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불규칙과다월경에 의한 철결핍성 빈혈과 자발적 성발달을 보인 45,X 터너증후군 1예
권미광,전숙,고관표,오승준,우정택,김진우,김영설 대한내분비학회 2005 Endocrinology and metabolism Vol.20 No.2
Short stature and gonadal dysgenesis are two characteristic clinical features of Turners syndrome. Very rarely, patients with Turners syndrome may menstruate and even be fertile. We experienced a case of Turners syndrome with spontaneous sexual development and menstruation. A 16-year-old girl was referred for severe anemia and menometrorrahgia. She had nearly normal features, with the exception of a short stature and a single right kidney. Also, she had spontaneous development of secondary sexual characteristics. We performed and anemia study and evaluated her short stature. In chromosomal study of her bone marrow and peripheral blood lymphocytes, she was revealed to have monosomy 45,X. Herein, this case is reported, with a brief review of literature 일염색체성 터너 증후군에서 자발적 성발달과 함께 자발적 월경을 보이는 경우는 매우 드물다. 저자들은 자발적 성발달과 초경을 경험하고 저신장 이외에 정상적인 외모를 지닌 16세여자 환자가 심한 비기능성 자궁출혈과 빈혈을 주소로 내원하여 일염색체성 45,X 터너 증후군으로 밝혀진 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
제2형 당뇨병 환자에서 아포지단백 E의 유전자 다형성과 미세알부민뇨 발생과의 연관성
권미광 ( Mi Kwang Kwon ),이상열 ( Sang Youl Rhee ),전숙 ( Suk Chon ),오승준 ( Seung Joon Oh ),우정택 ( Jeong Taek Woo ),김성운 ( Sung Woon Kim ),김진우 ( Jin Woo Kim ),김영설 ( Young Seol Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
목적: Apo E 유전자 다형성은 당뇨병성 신증 발생과 진행에 관여하는 유전적 인자 중의 하나로 연구되어 왔으나 이의 연관성에 대해 아직까지 명확한 결론이 없는 상태이다. 한국인 제2형 당뇨병 환자를 대상으로 한 연구에서는 e2 대립형질과 E2 아형이 현성 당뇨병성 신증 발생에 위험 요인임을 밝힌 연구가 있으나 모두 단면적 조사연구이고 또한 초기 당뇨병성 신증인 미세알부민뇨 발생과의 연관성을 밝힌 연구가 부족한 실정이다. 따라 서 본 연구에서는 미세알부민뇨군과 정상알부민뇨군을 비교함으로써 Apo E 유전자 다형성과 미세알부민뇨 발생과의 연관성을 확인하고 이에 혈청 지질농도가 관련이 있는지 알아보기로 하였다. 방법: 경희대학교 병원 내분비대사 내과 외래에서 10년 이상 치료 중인 제2형 당뇨병 환자들 중 1998년에 서 2003년 사이에 시행한 미세알부민뇨 검사 상 정상알부민뇨(n=59)나 미세알부민뇨(n=37)를 보이면서 당시 신기능이 정상이고 10년째의 당뇨 유병기간을 포함한 환자들을 대상으로 하였으며 real-time PCR을 이용해 Apo E 유전자형을 결정하였다. 두 군에서 성별, 연령, 고혈압의 빈도 등 임상적 특성과 함께 10년간의 평균 총 콜레스테롤, 중성지방, 크레아티닌, 당화 혈색소를 구하여 비교하였으며 Apo E 유전자형, 대립형질, 아형 발현빈도를 비교하였다. 결과: 미세알부민뇨군이 정상알부민뇨군에 비해 평균 당화 혈색소(7.6±1.3% vs 7.0±0.9%, p=0.012)와 평균 크레아티닌(1.2±0.7 mg/dL vs 1.0±0.2 mg/dL, p=0.004)이 유의하게 높았고 e3/e4 유전자형(5.6% vs 20.7%, p=0.045)과 E4 아형(5.9% vs 22.8%, p=0.035) 발현 빈도가 유의하게 낮았다. 당화 혈색소, 고혈압, 총 콜레스테롤, 중성지방을 보정하기 전 시행한 로지스틱 회기분석에서 E2 아형과 E4 아형의 비교위험도는 각각 0.833(95% CI 0.245-2.833), 0.205(95% CI 0.043-0.986)였다. 그러나 보정한 후에는 E2 아형과 E4 아형의 비교위험도가 각각 0.664(95% CI 0.134-3.289), 0.365(95% CI 0.061-2.187)로 Apo E 유전자 다형성과 미세알부민뇨 발생과의 연관성이 약화되었다. 건강대조군, 정상알부민뇨군, 미세알부민뇨군에서 Apo E 아형과 혈청 총 콜레스테롤, 중성지방 농도 사이에는 유의한 연관성이 없었다. 