당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

알코올 의존 환자에서 금주시간에 따른 갈망 정도와 Leptin, ACTH, Cortisol 혈중 농도의 변화와 상관 관계

김봉조,변기욱,한규희,손진욱,박철수,곽욱환 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.1

점진적 Distraction Technique을 이용한 상악골의 전방이동

박영욱,차봉근,김지혁 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.6

Several surgical and/or orthodontic procedures have been used in maxillary protraction. Currently procedures with the use of distraction osteogenesis have been studied by many investigators and applied to various clinical situations and this procedure is rapidly becoming an alternative technique to treat craniofacial growth disturbances and dysplasias. So we performed distraction osteogenesis for 12-year old young patient with maxillary hypoplasia, and 7-year old young patient with severe maxillary deficiency due to unilateral cleft lip & palate. First we performed incomplete Le Fort I osteotomy(pterygomaxillary dysjunction and no maxillary downfracturing) and then tried to protract the maxilla by way of extraoral device, Delaire type face mask. During the follow-up period of 12 months and 13 months respectively, we could attain the successful results by analysis of lateral cephalometrics in facial profiles. So we suggest that this maxillary distraction technique is one of the excellent therapeutic choices in the treatment of growing children with maxillary deficiency.

Sol-gel 공정에 의한 Silica sol의 합성 및 특성

이봉우,최용욱,우기석,박문수,김선일 조선대학교 생산기술연구소 1998 生産技術硏究 Vol.20 No.1

Reaction completion time was investigated to measure OH/CH ratio as reaction time at 25℃. In 50 and 60 minute reaction was completed in 1.0 ratio that was reached equilibrium state. In another method, equilibrium, state was investigated by measuring volume% of C₂H_(5)OH. From 40 to 50 minute. that was reached at 61.6 of volume% After reaction. monomer and tetrasilicate(92%) as main product was discovered and so oligomer(6%). Mean molecular weight (Mw) of sol solution was about 7.000. The beginning point and ending point of hardening was measured through the TGA investigation of reaction material. The hardening of sol solution was complected in 7 minute and viscosity was maximum from 4 to 5 minute and was set at 9 minute.

Type Ⅳ 과지질혈증에서 나타난 다발성 건 황색종 : 1례 보고 One Case Report

천동욱,김홍태,박봉훈,변영수,홍순만,손경락,문세광 최신의학사 1992 最新醫學 Vol.35 No.10

외상성 내반주의 수술적 치료에 대한 고찰

김호태,박봉훈,신창재,천동욱 최신의학사 1988 最新醫學 Vol.31 No.11

요추부 유합 후 인접분절 각운동의 변화

김홍태,박봉훈,천동욱,김형표,정재호 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1

A lumbar fusion may influence biomechanically on the remained unfused segments to take over the lost motions. The adjacent segments to fusion particulatly will experience an additional motional stress following a fusion, and then various late complications can occur. Moreover, the amount of this stress may differ according to the levels and extents of the fusions. The aim of this study is to evalu- ate this motional stress in different levels of fusion. A retrospective review of flexion and extension lateral radiograghs was undertaken for 142 consec- utive patients who had undergone various fusions in the lumbar region. Included in this study were the patients who had performed active daily livings after surgery and followed for minimum of two years. They were 60 males and 82 females, having mean age of 46.7(range 14-72). There were three posterior fusions, 123 lateral fusions, and 16 interbody fusions. The extent of fusions were one seg- ment in 71, two segments in 53, three segments in 16, and four segments in two patients. The follow- up period was 53 months in average(range 2-15 years). The intervertebral angles were measured on the flexion/extension lateral radiographs, and then the calculated intervertebral angular motions at follow-up periods were compared with those of preoperative values. The average increases of angular motion at the adjacent segments to fusions were 2.3˚at L1-2 seg- ment(ranging 0˚to 5˚increase),2.5˚at L2-3 segment(ranging 1˚decrease to 8˚increase), 2.9˚at L3-4 segment (ranging 3˚decrease to 12˚increase), 6.7˚at L4-5 segment(ranging 2˚to 18˚ increase), and 1.5˚at L5-S1 segment(ranging 5˚decrease to 7˚increase). The average increases of the above and below adjacent segments to fusions were 3.3˚(ranging 3˚decrease to 18˚increase) and 1.7˚(ranging 5˚decrease to 12˚increase) respectively. There were no significant differences in the changes of angular motion according to the extents of fusion and during these follow-up periods. In conclusion, the angular motions at the adjacent segment to fusions increased most signficantly at L4-5 segment regardless of the fusion sites whether it is below or above a fusion. Excluding the L4-5 segment, the angular motions at the above adjacent segments to fusion increased significantly compared to those at the below adjacent segments. The late complications at adjacent segments to lumbar fusions are expected to appear preferably at these segments.

