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).

국내에서 분리된 Aujeszky's Disease Virus의 면역원성 : Ⅰ. Aluminum Hydroxide겔 흡착 불활화 Aujeszky's Disease Virus항원의 면역원성 Ⅰ. Immunogenicity of the Inactivated Aujeszky's Disease Virus with Aluminum Hydroxide Gel Adjuvant

전무형,이헌준,박정우,안수환 충남대학교부설 생명공학연구소 1992 생물공학연구지 Vol.2 No.-

Aujeszky's disease virus(ADV), NYJ-1 strain, isolated from the diseased piglets in Korea was inactivated with binary ethyleneimine or formalin and absorbed in aluminum hydroxide gel. Safety and humoral and cellular immunogenicity of the antigens were investigated in mouse, guinea pig and piglets. In mouse inoculation test, the antigens showed 100% of safety and induced a significant level of ADV antibody. The protective potency following intracerebral challenge with the virulent ADV at 10^7.5TCID_50/0.2㎖ were 60% to 64.3%. In guinea pig inoculation test, it was found that the antigens were quite safe, inducing 63.2 to 124.9 of virus neutralization(VN) titers at the 5th week post inoculation(pi). The protectivity of the antigens against the challenge of the virulent ADV were 62.5% to 75.0%. In piglet inoculation test, the antigens were quite safe after the primary and booster injections, and induced 28.7 to 39.1 of VN titers at the 5th week pi. The high levels of ADV antibodies were also recognized by agar gel precipitation test, latex agglutination test and immunoenzyme assays. Leucocyte adherence inhibition(LAI) test for the piglets revealed 22.3±3.8% to 32.8±6.9% of LAI index at the 4th week pi, and the evident reactions of delayed type hypersensitivity was observed in subcutaneous inoculation of the antigen to the immunized piglets. Following the challenge, the immunized piglets showed none of specific clinical signs of AD and revealed the higher gain of body weight, and the lower secretion of ADV from the nasal cavity as compared with the control group.

제지폐수의 응집특성에 관한 연구

조준형,정원구,김준환 江原大學校 森林科學硏究所 1998 Journal of Forest Science Vol.14 No.-

본 연구에서는 우유팩을 이용하여 재생용 화장지를 만드는 제지공장의 제지폐수를 이용하여 폐수의 침강특성 및 SS, BOD_5, 제거 효율을 검토하고, Jar-tester를 이용하여 급속교반시간, 완속교반 시간에 따른 탁도, SS, BOD_5 및 최적 응집제 주입량을 결정하였다. 각종 응집제 첨가 및 침강 특성에 의한 탁도제거의 효율을 측정하였다. 적정 응집제 첨가량, 급속교반 및 완속교반의 시간에 따른 처리 효율의 이론식을 제시하였다. 또한 응집제 Polyalunlinium chloride(PAC) 및 Aluminium sulfate의 응집 비교 실험을 행하였다. Sedimentation characteristics SS, BOD_5 and removal efficiency of waste water in the tissue paper mill using milk carton were examined. Optimum dosage of coagulant, rapid mixing time and slow mixing time were determined by turbidity. SS and S-BOD_5 and then equation for treatment efficiency was suggested. For the coagulant, polyalumimium chloride(PAC) are compared with a little better efficiency compare to the aluminium sulfate.

CATV 망에서의 고속 DATA 서비스를 위한 적정 셀 규모에 관한 연구

정래성,구대성,김형준,김필중,김종빈 조선대학교 전자정보통신연구소 2001 電子情報通信硏究所論文誌 Vol.4 No.2

Recently the surrounding of data communication industry has been changing through the rapid growth of the information technology, which has been sparked by the convergence of computer and optical fiber technology. This phenomenon requires broadband network to transmit video, audio and data at once. Multimedia and broadband services are provided widely over the Internet. The traditional telephone companies, CATV operators, and Internet service providers are all rushing to provide integrated services over their infra-structures. Among them, CATV seems to be the most promising from an economic perspective, because CATV infrastructure is already in place in a majority of homes and can deliver broadband service without requiring costly upgrade of the existing CATV systems. In this paper, analysis the problem of data services over CATV network, suggest size the proper cell for the high speed data services over CATV network.