결론: 한국인 제2형 당뇨병 환자에서 E4 아형은 미세알부민뇨 발생을 증가시키지 않으며 이의 발생을 억제할 것으로 기대되고 Apo E 아형과 혈청 총 콜레스테롤, 중성지방간의 연관성은 없었다. Background: Apo E genetic polymorphism has been proposed as the one of the risk factors for diabetic nephropathy. We studied the association between Apo E genetic polymorphism and the development of microalbuminuria, which is the early stage of diabetic nephropathy. Methods: Fifty eight subjects with normoalbuminuria and Thirty six subjects with microalbuminuria were enrolled. They were all type 2 diabetic patients who had normal renal function and a history of diabetes longer than a 10 years duration. We examined the mean HbA1c, total cholesterol and triglyceride levels for 10 years, and we also examined several clinical characteristics. We determined the Apo E genotype by performing real time PCR. Results: In the microalbuminuria group, compared with the normoalbuminuria group, the HbA1c (7.6±1.3% vs 7.0±0.9%, respectively, p=0.012) and mean creatinine (1.2±0.7 mg/dL vs 1.0±0.2 mg/dL, respectively, p=0.004) levels were significantly higher, and the frequencies of the e3/e4 genotype (5.6% vs 20.7%, respectively, p=0.045) and the E4 carriers (5.9% vs 22.8%, respectively, p=0.035) were significantly lower. On logistic regression analysis, the crude odds ratio of being an E2 carrier and being an E4 carrier were 0.833 (95% CI: 0.245-2.833) and 0.205 (95% CI: 0.043-0.986), respectively. However, the odds ratio after adjusted by HbA1c, hypertension, total cholesterol and triglyceride were 0.664 (95% CI: 0.134-3.289) and 0.365 (95% CI: 0.061-2.187), respectively. There were no correlations between being an Apo E carrier and the lipid levels in the healthy controls and diabetic patients. Conclusions: Being an E4 carrier might play a role in protecting against the development of microalbuminuria in type 2 diabetic patients and there was no correlation among the Apo E genetic polymorphisms and the lipid levels. (Korean J Med 72:511-521, 2007)
진현정,권미광,이향이,김이형,고관표,박근용,전숙,오승준,우정택,김성운,김진우,김영설,양문호 대한내분비학회 2005 Endocrinology and metabolism Vol.20 No.4
Acute suppurative thyroiditis is an uncommon disease, which usually affects patients with pre-existing thyroid gland pathology. Here, a case of thyroid abscess associated with lymphocytic thyroiditis, was experienced in a 35-year-old female. She had a fever, chill, sore throat and tenderness in the area of the left thyroid of 10days duration. She visited our hospital due to her persistent sore throat, which did not subside after antibiotics treatment for 5 days. On neck ultrasonography, a heterogeneous nodule(1.3×1.5×2.1cm) in the right lobe and cyst-like nodule (1.8×1.5×2.8cm) in the left lobe of the thyroid were found. The thyroid gland showed slightly increased, uneven uptake of Tc-99m on a thyroid scan. Pus-like fluid aspirated from the left nodule showed numerous neutrophils and necrotic materials on cytological examination. Abundant lymphocytes were found in aspirates from the right thyroid nodule. Neither a finding suggestive of pyriform sinus nor other anomaly was discovered in the neck CT scan and UGI series. After further antibiotic treatments for 2 weeks, the inflammatory symptoms and thyroid tenderness completely subsided. However, the nodule in the right lobe of the thyroid was still palpable, but without tenderness when examined after 4 weeks 본 증례는 림프구성 갑상선염에 병발된 급성화농성 갑상선염으로 국내 최초의 보고이다. 환자는 평소 건강하게 지내다 상기도 감염 증세 후 지속된 인후통으로 내원하여 경부 초음파 상에서 양측에서 결절이 발견되었고 세침흡인 검사에서 우측 결절은 다량의 림프구 침윤을 보이고, 좌측 결절은 다수의 중성구와 괴사 조직을 포함하고 있었다. 갑상선 스캔은 불균등한 섭취를 보였고 갑상선 기능 검사는 정상이었다. 항생제 치료 후 경부 컴퓨터 단층 촬영에서는 좌측 농양은 사라지고 우측 결절은 남아 있는 상태로 그 외 해부학적 이상 소견은 없었다. 환자의 림프구성 갑상선염에 대해서는 향후 장기적인 추적관찰이 요구된다.
