양극성 경향과 스트레스 취약성:기분장애설문지 양성 반응군과 음성 반응군에서 지각된 스트레스, A형 행동, 그리고 생활습관의 비교

김병수,김성윤,최재원,주연호,윤대현,한내진,김유신,김선옥,Kim, Byung-Su,Kim, Seong-Yoon,Choe, Jae-Won,Joo, Yeon-Ho,Yoon, Dae-Hyun,Han, Nae-Jin,Kim, Yoo-Shin,Kim, Seon-Ok 한국정신신체의학회 2010 정신신체의학 Vol.18 No.1

연구목적 : 본 연구를 통해 양극성 장애 I형 혹은 II형 진단 기준에는 부합하지 않지만, (경)조증적 성향 혹은 기분 불안정성 등의 양극성 경향(bipolar tendency, bipolarity)을 가진 사람에게서, 주관적으로 지각하는 스트레스 수준, 스트레스 취약성을 반영하는 것으로 알려진 A형 행동 유형(Type A Behavior Pattern, TABP), 그리고 건강하지 못한 생활습관의 위험이 증가되어 있는지 확인하고자 한다. 방 법 : 정신과적 병력이 없는 30세 이상의 1987명의 연구 대상군이 분석에 포함되었다. 이들 중에서 기분장애설문지 (Mood Disorder Questionnaire, MDQ)의 (경)조증적 증상 경험에 대한 13개 항목 중에서 7개 항목에 "예"라고 응답한 사람들을 양극성 경향군으로 분류하였다. 양극성 경향군과 비양극성 경향군 사이에서 지각된 스트레스 척도(Perceived stress scale, PSS), TABP를 반영하는 A/B 생활 습관 설문(A/B Lifestyle ques-tionnaire) 점수와, 음주, 흡연, 불규칙적인 식사, 운동 부족 등의 생활 습관 변인을 비교하였다. 결 과 : 양극성 경향군(329명, 16.6%)은 비양극성 경향군에 비해 TABP를 반영하는 A/B 생활 습관 설문의 총 점수가 유의미하게 높았으며(125.4점 vs. 115.9점, p<0.001), TABP로 판정(총 점수 135점 이상)된 비율도 양극성 경향군에서 유의미하게 높은 것으로 관찰되었다(41.3% vs. 30.1%, p<0.001). 주관적으로 지각하는 스트레스 수준의 비교에서도, 양극성 경향군이 비양극성 경향군에 비해 유의미하게 높았다(18.5 vs. 16.5, p<0.001). 생활습관의 비교에서 '불규칙적인 식사'(20.1% vs. 14.3%, p=0.002), '주 4회 이상 음주'(29.8% vs. 16.5%, p<0.001), '현재 흡연'(41.9% vs. 23.0%, p<0.001), '주 2회 이하 운동'(63.2% vs. 55.1%, p=0.007) 이라고 응답한 사람의 비율이 양극성 경향군에서 유의미하게 높았다. 결 론 : 양극성 경향을 가진 경우는 스트레스에 취약한 행동 양상이 높게 관찰되고, 주관적으로 지각하는 스트레스 수준도 높고 흡연, 음주, 불규칙한 식사와 운동 부족과 같은 건강하지 못한 생활 습관을 가지고 있을 위험도 높은 것으로 확인되었다. 이러한 위험 요소들은 비만, 대사증후군, 당뇨, 그리고 심혈관계 질환의 발병 위험을 높일 수 있으므로, 양극성 경향을 가진 사람들은 스트레스 관리 및 건강한 생활 습관을 유지하기 위한 보다 적극적인 노력이 필요하다. Objectives:Authors hypothesized that bipolar tendency of non-psychiatric person would be associated with stress vulnerability. To test the hypothesis, we compared perceived stress level, Type A Behavioral Pattern (TABP) and unhealthy lifestyle between person with and without bipolar tendency. Methods:The study cohort consisted of 1987 subjects without past and current psychiatric history. In this study, bipolar tendency was determined by MDQ response which requires endorsement of at least 7 of the 13 "yes or no" questions. We compared the scores of Perceived Stress Scale, A/B lifestyle questionnaire, and unhealthy lifestyle(alcohol, smoking, lack of exercise, irregular meal) between MDQ positive and negative respondents. Results:We identified the bipolar tendency group determined by the MDQ positive response were 329 subjects(16.6%). The overall score of the bipolar tendency group was significantly high on the A/B lifestyle questionnaire compared to the non-bipolar tendency group(125.4 vs. 115.9, p<0.001), and the rate of the subjects defined as TABP was also significantly high(41.3% vs. 30.1%, p<0.001). In comparison of subjectively perceived stress level, the bipolar tendency group was observed to be significantly higher than the non-bipolar tendency group (18.5% vs. 16.5%, p<0.001). The bipolar tendency group was significantly higher than the non-bipolar tendency group on the rate of answering:'irregular eating habit' (20.1% vs. 14.3%, p=0.002), '4-or-more-times alcohol intake per week' (29.8% vs. 16.5%, p<0.001), 'currently smoking' (41.9% vs. 23.0%, p<0.001), '2-or-less-times physical exercises per week' (63.2% vs. 55.1%, p=0.007). Conclusion:By clinical diagnosis, even a person who does not meet the criteria of bipolar disorder has a high risk of stress-related behavioral pattern, and perceived stress when possessing bipolar tendencies such as the (hypo) maniac tendency or affective instability. Such individual has significantly higher risk of having unhealthy life-style such as smoking, drinking, irregular eating habit and lack of exercise compared to non-bipolar tendency group. Since these risk factors lead to increase the risk of obesity, metabolic syndrome, diabetes, and cardiovascular diseases, the individual with the bipolar tendency requires a more effort to manage stress and to maintain healthy lifestyle.

