정신의학적 증상을 수반한 Klinefelter 증후군 1예

박정주,허갑범,이홍식 大韓神經精神醫學會 1984 신경정신의학 Vol.23 No.4

The recent studies on Klinefelter's syndrome, which was first described by Klinefelter, et al. in 1942, revealed that intellectual impairment and neuropsychiatric disorders were combined in many cases of Klinefelter's syndrome. The authors present a 15 year old male patient with confirmed diagnosis of Klinefelter's syndrome, who showed various secondary psychiatric manifestations such as severe depression, anxiety, self and sexual identity confusion, various psychosomatic symptoms and adjustment problems with poor interpersonal relationship. The variety of psychiatric manifestations accompanying Klinefester's syndrome are reviewed from the literature. Comprehensive psychiatric evaluation and treatment via consultation-liaison psychiatry is strongly recommended for klinefelter's syndrome with psychiatric manifestations.

동맥경화증 위험요소와 혈청 비타민 농도

이종호,허갑범,장양수 한국지질학회 1999 韓國脂質學會誌 Vol.9 No.1

고콜레스테롤혈증을 동반한 제2형 당뇨병 환자에서 Simvastatin 의 투여 효과

김희진,박경수,허갑범,김성연,이홍규,송민경,송영득,이현철 한국지질학회 1998 韓國脂質學會誌 Vol.8 No.2

Background: Type 2 diabetic patients commonly have dyslipidemia that contributes to the acceleration of atherosclerosis, and diabetics have been a two- to threefold greater risk of cardiovascular disease death than nondiabetics with the same cholesterol levels. Therefore, aggressive therapy of diabetic dyslipidemia is important to reduce the risk of coronary heart disease in the patients with diabetes and HMG CoA reductase inhibitor is a first-line agent for diabetes with high LDL cholesterol. We performed this study to evaluate the efficacy and safety of simvastatin, HMG CoA reductase inhibitor, on hypercholesterolemia in type 2 diabetic patients. Methods: Type 2 diabetic patients with hypercholesterolemia were included, who had a serum triglyceride below 7.75 mmol/L(300 ㎎/dL) and HbA1c below 10%. During the first 4 weeks lipid-lowering diet(NCEP step 1 diet) was administered, and then for the following 12 weeks simvastatin 10-40 ㎎ was administered daily to the patients who had a serum total cholesterol above 5.17 mmol/L(200 ㎎/dL). After 12 week treatment with simvastatin, 4 week wash-out period was followed. Changes in semen lipid levels; glucose levels, HbA1c were checked at 4 week interval for 20 weeks as well as clinical and laboratory adverse reactions effects and the obtained results were compared with baseline level individually. Results: The average simvastatin dosage at completion of the study was 14±7(10-40) ㎎. By the end of 12 weeks, simvastatin produced a 29% reduction in total cholesterol(6.61±0.65 mmol/L vs. 4.65±0.52 mmol/L, p$lt;0.05), a 41% reduction in LDL cholesterol(4.52±0.72 mmol/L vs. 2.61±0.57 mmol/L, p$lt;0.05), a 14% reduction in triglyceride (4.03±1.60 mmol/L vs. 3.23±0.98 mmol/L, p$lt;0.05), a 38% reduction in apolipoprotcin B (4.01±0.62 mmol/L vs. 2.48±0.49 mmol/L, p$lt;0.05), and a 9.2% increment in HDL cholesterol(1.29±0.31 mmol/L vs. 1.40±0.33 mmol/L, p$lt;0.05). On the other hand, 4 weeks after the cessation of simvastatin, serum total cholesterol, LDL cholesterol and triglyceria were significantly increased(p$lt;0.05), and HDL cholesterol was significantly lowered(p$lt;0.05). There were no effects upon apolipoprotein AI, AST, ALT, CPK, total bilirubin, creatinine and glycemic control(HbA1c, fasting and postprandial 2 h glucose levels). Two patients were dropped out due to clinical adverse reactions related to sirnvastatin treatment such as itching and indigestion. During the treatment period, the clinical adverse reactions of simvastatin were mild and transient, including 5 cases of indigestion, 2 cases of dizziness, and 1 case of myalgia. Conclusion: Simvastatin is shown to be an effective treatment for dyslipidemia in type 2 diabetes and has no adverse effect on glycemic control.