치면열구전색제의 열구 침투에 primer의 효과

정혜선,최병재,최형준,이제호 大韓小兒齒科學會 1999 大韓小兒齒科學會誌 Vol.26 No.2

본 연구의 목적은 치면열구전색제 수복시에 상아질 접착제의 primer 도포의 치면열구전색제 열구 침투도 향상 효과를 확인하는 것으로 발거된 영구 구치상에서 통상적으로 치면열구 전색제를 도포한 대조군과 Scotchbond™ Multi-Purpose system과 ?? 2 system의 primer 도포 후에 치면열구전색제를 도포한 실험군들의 열구 기저부까지 전색제 침투 성공률을 비교하여 다음과 같은 결론을 얻었다. 1. Scotchbond™ Multi-Purpose system과 All-Bond 2 system의 primer를 사용한 군의 열구 기저부까지 치면열구전색제 침투 성공률은 primer를 사용하지 않은 대조군보다 높았으나 통계학적으로 유의성 있는 차이는 없었다(p>0.05) 2. 열구 깊이와 폭 및 '깊이/폭' 값은 열구 기저부까지 전색제 침투성공율에 대하여 통계학적으로 유의성 있는 효과를 나타내었다.(p<0.05) 3. 열구 기저부까지 전색제 침투 성공률은 열구 깊이가 25㎛ 증가할 때마다 약 0.9배로 감소하였고, 열구 입구의 폭이 25㎛ 증가할 때마다 약 1.1배로 증가하였으며, 열구의 '깊이/폭' 비율이 1 증가할 때마다 약 0.6배로 감소하였다. The objective of this study is to confirm the effect of dentine bonding primer application on penetration of sealant. Extracted permanent molars were used to compare penetration success rate of control group (sealant application only) and experimental groups (sealant application after applying the primers of Scotchbond™ Multi-Purpose system and All-Bond 2 system). The following results were obtained: 1. The experimental groups using the primers showed increased sealant penetration success rate to the base of fissure when compared to control group but there was no statistically significant differences(p>0.05). 2. The depth, width and 'depth/width' value of fissure had statistically significant effect on sealant penetration success rate(p<0.05). 3. The penetration success rate decreased about 0.9 times as the depth of fissure increased every 25㎛, and increased about 1.1 times as the width of the fissure orifice increased every 25㎛, and decreased about 0.6 times as the 'depth/width' value increased every 1. From the above results, it can be concluded that fissure morphology had a great effect on sealant penetration and for better penetration, use of dentine bonding primer can be helpful but it needs more study in clinical bases.

국내분리 Aujeszky's disease virus의 실험적 감염 자돈에 대한 바이러스학적 연구 : Pathogenecity, excretion, distribution and immunogenicity of virus