전신성 홍반성 루푸스에 병발된 결절성 다발동맥염

김한중,유대현,김성윤,이창우 ( Han Joong Kim,Dae Hyun Yoo,Seong Yoon Kim,Chang Woo Lee ) 대한피부과학회 1991 대한피부과학회지 Vol.29 No.3

A Case of Polyarteritis Nodosa Associated with Systemic Lupus Erythematiosus Han Joong Kim, M.D., Dae Hyun Yoo, M.D.*, Seong Yoon Kim, M.D.*, Chang Woo Lee, M.D. Departments of Dermatology & Rheumatology*, College of Medicine, Hanyang University, Seoul, Korea A 24-year-old female with systemic lupus erythematosus(SLE) diagnosed 3 year prior, presented with star-burst patches on her lower legs, which resembled livedo reticularis. In addition, she complained of intermittent lower abdominal pain. Histopathologic findings of the lesional skin showed necrotizing vasculitis of the medium sized dermal arteries. Direct immunofluorescent studies revealed deposits of IgG, IgM, and C_3 in the depp dermal arteries. Angiographic findings showed several foci of aneurysms in the superior mesenteric artery. Among those patients with SLE, the co-existences with polyarteritis nodosa have rarely been reported in the literature. We believe that circulating immune complexes of pahtological quantity and quality, which are thought to be related to the clinical activity of SLE, maybe relevant to the development of immune-complex mediated necrotizing arteritis in this patient.

주의력 결핍 과잉행동장애아를 위한 주의력 검사도구의 표준화연구 : Cognitrone 검사를 중심으로

홍택유(Tak Yoo Hong),유희정(Hee Jung Yoo),김진희(Jin Hee Kim),김성윤(Seong Yoon Kim),김창윤(Chang Yoon Kim),한오수(Oh Su Han) 한국정신병리진단분류학회 1998 精神病理學 Vol.7 No.2

N/A N/A

류마토이드 관절염에 대한 Thymopentin 의 치료효과에 관한 임상적 연구

유대현(Dae Hyun Yoo),배상철(Sang Cheol Bae),박찬현(Chan Hyun Park),김성윤(Seong Yoon Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.4