건강한 폐경전 여성에서 고지방 섭취후 혈청 중성지방과 인슐린치의 변화

김종희,이양자,차봉수,허갑범,윤지영,공운영,신민정,이종호 한국지질학회 1996 韓國脂質學會誌 Vol.6 No.2

A remarkable inter-individual variability in postprandial serum triglyceride(TG) level is present even in subjects with same sex, similar age, body mass index and normal range of fasting cholesterol and triglyceride. As serum TG and insulin levels are correlated and both seem to be associated with the insulin resistance syndrome, postprandial serum TG level may be related to postprandial insulin level. The purpose of this study was to determine the relationship of fasting and postprandial serum TG to fasting and postprandial insulin levels. After overnight fast, 77 healthy, premenopausal and non-obese women ingested a high fat sandwich, which contained 585㎉ consisting of 17% protein, 39% fat and 44% carbohydrate. Blood samples were taken prior to the test meal and at 1, 2, 3, 4, 5, 6hr after the meal for the analysis of TG, insulin, free fatty acid(FFA), C-peptide, glucose, HDL, LDL and total cholesterol. At the next day, blood was obtained for measurement of glucose, insulin, C-peptide and FFA before, and 30, 60, 120min after, the 75g oral glucose load. Postprandial hypertriglyceridemia or high responder was defined as postprandial TG maxima above the 80th percentile(200㎎/dL) of TG maxima distribution after a high fat meal in study subjects. Fasting serum TG and TG max were highly correlated(r=0.872, p$lt;0.00001). However, 9 of 16(56%) high responders had normal fasting serum TG($lt;150㎎/dL). Therefore, we devided high responders further into 2 groups with normal and high fasting serum TG($gt; 150㎎/dL). Although normal responders and high responders showed similar age and percent of ideal body weight, high responders with normal fasting serum TG showed the highest waist to hip ratio and a remarkable increase at 2, 3, 4, 5hr in the postprandial serum TG change. Postprandial serum FFA change at 1, 3, 6hr and postprandial insulin levels at 1, 2, 6hr were higher in high responders with normal fasting TG, compared with normal responders and high responders with high fasting TG, respectively. High responders with normal fasting serum TG showed the highest insulin response area during oral glucose tolerance test. TG max positively correlated with postprandial insulin area(r=0.32, p $lt;0.01) and insulin response area(r=0.40, p $lt;0.005). In healthy and non-obese women, the prediction of high response was only 44% based on fasting serum TG levels. Fifty six percents of high responders showed normal fasting serum TG levels, high magnitude and prolonged duration of postprandial TG levels, central type of body fat distribution and high postprandial insulin levels. Our results indicate that high postprandial serum TG responses in subjects with normal fasting TG levels, may link to the insulin resistance.

남성에서 비만도와 연령에 따른 체지방 및 근육 분포와 동맥경화증 위험요소의 변화

이종호,이현철,허갑범,이승민,정남식,장양수,김오연,권석주 한국지질학회 1999 韓國脂質學會誌 Vol.9 No.4

Background: Throughout the adult life there are continuous changes in body fat and muscle distribution, serum levels of hormones and lipids and antioxidant defenses according to an increase in age and changes in lifestyle pattern. The purpose of this study was undertaken to characterize these cardiovascular risk factors at the age of 40 s, compared to the age of 30s and 40s in healthy Korean men. Methods: Two categories of subjects were identified: one of normal weight males (n=81) and one of overweight males (n=72). The number of subjects within the age of 30∼39 y, 40∼49 y, 50∼59 y were 26, 34, and 21 in normal weight groups and 18, 23, 31 in overweight groups. Adipose tissue and muscle areas were calculated from computed tomography scans made at four body levels, L1, L4 and mid portion of thigh and calf. Fasting levels of lipids, hormones and antioxidants were determined. Results: The mean value of free androgen index in overweight group declined by 24% at the age of 40 s and 44% at the age of 50 s compared to the age of 30 s, while this value in normal weight group remained relatively stable before the age of 50 and declined by 24% at the age of 50 s. The areas of visceral fat at L1 and L4 levels at the age of 40 s increased by 11% and 25% of those at the age of 30 s in overweight males, respectively. In normal weight males, visceral fat areas at L1 and L4 levels increased with age, however, these areas at all age groups were lower than 100㎠. Thigh muscle areas in normal weight males showed a small but significant decrease at the age 40∼59, compared to the age of 30 s. In overweight males, the mean areas overweight males, the mean areas of thigh and calf muscle areas declined by 15% and 10% between the age of 30 s and 50 s, respectively. Overweight males at the age of 40 s showed the highest mean values of serum triglyceride (217 ㎎/dL), LDL(136 ㎎/dL), and total cholesterol (220 ㎎/dL) and these values decreased gradually at the age of 50 s. Overweight males at the age of 40 s had the lowest mean activities of serum glutathione peroxidase and red blood cell superoxide dismutase. Overweight male at the age of 40 s showed the highest alcohol consumption and an increase in intakes of calories, protein and carbohydrate, when compared to normal weight males at same age. Conclusion: This study showed that overweight Korean men at the age of 40 s might have increased risk factors for atherosclerosis such as hyperlipidemia, decreased activities of antioxidant enzymes, visceral fat accumulation and muscle loss. These factors seem to result from an increase in calorie intake and alcohol consumption, and a decrease in free androgen and physical activity.

