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( Yung Ly Kim ),( Hyun Wook Kim ),( Eun Young Lee ),( Seung Gyu Han ),( Young Su Joo ),( Shin Wook Kang ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Recent studies have indicated that vitamin D may affect the effi cacy of erythropoiesis through its anti-infi ammatory action. Even though both vitamin D defi ciency and anemia are prevalent in patients with end-stage renal disease (ESRD), the association between these two factors remains poorly understood. In this study, therefore, we investigated the impact of vitamin D defi ciency on anemia in ESRD patients. Methods: This study included 106 ESRD patients who underwent kidney transplantation at Yonsei University Health System between April 2002 and May 2004. Patients were divided into tertiles according to the levels of 25-hydroxyvitamin D [25(OH)D] (Group 1, 15.50 ng/mL). Independent association between vitamin D and hemoglobin (Hb) concentrations was evaluated by multivariate linear regression analysis. Results: The mean serum 25(OH)D and Hb levels were 13.06±6.31 ng/mL and 9.45±1.76 g/dL, respectively. Hb concentrations showed a signifi cant trend of increase across the 25(OH)D groups (Group 1, 9.0±1.8; Group 2, 9.4±1.7; Group 3, 9.9±1.7 g/dL; P for linear trend=0.047). Multivariate linear regression analysis revealed that serum 25(OH)D levels were independently associated with Hb concentrations after adjustment for sex, age, serum calcium and phosphorus levels, intact parathyroid hormone concentrations, and the use of erythrocyte stimulating agents (per 1 ng/mL increase, ß=1.168, 95% confi dence interval= 0.434 to 1.901, P=0.02). Conclusions: Vitamin D defi ciency was signifi cantly associated with anemia in ESRD patients. Further studies are needed to verify whether vitamin D supplement can improve anemia in this population.
S-368 : Clinical implication of crescentic lesions in immunoglobulin A nephropathy
( Yung Ly Kim ),( Mi Jung Lee ),( Ki Heon Nam ),( Kyoung Sook Park ),( Young Eun Kwon ),( Seung Yeong Ahn ),( Hyung Jung Oh ),( Tae Hyun Yoo ),( Shin Wook Kang ),( Beom Jin Lim ),( Hyeon Joo Jeong ),( 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Background and objectives: To date, there has been much controversy about the role of crescentic lesion as a significant prognostic factor in immunoglobulin A nephropathy (IgAN). This study, therefore, evaluated whether crescentic lesions predict adverse renal outcomes in patients with IgAN. Design, setting, participants, and measurements: A total of 430 patients with biopsy-proven IgAN between January 2001 and December 2010 were included. Histologic variables of the Oxford classification (Oxford-MEST) and the presence of crescents were assessed. The primary endpoint was a 50% decline in estimated glomerular filtration rate. Results: Of the 430 patients, 81 (18.8%) patients had a crescentic lesion. During a mean follow-up of 61 months, the primary outcome occurred in 19 (23.5%) patients with crescents compared to 40 (11.5%) patients without crescents (p=0.01). A Kaplan-Meier plot showed that the 10-year renal survival rate was significantly lower in patients with crescents than patients without crescents (p=0.01). However, in a multivariable Cox analysis which included clinical factors and the Oxford-MEST, crescents were not significantly associated with an increased risk of developing the primary outcome [hazard ratio: 0.78, 95% confidence interval (CI): 0.40-1.51, p=0.48]. Furthermore, adding crescents to the Oxford classification did not improve the discriminative ability for the prediction of renal outcomes [c-statistic: 0.86 (0.81-0.91) vs. 0.86 (0.80-0.91), p=0.35]. Conclusions: This study showed that crescentic lesion was not an independent prognostic factor, suggesting that crescents have limited value in predicting renal outcomes of IgAN.