박정우,전무형,안수환 충남대학교부설 생명공학연구소 1992 생물공학연구지 Vol.2 No.-

To investigate the etiology, pathogenicity and virological properties of NYJ-1-87 strain of Aujeszky's disease virus (ADV) that was isolated from the diseased piglet in Korea, the virus at 10^(6.0)TCID_50/0.1㎖ was inoculated intranasally and subcutaneously into 30 to 35 days-old piglets. Results obtained through the experiments were summarized as follows. 1. Ten of the infected piglets were clinically observed for 15 days. On the 2nd day post-inoculation(pi), the signs of pyrexia, anorexia and convulsion were noted. On the 4th 7th days pi, nervous signs of incoordination and intermittent spasm were shown in the most of piglets, and one out of 5 piglets infected intranasally was died with severe nervous signs at the 7th day pi. The signs became relieved on the 8th day pi and all of remainder were completely recovered on the 13th to 14th days pi. 2. In hematological study, prominent decrease in the number of total leukocyte and lymphocyte was shown in the ADV-infected piglets on the 6th day pi. On the 8th day pi, the cell numbers were slightly increased and returned to normal level on the 10th day pi. 3. Viral excretion of the ADV-inoculated piglets was examined by swabbing of nasal and oral cavities, and rectal feces. During the periods of the 3rd to11th days pi, the virus was excreted intermittently from nasal and oral cavities, and rectal feces. The nasal excretions were shown the highest virus concentration of 10^(5.2)TCID_50/0.1㎖ at the 5th day pi. 4. Recovery of the inoculated virus from various organs of the piglets that were died or experimentally slaughtered was attempted, and the virus was isolated from the tissues of brain and tonsil by the cultured cell-inoculation method. The highest recovery rate was noted in the tonsil. By indirect immunofluorescence antibody assay using ADV-monoclonal antibody, the viral antigens were detected in tissues of spleen and liver as brain and tonsil on the 7th to 9th days pi. The virus was not isolated from blood and the tissues of lung and kidney throughout the experiments. 5. Titers of virus neutralizing antibody in the piglets experimentally infected with ADV became increased after the 6th to 9th days pi in both of intranasal and subcutaneous inoculation showing the highest titers of 64 to 128 on the 29th day pi. When the antibody levels were measured by radial immunodiffusion enzyme assay, the reactive diameter was enlarged to be positive after the 4th to 6th days pi in both of intranasal and subcutaneous inoculation showing the largest diameter of 13 to 14mm on the 29th day pi.

HBx형질전환 생쥐에서 발생한 간세포암종에서 H-ras 및 c-myc의 발현에 관한 연구

문형배,소병준,김학철,윤기중,한원철,조향정,유대열,정영진 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

<연구목적> HBx형질전환 생쥐에서 발생한 간세포암종의 발암과정에 종양유전자(H-rgs, c-myc)의 발현 정도를 조사하고자 하였다. <연구방법> 정상생쥐 12마리(4-18개월) 및 HBx 형질전환 생쥐 44마리(4-18개월)를 대상으로 포르말린에 고정하고 파라핀에 포매한 간 조직을 이용하여 면역조직화학적염색을 실시하였다. 실험군은 정상 부위, 이형성 부위 및 종양 부위로 구분하였으며, 종양 부위는 소결절성병변 부위와 간세 포암종 부위로 구분하였고, 이형성병변 부위는 이형성병변만 발견되는 부위, 소결절성병변과 동반된 이형성병변 부위 및 간세포암종과 동반된 이형성병변 부위로 구분하였다. <연구결과> H-rgs의 발현은 정상 간조직에 비하여 이형성병변 부위(P<0.05) 및 종양 부위(P<0.01)에서 증가하였으며, 소결절성병변 부위과 간세포암종 부위 사이에서는 간세포암종 부위에서 증가된 경향이었으나 통계학적으로 유의한 차이가 없었으며, 각 이형성병변 부위 사이에서도 유의한 차이는 없었다. c-myc의 발현은 정상 간조직 및 이형성병변 부위에 비해 종양 부위에서 증가하였으며(P<0.001), 소결절성병변 부위와 간세포암종 부위에서는 비슷하였고, 각 이형성병변부위 사이에서도 비슷하였다. <결론> HBx형질전환 생쥐에서 발생하는 간세포암종의 발생에 H-rgs는 이형성 변화를 일으키는 시기에 관여하며, c-myc은 이형성병변에서 암으로 이행하는 시기에 관여할 것으로 생각한다. Background: This experiment was designed for the expression of H-ras and c-myc in hepatocarcinogenesis of the HBx transgenic mice. Methods: Immunohistochemical stains in the paraffin embedded tissue of the liver were used for the detection of H-ras and c-myc in the 12 normal mice and 44 HBx transgenic mice of the 4-18 month old. Results: Expression of the H-ras was significantly increased in the dysplastic area (P<0.05) and tumor area (P<0.01) than in the normal liver. But there were no differences of H-ras expression between areas of microscopically identified hepatocellular carcinoma (MI-HCC) and grossly identified hepatocellular carcinoma (GI-HCC) and dysplastic areas among the only dysplastic areas, dysplastic areas with MI-HCC and GI-HCC. Expression of the c-myc was significantly increased in the tumor area (P<0.001) than in the normal liver and dysplastic area. But there were no differences of c-myc expression between areas of MI-HCC and GI-HCC, and dysplastic areas among only dysplastic areas, dysplastic areas with MI-HCC and GI-HCC. Conclusions: Our study suggests that H-ras is related to the dysplastic change and c-myc is related to the neoplastic change in the hepatocarcinogenesis of the HBx transgenic mice.