폐경전 중년여성에서 Sex Hormone-Binding Globulin 과 내장지방 축적 , 혈청 인슐린 및 지질 농도와의 관계

조은영,박영심,허갑범,이종호,윤지영,공운영,김정환,송영득,이현철 한국지질학회 1995 韓國脂質學會誌 Vol.5 No.1

To assess the relationship of SHBG levels to abdominal fat and glucose and lipid metabolism, we measured serum concentrations of sex hormones, insulin and SHBG in 67 premenopausal women and studied the relationship between these variables and parameters of body fat distribution and glucose and lipid metabolism. Multiple regression analyses revealed that the primary determinant of visceral fat area and the triglyceride and HDL cholesterol levels was the SHBG level. Since overweight-obese subjects showed a wide range of SHBG level, we divided subjects into 3 groups according to their SHBG levels, to define overweight-obese women with low SHBG(LSO) in comparison with those presenting normal SHBG levesl(NSO). An age-matched group of normal weight healthy women served as controls. Both LSO and NSO had similar PIBW, whereas visceral fat area and the ratio of visceral to subcutaneous fat was significantly higher in LSO than in NSO. The testosterone level and free androgen index were higher in LSO than in NSO, whereas estradiol level tended to be lower in LSO than in NSO. Moreover, compared to NSO, LSO women showed significantly lower level in HDL-cholesterol and higher values in triglyceride, fasting insulin and C-peptide, glucose-stimulated insulin and the ratio of LDL to HDL-cholesterol. These endocrine and metabolic values in NSO women were similar to women in control group. The results of the present study indicate that obese women with reduced SHBG had distinctive clinical, endocrine and metabolic characteristics in comparison to those with normal SHBG, namely, ① hyperinsulinemia, ② visceral-type obesity, ③ hyperandrogenicity, and ④ abnormal serum lipid and lipoprotein levels.