구개인두 부전증 16증례의 임상적ㆍ방사선학적 연구

김종렬,박봉욱 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.5

Velopharyngeal adequacy is the ability of speech mechanism to create a seal between the oral and the nasal cavities during speech. The basic components of the velopharyngeal mechanism are the soft palate, the lateral pharyngeal wall, the posterior pharyngeal wall, associated musculature of the soft palate and pharyngeal wall, and the adenoid mass. If velopharyngeal inadequacy exists, the complete seal cannot be obtained during speech, resulting in hypernasal speech quality. This report is the clinical and cephalometric study of 16 consecutive cases of velopharyngeal inadequacy which were corrected by superiorly based pharyngeal flaps with lateral port control. The summarized results were as follows; 1.The total number of patients was 16(11 males, 5 females). They all showed hypernasality and nasal emission at preoperative period. 2.Hypernasality and nasal emission were shown in 13 and 5 patients respectively at immediate after operation, and decreased as 4 and 2 respectively at 6 months after operation. 3.Most patients showed snoring after operation and slowly decreased during follow-up periods. 4.During follow-up periods, the pharyngeal flap was slightly elongated at its horizontal length and moved inferiorly at its attached base. But this change was not as significant as it influenced on the clinical results.

항정신병약물을 투여 받은 정신분열병환자의 체중,BMI,및 혈장 Leptin 농도의 변화

김재종,변기욱,김봉조,손진욱,박철수 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.1

Objective : Weight gain is a major side elect of treatment with newer antipsychotics. The mechanism, however, of weight gain is poorly understood. Recent researches suggested that there is a positive relationship between the levels of plasma leptin and the weight gains of the schizophrenic patients receiving the antipsychotics. This study was conducted to verify, firstly, the effect of the use of olanzapine and haloperidol on the weight gain, BMI, and the change of plasma leptin concentration and to find, secondly, whether there is any co-relationship between the plasma leptin level and the antipsychotic-induced weight gain. Method : 18 male schizophrenia inpatients were divided into two groups receiving olanzapine(N=8) or haloperidol(N=10) treatment and weight, BMI and plasma leptin level were measured weely over 5 weeks. Prior to the whole measurements, and patients were curtailed all diet from 21:00 of the previous day and the blood samples were collected at 8:00 and 8:15 in the morning. Results : In schizophrenic patients receiving olanzapine, significant increases in weight and BMI were found from the second week of medication, while those of the plasma leptin levels were shown from third week. In schizophrenic patients receiving haloperidol, no significant increases in the measurements were found for the 5 weeks of medication period. There was a close co-relationship between the plasma leptin concentration and the body weight increases. The weight gains were initiated from the second week of medication while the increases of plasma leptin concentration were started from the third week. The weight gains were followed by the continuative increases in plasma leptin levels for up to 5 weeks. Conclusion : Medication of olanzapine appears to be associated with an increase in weight, BMI, and plasma leptin level, whereas that of haloperidol does not. From the results observed the following suggestion could be made that most probable reason for olanzapine-induced increases in leptin levels are weight gain.

反應性 加熱 蒸着法에 依한 水素化된 非晶質 게르마늄의 電氣的 特性

李原鎭,梁承勳,朴奉斗,羅炳旭 慶北大學校 師範大學 1985 敎育硏究誌 Vol.27 No.-

Reactive thermal evaporation of high purity polycrystalline germanium was carried out in an atmosphere of hydrogen plasma. Deposition temperature (T_s) and hydrogen pressure (P_(H_2)) were proved to be important parameters to determine the electrical properties of samples, as expected, and the optimum T_s was determined as 200℃. Evaporation onto a substrate at 200℃ in an atmosphere of 1 torr hydrogen plasma has been shown to yield a film which shows a low RT conductivity (10^-6Ω^-1㎝^-1) and an activation type conduction (with an activation energy of 0. 38 0. 42eV) in measuring temperature (above RT). And for optimized samples, germanium hydrogen bonds were proved to be stable even after annealing at 400℃.