청소년 고혈압 관련 유전자의 연관성 분석: Kangwha Study

서일,남정모,김성주,신동직,허남욱,강대룡,Suh, Il,Nam, Chung-Mo,Kim, Sung-Joo,Shin, Dong-Jik,Hur, Nam-Wook,Kang, Dae-Ryong 대한예방의학회 2006 예방의학회지 Vol.39 No.2

Objectives : In this study we examined the association between the genetic markers ACE (A-240T, C-93T, I/D, A2350G), AGT (M235T), AT1R (A1166C), CYP11B2 (T344C, V386A), REN (G2646A), ADRB2 (G46A, C79G, T47C, T1641), GNB3 (C825T) and ADD1 (G460W) and the presence of essential hypertension in adolescents. Methods : The Kangwha Study is an 18-year prospective study that is aimed at elucidating the determinants of the blood pressure level from childhood to early adulthood. For this study, we constructed a case-control dataset of size of 277 and 40 family trios data from the Kangwha Study. For this purpose, we perform a single locus-based case-control association study and a single locus-based TDT (transmission/disequilibrium test) study. Results : In the case-control study, the single locus-based association study indicated that the ADD1 (G460W) (p=0.0403), AGT (M235T) (p=0.0002), and REN (G2646A) (p=0.0101) markers were significantly associated with the risk of hypertension. These results were not confirmed on the TDT study. This study showed that genetic polymorphisms of the ADD1, AGT and REN genes might be related to the hypertension in Korean adolescents. Conclusions : This study provided useful information on genetics markers related to blood pressure. Further study will be needed to confirm the effect of the alpha adducin gene, the angiotensinogen gene and the renin gene on essential hypertension.

고혈압의 발견, 평가 및 치료에 대한 미국합동위원회의 제6차 보고서 : 서론 Introduction

서일 대한고혈압학회 1998 대한고혈압학회지 Vol.4 No.1

한국에서 관상동맥질환의 역학적 특성

서일 주식회사 녹십자 2003 녹십자의보 Vol.31 No.4

전국 남자 중.고등학교 학생의 흡연실태

서일,손명세 외4명 한국역학회 1988 Epidemiology and Health Vol.10 No.2

한국에서의 심혈관계 질환의 변천양상

서일,지선하 외1명 한국역학회 1993 Epidemiology and Health Vol.15 No.1

성장기 청소년의 혈압변화와 결정요인

서일,남정모,지선하,김석일,김영옥,김성순,심원흠,김춘배,이강희,하종원,강형곤,오경원,Suh, Il,Nam, Chung-Mo,Jee, Sun-Ha,Kim, Suk-Il,Kim, Young-Ok,Kim, Sung-Soon,Shim, Won-Heum,Kim, Chun-Bae,Lee, Kang-Hee,Ha, Jong-Won,Kang, Hyung-Gon,Oh, Ky 대한예방의학회 1997 예방의학회지 Vol.30 No.2