Ho Kim, Chan,Jin Lim, Beom,Sung Bae, Yoon,Eun Kwon, Young,Ly Kim, Yung,Heon Nam, Ki,Sook Park, Kyoung,Yeong An, Seong,Mo Koo, Hyang,Mee Doh, Fa,Jung Lee, Mi,Jung Oh, Hyung,Yoo, Tae-Hyun,Kang, Shin-Woo Springer Science and Business Media LLC 2014 Modern pathology Vol.27 No.7
<P>Recently, there has been emerging concern that crescents, the main histologic feature of Henoch-Sch?nlein purpura nephritis, merely reflect active inflammation, and may not be useful in predicting long-term outcomes. We therefore conducted a single-center retrospective study to evaluate whether the new Oxford classification of immunoglobulin A nephropathy can be used to predict long-term outcome in patients with Henoch-Sch?nlein purpura nephritis. We included 61 biopsy-proven patients with Henoch-Sch?nlein purpura nephritis between January 1991 and August 2010. In addition to the International Study of Kidney Disease in Children classification, pathologic findings were also evaluated by the Oxford classification. Primary outcomes were defined as either the onset of estimated glomerular filtration rate <60?ml/min per 1.73?m(2) with 30% decrease in estimated glomerular filtration rate from baseline or end-stage renal disease. During a median follow-up of 49.3 months, 13 (21%) patients reached the primary end point. A Kaplan-Meier plot showed that renal event-free survival was significantly longer in patients with <50% crescents than in those with crescents in 50% of glomeruli (P=0.003). Among the components of the Oxford classification, patients with endocapillary hypercellularity (E1; P=0.016) and tubular atrophy/interstitial fibrosis (T1/T2; P=0.018) had lower renal survival rates than those with E0 and T0. In a multivariate Cox model adjusted for clinical and pathologic factors, E1 (hazard ratio=8.91; 95% confidence interval=1.47-53.88; P=0.017) and T1/T2 (hazard ratio=8.74; 95% confidence interval=1.40-54.38; P=0.020) were independently associated with reaching a primary outcome, whereas the extent of crescentic lesions was not. Our findings suggest that the Oxford classification can be used in predicting long-term outcomes of Henoch-Sch?nlein purpura nephritis.</P>
한국 성인의 비타민D 섭취량과 혈중 25OHD 농도 및 골밀도와의 관련성
김미연(Kim, Mi-Yeon),김미자(Kim, Mi-Ja),이선영(Ly, Sun Yung) 한국영양학회 2016 Journal of Nutrition and Health Vol.49 No.6
본 연구는 국민건강영양조사 5기의 2011년 자료를 이용하여 만 19세 이상 남녀를 대상으로 비타민D 섭취량과 혈중 25OHD 농도, 골밀도와의 관계를 분석하였다. 평균 비타민D 섭취량은 남성이 3.84 ± 0.23 μg/day, 여성은 2.22 ± 0.11 μg/day로 나타났으며, AI 미만 섭취 비율은 남성은 71.6~96.6%,여성은 80.2~98.5%로 모두 높게 나타났으며 여성이 남성에 비해 더 높았다. 혈중 25OHD 농도는 연령이 높아질수록 증가했으며, 혈중 25OHD의 결핍수준을 20ng/mL 미만으로 보았을 때 남성은 47.8~81.1%, 여성은 59.4~92.8%의 결핍률을 보였고 젊은 층의 결핍률이 더 높았다. 50세 미만과 이상으로 나누어 비타민D 섭취량과 혈중 25OHD 농도, BMD와의 관계를 조사한 결과 50세 미만 연령층군에서는 비타민D 섭취량이 10 μg/day 이상인 군이 5 μg/day 이하인 군에 비하여 유의하게 혈중 25OHD 농도가 더 높았으며, 50세 이상 여성에서는 비타민D 섭취량이 10 μg/day 이상인 군이 5 μg/day 이하인 군에 비하여 골밀도가 유의하게 높게 나타났다. 즉, 한국 성인 남녀의 비타민D 섭취량 수준은 상당히 취약한 상태이나 식사를 통한 비타민D가 혈중 25OHD 농도를 상승시킬 수 있음을 보여주고 있다. 그러므로 한국인이 비타민D 섭취량을 늘릴 수 있도록 강화식품 정책 등을 통해 비타민D 섭취량을 늘리는 방안을 모색하여야 한다. 