인슐린 분비의 신호전달 체계

성연아 대한당뇨병학회 1995 Diabetes and Metabolism Journal Vol.19 No.1

경구혈당강하제 선택과 병합의 가이드라인

성연아 대한임상노인의학회 2009 대한임상노인의학회지 Vol.10 No.3

Comparison of the Body Adiposity Index to Body Mass Index in Korean Women

성연아,이혜진,오지영 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.4

Purpose: Obesity is a major public health issue and is associated with many metabolicabnormalities. Consequently, the assessment of obesity is very important. A new measurement, the body adiposity index (BAI), has recently been proposed to provide valid estimates of body fat percentages. The objective of this study was to compare the BAI and body mass index (BMI) as measurements of body adiposity and metabolic risk. Materials and Methods: This was a cross-sectional analysis performed on Korean women. The weight, height, and hip circumferences of 2950 women (mean age 25±5 years old, 18--39 years) were measured, and their BMI and BAI [hip circumference (cm)/height (m)1.5-18] values were calculated. Bioelectricimpedance analysis was used to evaluate body fat content. Glucose tolerancestatus was assessed with a 75-g oral glucose tolerance test, and insulin sensitivitywas estimated with the insulin sensitivity index. Results: BMI was more significantly correlated with fat mass and fat percentage. Additionally, BMI was also more significantly associated with metabolic parameters, including fasting glucose, post-load 2-h glucose, fasting insulin, post-load 2-h insulin, triglycerides, and high density lipoprotein cholesterol than BAI. Receiver operating characteristiccurve analysis revealed that BMI was a better tool for predicting body fat percentagethan BAI. Insulin sensitivity and metabolic syndrome were more significantlyassociated with BMI than with BAI. Conclusion: In Korean women, the current BMI-based classifications for obesity might be superior to BAI-based measurementsfor determining obesity and predicting metabolic risk.

갑상선 형성부전에 의한 선천성 갑상선기능 저하증 1예

성연아,경난호 梨花女子大學校 醫科大學 醫科學硏究所 1990 EMJ (Ewha medical journal) Vol.13 No.4

Congenital hypothyroidism result in permanent changes of skeletal system and intellectual development. We treated a 37-year old man with congenital hypothyroidism due to thyroid hypoplasia. He was presented with mental retardation, dwarfism, skeletal abnormalities including hip dislocation and megacolion. He has never been diagnosed or treated. Thyroid function test revealed decreased serum T3 and T4. increased TSH and decreased I-131 uptake. Technetium-99m-pertechnate thyroid scan diclosed no functioning thyroid tissue, but normal serum thyroglobulin suggesting thyroid hypoplasia rather than athyrosis. X-ray filims of skull, hands, pelvis and knee revealed still present epiphysis, unerupted teeth, dislocated hip. A CT scan of abdomen revealed enlarged colon and tectum. Neonatal screening program of congenital hypothyroidism will be needed in Korea.

부신우연종

성연아 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.3

당뇨병환자에서 동물인슐린의 사람인슐린으로 전환치료에 관한 연구

성연아,경난호 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.3

배 경 : 동물 인슐린을 사용하던 환자들에게 더 순수하고부작용이 적은 사람 인슐린으로 전환후 인슐린 요구량, 혈당조절 정도, 부작용의 빈도를 관찰 비교하여그 임상적 효능과 안정성을 평가해 보고자 한다. 방 법 : 1990년 1월 4일에서 1992년 12월 31일까지의 3년간전국 55개 대학 병원과 종합병원에서 동물 인슐린으로치료 받던 528예의 당뇨병환자에서 사람 인슐린으로전환한 후 인슐린 요구량, 혈당치, HbAIC의 변화,부작용 발현 빈도 및 만족도를 비교하였다. 결 과 : 1) 혈당농도와 Hb AIC및 인슐린 요구량은 동물인슐린을 사람 인슐린으로 전환한후 전환전에 비해의미 있게 감소되었다(p<0.05). 2) 부작용은 사람인슐린으로 전환후에는 저혈당이13명 (2.5%)으로 전환전보다 많았으나(P<0.05), (오한, 주사부위 부작용은 전환전에 비해 감소되었다). 3) 환자가 느끼는 만족도는 사람인슐린으로 전환후전환전에 비해 인슐린 의존형및 비의존형 당뇨병환자모두에서 의미있게 증가되었다(p<0.05) 결 론:동물인슐린치료에서 사람인슐린으로 전환한후 인슐린 요구량, 혈당 조절정도, 부작용의 빈도및 치료만족도가 모두 개선되어 사람인슐린의 치료는 안전하고 경제적인 방법으로 생각되었다. Background : The purpose of this study is to investigate the clinical efficacy and stabilityof human insulin therapy compared with conventional animal insulin therapy in respect ofadverse reactions, glycemic control, insulin requirement and subjective satisfaction. Methods : To investigate the clinical efficacy and stability of human insulin therapy, weconducted this study in 55 university hospitals and goneral hospitals in Korea nationwide,for a period of 32 months from January 4, 1990 through December 31, 1992. The study wasset out to replace conventional animal insulin with human insulin(Humulin^R) and observedadverse reactions, changes in blood glucose levels, HbA1C, insulin requirement and subjectivesatisfaction after replacement Results : Results are given as fo11ows. 1) Blood glucose level, HbAlc, and insulin requirement were significantly decreased afterreplacement animal insulin with human insulin(p<0.05). 2) As for adverse reactions, hypoglycemia was observed more frequently and the incidenceof chills and local allergic reaction at the site of insulin injection were decreased after replacement animal insulin with human insulin. 3) As for subjective satisfaction of the patients, number of patients with subjective satisfactionwere significantly increased after replacement animal insulin with human insulin(p<0.O5). Conclusion : These results suggest that human insulin is preferable to animal insulins interms of glycemic control, insulin requirement and subjecive clinical response.

