쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

D-Amphetamine이 니코틴성 흥분작용에 의한 카테콜아민 분비작용에 미치는 영향

임건한,서유석,민선영,임지연,김용직,나광문,임동윤 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1

본 연구의 목적은 d-arphetamine이 흰쥐의 적출부신 관류모델에서 니코틴 수용체 흥분에 의한 카테콜아민(CA) 유리작용에 미치는 영향을 검색하여 그 작용기전을 규명하고자 하였다. D-amphetamine은 흰쥐 부신정맥내로 60분간 관류시 d-amphetamine자체는 약한 CA 분비작용을 나타내었으나, d-amphetamine (30 μM)을 비롯한 강력한 neuronal nicotine 수용체 작용제인 cytisine (50 μM) 및 epibatidine (30 μM)에 의한 CA 유리작용을 처음 4-10분 동안만 유의하게 증강시켰다. 또한, d-amphetamine (30 μM)은 60분간 부신정맥 내로 관류한 상태에서 dihydropyridine L-형 칼슘통로 개방약물인 Bay-K-8644 (10 μM)과 세포질내 칼슘저장고에서 Ca^(2+) ATPase 억제제인 cyclopiazonic acid (10 μM)의 CA 유리작용을 처음 4분간만 유의하게 증강시켰다. 그러나, 고농도의 d-amphetamine (500 μM)은 상기한 모든 분비촉진제의 CA분비작용을 오히려 억제하였다. 이와 같은 연구결과로 보면, 흰쥐 관류 부신수질에서 d-amphetamine은 낮은 농도에서는 콜린성 니코틴 수용체 흥분에 의한 카테콜아민 분비반응을 증강시키지만, 고농도에서는 오히려 억제적으로 작용함을 시사한다. 따라서, d-amphetamine은 용량에 따라서 흰쥐 적출 관류부신수질의 니코틴 수용체의 작용제 및 길항제로 이중 작용(dual action)을 나타내는 것으로 생각된다. 이러한 d-amphetamine의 작용은 흰쥐 부신수질 크롬친화세포의 dihydropyridine계 L-형 칼슘통로의 활성화 및 세포 내 칼슘저장고로부터 칼슘유리작용과 관련성이 있는 것으로 사료된다. The purpose of the present study was to examine the effect of d-amphetamine on CA release evoked by nocotinic receptor stimulation from the isolated perfused model of the rat adrenal gland, and to establish its mechanism of action. D-amphetamine(30 μM), when perfused into an adrenal vein of the rat adrenal gland for 60 min, enhanced the CA secretory responses evoked by ACh (5.32 mM), nicotine (30 μM), cytisine (50 μM, a selective neuronal nicotinic Nn-receptor agonist) and epibatidine (30 nM, a selective neuronal nicotinic Nn receptor agonist) only for the first period (4~10 min), although it alone has weak effect on CA secretion. Moreover, d-amphetamine (30 μM) in to an adrenal vein for 60 min also augmented the CA release evoked by BAY-K-8644, an activator of the dihydropyridine L-type Ca^(2+) channels, and cyclopiazonic acid, an inhibitor of cytoplasmic Ca^(2+) ATPase only for the first peroid (4 min). However, in the presence rather inhibited the CA secretory responses evoked by the above all of secretagogues. Taken together, these experimental results suggest that d-amphetamine at a low concentration enhances the CA secretion from the rat adrenal medulla evoked by stimulation of cholinergic nicotininc receptors, but at a high concentration it rather inhibits them. It semms that d-amphetamine has dual action acting as both agonist and antagonist at nicotinic receptors of the isolated perfused rat adrenal medulla, which are might be dependent on the concentration. It is also thought that these actions of d-amphetamine are probably relevant to the activation of the dihydropyridine L-type Ca^(2+) channels located on the rat adrenomedullary chromaffin cell membrane and release of Ca^(2+) from the cytoplasmic store.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

물시멘트비 및 단위수량에 따른 고품질 재생잔골재를 사용한 재생콘크리트의 공학적 특성에 관한 실험적 연구

문형재,송민섭,김재환,장종호,김용로,김무한 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1(구조계)

The purpose of this study is to investigate and analyze experimentally and positively engineering properties of recycled concrete using high quality recycled fine aggregate according to w/c ratio and unit water contents. And it is intend to present fundamental data for the mix design and the improvement of quality. The results are as follows; According to the increase of W/C ratio, the addition ratio of superplasticizer was reduced, the strength of compressive and tensile showed low and carbonation depth and chloride penetration depth showed high. And according to the increase of unit water contents, the addition ratio of superplasticizer was reduced, the strength of compressive and tensile showed low and carbonation depth and chloride penetration depth showed high.

외상 후 뇌 지방색전증 1예

문정미,소정일,김용권,류진호,허탁,서정진,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Post-traumatic fat embolism was first reported by Zenker in 1862, Von Bergmann reported the first clinical diagnosis of the fat embolism syndrome in 1873. Fat embolism has been associated with traumatic or non-traumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. The diagnosis of fat embolism syndrome is based on the patient's history, is supported by clinical signs of pulmonary, cerebral, and cutaneous dysfunction, and is confirmed by the demonstration of arterial hypoxemia in the abscence of other disorders. Two different mechanisms cause fat to embolize: direct entry of deposit fat into the blood stream and agglutination of endogenous or exogenous plasma fat. MRI can detect a cerebral fat embolism with a higher sensitivity than cerebral CT. We report a case of post-traumatic cerebral fat embolism without pulmonary involvement, and we present a review of the literature. A 16-year girl had a traffic accident and pelvic bone fracture. Forty eight hours later severe trauma become stuporous without a focal neurological deficit. The patient received supportive therapy, and her condition improved throughout her hospital course. She was discharged with good condition after a 30-day hospital stay.

