당뇨 환자에서 활차 운동 후 혈중 t-PA 및 PAI-1 의 변화

최정혜(Jung Hye Choi),김순길(Sun Gil Kim),이응수(Woong Soo Lee),김태화(Tae Wha Kim),김태영(Tae Young Kim),신진호(Jin Ho Shin),이재웅(Jae Ung Lee),김경수(Kyung Soo Kim),김정현(Jeong Hyun Kim),임헌길(Heon Kim Lim),이방헌(Bang Hun Lee) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objectives : Plasma fibrinolytic activity is determined by the balance between plasmonogen activators and their inhibitors. The aim of this study was to compare the fibrinolytic activity before and after exercise of the type 2 diabetic patients with control group. Methods : We measured plasma tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigen before and after standardized treadmill exercise in 21 type 2 diabetic patients (14 men, 11 women, ages 46.2±5.6 years) and 21 sex and age- matched control group (10 men, 11 women, ages 48.6±5.4 years). Results : 1) Post exercise t-PA antigen increased in both diabetic group (from 7.36±3.89 to 10.62±4.81 ng/ml, p<0.05) and control group (from 8.30±3.99 to 10.99±5.52 ng/ml, p<0.05). But the rise in t-PA antigen with exercise was similar in both group. 2) Both base line and post exercise PAI-1 antigen levels were similar between the diabetic group (from 29.46±10.35 to 31.48±12.94 ng/ml, p>0.05) and control group (from 30.04±10.40 ng/ml to 31.06±10.88 ng/ml, p>0.05). 3) In diabetic group, significant correlations between base line PAI-1 antigen levels and serum triglyceride levels were observed. And post exercise PAI-1 antigen levels were correlated with systolic blood pressure. Conclusion : The results show that plasma t-PA antigen level is increased after vigorous exercise in patients with type 2 diabetes mellitus and plasma PAI-1 antigen level is not changed. The increment of plasma t-PA level is not different with healthy subjects.

경흉막 후복막 접근에 의한 복부대동맥 축착 수술

이철범,송동섭,김혁,김영학,강정호,이재웅,김순길,Lee, Chul-Burm,Song, Dong-Sub,Kim, Hyuk,Kim, Young-Hak,Kang, Jung-Ho,Lee, Jae-Ung,Kim, Sun-Gil 대한흉부심장혈관외과학회 2001 Journal of Chest Surgery (J Chest Surg) Vol.34 No.3

신동맥 사이 또는 신동맥 상부에 위치하는 대부분의 복부대동맥 축착은 흉복부절개의 접근으로 수술한다. 우리는 경흉막 후복막 접근으로 개복을 하지 않고 단측단측 흉복부대동맥의우회술을 시행한 1례의 수술을 소개하고자 한다. 경흉막 후복막 접근은 흉복부대동맥의 시야가 매우 좋으며 개복을 할 때보다 더 쉽게 흉복부대동맥의 우회술을 할 수 있고 복강내 장기를 노출하지 않는 장점이 있다.

관동맥 질환에서 혈중 Lipoprotein(a)의 농도

한세환 ( Han Se Hwan ),정일권 ( Jeong Il Gwon ),김기업 ( Kim Gi Eob ),문종호 ( Mun Jong Ho ),박찬욱 ( Park Chan Ug ),신승호 ( Sin Seung Ho ),양동호 ( Yang Dong Ho ),김순길 ( Kim Sun Gil ),홍세용 ( Hong Se Yong ) 대한내과학회 1993 대한내과학회지 Vol.44 No.4