특히, 2010년에 비해 2015년 한국인영양소섭취기준에서 19~49세 연령층의 비타민D 충분섭취량을 5 μg에서 10 μg으로 상향조정한 것은 바람직한 방향으로 개정된 것으로 판단된다. Purpose: The purpose of this study was to estimate dietary intake of vitamin D and the relationship between serum 25-hydroxyvitamin D (25OHD) concentration and bone mineral density (BMD) in Korean adults using the 2011 data from the Korea National Health and Nutrition Examination Survey. Methods: Daily intake of vitamin D and ratio of subjects that consumed less vitamin D than adequate intake (AI) were estimated in 4,879 Korean adults. The relationship between daily intake of vitamin D and serum 25OHD and BMD were analyzed. Results: Average daily intakes of vitamin D were 3.84 ± 0.23 μg/day for men and 2.22 ± 0.11 μg/day for women. Approximately 72∼97% of men and 80∼99% of women consumed less than the AI of vitamin D for Koreans. Serum 25OHD concentration increased with age, and the ratios of serum vitamin D deficiency (< 20 ng/mL) were 47.8~81.1% for men and 59.4∼92.8% for women. Average intake of vitamin D was higher in subjects aged < 50 yr than in those ≥ 50 yr, but lower in serum 25OHD concentration. In subjects aged < 50 yr, serum 25OHD was higher in subjects that consumed 10 μg/day of vitamin D than in those that consumed less than 5 μg/day. In female subjects aged ≥ 50 yr, average intake of vitamin D was associated with higher bone mineral density. Conclusion: It was found that dietary intake of vitamin D could increase serum 25OHD concentration in young adults and bone mineral density in old women. Therefore, nutrition policies for enriched foods with vitamin D and nutrition education to consume more vitamin D-rich foods are needed to ameliorate vitamin D status of the Korean population. Adequate intake for Korean population aged < 50 yr might be adjusted upwardly up to 10 μg/day.
제 2형 당뇨 환자의 저혈당지수 영양교육이 혈당관리에 미치는 영향
김미자(Kim Mi-Ja),권순자(Kwon Sunja),이선영(Ly Sun Yung) 韓國營養學會 2010 Journal of Nutrition and Health Vol.43 No.1
This study was intended to assess the effects of low glycemic index (LGI) nutrition education on dietary management and glycemic control of patients with type 2 diabetes mellitus. The subjects were 48 sex-matched patients with type 2 diabetes mellitus, aged 66.5 ± 6.2 years, visiting a public health center. They were divided into two groups: the control group (males 10, females 14) and the educated group (males 10, females 14). The educated group was provided with a LGI nutrition education program for 7 weeks. The control group was educated only one time for general diabetic education. Anthropometric indices, knowledge and perception of efficacy of low glycemic index carbohydrates, dietary glycemic index (DGI) and glycemic load (DGL), fasting blood glucose, and HbA1c were assessed. In the educated group body weight, body mass index and systolic blood pressure (from 138.0 ± 18.9 ㎜Hg to 130.6 ± 15.0 ㎜Hg) were significantly reduced after the nutrition education (p < 0.05). The scores of knowledge and perception of efficacy of low glycemic index carbohydrates increased significantly in the educated group. Dietary glycemic index and glycemic load of the educated group decreased significantly from 103.4 ± 67.6 to 45.4 ± 27.1 (p < 0.001), and from 173.3 ± 135.9 to 66.8 ± 50.4 (p < 0.001), respectively. Also fasting blood glucose and HbA1c levels of the educated group significantly decreased from 124.5 ± 28.8 ㎎/㎗ to 96.7 ± 21.6 ㎎/㎗ (p < 0.001) and from 7.1 ± 1.3% to 6.4 ± 1.2% (p < 0.05), respectively. The score of knowledge and perception of efficacy of low glycemic index significantly correlated with fasting blood glucose and HbA1c levels negatively. DGI, DGL and duration of diabetes significantly correlated with HbA1c level positively. From stepwise multiple linear regression analysis, DGI, DGL and the duration of diabetes were extracted as factors influencing HbA1c level of the subjects. The results of this study suggest that low glycemic index nutrition education programs is an effective intervention measure for the glycemic control in type 2 diabetic patients.