본 연구는 1992년 당시 경기도 강화군 강화읍내에 거주하는 중학교 1학년에 재학중인 남자 335명과 여자 375명을 대상으로 5년간 혈압수준 및 변화에 대한 분포를 제시하고 혈압수준 및 변화의 결정 요인을 밝히고자 하였다. 혈압의 수준 및 변화와 관련된 요인으로는 신체적 요인, 혈청학적 요인 및 영양소 섭취요인을 조사하였다. 주요 연구결과는 다음과 같다. 1. 12세부터 16세까지 5년간 남자의 수축기혈압의 평균은 108.7mmHg에서 118.1mmHg로, 이완기혈압의 평균은 69.5mmHg에서 73.4mmHg로 증가하였으며 15세에 가장 높은 혈압수준을 보였다. 그러나 동기간 동안 여자의 수축기혈압의 평균은 114.4mmHg에서 113.5mmHg로, 이완기혈압의 평균은 75.2mmHg에서 72.1mmHg로 감소하였으며 13-14세 때에 가장 높은 혈압 수준을 보였다. 2. 남자의 5년간 신장, 체중, 신체비만지수 등은 계속 성장하였으나 여자는 15세를 기점으로 신체적 성장이 둔화되는 경향을 보였다. 한편 연령이 증가할 수록 남자의 혈청 총 콜레스테롤은 감소하고 중성지방은 증가하는 경향을 보였으나 여자에서는 특별한 변화가 없었다. 식이섭취에서는 지질의 섭취가 연령에 따라 약간 증가하는 경향을 보였으나 전반적으로 남녀 모두 에너지의 20% 정도였다. 3. 혈압수준과 체중, 신체비만지수, 피부두께 등은 남녀 모두 각 연령에서 통계학적으로 유의한 관련성이 있었다. 신체비만지수의 영향을 통제하였을 때 혈청 총 콜레스테롤은 남자에서 연령의 증가에 따라 수축기혈압과 음의 관계에서 양의 관계로, 여자의 경우에는 이완기혈압과 15-16세에서 양의 관련성을 보였다. 그리고 중성지방과 크레아티닌은 남자에서는 혈압과 양의 관련성을 보였으나 여자의 경우에는 관련성이 없었다. 한편 영양소 섭취와 혈압과의 관계는 성별-연령별로 일관성 있는 결과가 없었으나 남자의 이완기혈압과 단백질 섭취가 양의 관련성이 있었고 여자의 14세 때 수축기혈압과 비타민 A 섭취가 음의 관련성이 있었다. 4. 혈압변화와 신체비만지수의 변화, 혈청 총 콜레스테롤의 변화는 남녀 모두 양의 관련성을 보였으며 크레아티닌의 변화는 남자에서는 양의 관계를, 여자에서는 음의 관계를 보였다. 또한 남자에서 소디움 섭취가 높은 군이 계속해서 높은 혈압수준을 유지하였으며 여자의 경우에는 에너지에 대한 지질 섭취비율이 높은 군이 계속해서 낮은 혈압수준을 유지하여 성별에 따른 차이를 보였다. 전체적으로 성장기 혈압변화에 가장 큰 영향을 미치는 요인은 남녀 모두 신체비만 지수이었다. Many studies have led to the notion that essential hypertension in adults is the result of a process that starts early in life: investigation of blood pressure(BP) in children and adolescents can therefore contribute to knowledge of the etiology of the condition. A unique longitudinal study on BP in Korea, known as Kangwha Children's Blood Pressure(KCBP) Study was initiated in 1986 to investigate changes in BP in children. This study is a part of the KCBP study. The purposes of this study are to show changes in BP and to determine factors affecting to BP level and change in Korean adolescents during age period 12 to 16 years. A total of 710 students(335 males, 375 females) who were in the first grade at junior high school(12 years old) in 1992 in Kangwha County, Korea have been followed to measure BP and related factors(anthropometric, serologic and dietary factors) annually up to 1996. A total of 562 students(242 males, 320 females) completed all five annual examinations. The main results are as follows: 1. For males, mean systolic and diastolic BP at age 12 and 16 years old were 108.7 mmHg and 118.1 mmHg(systolic), and 69.5 mmHg and 73.4 mmHg(diastolic), respectively. BP level was the highest when students were at 15 years old. For females, mean systolic and diastolic BP at age 12 and 16 years were 114.4 mmHg and 113.5 mmHg(systolic) and 75.2 mmHg and 72.1 mmHg(diastolic), respectively. BP level reached the highest point when they were 13-14 years old. 2. Anthropometric variables(height, weight and body mass index, etc) increased constantly during the study period for males. However, the rate of increase was decreased for females after age 15 years. Serum total cholesterol decreased and triglyceride increased according to age for males, but they did not show any significant trend fer females. Total fat intake increased at age 16 years compared with that at age 14 years. Compositions of carbohydrate, protein and fat among total energy intake were 66.2:12.0:19.4, 64.1:12.1:21.8 at age 14 and 16 years, respectively. 3. Most of anthropometric measures, especially, height, body mass index(BMI) and triceps skinfold thickness showed a significant correlation with BP level in both sexes. When BMI was adjusted, serum total cholesterol showed a significant negative correlation with systolic BP at age 12 years in males, but at age 14 years the direction of correlation changed to positive. In females serum total cholesterol was negatively correlated with diastolic BP at age 15 and 16 years. Triglyceride and creatinine showed positive correlation with systolic and diastolic BP in males, but they did not show any correlation in females. There was no consistent findings between nutrient intake and BP level. However, protein intake correlated positively with diastolic BP level in males. 4. Blood pressure change was positively associated with changes in BMI and serum total cholesterol in both sexes. Change in creatinine was associated with BP change positively in males and negatively in females. Students whose sodium intake was high showed higher systolic and diastolic BP in males, and students whose total fat intake was high maintained lower level of BP in females. The major determinants on BP change was BMI in both sexes.

