$\beta_2$ 교감신경 수용체 다형성이 아토피 및 혈청 IgE에 미치는 영향

이신형,심재정,강용구,정혜철,김경규,권영환,김제형,이승룡,이소라,이상엽,조재연,인광호,유세화,강경호,Lee, Sin-Hyung,Shim, Jae-Jeong,Kang, Yong-Koo,Jeong, Hye-Cheol,Kim, Kyung-Kyu,Kwon, Young-Hwan,Kim, Je-Hyeong,Lee, Sung-Yong,Lee, So-Ra,Lee, San 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.6

연구배경 : $\beta_2$ 교감신경 수용체의 다형성이 기관지 천식의 표현형에 영향을 미친다고 알려져 있다. 이에 저자들은 먼저 기관지 천식 환자와 정상인에서의 $\beta_2$ 교감신경 수용체의 다형성의 빈도에 차이가 있는가를 알아보고, 또한 기관지 천식 환자에서 아토피의 유무 및 혈청 총 IgE의 증가 여부와 $\beta_2$ 교감신경 수용체의 다형성이 관계가 있는지 알아보고자 본 연구를 시행하였다. 방 법 : 기관지 천식 환자 109명과 정상인 42명에 대하여 혈청 총 IgE를 측정하고, 항원 특이 IgE 검사 및 피부 단자 검사를 실시하였고, mutated allele specific amplification 법으로 $\beta_2$ 교감신경 수용체와 다형성을 검색하였다. 결 과 : $\beta_2$ 교감신경 수용체의 다형성을 조사한 결과 16번 아미노산 위치에서는 Arg 야생형 및 Arg/Gly 이형접합체 변이형, Gly 동형 접합체 변이형이, 그리고 27번은 Gln 야생형, Gln/Glu 이형 접합체 변이형, Glu 동형 접합체 변이형이 관찰되었다. 34번 아미노산의 경우는 Val 야생형과 Val/Met 이형 접합체 변이형이, 164번은 Thr 야생형만 있었다. 1) 정상인과 기관지 천식 환자에서 $\beta_2$ 교감신경 수용체의 16, 27, 34번 아미노산 위치에 있어서 다형성의 빈도는 통계학적으로 차이가 없었다(p>0.05)(Table 3). 2) 기관지 천식환자에서 $\beta_2$ 교감신경 수용체 다형성의 빈도와 아토피의 존재 유무는 16, 27, 34 번 아미노산에서 모두 통계학적으로 관계가 없었다(p>0.05) (Table 4). 3) 기관지 천식 환자 중 혈청 총 IgE가 증가된 군과 정상 군에서 $\beta_2$ 교감신경 신경 수용체 다형성과 혈청 총 IgE의 증가 여부의 비교는 16, 27, 34번 아미노산 모두 통계학적인 관련이 없었다(p>0.05) (Table 5). 결 론 : 결론적으로 기관지 천식 환자와 정상인 사이의 $\beta_2$ 교감신경 수용체의 다형성은 16, 27, 34번 아미노산 위치에서 차이가 없었고, 기관지 천식환자에서 아토피의 유무 및 혈청 총 IgE의 증가 여부와 $\beta_2$ 교감신경 수용체의 다형성의 빈도는 통계적으로 유의한 관계가 없었다. Background : The $\beta_2$ adrenergic receptor ($\beta_2$ AR) polymorphisms occurring at amino acid position 16 (Arg to Gly), 27 (Gln to Glu), 34 (Val to Met), and 164 (Thr to Ile) are known to be functionally relevant and also disease-modifying in subjects with asthma. However the contribution of these polymorphisms to the development of the asthmatic phenotype or other markers for allergic disease remains to be established. Methods : 109 patients with bronchial asthma and 42 healthy person were included. Serum total IgE, allergen specific IgE, and skin prick test were performed to all of the subjects. $\beta_2$ AR polymorphisms were checked by mutated allele specific amplification (MASA) method. Results : The results were as follows. The frequencies of $\beta_2$ AR polymorphisms in asthmatic patients and healthy person were not statistically different(p>0.05). There was no association between $\beta_2$ AR polymorphisms of amino acid position 16, 27, 34 and the existence of atopy among asthmatic patients(p>0.05). Between asthmatic patients with or without elevated IgE level and $\beta_2$ AR polymorphisms of amino acid position 16, 27, 34, there was no statistically significant association(p>0.05). Conclusion : There was no difference in frequency of the $\beta_2$ AR polymorphism between asthmatic patients and healthy person. In the bronchial asthma, association of $\beta_2$ AR polymorphism and atopy/serum total IgE was not found.

클레임보험의학

이신형,Lee, Sin-Hyung 한국생명보험의학회 2011 保險醫學會誌 Vol.30 No.2

Insurance medicine has been known to medical risk selection. The role of insurance medicine is sound maintenance of insurance system. So it's function is medical underwriting of life risks. However, emerging market has insufficient medical epidemiological research that is necessary for estimation of extra-risk and such market is usually lack of full understanding of life insurance among insurance customers. This problem makes difficult of performing the medical underwriting, as an original insurance medicine. Medical contributions at the stage of claims adjudication comparing the coverage provided in the product, with the information provided in the claims, based on medical records and the agreement between them. This is called medical verification. The insurance doctors can also use their medical knowledge to help the claims staff with informing claimants about the medical basis of claims decisions.

