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체외수정시술을 위한 과배란 유도 시 유전자 재조합에 의하여 생산된 사람융모생식샘자극호르몬제의 임상적 효용성에 관한 연구
이향아 ( Hyang Ah Lee ),김정훈 ( Chung Hoon Kim ),구윤희 ( Yun Hee Koo ),서미원 ( Mi Won Seo ),김성훈 ( Sung Hoon Kim ),채희동 ( Hee Dong Chae ),강병문 ( Byung Moon Kang ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.4
목적: 보조 생식술을 위한 과배란 유도의 과정 중 최종 난포의 성숙 유도를 위하여, 임신한 여성의 뇨 중에서 추출된 사람 융모생식샘자극호르몬제재의 투여는 필수적인 과정이다. 그러나 뇨 추출물 과정에서 생기는 정제 과정의 불확실성, 소변의 정도 관리의 어려움, 항원 항체 반응의 출현, 동일 단위당의 예측 불가능한 효능 등이 문제점으로 제기 되고 있다. 본 연구에서는 재조합법으로 생성된 사람융모생식샘자극호르몬제재의 최종 난포 성숙과 관련된 임상적 효용성을 알아보고자 하였다. 연구방법: 2005년 1월부터 9월까지 서울 아산병원 불임 클리닉에서 체외 수정술을 시행 받은 환자 84명을 대상으로 전향적으로 연구되었다. 난자 채취 36시간 전에 42명에게는 재조합 사람융모생식샘자극호르몬 250 ug투여 되었으며 대조군에는 요 추출 사람융모생식샘자극호르몬 10,000 IU가 투여되었다. 난자 채취일에 약물의 국소적 부작용이 조사되었고 3일 후에 배아 이식하였다. 또한 두 군의 채취된 난자의 수, 수정된 난자의 수와 질, 배아의 질, 임신률을 비교하였다. 결과: 성선 자극 호르몬 투여 후 5일째의 혈중 사람융모생식샘자극호르몬과 프로제스테론 농도는 재조합 사람융모생식샘자극호르몬을 투여받은 군에서 유의하게 높았다 (p<0.01, p<0.05). 그 외의 채취된 난자의 질과 개수, 배아의 질, 임신률은 차이를 보이지 않았다. 또한 동통, 가려움, 피하 출혈 등의 약물 투여 부위의 국소적 부작용은 재조합 사람융모생식샘자극호르몬을 투여받은 군에서 의미 있게 낮은 빈도를 나타냈다 (p<0.01, p<0.01 and p<0.05). 결론: 체외 수정술을 위한 과배란 유도 환자 군에서 재조합 사람융모생식샘자극호르몬의 투여는 황체기의 황체호르몬의 농도를 상승시켰으며 국소적인 부작용은 요추출 제재 보다 의미 있게 낮았다. Object: Human chorionic gonadotropin (hCG) is used to induce final follicular maturation in women undergoing controlled ovarian hyperstimulation (COH). Urinary preparations are associated with a number of disadvantages including an uncontrolled source, batch-to-batch variability and lack of purity. We performed this study to compare the efficacy of recombinant hCG and urinary hCG for induction of final follicular maturation in women undergoing IVF-ET. Methods: Prospective trial was performed on a total of 84 IVF cycles carried out in 84 infertile women with tubal and peritoneal factor. Patients were randomized 1:1 to 250 ug of recombinant hCG subcutaneous injection or 10,000 IU of urinary hCG intramuscular injection after completing recombinant human follicle stimulating hormone (FSH) stimulation. Oocyte pickup was scheduled 36 hours after hCG administration and embryos were transferred 3 days after oocyte pickup. We measured the efficacy points including the number of retrieved and fertilized oocytes, quality of oocytes and embryos, and clinical pregnancy rate. Results: Serum progesterone and hCG level on post-hCG day 5 were significantly higher in the recombinant hCG group (p<0.01, p<0.05). There were no significant differences in outcome including the number of retrieved oocytes, quality of oocytes and embryos, clinical pregnancy rate between the two preparations. The incidence of injection-site reactions such as pain, itching, and bruising were significantly lower in the recombinant hCG group (p<0.01, p<0.01 and p<0.05). Conclusions: For triggering ovulation, recombinant hCG seems to have significant advantages compared with urinary hCG in terms of luteal progesterone and local tolerance.