지질섭취와 관상동맥질환

서일 한국지질동맥경화학회 ( 구 한국지질학회 ) 2005 한국지질동맥경화학회 추계학술발표논문집 Vol.1 No.-

의료보험 실시후 2년간의 진료양상의 변화 -서울시내 의료기관 입원환자를 중심으로-

서일,Suh, Il 대한예방의학회 1981 Journal of Preventive Medicine and Public Health Vol.14 No.1

To identify the changes in professional care patterns after the introduction of medical insurance in Korea, professional care in hospitals and clinics of two succeeding years were compared. The hospitals and clinics selected for this study were those which located in Seoul city. Hospitals were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtained from the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studied were 3 months of each year from March 1st to May 31st in 1979 and 1980, The total number of normal delivery studied was 289 in 1979, 301 in 1980 respectively and the acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both diseases in all types of hospital, but in the private clinic the average clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities, More cost changes by items were seen in acute appendicitis than in normal delivery between two study periods. The total hospital costs can be devided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly in 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospitals was mainly due to the increase in the cost for drugs for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal delivery was characteristically increased in 1980 in all hospitals studied. In general the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mentioned changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.I.C. for the assessment of the fee request made by clinics and hospitals.

국민학생의 6년간 혈압의 변화양상과 혈압변화와 관련된 요인 분석

서일,이순영,남정모,김일순,Suh, Il,Lee, Soon-Young,Nam, Chung-Mo,Kim, Il-Soon 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.1

For the purposes of analyzing the distribution and the change in blood pressure according to age and determining the factors affecting the change in blood pressure, a follow-up study had been conducted for 6 years from 1986 to 1991 for 430 primary school children aged 6 years old in 1986 in Kangwha County, Korea. The mean blood pressure increased according to age. Specifically mean systolic blood pressure increased from 97.3 mmHg for male and 96.4mmHg for female (at 6 years of age) to 108.8mmHg fur male and 112.1mmHg for female (at 11 years of age). Mean diastolic blood pressure increased from 60.0mmHg for male and 61.8mmHg for female (at 6 years of age) to 72.9mmHg for male and 73.8mmHg for female (at 11 years of age). The average annual increase in blood pressure was 2.3mmHg (in systolic blood pressure) and 2.6 mmHg (in diastolic blood pressure) for male : and 3.1mmHg (in systolic blood pressure) and 2.4mmHg (in diastolic blood pressure) for female, respectively. To determine the factors affecting the change in blood pressure, the stepwise regression analysis was conducted. Children were divided into the three groups(low, middle, and upper) according to the level of systolic and diastolic blood pressure at the age of 6, and the regression analysis was performed in each group. For the change in systolic blood pressure, the changes in weight and skinfold thickness or initial skinfold thickness fer male, and the change in weight for female were selected as significant factors for children in middle and upper group. For the change of blood pressure in diastolic blood pressure, no variables was significant.

아동혈압의 시계열 변화 양상 및 평균혈압에 관련된 요인 분석

서일,김일순,남정모,이순영,오희철,김춘배,박은철,Suh, Il,Kim, Il-Soon,Nam, Chung-Mo,Lee, Soon-Young,Oh, Hee-Chul,Kim, Chun-Bae,Park, Eun-Cheol 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.3

To show the distribution and change of blood pressure according to age and to find factors affecting the level of blood pressure in primary school children, a follow-up study was conducted from 1986 to 1989 on 401 first grade children attending primary school in Kangwha County in 1986 and their parents. The blood pressure of the children was significantly increased according to age. The average annual increase was 1.8mmHg in systolic blood pressure and 2.5mmHg in diastolic blood pressure. The level of blood pressure did not show any significant difference in both sexes. Among children who were at or above the 80th percentile of blood pressure in the first grade, 35 and 30% of them have remained at the same level of systolic and diastolic blood pressure respectively in the fourth grade. But we could not find any significance in the tracking of blood pressure of children who were at or above the 90th percentile of blood pressure in the first grade. Weight and pulse rate were shown to be significant factors affecting systolic blood pressure in children of both sexes and mother's blood pressure and skinfold thickness were also affected systolic blood pressure in girls. The variables significantly affecting diastolic blood pressure were arm circumference and pulse rate for boys and height and pulse rate for girls.