N/A Thymopentin is a synthetic pentapeptide corresponding to residues of 32-36 of the parent thymic hormone, thymopoietin, and has been shown to have some immunomodulating actions, especially on T lymphocytes. Thymopentin was used in the treatment of rheumatoid arthritis, and its clinical efficacy was noted by a few investigators. We experienced the antirheumatic effect and side reaction of thymopentin in 20 patients with active rheumatoid arthritis. The results were as follow; 1) Eleven out of the 20patients studied were classified as responders. 2) With thymopentin treatment, clinical rheumatic activity improved moderately in 2patients, minimally in 9patients, uchanged in 7patients, and worsened in 2patients. 3) ESR was changed after the 10th and 12th week but not changed during thymopentin therapy. 4) The Ritchie articular index, swollen joint score, the number of painful joints on motion and rest, and the patients self-assessment of pain improved between the 6th and 8th week, but the grip strength of both hands and the duration of morining stiffness were not changed significantly. 5) Side reactions were found in only 3 patients and eliminated without specific medical intervention. In summary, thymopentin could be administered without serious side effects for 8weeks. Although the clinical effect was noted after 6weeks of treatment, the antirheumatic effect of thymopentin was not significant. It may be necessary to conduct further studies regarding a more simple method of administration, combination therapy with conventianal I)MARD, and maintenance therapy of thympentin.

한국인에서 류마토이드 관절염과 제 2 형 조직적합항원과의 연관성에 관한 연구

유대현(Dae Hyun Yoo),서정대(Jeong Dai Suh),배상철(Sang Cheol Bae),김성윤(Seong Yoon Kim),김목현(Mok Hyun Kim),김신규(Thin Kyou Kim),주경빈(Kyung Bin Joo) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

N/A Rheumatoid arthritis is a chronic inflammatory disease characterized as destructive polyarthritis and has evidence of immunogenetic and environmental elements in its etiologic factors. Many studies document that one of the key genetic elements is closely linked to the class II major histocompatibility complex located in chromosome 6. Although it is not. known precisely how HLA genes contribute to disease susceptibility, many studies document a close association between rheumatoid arthritis and the specific histocompatibility marker, HLA-DR4. However, studies of HLA-DR4 in disease severity have yielded conflictiing results. Association between HLA- DR4 and the rheumatoid factor, earlier age of onset, increased general disease severity and more erosive radiographic changes have been reported, but these associations have not been confirmed in other studies. In addition, there has been no report regarding the association between rheumatoid arthritis and class II MHC in Koreans. Therefore this is the first epidemiologic study regarding the association between rheumatoid arthritis and class II MHC. The disrtibution of class II major histocompatibility complex and association between HLA- DR4 and disease severity were analyzed in 206 Korean patients with rheumatoid arthritis in this study. The results were as follows: 1) HLA-DR4 was associated with rheumatoid arthritis in 61.6% of the patients studied. The relative risk and etiologic fraction of HLA-DR4 were 2.47 and 0.367, respectively. HLA-DR1 was positive in 11.1% and the etiologic fraction of HLA-DR1 was 0.008. Therefore HLA-DR4 was associated strongly with rheumatoid arthritis in Koreans, similar to other ethnic populations, but HLA-DR1 was not associated with rheumatoid arthritis in Koreans. 2) HLA-DR2 was positive in 19.9% and the preventive fraction of HLA-DR2 was 0.205. HLA-DR7 was positive in 4.3% and the preventive fraction of HLA- DR7 was 0.011. Hence HLA-DR2 was the most preventive class II MHC against the development of rheumatoid arthritis in this study. 3) HLA-Dgw3 was positive in 62.1% and the relative risk of HLA-DQw3 was 1.65, HLA-DQw7, which was known as HLA-DQw3.1, was positive in 20.5% and HLA-DR4 Dgw7 haplotype was positive in 15% of the total number of patients. 4) HLA-DR4 was significantly associated with a more advanced ARA anatomical grade and more severe radiographic changes, including bony erosion, joint space, narrowing and total radiographic score. 5) The rheumatoid facor was positive in 84.3% of the HLA-DR4 positive patients and positive in 82.3% of the HLA-DR4 negative patients. HLA-DR4 v as positive in 62.2% of the 172 seropositive patients and positive in 58.8% of the 34 seronegative patients. Therefore HLA-DR4 was not associated significantly with the presence of a rheumatoid factor in this study. 6) HLA-DR4 was not associated significantly with joint count (Ritchie index), ARA functional class, ESR, C-reactive protein or other demographic data. HLA-DR4 was not associated significantly with the positive rate of ANA, cryoglobulin. 7) Homozygous HLA-DR4 patients were 31 out of 127 DR4-positive patients and showed more advanced ARA anatomical stage and radiographic changes than heterozygous DR4 patients, but the difference was statistically insignificant. In summary, HLA-DR4 was significantly associated with rheumatoid arthritis in Koreans, similar to other ethnic populations, Also HLA-DR4 was significantly associated with more destructive arthritis, but not associated with rheumatoid factor positivity and the parameters representing disease activity of rheumatoid arthritis.

