쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

모과내 기능성 유용성분 용매추출공정의 최적화

전주영 ( Ju Yeong Jeon ),조인희 ( In Hee Jo ),경현규 ( Hyun Kyu Kyung ),김현아 ( Hyun A Kim ),이창민 ( Chang Min Lee ),최용희 ( Yong Hee Choi ) 한국산업식품공학회 2010 산업 식품공학 Vol.14 No.2

본 연구에서는 모과내의 여러 가지 기능성 유용성분을 효과적으로 추출하기 위해서, 모과나무의 익은 열매로 만든 약재인 모과를 사용 하였다. 모과의 기능성 유용성분용매 추출 공정의 최적 조건을 확립하고자 하였다. 모과를 에탄올에 추출하여 반응표면 분석법으로 모니터링하여 최적 용매 조건을 설정하였다. 중심합성계획법에 따라 시료에 대한 용매비(X1)와 추출온도(X2), 추출시간(X3)을 요인변수로 하고 추출수율(Y1), 총페놀 함량(Y2), 전자공여능(Y3), 갈색도(Y4), 환원당(Y5)을 종속변수로 하여 시행하였다. 실험 결과 추출수율은 추출 온도와 추출 시간에 유의하게 영향을 받음을 알 수 있었다. 안장점에서 추출조건은 시료에 대한 용매비는 26.38mL/g, 추출온도는 72.82oC, 추출시간은 74.86 min에서 최대값을 나타내었다. 총페놀 함량은 용매비와 시간에 영향을 거의 받지 않았고 추출시간에는 영향을 받았으며, 최대값은 20.70mg/mL 로 나타났다. 이때의 추출조건은 시료에 대한 용매비는 22.61mL/g, 추출온도는 84.49oC, 추출시간은 77.25 min으로 나타났다. 전자공여능은 추출온도에 따라 유의하게 영향을 받은 것으로 나타났다. 안장점에서의 추출조건인 시료에 대한 용매비 10.65mL/g, 추출온도 67.78oC, 추출시간 96.75 min에서 추출수율은 94.12%로 예측되었다. 갈색도에 대한 추출조건은 시료에 대한 용매비 23.77mL/g, 추출온도 87.27oC, 추출시간 96.68 min 일 때 안장점이 나타났다. 환원당은 시료에 대한 용매비 26.83mL/g, 추출온도 82.167oC, 추출시간 81.94 min에서 10.55mg/mL로 최대값을 나타내었고 추출시간에 영향을 받았다. In this study, various active functional components in Chinese Quince were extracted by solvent extraction method. A central composit design for optimization was applied to investigate the effects of independent variables such as solvent to sample ratio (X1), extraction temperature (X2), and extraction time (X3) on the soluble solid contents (Y1), total phenols (Y2), electron donating ability (Y3), browning color (Y4) and reducing sugar contents (Y5). It was found that extraction temperature and extraction time were the main effective factors in this extraction process. The maximum soluble solid contents of 35.77% was obtained at 26.38mL/g (X1), 72.82oC (X2) and 74.86 min (X3) in saddle point. Total phenols were rarely affected by solvent ratio and extraction time, but it was affected by extraction temperature. The maximum total phenols of 20.70% was obtained at 22.61mL/g (X1), 84.49oC (X2), 77.25 min (X3) in saddle point. The electron donating ability was affected by extraction time. The maximum electron donating ability of 94.12% was obtained at 10.65mL/g (X1), 67.78oC (X2), 96.75 min (X3) in saddle point. The maximum browning color of 0.32% was obtained at 23.77mL/g (X1), 87.27oC (X2), 96.68 min (X3) in saddle point. The maximum value of reducing sugar content of 10.55% was obtained at 26.83mL/g (X1), 82.167oC (X2), 81.94 min (X3). Reducing sugar content was affected by extraction time.