마비성 장폐쇄를 동반한 변비와 고혈당 악화로 발현된 부신경절종 1예
황승준,권미광,전숙 대한내분비학회 2008 Endocrinology and metabolism Vol.23 No.6
Paragangliomas are extra-adrenal pheochromocytomas that arise from specialized neural crest cells. They are distributed anywhere from the upper neck to the pelvic floor, and they are classified on the basis of their anatomic origin. Functioning paragangliomas can cause the same clinical manifestations as pheochromocytoma, such as hypertension, diabetes mellitus, hyperadrenergic spells and so on. We experienced a retroperitoneal paraganglioma that was found in 66 year-old male who suffered from intractable constipation, and his constipation was caused by paralytic ileus and uncontrolled hyperglycemia. After he was diagnosed, removal of the paraganglioma was done and his clinical symptoms and sustained hyperglycemia were successfully resolved
이상열,전숙,권미광,박이병,안규정,김인주,김성훈,이형우,고경수,김두만,백세현,이관우,남문석,박용수,우정택,김영설 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.5
Background: The Korean National Diabetes Program (KNDP) cohort study is performing an ongoing large-scale prospective multicenter investigation to discover the pathogenesis of type 2 diabetes in Korean patients. This study was performed to examine the prevalence of chronic complications in patients with type 2 diabetes among those registered in the KNDP cohort within the past 4 years. Methods: This study was performed between June 2006 and September 2009 at 13 university hospitals and included 4,265 KNDP cohort participants. Among the participants, the crude prevalence of microvascular and macrovascular diseases of those checked for diabetes-related complications was determined, and the adjusted standard prevalence and standardization of the general population prevalence ratio (SPR) was estimated based on the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) population demographics. Results: Among the KNDP registrants, 43.2% had hypertension, 34.8% had dyslipidemia, 10.8% had macrovascular disease, and 16.7% had microvascular disease. The SPR of the KNDP registrants was significantly higher than that of the KNHANES subjects after adjusting for demographics in the KNHANES 2005 population. However, with the exception of cardiovascular disease in females, the standardized prevalence for the most complicated items in the survey was significantly higher than that in the KNHANES subjects. Conclusion: The prevalence of macrovascular disease and peripheral vascular disease were significantly higher in Korean patients with type 2 diabetes than in the normal population. However, no significant difference was noted in the prevalence of cardiovascular disease in females.