접착용 시멘트의 균일한 도포를 위한 교정용 밴드 장착방법의 모색

김형준,정태성,김신 대한소아치과학회 2006 大韓小兒齒科學會誌 Vol.33 No.3

교흔으로 인해 발생한 Eikenella corrodens 간농양 1예

고근준,이은재,최형섭,김상수,최정은,임환섭,김준명,이꽃실 대한감염학회 2004 감염과 화학요법 Vol.36 No.2

E. corrodens는 면역저하 환자에서 주로 문제를 일으키며, 감염시 두경부, 폐, 복부 등에 위험을 초래할 수 있어 치료의 적절성에 대한 중요성이 부각되고 있다. Eikenella corrodens는 균 동정을 위해 CO₂의 공급을 필요로 하며 서서히 자라는 특성상 까다로운 배양조건을 필요로 하는 균주이다. 혐기성 균주이지만 metronidazole이나 clindamycin과 같은 항균제에는 반응을 안하는 특이한 항생제 감수성에 의해 보편적인 구강내 상재균에 대한 경험적 치료에 실패할 수 있다. 치료에 있어 잘못된 초기 항생제 선택이나 외과적 시술이 적절히 시행되지 않은 경우에 치료실패의 요인이 될 수 있으므로 적절한 항생제 사용과 함께 외과적 처치가 동반되어야 한다. 저자들은 정상 면역력을 가진 성인에서 사람에게 물리고 난 후 발생한 E. corrodens에 의한 간농양의 적절한 치료의 결과를 문헌고찰과 함께 보고하는 바이다. Eikenella corrodens is a slow growing, facultatively anaerobic gram-negative rod that is part of the normal flora of the oral cavity and upper respiratory tracts. In most patients with E. corrodens infections, host defenses are compromised due to surgery, or chronic debilitating illness such as malignancies, or immunosuppressive therapy. This organism causes abscesses and infections that are at times fatal. We experienced a case of E. corrodens isolated from liver abscess in an immunocompetent patient. A 50-year-old man who is a dentist, was hospitalized because of fever and myalgia of 10 days' duration. Abdominal ultrasonography showed non-septated, 3.8×4.6 ㎝ sized abscess in the segment 6/7 of the liver. E. corrodens was isolated from aspiration of liver abscess. This organism was presumably acquired from his patient's oral cavity during dental procedure. We hope that increased awareness to E. corrodens will raise the index of suspicion, and contribute to optimal management of these infections, minimizing the significant morbidity associated with this organism.

7두의 개에서 배설성 요로조영술을 통한 신장 기능 평가

최윤정,이기자,최형준,이용진,박성준,송근호,정성목,최호정,이영원 忠南大學校 獸醫科大學 動物醫科學硏究所 2005 動物醫科學硏究誌 Vol.13 No.-

Excretory urography is a type of contrast study used to verify and localize upper urinary tract disease. It is an inexpensive and easy way to visualize of anatomic and functional status of the kidney and has been used as a primary imaging modality for the evaluation of urinary tract abnormalities. We describe urological signs of 7 dogs who examined with excretory urography and ultrasonography. Six cases were referred to veterinary medical teaching hospital. Chungnam national university (VMTH, CNU) to evaluate renal function after the treatment for renal failure and one case was referred showing hematuria. In case 1, 2 and 4, blood test and urinalysis was normal and the results of excretory urography presented that renal function were normal range. In case 3, the results of urinalysis, ultrasonography, and excretory urography except blood test presented abnormal kidney and hydronephrosis was diagnosed. In case 5 and 6, blood test, urinalysis, ultrasonography and excretory urography indicated renal failure. In case 7, blood test, urinalysis and ultrasonography presented partially abnormal signs, however, the results of excretory urography was normal range.