항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

연작업자들에서의 δ -aminolevulinic acid dehydratase 유전형질의 다형성이 신기능에 미치는 영향

안익수,황보영,김용배,리갑수,이성수,장봉기,함정오,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

δ-aminolevulinic acid hehydratase (ALAD) is a polymorphic enzyme that has two alleles, ALAD1 (ALAD1-1 as phenotype) and ALAD2 (ALAD1-2 or ALAD2-2 as phenotype). ALAD genotype has been reported to modify the toxicokinetics of lead. To investigate the influence of ALAD genotype polymorphism on renal function in lead workers, author studied 1022 male lead workers and 149 non lead workers in the same industries. For the cross-sectional renal function indices, blood urea nitrogen (BUN), serum creatinine, uric acid and total protein were selected. Blood lead and blood zinc protoporphyrin were also measured as indices of lead exposure. Information on weight, age, job duration, smoking & drinking history were collected. Following results are as follows: 1. Whereas the mean (standard deviation) of blood lead and blood ZPP of lead workers were 27.2±12.5 ㎍/㎗ and 57.7±37.8 ㎍/㎗, those of non-lead workers in the same premises were 14.9±6.5 ㎍/㎗ and 44.6± 15.8 ㎍/㎗ respectively. The difference of mean blood lead and blood ZPP between two groups were statistically significant. 2. Whereas the prevalence of the variant allele, ALAD2 in 1022 lead workers was 10.2 %, the prevalence of that in 149 non-lead workers was 7.4 %. But there was no difference of prevalence between two groups. 3. The mean±standard deviation of blood lead of subjects with ALAD1 was 25.5± 12.7 ㎍/㎗ and was slightly lower than that of subjects with ALAD2 (26.5±10.9 ㎍/㎗), and the mean±standard deviation of blood ZPP of subjects with ALAD1 was slightly higher than that of subjects with ALAD2 (56.7±37.3 ㎍/㎗ vs 48.9±18.6 ㎍/㎗). But the differences of blood lead and blood ZPP between two genotypes were not statistically significant. 4. There were no differences of cross-sectional renal function indices (BUN, serum creatinine, uric acid and total protein) either by lead workers and non-lead workers or two genotypes. 5. In multiple regression analysis of ALAD genotype on BUN after controlling for possible confounders (sex, weight, job duration, smoking and drinking status), the mean of BUN in ALAD2 subjects was 0.629 ㎎/㎗ lower than ALAD1 subjects with a weak statistical significance (p=0.07). But in logistic analysis of ALAD genotype on median value of BUN revcaled that subjects of ALAD2 genotype were 32% less likely to have median value or more of BUN than subjects of ALAD1 with odd ratio of 0.618 (95% confidence interval 0.411-0.920). 6. In multiple regression analysis of ALAD genotype on serum creatinine after controlling for possible confounders (sex, weight, job duration, smoking and drinking status), the mean of serum creatinine in ALAD2 subjects was 0.0271 ㎎/㎗ lower than ALAD1 subjects with statistical significance (p=0.02). On the other hand, in logistic analysis of ALAD genotype on median value of serum creatinine revealed that subjects of ALAD2 genotype were 30% less likely to have median value or more of scrum creatinine than subjects of ALAD1 with odd ratio of 0.700 (95% confidence interval 0.442-1.080). With the above results, it was found that the variant allcle, ALAD2 appeared to modify the association of lead and renal function and ALAD2 genotype may be supportive for the protective effect of lead.

價値와 事實에 관련된 政策科學의 方法論的 基礎

안병용 동국대학교 대학원 1990 연구논집 Vol.20 No.-

제조에 對한 文獻的 考察

안태규,최병렬,송기철,이용연,유화승,서상훈,최우진,조정효,이연월,손창규,조종관 대전대학교 한방병원 2001 惠和醫學 Vol.10 No.1

In the literatual study on Holotrichia, the results were obtained as follows ; 1. Holotrichia is larva of Holotrichia diomphalia Bates etc. powder or liquor of Holotrichia is used medically. 2. Appearance of Holotrichia is shape of kidney, yellowish color. 3. The oriental characters of Holotrichia is warm, toxicant, salty. 4. The significant efficancy of Holotrichia is breaking the stagnant blood. 5. Holotrichia can be applied to the diseases related to thrombosis, and recover the demage of liver. 6. Holotrichia avails Liver diseases such as Hepatitis, Liver cirrhosis, Hepatosplenomegaly, Hepatoma etc.