관절의 연골조직에서 VLA항원의 발현에 관한 연구

유대현 ( Dae Hyun Yoo ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),김성윤 ( Seong Yoon Kim ),정현기 ( Hyun Kee Chung ),최일용 ( Il Yong Choi ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

목적: 대표적인 유착분자인 VLA항원은 세포와 세포 간, 세포와 세포외 기질단백 특히 collagen, fibronectin, laminin 등과의 유착에 관여하여 매우 다양한 생물학적 기능을 보유하고 있다. 류마티스 관절염과 퇴행성 관절염에서 질환의 발병기전과 연골의 재생과정에 VLA항원이 관여할 것으로 추측되지만 이에 대한 연구는 미진하였다. 이에 저자들은 정상인과 류마티스 관절염 및 퇴행성 관절염 환자의 연골조직에서 VLA항원의 발현양 상을 관찰하고 정상조직과의 차이점을 비교하기 위해 본 연구를 시도하였다. 방법: 정상 대조조직 1예, 류마티스 관절염 10예, 퇴행성 관절염 7예에서·연골조직을 획득하여, 단세포군항체를 이용한 면역조직화학법으로 VLA항 원의 발현을 관찰하였다. 결과: 1) 정상 연골조직은 CD29와 VLA-5의 발현이 가장 현저하였고, VLA-l와 3는 대단히 약하고 일정하지 않은 발현을 보였다. CD51의 발현은 CD29와 비슷한 정도로 강하였으나 CD61의 발현 은 없었다. 2) 퇴행성 관절염의 연골조직은 CD29, CD51, VLA-5의 발현강도가 정상 조직에 비해 증가되었고 연골세포의 증식으로 군집을 형성한 부위에서 가장 현저하였다. VLA-l과 3의 발현양상은 정상 연골과 비슷하였으냐, 연골세포가 군집을 이룬 부위에서는 발현의 강도가 현저히 증가하였다. 3) 류마티스 관절염의 연골조직도 퇴행성 관절 염의 조직소견과 유사하게 CD29, CD51, VLA-l, 3의 발현강도가 정상 조직보다 약간 증가된 소견을 보였다. 결론: 이상의 결과로 VLA항원이 류마티스 관절염과 퇴행성 관절염의 연골조직에서 정상보다 강하게 발현되고, 특히 fibrnectin을 배위자로 하는 VA 5와 a.f1이 주로 발현되는 VLA항원임을 알았다. 향후 VLA항원이 관절염의 발병기전에서 차지하는 기능에 관한 연구와 여러 성장인자들과 cyokine이 VLA항원의 양적인 발현에 미치는 영향에 관한 연구가 필요할 것으로 사료된다. Objective: The adhesion molecule that mediate cell-cell and cell-extracellular matrix adhesion provides very important role in growth and differentiation of cells and tissue. VLA integrin is a prototype of adhesion molecule which participate in cell-cell and cell-extracellular matrix interacton, especially for collagen, laminin and fibronectin. The biologic functions of VLA-integrin are very diverse. Cartilage is the target tissue of various arthritides including rheumatoid arthritis and osteoarthritis and the process of homeostasis in cartilage matrix may be very important in preservation of cartilage. Although VLA integrin may participate in the process of cartilage degeneration and repair mechanism, tissue distribution and exact role of VLA integrin in cartilage was not yet clearly defined. Methods: Immunohistochemical analysis of VLA-integrin in cryostat section of articular cartilage was conducted using monoclonal antibody and avidin-biotin complex method. Analysis was performed in 10 rheumatoid arthritis specimens, 7 osteoarthritis specimens and 1 normal control. Results: 1) Normal cartilage showed strong and diffuse stain with CD29, CD51 and moderate stain of VLA-5. Staining pattern of VLA-1 and 3 was inconstant and weak in intensity. 2) The intensity of VLA expression in articular cartilage of osteoarthritis was upregulated chiefly in CD29, CD51 and slightly in VLA-5. The positive rate of VLA-l and 3 was similar to that of normal cartilage though the intensity was increased especially at cluster of chondrocytes. 3) VLA-integrin expression of rheumatoid arthritis cartilage was similar to that of osteoarthritis cartilage. Conclusion: VLA integrins functioning as fibronectin receptor such as VLA-5 and α,β1 were upregulated in osteoarthritis and rheumatoid arthritis. Intensity was increased at clusters of chondrocytes. It was able to presume from above findings that VLA molecule has some role in the maintenance and repair of articular cartilage. The regulation of expression by cytokines and growth factors and exact function of VLA molecule in cartilage have to be elucidated.