A Comparative Experimental Study of the, In-vitro Efficiency of Hypertonic, Saline-Enhanced Hepatic Bipolar and, Monopolar Radiofrequency Ablation

Lee, Jeong Min,Han, Joon Koo,Kim, Se Hyung,Sohn, Kyu Li,Lee, Kyoung Ho,Ah, Su Kyung,Choi, Byung Ihn Korean Radiological Society 2003 Korean Journal of Radiology Vol.4 No.3

Optimization of Electric Field-assisted Ultrasonication for Disintegration of Waste Activated Sludge

( Kyung-won Jung ),( Tae-un Jeong ),( Min-jung Cha ),( Kyu-hong Ahn ) 한국폐기물자원순환학회(구 한국폐기물학회) 2014 한국폐기물자원순환학회 심포지움 Vol.2014 No.1

In the present study, an electric field is applied in order to disintegrate waste activated sludge (WAS). As a preliminary step, feasibility tests are investigated using different applied voltages of 10 to 100 V for 60 min. As the applied voltage increases, the disintegration degrees (DD) are gradually enhanced, thereby the soluble N, P, and carbohydrate concentrations increase simultaneously due to the protein decomposition. Subsequently, an optimization process is conducted using response surface methodology with a Box-Behnken design (BBD). The total solid concentration, applied voltage, and reaction time are selected as independent variables, while the DD is selected as the response variable. The overall results demonstrate that the BBD with an experimental design can be useed effectively in the optimization of the electric field treatment of WAS. In the confirmation test, a DD of 10.26±0.14% is recorded, which corresponds to 99.1% of the predicted response value under the statistically optimized conditions. Finally, the statistic optimization of the combined treatment (electric field + ultrasonication) showed that even though this is limited to highly disintegrated WAS when being applied individually, a high DD of 47.28±0.20% was recorded where the TS concentration was 6,780 mg/l, the strength of ultrasonication was 8.0 W, the applied voltage was 68.4 V, and the reaction time was 44 min. E-SEM images clearly revealed that the application of the electric field is a significant alternative method for the combined treatment of WAS, and this is first attempt to increase disintegration using electric field for combined treatment with ultrasonication.

본태성 고혈압 환자의 적혈구 Na+-Li+ Countertransport 와 적혈구막 지방산 구성에 대한 연구

이영우,고경수,고재준,박경수,김원배,한은경,김성연,조보연,이홍규,고창순,민현기 한국지질학회 1991 韓國脂質學會誌 Vol.1 No.1

Since the changes of Na^+-Li^+ countertransport (SLC) Vmax in essential hypertension have been reported. it has been known that hyperlipidemia could affect SLC independently of blood pressure. To reveal the relation between SLC Vmax and RBC membrane fatty acid conposition in the hypertensive patients, we divided patients into two groups according to their levels of SLC Vmax of erythrocytes(elevated SLC Vmax: n=4, normal SLC Vamx: n=6). The results were as follows: 1) There was no difference in body mate index, waist-hip ratio, blood pressure, serum cholesterol level between two groups. Triglyceride were higher in elevated group (278.0±180.0 ㎎/㎗) than normal group (124.3±60.7 ㎎/㎗) but there was no statistical significance. HDL-cholesterol levels were significantly lower in elevated group (32.0±3.6 vs. 44.8±8.9 ㎎/㎗) and free fatty acid concentrations, intracellular (RBC) Na^+ concentrations were similar between two groups. 2) The results of oral glucose tolerance test showed no differences in the glucose and insulin area, however the incremental insulin areas of elevated group (108.8±31.3, μU. min/㎖×10²) were significantly higher compared with those of normal group (56.3±20.7 μU. min/㎖×10²). 3) In the elevated group, palmitic acid proportions of erythrocytes (22.1±0.7%) were higher than those of normal group (20.1±0.7%) and SLC Vmax showed significant correlation (r=0.81, p$lt;0.01) with palmitic acid proportion. These results suggest that the abnormal lipid metabolism may change the RBC Na^+ transport system through the alterations of RBC membrane fatty acid composition.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

단주기 구조물의 비탄성 응답제어를 위한 최대응답 계수를 사용한 개선된 마찰감쇠기 설계방법

민경원,이명규,이상현,김형섭 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

The purpose of this paper is to present a design method for friction damper (FD) for inelastic response control of short period structure. A critical design parameter of FD is maximum friction force (MFF) and previous study evaluated MFF using equivalent damping ratio which is based on the maximum displacement. This procedure, however, gives the overestimated MMF for short period structure. In this study, MFF of FD is evaluated based on RMS displacement response which is obtained by using given maximum response and peak factor. Numerical analysis shows that proposed method provide a reasonable MFF of FD for short period structure.