미세 펀칭 구멍의 디버링 특성에 관한 연구

안병운,최용수,박성준,윤종학 한국공작기계학회 2003 한국공작기계학회 추계학술대회논문집 Vol.2003 No.-

In micro hole punching process the burr occurs inevitably, but the burr must be minimized in order to improve the quality and accuracy of the product. In this study, magnetic field assisted polishing technique is applied to remove the burr which exists in nozzles for ink jet printer head and proved to be a feasible for deburring by experiment. The deburring characteristics of sheet metals was investigated changing with polishing time. After the deburring, the burr size has remarkably reduced and roundness of the hole also has improved.

Golgi 염색 기법에 대한 연구

안병권,박매자,김은희,배용철,홍해숙,조희중,주강 慶北大學校 醫科大學 1990 慶北醫大誌 Vol.31 No.4

여러 Golgi methods 중에서 본 실험실 환경에 적합한 방법을 확립하기 위해서, Golgi Method, Golgi-Kopsch modification, silver-chromate Golgi method 그리고 Rapid Golgi method의 네가지 방법을 실제로 실시했는데 그 중 Adam의 silver-chromate Golgi method에서 가장 좋은 결과를 얻었는데 그 결과는 다음과 같다. 1) 착색에 소요되는 시간이 약 7일 정도였다. 2) 대뇌피질, 시상하부, 뇌간의 모든부위 등 실험을 실시한 거의 모든 부위에서 착색된 신경세포를 관찰할 수 있었다. 3) 착색된 신경세포는 세포체 뿐만 아니라 축삭돌기, 수상돌기 그리고 수상돌기소극 등의 미세구조도 잘 관찰되었으며, 규칙적인 분포를 하였다. 4) 착색된 신경교세포와 혈관은 저밀도로 관찰되었다. Four modifications of the Golgi method, i. e. Golgi method, method, Golgi-Kopsch modification, silver-chromate Golgi method and rapid Golgi method were tested to find out most reliable method. Compared to another 3 modifications, Adams' silver chromate Golgi method was found to have several advantages as follows. 1) It took 7 days for impregnation procedure. 2) Neurons were well impregnated and their axons, dendrites and spines could be identified very clearly. 3) Impregnated neurons formed few clusters. 4) Glias and vessels showed very minimal impregnations.

韓國地方稅行政에 관한 硏究

安秉龍 동국대학교 행정대학원 1983 행정논집 Vol.13 No.-

직업적 연폭로가 일부 신경행동학적 검사수행에 미치는 영향

안익수,안현철,김용배,리갑수,김화성,황규윤,최은,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

In order to investigate that blood lead levels of lead exposed workers is associated with decreased performance in neurobehavioral tests in adults, we investigate 78 workers in a battery industry. Three items among neurobehavioral core test battery of World Health Organization, including digit span, Santa ana dexterity, digit symbol were administered to workers occupationally lead exposed workers by operational guide for the WHO neurobehavioral core test battery. Blood lead (PbB) and zinc protoporphyrin in whole blood (ZZP) were selected as an index of lead exposure. Detailed occupational history such as exposed agent, age, work duration, smoking and drinking habits, were recorded as confounding factors. After controlling age, the results of digit span and digit symbol among the neurobehavioral tests were significant contributed by PbB.

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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價値와 事實에 관련된 政策科學의 方法論的 基礎

안병용 동국대학교 대학원 1990 大學院硏究論集-東國大學校 大學院 Vol.20 No.-

In response to the radical social change, the policy sciences is in full swing in every field of social science. What is the policy science as a new academic mainstream? Since the coinage of this new word by harald D. Lasswell. there have been no systematic and consistent wiews on the condept, scope, and nethod of the policy sciences. Also he proposed. If our policy needs are to be served. what topics of reseasch as most worthy of pursuit? what are the most promising methods of gathering facts and interpreting their significance for policy? How can facts and interpretatins be made effective in the decision making process itself? If this study the essential problems in the policy ciences are dealt with values and facts. About the question of policy sciences, it has been stimulated by the fact that policy sciences is an exceedingly popular enterprise thesedays. but any reading of the literature on "policy" make it abundantly clear that it is not a well defined concept. This thesis is made up of five chapters. Chapter one is an introduction, chapter two is the policy science as a new a academic mainstream, chapter three is methodological bases of policy science, chapter four is development of policy science, and chapter five is conclusion. In short, the policy sciences is an emancipatory discipline that improves the human dignity in theory and practice and is practice that reifies the normative theory in the real situational context