연구배경 : 최근 관동맥질환에서 고콜레스테롤혈증과 함께 Lipoprotein(a){Lp(a)}의 증가가 중요한 위험인자로 알려졌다. 저자들은 Lp(a)가 혈전유발인자인 동시에 한국인의 관동맥질환에서 위험인자가 될수 있음을 알아보기 위하여 본연구를 시행하게 되었다. 방법 : 관동맥 질환 환자 26명(급성 심근경색증 12명, 협심증 14명), 고혈압 환자 16명, 건강이 50명을 대상으로 혈중 Lp(a)를 ELISA법으로 측정하고, 관동맥질환 및 고혈압 환자의 혈중 총콜레스테롤치와 혈중 Lp(a)치와의 관계를 비교하여 보았다. 결과 : 혈중 Lp(a)는 관동맥 질환군에서 358±155mg/L, 고혈압군에서 207±110mg/L, 정상군에서 166±33mg/L로 관동맥 질환군에서 고혈압 및 정상 대조군보다 현저하게 증가되어 있었다(p<0.005). 관동맥 질환 환자중 혈중 총콜레스테롤이 200mg/dl 이하인 16례를 다시 분석해보면 혈중 Lp(a)는 294±129mg/L로 역시 고혈압군 및 정상대조군보다 의미있게 증가되어 있었다.(p<0.05). 각 군에서 혈중 Lp(a)의 성별, 연령별 유의한 차이는 없었으며 콜레스테롤이나 중성지방의 농도에도 통계학적으로 유의한 차이는 없었다. 결론 : 관동맥 질환 환자에서 높은 혈중 Lp(a)는 관동맥 질환에 대한 하나의 위험인자가 됨을 시사한다. 또한 혈중 총콜레스테롤이 200mg/dl 이하인 관동맥질환군에서 높은 Lp(a)농도는 콜레스테롤과는 무관하게 하나의 독립적이 위험인자가 되는 것으로 사료된다. Background: Since its description in the early 1960s by Berg, Lp(a) has been shown to be associated with coronary artery disease(CAD). Lp(a) is composed of one LDL particle, to which one molecule of apolipoprotein(a) is covalently linked. Lp(a) excess is considered to have not only ahterogenic but also antifibrinolytic activities by complex mechanisms. The purpose of this study was to evaluate Lp(a) as a risk factor of CAD, and to study the relations between Lp(a) and cholesterol level in patients with CAD. Methods: We determined plasma levels of Lp(a) in 26 patients with CAD including AMI and AP(11 men and 15 women, median age 60 years), in 16 patients with HT(6 men and 10 women, median age 61 years), and in 50 control subjects (25 men and 25 women, median age 57 years) clinically free of cardiovascular disease. We measured plasma Lp(a) level in CAD and HT group with ELISA method and compared the result with that of control group. We also measured serum cholestreol and TG with autoanalyzer in CAD and HT groups. Results: Plasma Lp(a) levels were 358±155mg/L in CAD group, 207±110mg/L in HT group and 166±33mg/L in control group. Patients with CAD had higher Lp(a) levels than HT and control subjects(p<0.005). No gender differences in Lp(a) levels were observed between men and women(patients or control subjects). No statistically significant differences were seen for total cholesterol and TG in each group. We analyzed again plasma Lp(a) levels of 16 patients with CAD whose cholesterol levels are below 200 mg/dl. It was 294±129mg/L, also higher in CAD compared with HT and control groups(p<0.05). Conclusion: The Lp(a) levels of the CAD groups were significantly higher than those of HT and control groups, this suggest that Lp(a) excess is a risk factor for the development of CAD. The high Lp(a) levles in patients who has serum total cholesterol below 200 mg/dl is considered that is a risk factor, independent of high cholesterol level.

혈중 Urokinase 농도와 Plasmin 형성에 관한 연구

홍세용 ( Hong Se Yong ),양동호 ( Yang Dong Ho ),신현길 ( Sin Hyeon Gil ),신승호 ( Sin Seung Ho ),조용욱 ( Jo Yong Ug ),김순길 ( Kim Sun Gil ),김기용 ( Kim Gi Yong ),기은경 ( Gi Eun Gyeong ),정광회 ( Jeong Gwang Hoe ) 대한내과학회 1992 대한내과학회지 Vol.42 No.3

urokinasr를 치료목적으로 사용할 때 바람직한 urokinase의 혈중 농도를 알기 위하여 시험관 내에서 free form plasmin을 형성하는 urokinase의 농도를 다음과 같은 실험을 통하여 규명하였다. Normal pooled plasma (NPP)에 urokinase를 가하여 다양한 농도의 urokinase를 포함하는 NPP를 만들고 S-2444 및 S-2241를 이용하여 free form urokinase 및 plasminm을 측정하였고 동시에 FDP가 형성되는 양상을 관찰하였으며 SDS-PAGE and electrophoretic enzymography를 이용하여 free form plasmin이 형성되는 urokinase의 농도를 알아내고자 하였던 바 free form plasmin은 urokinase 5-10 unit/ml의 농도에서 검출되기 시작하였다. 따라서 urokinase 투여중 therapeutic window는 urokinase 10 unit/ml을 기준으로 설정되어야 하며 이를 기준으로 loading dose 및 maintenance dosage를 위한 연구가 있어야 할 것으로 사료된다. To find out the urokinase concentration at which free form plasmin begin to form in plasma, we measured plasmin from the normal pooled plasma of various concentration of urokinase between 300 unit/ml and 2.4 unit/ml, by chromogenic method (S-2251) and SDS-PAGE with fibrin-agar zymography. Free form plasmin begin to be detected by both chromogenic method and SDS-PAGE with fibrin-agar zymography between 5∼10 unit/ml of urokinase. This finding suggest that the urokinase concentration should be around 10 unit/ml for the effective fibrinolysis during intravenous administration.

