patients who underwent PET/CT scan for 2 years at the National Cancer Center was conducted. The results confirmed that BAT was significantly activated in normal-weight women under 50 years old who underwent PET/CT scan in weather with an outdoor temperature of less than 14.5℃. Based on this result, the patient applied to the factor can be identified in advance, and it is thought that it will help to reduce BAT activation through several studies in the future.

갈색지방세포(Brown fat 또는 Brown Adipose Tissue, BAT)는 포도당 대사(glucose metabolism)와 비오한성 열생성(non-shivering thermogenesis)을 통하여 열을 발산하여 추위로부터 생명체를 보호한다. BAT의 활성화는 연령, 성별, 체질량지수(BMI) 등의 환자 내적 요인과 기온, 환경 등의 환자외적 요인에 의해 확률적으로 발생한다. 본 연구에서는 후향적, 의무기록 관찰 연구를 진행하여 여러 인자들을 추출하고 통계 분석을 실시하여 BAT 활성화와 여러 인자 간에 관련성을 확인하고자 한다. 2018년 1월부터 2019년 12월까지 2년간 국립암센터에서 PET/CT 검사를 시행한 환자의 의무기록을 수집하여 총 9155명의 환자를 추출하고 중복 검사를 포함한 13442건의 환자데이터를 대상으로 하였다. 환자데이터의 의무기록에서는 BAT 발생여부, 성별, 검사당시 나이, 영상촬영날짜, 검사장소, 주사시간, 키, 체중, 혈당, 진단명이 나오도록 조건을 설정하였다. BAT 활성화가 PET/CT 촬영 시 환경(기온, 검사장소)과 환자의 상태(혈당, BMI, 암의 종류, 성별, 나이)에 따라 영향을 받는지 확인하기 위하여 단변량 로지스틱 회귀분석을 실행한 후, P<0.1인 변수를 선택하여 BAT 활성화에 영향을 주는 다변량 회귀분석 모형을 최종적으로 분석하였다. BAT 활성화는 전체 13442건 중 93건(0.7%)이 발생되었다. 단변수 로지스틱 회귀분석 결과에서 유의한 결과는, 50세 이상인 환자보다 50세 미만인 환자에게서(P<0.001), 여성이 남성에 비해서(P<0.001), 외부기온 14.5도 미만에서(P<0.001), 정상 BMI보다 낮은 BMI에서(P<0.001), 혈당이 100mg/dl 미만에서(P<0.001), 오후 12시 30분 이전에 주사를 맞은 환자에게서(P<0.001) BAT 활성화가 증가하였다. 반면, 정상보다 높은 BMI에서(P<0.001), 폐암진단을 받은 환자에게서(P<0.05) 감소하였다. 다변수 결과에서는, 50세 미만인 환자에게서(P<0.001), 여성에게서(P<0.001), 외부기온 14.5도 미만에서(P<0.001) BAT 활성화가 유의하게 증가하였고, 정상보다 높은 BMI에서(P<0.05) 유의하게 감소하였다. 국립암센터에서 2년간 PET/CT 시행한 환자를 대상으로 BAT 활성화에 영향을 미치는 인자에 대한 후행 연구를 진행하였다. 그 결과, 외부기온 14.5도 미만의 날씨에 PET/CT 검사를 시행했던 50대 미만의 정상 체중 여성에게서 BAT가 유의하게 활성화가 되었음을 확인할 수 있었다. 이 결과를 토대로 해당 인자에 적용된 환자를 사전에 식별할 수 있으며, 앞으로 여러 연구를 통하여 BAT의 활성화를 줄이는 것에 도움이 될 수 있다고 사료된다.

Keywords

References

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