경구용 혈당강하 약제와 인슐린 사용의 실제

성연아 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

당뇨병 백서의 부신 Glomerulosa세포에서 Angiotensin Ⅱ자극후 인지질분해효소 활성의 변화

성연아 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.1

연구배경: 당뇨병에서 흔히 고칼륨혈증과 대사성 산혈증을 초래 하는 저aldosterone혈증의 원인은 확실히 밝혀져 있지 않으나 혈중의 renin농도와 ACTH, K^+ 자극에 대한aldosterone의 분비는 다양하였으나 angiotensin Ⅱ(A Ⅱ)자극에 대한 aldosterone의 분비는 공통적으로 감소 되어 있다고 보고되었다. 그러나 이러한 AⅡ 자극 aldosterone분비 감소의 기전은 확실히 밝혀져 있지 않다. 본 연구는 당뇨병을 유발시킨 백서에서 생체와 시험 관내 aldosterone분비의 변화양상을 관찰하고 AⅡ 자 극 aldosterone 분비의 감소가 세포막 신호전달계의 이 상에 의해 나타나는지 밝히기 위해 AⅡ 작용의 세포막 신호 전달계중 세포내칼슘증가와 PKC활성화에 중요한 PLC 및 PLD의 활성의 변화를 관찰하여 당뇨병에서 AⅡ 자극 aldosterone분비변화의 기전을 AⅡ의 신호 전달계중 인지질분해효소 활성화를 중심으로 밝히고 이러한 변호가 인슐린 치료에 의해 교정되는지 규명하고자 하였다. 방 법: Sprague-Dawley 백서를 정상대조군, streptozotocin으로 당뇨병을 유발시킨 군, 당뇨병 유발후 인슐린으로 혈당조절을 한 세군으로 분류하고 실험시작 2주후 회 생시켜 혈중 renin과 aldosterone을 측정하였다. 부신 glomerulosa세포를 분리한 후 시험관내에서 ACTH와 K^+ 자극 aldosterone 분비 반응의 변화 및 AⅡ 자극 aldosterone 분비 반응을 측정하였다. AⅡ 자극후 PLC 및 PLD의 활성을 반영하는 IP_3, PA,PEt, DAG를 측정하였다. 결 과: 1)당뇨병백서의 혈장 renin활성도와 aldsoterone 농도는 정상 대조군 및 인슐린으로 혈당을 조절한 군과 유 의한 차이가 없었다(p<0.05). 2)당뇨병백서의 부신 glomerulosa세포의 기저상태, K^+, ACTH자극 aldosterone 분비는 정상대조군과 차이가 없었으나(p>0.05), AⅡ자극 aldosterone의 분비가 정상대조군과 유의한 차이가 없었다.(p>0.05). 3) AⅡ자극에의한 IP_3와 PA, PET, DAG의 생성은 세균간에 유의한 차이가 없었다.(p>0.05). 결 론: 당뇨병백신에서 부신 glomerulosa세포의 AⅡ자극 aldosterone분비가 감소되며 이러한 AⅡ자극 알도스테론 분비 변화는 인슐린의 치료에 의해 교정되고 PLC와 PLD 활성화후 산물의 생성이 정상군과 차이가 없는 것으로 보아 phospholipase의 활성화이후의 신호 전달체계의 결함에 의할 것으로 생각되었다. Objectives : Diabetic patients develop hypoaldosteronism which frequently caused hyperkalemia and metabolic acidosis and diabetic hypoaldosteronism is associated with selective unresponsiveness of aldosterone to angiotensin Ⅱ(AⅡ), but mechanism of defect in AⅡ stimulated aldosterone response still remain unclear. To elucidate the mechanism of defect in AⅡ stimulated aldosterone response and whether the defect was corrected by insulin treatment. author evaluated the responses of aldosterone production to AⅡ, K^+ and ACTH. I also evaluated the products of phospholipase C(PLC) and phospholipase D(PLD) activation important for increase of intracellular calcium and protein kinase C activation after AⅡ activation in adrenal glomerulosa cells prepared from streptozotocin induced diabetic rats. Methods : Two weeks after induction of diabetes by streptozotocin, rats were sacrificed by decapitation. The aldosterone production to AⅡ, K^+ and ACTH was measured by RIA. Inositol triphosphate(IP_3) and diacylglycerol(DAG) generated by activation of PLC and phosphatidic acid(PA), phosphatidylethanol(PEt) and DAG generated by activation of PLD were measured by anion exchange column and thin layer chromatography. Results : 1) Plasma renin activity and aldosterone level were not different among control rats, untreated and insulin treated diabetic rats. 2) basal, ACTH and K^+-stimulated aldosterone production were similar in cells from the three groups(p>0.05), but AⅡ stimulated aldosterone production was significantly decreased in cells from untreated diabetic rats compared with control and insulin treated diabetic rats(p<0.05). 3) AⅡ-induced IP_3, PA, PEt and DAG generation was similar among the three groups(p>0.05). Conclusion : These results suggested that decreased AⅡ-stimulated aldosterone response was present in glomerulosa cells from strepzptocin induced diabetic rats and reversed by insulin treatments. The main defect of altered AⅡ response of zona glomerulosa might be located in the step distal to the activation of phospholipase.

경구용 혈당강하 약제와 인슐린 사용의 실제

성연아 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.2

임상강좌 : 젊은 여성의 비만

성연아 대한내과학회 2010 대한내과학회 추계학술발표논문집 Vol.2010 No.-