간경변증 환자에서 t - PA , Euglobulin 섬유소용해능 및 Protein C , S 의 변화와 식도정맥류출혈과의 관계

황성규(Seong Gyu Hwang),백승호(Seung Ho Baik),양동호(Dong Ho Yang),이문호(Moon Ho Lee),조용욱(Yong Wook Cho),김순길(Soon Gil Kim),오도연(Don Yeun Oh),조성원(Sung Won Cho),김선주(Sun Joo Kim),홍세용(Sae Yong Hong) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Bleeding is common complication and a leading cause of death in cirrhotic patients, Accelerated fibrinolysis and coagulation inhibitor were contributing factors to bleeding. Method: In a study of 20 normal control and 20 liver cirrhosis (10 liver cirrhosis without esophageal variceal bleeding and 10 liver cirrhosis with esophageal variceal bleeding), we tried to evaluate fibrinolytic activity 8r inhibitory factors of the coagulation in liver cirrhosis and to find correlation between variceal bleeding and parameters of fibrinolysis % coagulation inhibitors. Results: 1) t-PA antigen was significantly increased(p <0.05) in patients with liver cirrhosis(22.2±12.5ng/ml) than in normal contro1(3.9±1.9ng/ml), but there was no statistically significant increase in cirrhotic patients with bleeding(26.2±13.8ng/ml) as compared to cirrhotic patients without bleeding(18.2±10.1ng/ml). 2) Euglobulin fibrinolytic activity was significantly higher(p<0,05) in patients with liver cirrhosis(145±37.6 BAU) than in normal control(91±7.8 BAU), but there was no statistically significant increase in cirrhotic patients with bleeding(150±64 BAU)as compared to cirrhotic patients without bleeding(131±22 BAU). 3) The activities of protein C was significantly lower(p<0.05) in patient with bleeding(41±9%) than in patient siwthout bleeding(54±18%). 4) The activities of protein S was lower in patient with bleeding(62±18%) than in patients without bleeding group(77±17%), but there was no statistical significance. 5) There was a significantly linear correlatian between t-PA antigen and euglobulin fibrinolytic activity in normal control and in patients with liver cirrhosis (r=0.807, p<0.01). Conclusion: Fibrinolytic activity(t-PA k euglobulin fibrinolytic activity) was increased in cirrhotic patients, but there was no statistically significant increase of fibrinolytic activity with relation to esophageal variceal bleeding. The activities of protein C was significantly decreased in liver cirrhosis with relation to esophageal variceal bleeding.

본태성 고혈압의 이론

김순길 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.1

At the present time, the mechanism of pathogenesis of essential hypertension is not completely understood, and no single specific genetic defect is known for it. The interplay of various genetic and environmental factors may precipitate the disease. The proposed pathogenetic mechanisms are genetic predisposition, increased renal retention of sodium defects in cell membrane transport, increased sympathetic nervous activity, vascular hypertrophy and increased peripheral arterial resistance, defects in renin-angiotensin system, and insulin resistance and hyperinsulinemia. However understanding of these mechanisms is essential for prevention and treatment of essential hypertension. Therefore the major theories of the pathogenesis and their controversies are discussed and literatures are reviewed.

수축기 고혈압의 관리를 위한 약제의 선택

김순길 대한간질학회 2003 대한간질학회지 Vol.9 No.1

구리 지역에서 조사한 고혈압의 인지도, 치료률 및 관리률

홍철호,김순길,홍택원,이제,신진호,이재웅,김경수,김정현,임헌길,이방헌 대한간질학회 2003 대한간질학회지 Vol.9 No.1

항응고제 사용 중 발병된 소장의 체강벽내 혈종

김종표,김순길,오승일,박준성,김동욱,이재형,이 상,이재웅,김경수,이철범,김정현,임헌길,이방헌 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Hemorrhages are the main complications associated with oral anticoagulant therapy. Spontaneous intramural small bowel hemorrhage is considered to be a rare but clinically serious problem. The exact pathogenesis of these complications is unknown. Neither the clinical nor the laboratory and radiologic features are in themselves diagnostic of intramural hematoma, but if a patient receiving anticoagulant therapy is suspicious to have hemorrhagic complications, then radiological workup of the patient including abdominal ultrasound and a CT scan should be considered. The management of patients with proved or suspected anticoagulation associated intramural hemorrhage of the small intestine is conservative, but surgery should be contemplated if the patient's condition does not improve when the anticoagulant is withdrawn. A 75-year-old female patient who received anticoagulant therapy with warfarin due to atrial fibrillation, mitral stenosis and aortic regurgitation was admitted to our hospital because of abdominal pain. A pre-contrast abdominal CT scan revealed intramural hematoma of small intestine. After immidiate cessation of the anticoagulant and conservative treatment with transfusion, the patient was improved. Therefore, we report the clinical course of the patient and review literatures.

자발성 관동맥 박리증에 의한 급성 심근경색증

홍택원,김순길,김태엽,정재면,고동희,이재웅,김경수,김정현,임헌길,이방헌,이철범 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It occurs in relatively young people with a striking predilection for women, mainly during or after prognancy. The optimal management of spontaneous coronary artery dissection has not been established yet and may vary, depending upon the presence of intimal versus extramural compromise. Coronary artery bypass, stenting, and thrombolysis may have been successful and also may have failed, owing to extension of dissection. We describe a case of acute myocardial infarction caused by spontaneous coronary artery dissection which occurs in a 51-year old man. The coronary angiography showed a spiral dissection of right coronary artery, from the origin of conus branch to the distal portion of right coronary artery. An intimal plaque with 35% obstruction and normal (TIMI 3) flow was demonstrated. The patient was functionally recovered after conventional midical treatment including heparin, beta blockers and long acting nitrates. Four months later, follow up coronary angiography showed stabilization of coronary lesion and improvement of stenosis.