환자이탈군 특성요인과 이탈환자 예측모형에 관한 연구

민경진,송규문,김광환 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

Background : We developed a model for predicting premature discharge and identifying related factors. Methods : Prediction model was developed by data mining techniques. Basic data were collected from the total discharge data base of a university hospitals in Chungnam province during the period from July 1, 1999 to June 30, 2000. Results : 1. Among 22,873 patients, the number of patients discharge with usual discharge orders were 21,695 or 94.8%. The number of the prematurely discharged patients were 1,178 or 5.2%. 2. The primary reason for unusal discharge was transfer to other hospital. Move to a local hospital closer to their home and burdensome medical expenses were main reasons. 3. Predictability of each model was tested using the top 10 percent of patients with the highest probabilities of premature discharge. The neural network model was chosen as the most appropriate model for predicting prematurely discharged patients. 4. Ten percent of the total number of patients had been selected randomly to test the effectiveness of the neural network model. We have chosen the threshold of the neural network model as 0.7. The number of patients who were expected to discharge prematurely was 312. Among them, 241 had been discharged prematurely(77.2%). Conclusion : of the several data mining techniques used, the neural network model was the most effective, It can be used to identify and manage the patients who are expected to discharge prematurely.

급성 충수염으로 진단된 예측 불가 염증성 맹장 종물에 대한 외과적 고찰

민경진,백무준,채만규,김성용,이문수,김창호,김재준,송옥평 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: An unexpected inflammatory cecal mass of uncertain etiology was encountered during surgery for presumed appendicitis. In this case, the surgeon couldn't exclude differential diagnosis which were severe appendicitis involving the cecal region, diverticular disease, other inflammatory bowel diseases, and neoplasm. Therefore, this finding leads to a therapeutic dilemma for the surgeon, when making surgical decisions during the operation. The aim of this study was to resolve this dilemma, a retrospective review was undertaken in this study. Methods: A retrospective study was performed to review the management of this problem at Soonchunhyang University Chunan Hospital for eight and half years from July 1991 to December 1999. A review of the emergency operation records identified 50 patients who had undergone ileocecal resection or right hemicolectomy for an inflammatory ileocecal mass of uncertain etiology when operated on for probable appendicitis. Results: Altogether, 39 patients underwent ileocecal resection, and 11 patients underwent right hemicolectomy. The final pathologic diagnosis was appendiceal abscess in 32 patients (63%), cecal diverticulitis in 7 patients (14%), neoplasm in 6 patients (12%), appendiceal phlegmon in 3 patients (6%), ileal tuberculosis in 1 patient (2%) and Anisakiasis in another patient (2%). The neoplasm of the 6 neoplasm patients was ascending colon cancer for 4 patients and cecal cancer for 2 patients. There was no mortality in this group. Conclusion: Although most inflammatory cecal masses are caused by benign disease, all cases in which the intraoperative diagnosis is unclear, any pathologic diagnosis including neoplasm cannot be ruled out. So this suggest ileocecal resection or right hemicolectomy to remove a possible underlying malignancy, and to decrease morbidity and mortality.

위험물 운송 사고 저감을 위한 HAZ-RAM 개발

김경호,박민규 김천과학대학 2011 김천과학대학 논문집 Vol.37 No.-

The accident of HAZMAT causes not only physical damage but also secondary accidents which makes negative effects in regional environment and society. Thus, based on a particular management system in HAZMAT transportation, it is necessary to prevent accidents and to minimize secondary damages. According to the accident data, the causes of accidents are human factor(62.8%), physical factor(9.9%), other factors(23.1%) and unknown factors(4.2%). Especially the most accidents related with human factor are caused by neglect of management and surveillance. In this study to minimize the risk caused by human factor, HT-RAM(Hazmat Transportation Risk Assessment Matrix) was developed using current RAM(Risk Assessment Matrix). For developing HT-RAM effectively, the following 3 factors are also considered. First, the type of HAZMAT accident is defined and classified. Secondly, the severity and the frequency are analyzed by accident type. Finally, the plan for management in transportation was suggested to reduce the risk and accident. In the future, HAZ-RAM developed in this research is applied to the HAZMAT transportation management system, it will reduce not only traffic accident but also the secondary damage caused by the accident.