건강한 내장형 비만 여성에서 혈청 호르몬과 인지질 지방산의 변화

이양자,이종호,허갑범,윤지영 한국지질학회 1997 韓國脂質學會誌 Vol.7 No.2

Background: Visceral-type obese women are known to show hyperinsulinemia, hyperandrogenicity, and low serum IGF-1 level. These endocrine perturbations with visceral fat accumulation will change the fatty acid composition of serum phapholipids(PL). Methods: Anthropometric and computed tomographic measurements at umbilicus and thigh midway between the patella and pubis were performed in 169 middle-aged healthy women. An oral glucose tolerance test, the fatty acid composition of serum PL, fasting serum levels of lipids, IGF-1 and testosterone, and free androgen index were determined. Results: Since visceral fat to subcutaneous fat ratio(VSR) correlated most significantly with the fatty acid composition, we devided overweight subjects into 3 groups according to their VSR. When VSR was equal to or more than 0.4, it was defined visceral-type and when VSR was less than 0.3, it was defined subcutaneous-type. Both visceral-type and subcutaneous-type groups showed similar age, body mass index, waist/hip and total abdominal fat area. An age-matched group of normal weight women served as controls. Compared with the subcutaneous-type, visceral-type group showed an increase in fasting levels and response areas of glucose and insulin, free androgen index and serum concentrations of triglyceride, LDL and total cholesterol, and a decrease in serum levels of HDL, SHBG and IGF-1. Stearic(C18:0), dihomo-γ-linolenic(C20:3ω6) acid and C20:3/18:2(Δ6-desatrase+elongation activity) in serum PL was higher in visceral-type group than the subcutaneous-type. Linoleic(C18:2ω6), arachidonic(C20:4ω6), linolenic(C18:3ω3), docosahexaenoic(C22:6ω3) acid, and C20:4/20:3(Δ5-desaturase activity) in serum PL was lower in the visceral-type than the subcutaneous-type. The averages of these parameters in the subcutaneous-type were similar to those in the normal-weight group. Δ5-desaturase activity positively correlated with the levels of SHBG(r=0.431, P$lt;0.001), IGF-1(r=0.484, P$lt;0.001) but negatively with insulin response area(r=-0.309, P$lt;0.001), testosterone level(r=-0.343, P$lt;0.001) and free androgen index (r=-0.500, P$lt;0.001). Serum IGF-1 level was negatively correlated to VSR(r=-0.440, P$lt;0.001), total saturated fatty acids(r=-0.626, P$lt;0.001), C18:0/16:0(r=-0.510, P$lt;0.001), C20:3/18:3 (r=-0.222, P$lt;0.05), but negatively to total polyunsaturated fatty acids(r=0.499, P$lt;0.001) in the serum PL fraction. Conclusion: Our results indicate that in the visceral-type obesity, insulin resistance and hyperinsulinemia might change fatty acid desaturase activity. It is also concluded that hyperandrogenicity and low secretion of growth hormone might indirectly influence fatty acid composition because of close relationship between visceral-type obesity and endocrine abnormalities. This explains why visceral-type obesity rather than the relative body weight for height has a greater role in determining the fatty acid composition in serum PL.

Abstract : A Case of Occupational Asthma to Chemical Vapor

( Chein Soo Hong,Seung Heon Oh,Hyun Chul Lee,Kab Bum Huh,Sang Yong Lee ) 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 1984 한일합동심포지움 Vol.4 No.2

중년 여성에서 폐경여부가 체지방 분포 , 혈청 지질 및 호르몬 농도에 미치는 영향

이종호,이현철,김희선,차봉수,허갑범,백인경 한국지질학회 1997 韓國脂質學會誌 Vol.7 No.2

Background: The purpose of this study was to compare body fat distribution and serum levels of lipids and hormones in pre- and post-menopausal healthy women with similar degree of obesity. Body fat distribution was measured using waist to hip circumference ratio(WHR) and computerized tomography(CT) scan. Methods: Body weight, body mass index, WHR and abdominal fat areas by CT scan at the umbilical level were measured in 134 pre- and 62 post-menopausal women. Fasting serum levels of lipids and hormones were determined and an oral glucose tolerance test(OGTT) was performed. Results: There was no significant difference between the two groups in body weight, body mass index, percentage of total body fat and subcutaneous fat area, even though post-menopausal women showed an increase in age and WHR. Total abdominal fat area, visceral fat area and visceral to subcutaneous fat area ratio were higher in post-menopausal women than pre-menopausal women. Serum levels of LDL, total cholesterol and triglyceride, basal levels of glucose and free fatty acid, and sums of serum glucose and free fatty acid during OGTT were higher in post-menopausal women, while serum concentration of HDL-cholesterol was lower in post-menopausal women. No difference was found between two groups in basal levels and sums of serum C-peptide and insulin during OGTT. Post-menopausal women showed a decrease in serum levels of estradiol, testosterone and insulin like growth factor-1 but an increase in serum levels of luteinizing hormone and follicle stimulating hormone. No significant difference was observed in free androgen index and serum levels of sex hormone-binding globulin and growth hormone. There was a significant correlation between anthropometric parameters and metabolic variables in both pre- and post-menopausal women. When stepwise -multiple regression analysis was used to evaluate the joint effect of anthropometric variables on metabolic variables, visceral fat area proved to be the primary determinant for the serum levels of LDL, total cholesterol and triglyceride and sums of serum glucose and insulin during OGTT. Conclusion: Our results suggest that an increase in visceral fat area after menopause may constitute a greater risk in cardiovascular and metabolic disorders than a simple degree of obesity alone. In addition, both aging and increased release of free fatty acid from visceral adipocytes in post-menopausal women may result in a reduction in the secretion of growth hormone, which could accelerate visceral fat accumulation.

과체중/경도비만의 중년 여성에서 체중감소 전후의 경구당부하 검사와 혈청지질의 변화

송영득,차봉수,남문석,이은직,임승길,김강래,이현철,허갑범,윤지영,이종호 한국지질학회 1995 韓國脂質學會誌 Vol.5 No.1