의적클레임검토 유형론

이신형,Lee, Sin-Hyung 한국생명보험의학회 2007 保險醫學會誌 Vol.26 No.-

In the course of insurance claim administration, medical experts' opinions are called medical claim reviews. They are classified into two main categories: medical verification and counsel for claim staff. Medical verification compare between product coverage and the insured's physical condition. Medical counsel for claim staff is advice for claim staff when they have a question about medical knowledge to make a claim decision. A common example of medical verification is insurance coding of pituitary apoplexy. Some clinicians have insisted that the ICD coding of pituitary apoplexy is l63 of cerebral infarction, but the exclusion criteria of I code show that neoplasm is coded as C00 to D48. Thus, pituitary apoplexy must be coded as D33. An example of medical counsel for claim staff is interpretation of some medical conditions. It is divided into UCR(usual, customary, and reasonable) assessment, assessment of causality, and so on. Disability evaluation is another subject of medical counsel for claim staff. The final claim decision must be made by claim staff because only the claim staff have the authority of claim decision. Medical claims review is only an expert's opinion.

주요 류머티스 질환의 보험의학적 이해

이신형,Lee, Sin-Hyung 한국생명보험의학회 2012 保險醫學會誌 Vol.31 No.1

Nowadays, Rheumatic diseases are increasing more and more. So, it's important knowing the pathophysiology and extra-risk of each rheumatic disease so as to do sound underwriting. Here is brief review and long-term prognosis of some rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sj$\ddot{o}$gren syndrome, antiphospholipid syndrome, systemic sclerosis, ankylosing spondylitis, Takayasu's arteritis, and Behcet syndrome.

폐암과 보험의학

이신형,Lee, Sin-Hyung 한국생명보험의학회 2012 保險醫學會誌 Vol.31 No.1

Lung cancer such as small cell lung cancer(SCLC) and non small cell lung cancer(NSCLC) have high mortality rate, so, we insurance doctors have little interest in their risk. But nowadays there's a lot of development in targeted therapy of NSCLC. Screening by CT scanning and early resection strategy also shows better prognosis. It is helpful for underwriters and insurance doctors to review the current development of targeted therapy of NSCLC and estimation of extra-risk of early lung cancer. The preferred treatment option for patients whose tumors contain EGFR-activating mutations are one of the EGFR-directed tyrosine kinase inhibitors, such as gefitinib or erlotinib. In patients with NSCLC whose tumors harboured an ALK rearrangement, there was 61% objective response rate to crizotinib in the phase 1 study. The median survival progression-free survival was 10 months. Mortality analysis of early lung cancer who were detected by CT screening, MR of 105% and EDR of 1‰ were calculated.

보험의학회지 제27권 1호의 발간에 즈음하여...

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.1

Korean life insurance medical association's public periodical, the Journal of Korean Life Insurance Medical association (J Kor Lif Ins Med Assoc, JKLIMA) is now published $27^{th}$ issue. From this issue there are some changes of the journal than before. It is because general requirements for medical journals from the Korean association of medical journals editors. It can be remedy for the development of JKLIMA, in terms of academicism. First, the style of the manuscripts, medical opinion of insurance administration is added. This style of manuscript needs not keep the format of original research article such as background, materials, results, and discussion. Secondly, It is emphasized that submitted manuscripts must be reviewed by peer reviewers. Thirdly, we will make an effort to globalization of our journal. Lastly the publication period has been changed from annual to biannual. The publication date will be at March 31st and September 30th every year.

진료과목 관련성을 중심으로 분석한 의학적클레임검토 유형론에 관한 연구

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.1

BACKGROUND : The medical claims review(MCR) is unique methodology of medical consultation in terms of insurance claim administration in Korean insurance market. The most important practical matter in the MCR is formatted question. In Korea, medical specialty is composed of 26 legally defined hospital departments. It is worth of studying to investigate type of MCR by hospital departments. METHODS : Fifty Cases of the MCR were selected randomly by statistical program SPSS among 1,032 cases which were performed between April 1, 2006 and March 31 2007. All of selected cases were evaluated one insurance doctor and made a score points from 0 to 10 in terms of hospital department. RESULTS : Multidimensional scaling was performed. The MCR types - diagnosis, malignancy and cause of death are located in the same 2-dimensional configuration area. It can be called as verification of benefit. Others are advice. - such as causality, interpretation, translation, independent medical examination, and so on. DISCUSSION : We can conclude the classification of MCR typology are two main subjects, verification and advice. Theses results are same as previous article which was based on experience.

제한적인 출처논문을 활용한 사망률분석

이신형,Lee, Sin-Hyung 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.2

Medical risk selection or mortality analysis is very important in insurance medicine. Among many kind of source articles there have been several limitations. There are few long-term follow-up studies in rare disease, as Romeo's article. We can do mortality analysis of this type using cause of death within the article and assumption of expected mortality q'. In the case of article which is published in foreign country such as Tikkanen et al, we can use comparative group from the control group within source article. It is another way for mortality analysis of limited article. However Retrospective study even performed in Korea, is unusable for estimation of extra-mortality.

만성폐쇄성폐질환의 보험의학적 이해

이신형,Lee, Sin-Hyung 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.1

Global prevalence of chronic obstructive pulmonary disease(COPD) is known to 5.6 ~ 9.8%. Then life insurance applicants from persons with COPD are frequently encountered, and the underwriter and insurance medical doctors are called on with some regularity to render assessments of the mortality risk associated with COPD. According to previous article which contains long-term follow up of COPD, mortality ratio and excess death rate were 230% and 29 per 1000, respectively. Nowadays molecular genetic methodology such as GWAS has been developed. So it might be possible that molecular diagnostic methods may be one of useful underwriting tools in the life insurance risk selection of COPD applicants.

보험진단 심전도에서 QRS군 확장의 내막(內幕)은?

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.2