응급실에 내원한 환자에서 어지럼증의 원인과 임상양상의 분석

문원식,정경운,위준선,문정미,전병조,김용권,소정일,류진호,허탁,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. Methods: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. Results: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo Conclusion: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, spectral radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.

급성 충수염으로 진단된 예측 불가 염증성 맹장 종물에 대한 외과적 고찰

민경진,백무준,채만규,김성용,이문수,김창호,김재준,송옥평 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: An unexpected inflammatory cecal mass of uncertain etiology was encountered during surgery for presumed appendicitis. In this case, the surgeon couldn't exclude differential diagnosis which were severe appendicitis involving the cecal region, diverticular disease, other inflammatory bowel diseases, and neoplasm. Therefore, this finding leads to a therapeutic dilemma for the surgeon, when making surgical decisions during the operation. The aim of this study was to resolve this dilemma, a retrospective review was undertaken in this study. Methods: A retrospective study was performed to review the management of this problem at Soonchunhyang University Chunan Hospital for eight and half years from July 1991 to December 1999. A review of the emergency operation records identified 50 patients who had undergone ileocecal resection or right hemicolectomy for an inflammatory ileocecal mass of uncertain etiology when operated on for probable appendicitis. Results: Altogether, 39 patients underwent ileocecal resection, and 11 patients underwent right hemicolectomy. The final pathologic diagnosis was appendiceal abscess in 32 patients (63%), cecal diverticulitis in 7 patients (14%), neoplasm in 6 patients (12%), appendiceal phlegmon in 3 patients (6%), ileal tuberculosis in 1 patient (2%) and Anisakiasis in another patient (2%). The neoplasm of the 6 neoplasm patients was ascending colon cancer for 4 patients and cecal cancer for 2 patients. There was no mortality in this group. Conclusion: Although most inflammatory cecal masses are caused by benign disease, all cases in which the intraoperative diagnosis is unclear, any pathologic diagnosis including neoplasm cannot be ruled out. So this suggest ileocecal resection or right hemicolectomy to remove a possible underlying malignancy, and to decrease morbidity and mortality.

연령의 증가에 따른 남성의 골밀도와 골교체율의 생화학적 표지자의 변화

민용기,안규정,정재훈,고은미,이명식,이문규,김광원,이종헌 대한골대사학회 1995 대한골대사학회지 Vol.2 No.2

자동문을 위한 무선 안전 장치 시스템 및 중앙 통제 소프트웨어 개발

문병현,박종수,최상민,최용운,제정광 대구대학교 정보통신연구소 2004 情報通信硏究 Vol.3 No.2

본 논문에서 고급형 실내 자동문의 설계 및 제작한다. 실내에서 사용되는 특성에 따라 소음이 최소화되어야 하며 미세한 물건이나 어린이의 작은 신체 일부가 자동문에 끼이는 안전사고를 방지하기 위한 안전장치가 필수적이다. 따라서 본 시스템은 IrDA의 적외선 방식과 용량성 센서를 이용한 안전 장치 시스템을 설계하고 자동문을 가정용 컴퓨터를 이용하여 직접제어 하거나 외부에서 이더넷(Ethernet)으로 접속하여 제어 및 표시할 수 있는 프로그램을 개발한다. 또한 지능형 빌딩과 같이 다수의 자동창문을 화재, 강제 환기 및 기타 관리를 위한 중앙 통제 관리 시스템으로 확장된 중앙 통제 소프트웨어를 개발을 하였다. In this paper, the automatic door for indoor use is designed and developed. Since the door is used indoor, the noise should be minimized and the accident that can happen by small object and childrens fingers strapped by the door would be prevented. Thus, Safety module by using infrared is designed and the program that controls the door using ethernet is also developed. For the use of the large intelligent building, the program that can control the multiple doors is also developed.

세라믹 섬유필터를 이용한 디젤 입자상물질 배출저감에 관한 기초연구

주용남,홍민선,문수호,이동섭,임우택 한국대기환경학회 2003 한국대기환경학회지 Vol.19 No.3

Works were focused on back pressure characteristics of ceramic fiber filter on DPF(Diesel Particulate Filter) system and experiments were performed to select appropriate filter which can filter particulates. Filters were installed on metal-support tube which has openings for exhaust as flow. Ceramic fiber filters with high specific surface area and adequate high temperature strength are commercially available for filtration of diesel particulates and in-situ hot regeneration. Thus, ceramic blanket and ceramic board which are used as insulating media were applied to filter and filteration apparatus was installed on exhaust as line connected to 2.0L diesel engine. Alternating filter structure to adapt DPF system, collection efficiency test of diesel particulates was measured. In case of ceramic blanket, pressure drop was low, caused by the destruction of soft structures. Also, particulate collection efficiency was decreased depending on loading time. In case of ceramic board, structure design was altered to reduce back pressure on DPF system. Structure design was altered to induce Z-flow by making 10mm and 5mm holes on the surface of media. Alteration of 5mm hole showed that media have low back pressure but particulate collection efficiency was 77%, while 10mm hole showed that of 90%.