주의력결핍과잉행동장애의 아형에 따른 기질 및 성격 변인의 차이

유한익 ( Han Ik K. Yoo ),김진용 ( Jin Yong Kim ),전정원 ( Jeong Won Jeon ),박수빈 ( Su Bin Park ),홍진표 ( Jin Pyo Hong ),김성윤 ( Seong Yoon Kim ),김창윤 ( Chang Yoon Kim ),류인균 ( In Kyoon Lyoo ) 한국정신병리진단분류학회 2005 精神病理學 Vol.14 No.1

Objectives: This study was performed to identify temperament and character factors in children and adolescents with attention deficit hyperactivity disorder(ADHD) according to diagnostic subtypes, which were assessed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version(KSADS-PL). Methods: Ninety subjects with ADHD(72 males, 10.07±2.73 years) were diagnostically assessed with the KSADS-PL given separately to mothers about their children and to children about themselves. The JTCI was applied to measure temperament and character factors. Separate JTCI data were obtained from mothers about their children and from children about themselves. Basic demographic data were also obtained. Results: More girls were diagnosed as predominantly inattentive type of ADHD(p=.048). Even after adjusting the influence of sex, combined and predominantly hyperactive-impulsive type of ADHD group showed higher Reward Dependence(p<.001) and Persistence(p=.007), and lower Self-Directedness(p=.048) and Cooperativeness(p=.004), and younger age(p=.038) than predominantly inattentive group. Conclusion: Temperament and character factors were significantly associated with ADHD subtypes.

연골표면에 침착한 면역물질의 양상에 관한 연구

유대현(Dae Hyun Yoo),정성수(Sung Soo Jung),이인홍(In Hong Lee),배상철(Sang Cheol Bae),김성윤(Seong Yoon Kim),김신규(Think You Kim),정현기(Hyun Kee Chung),최일용(Il Yong Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.6

N/A Background: Immune deposits were found on the articular surface of rheumatoid arthritis and osteoarthritis even though the prevalence and pattern of immune deposits were differnt between rheumatoid arthritis and osteoarthritis. Authors conducted this study to compare the pattern and positive rate of immune deposits on surface of articular cartilage between rheumatoid arhtritis and osteorthritis. Methods: Articular cartilages were obtained from patients who were conducted total joint replacement surgery at knee or hip joint. Selected cases were 15cases of rheumatoid arthritis, 45cases of osteoarthritis. Immune deposits were searched using direct immunofluorescent technique with FITC conjugated anti-IgG, IgA, IgM, C, antibody. Results: 1) Positive rate of immune deposits on articular cartilage was 66.7% in rheumatoid arthrtis and 26.7% in osteoarthritis. 2) Granular staining pattern was found in only 6patients out of 10positive patients with rheumatoid arthritis. In osteoarthritis, the pattern of immune deposits was not granular but nongranular pattern such as intermittent linear or linear pattern. 3) Positive rate in primary osteoarthrits and secondary arthritis was 32%, and 26.7% respectively. 4) Rheumatoid factor was reactive not only in 6cases with granular pattern but also in 3cases without immune deposits and in 2cases with nongranular pattern. Coclusion: Immune deposits was found more frequently in rheumatoid arthritis than osteoarthritis and granular pattern was noted in cases with rheumatoid arthritis only. The differences in prevalence and pattern of immune deposits between rheumatoid arthritis and osteoarthritis may be due t different antigen, mechanism of immune deposition or another unknown factors. Further investigation have to be conducted in these respects.