분만 후 출혈 환자에서 선택적 색전술 후 자궁동맥의 부분적 폐쇄에도 불구하고 발생한 자궁괴사
이지연 ( Yeon Lee ),황종윤 ( Jong Yun Hwang ),이향아 ( Hyang Ah Lee ),이동헌 ( Dong Hun Lee ),이승구 ( Seung Koo Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.5
Selective uterine arterial embolization is widely used in the management of obstetric hemorrhage. Owing to the physiological changes associated with pregnancy and selection of uterine arteries, ischemic injury after uterine arterial embolization in postpartum bleeding is rare. In previous reports, the known causes of ischemic injury after embolization are using the too small particle and complete occlusion of fine branch of uterine artery with absence of collateral ovarian artery. We experienced uterine necrosis despite partial obstruction of uterine arteries following the selective embolization. We report this case with brief review of literature.
이지연 ( Ji Yeon Lee ),신승호 ( Seung Ho Shin ),하중규 ( Joong Gyu Ha ),최성권 ( Song Kwon Choi ),이승구 ( Seung Koo Lee ),나성훈 ( Sung Hoon Na ),이향아 ( Hyang Ah Lee ),이동헌 ( Dong Heon Lee ),황종윤 ( Jong Yun Hwang ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.11
Isolated tubal torsion is a rare disease that causes acute lower abdominal pain. In most of cases, the ovary and the fallopian tube are together twisted due to an ovarian tumor, but the fallopian tube alone is rarely twisted. Tubal torsion mainly occurs in fertile women, and it rarely occurs prior to menarche and during menopause. We experienced a case where isolated tubal torsion occurred in a perimenopausal female with total abdominal hysterectomy, while the findings showed a normal ovary. We report this case with a brief review of related literature.
다낭성난소증후군 환자에서 Pioglitazone이 인슐린 민감도, 난소 기능, 난소 기질 내 혈류에 미치는 영향
이향아,김정훈,최정원,박선정,이수정,최은선,김성훈,채희동,손영수,강병문,Lee, Hyang-Ah,Kim, Chung-Hoon,Choi, Jeong-Won,Park, Sun-Jung,Lee, Soo-Jeong,Choi, Eun-Sun,Kim, Sung-Hoon,Chae, Hee-Dong,Son, Young-Soo,Kang, Byung-Moon 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.2
Objective: This study was performed to investigate the effects of pioglitazone, an insulin sensitizing agent, on insulin resistance, ovarian function and intraovarian stromal blood flow in patients with polycystic ovarian syndrome (PCOS). Material and Methods: Thirty patients with PCOS, aged 18~34 years, were recruited. Criteria for diagnosis of PCOS were as defined in 2003 Rotterdam consensus. They were treated for 6 months with pioglitazone at a dose of 30 mg/day orally. The hormonal blood profile, fasting serum glucose levels, a glycemic response to 75 g oral glucose tolerance test (OGTT), and an ovarian stromal artery (OSA) blood flow were assessed at baseline and after 6 months of treatment. Results: Eighteen (60.0%) of 30 patients treated with pioglitazone demonstrated a spontaneous ovulation After pioglitazone treatment, fasting insulin concentrations, serum glucose levels after 75 g OGTT significantly decreased (p=0.001, p=0.04, respectively), and fasting glucose to insulin (G/I) ratio significantly increased (p<0.001). The pioglitazone treatment induced a significant reduction in serum LH, testosterone (T) and free T levels (p<0.001, p=0.02, p=0.002, respectively). The resistance index (RI) values of OSA significantly increased after treatment (p<0.001). In analyzing pioglitazone-treated patients according to their body mass index (BMI), nonobese group as well as obese group showed a significant improvement in fasting G/I ratio (p<0.01). The pioglitazone treatment induced a significant reduction in serum LH and free T levels in nonobese group (p<0.001, p<0.05, respectively) as well as obese group (p=0.001, p<0.05, respectively). The RI values of OSA significantly increased in both nonobese and obese groups after pioglitazone treatment (p<0.001, p=0.003, respectively). Conclusions: Pioglitazone could ameliorate the glycoinsulinemic metabolism, and this beneficial effects of this drug could improve the endocrine-reproductive condition associated with the decrease of ovarian stromal artery blood flow, in both nonobese and obese patients with PCOS.