다발성 폐결절로 나타난 Behcet 씨병의 폐동맥염 1 예

유대현(Dae Hyun Yoo),정성수(Sung Soo Jung),최영춘(Young Chun Choi),이진(Jin Lee),안종훈(Jong Hoon Ahn),김성윤(Seong Yoon Kim),박성수(Sung Soo Park),이정희(Jung Hee Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.5

N/A Behcet's disease is known as a multisystemic disease caused by nonspecific vasculitis of obscure origin. Among the systemic manifestations, pulmonary involvement is know to be very rare and only a few cases have been documented. The most important features of pulmonary lesions in Behcet's disease are the fleeting nature of the pulmonary infiltrate and recurrent hemoptysis, which is often massive and fatal. We report a case of Behcet's disease manifested as multiple pulmonary nodules which was caused by pulmonary infarction as a result of pulmonary arteritis.

류마티스 관절염과 퇴행성 관절염의 활액막조직에서 VLA 항원의 발현에 관한 연구

유대현(Dae Hyun Yoo),정성수(Sung Soo Jung),이인홍(In Hong Lee),배상철(Sang Cheol Bae),김성윤(Seong Yoon Kim),김목현(Mok Hyun Kim),정현기(Hyun Kee Chung),최일용(Il Yong Choi) 대한내과학회 1994 대한내과학회지 Vol.46 No.5

N/A Objective: The adhesion molecule that mediate cell-cell and cell-extracellular matrix provides very important role in various physiologic and pathologic conditions, VLA integrin is heterodimeric transmembrane glycoprotein which participate in cell-cell and cell-extracellular matrix, especially collagen, laminin and fibronectin. Rheumatoid arthritis is important prototype of chronic inflammatory disease. Continuous emigration and anchorage of chronic inflammatory cells are prerequisite for the perpetuation of disease. Transient episode of inflammatory synovitis could be found in osteoarthritis also. Although the notion that VLA-integrin play a major role in the initiation and perpetuation of arthritis would be possible, distribution of VLA integrin in synovial tissue of rheumatoid arthritis and osteoarthritis was investigated by immunohistochemistry. Methods: Immunohistochemical analysis of synovial tissue utilizing avidin-biotin complex method was con- ducted. Applied monoclonal antibodies were CD49a-f, CD29, CD51, and CD61. The pattern of expression was scored by semiquantitative grading system. Results: 1) The expression of CD29 was diffuse and intense at synovial lining cells, endothelium and infiltrating inflammatory cells. Endothelial stain was evident with VLA-1, 6, CD51 and negative with VLA-4. Inflammatory cells expressed VLA-4, 5 intesively and synoviocytes expressed VLA-3, 5, 6 and CD51 as ligand for fibronectin and laminin. 2) CD29 expression of inflammatory cells were prominent around small blood vessles which showed strong stain of CD29 and located just beneath the synovial lining cells. 3) VLA-integrin expression in synvoium of osteoarthritis was smimilar to that of rheumatoid arthritis except little inflammatory cell infiltratilon and little proliferation of microvasculature. Conclusion: It was able to presume from above findings that VLA-integrin has been doing some role in the development and perpetuation of synovitis. Future perspectives in field of VLA-integrin may be exact process of intracellular signalling, functional aspect of integrin and regulation of expression by some cytokines and growth factors.