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한국의 제2형 당뇨병 환자에서 continuous subcutaneous insulin infusion 치료시 혈당 / 인슐린 지수와 당질/인슐린 비에 관한 연구
김선두(Sun Doo Kim),이길도(Kil Do Lee),김순제(Soon Je Kim),최의광(Ewi Kwang Choi),최수봉(Soo Bong Choi),박선민(Sun Min Park) 대한내과학회 2000 대한내과학회지 Vol.59 No.6
N/A Background : According to the results of Diabetes Control and Complication Trial, the best strategy to prevent and/or delay diabetic complications is to maintain the normal blood glucose levels. This led to emphasize the necessity of intensive management of diabetes. The purpose of the study was to determine blood glucose/insulin index and carbohydrate (CHO)-to-insulin ratios after normalization of blood glucose levels, and to select the factors to influence the blood glucose/insulin index and CHO-to-insulin ratios in Korean type 2 diabetic patients with continuous subcutaneous insulin infusion (CSII) treatment using insulin pump and CHO counting as a meal management. Methods : Fifty-five type 2 diabetic patients who started CSII therapy checked their blood glucose levels before and after three meals, and recorded the amounts of insulin injected in fasting and each meal and the amounts of carbohydrates consumed in each meal. Actual blood glucose/insulin index and CHO-to-insulin ratio were determined using the records, and also they were calculated using Functional Insulin Treatment Training Methods (FITTM) proposed by Howorka. Calculated values were compared to actual values. The meaningful factors to influence the actual values were selected by backward stepwise regression analysis. Results : The average age of the subjects was 49.9±12.5 years, and the duration of diabetes was 8.7±4.5 years. Their body mass index was 22.5±3.6 kg/m2. Daily insulin requirements to normalize the blood glucose levels reached to maximum levels at l0 day CSII treatment, and they were reduced and stabilized after 20 days of the treatment. The quotient K, representing insulin sensitivity, was also decreased after CSII treatment. The basal insulin index was 0.21 IU/kg at 10 days and 0.16 IU/kg at 20 days in our study, and these values were lower than the value from FITTM, 0.35 IU/kg The blood/glucose index was -2.5 mmol/L at 10 day CSII treatment, and it was decreased to -4.4 mmol/L at 20 day treatment to the stable levels. CHO-to-insulin ratio provided by FITTM was 2.59 IU/CHO exchange unit and the ratio was 3.12 IU/CHO exchange unit at 10 days, which was decreased to 1.84 IU/CHO exchange unit at 20 days in our study. CHO-to-insulin ratios at breakfast from carbohydrate counting were higher than those of lunch and dinner, and the ratios were 1.5 to 2.5 IU/CHO exchange unit. According to the stepwise regression analysis, the blood glucose/insulin index was affected by gender, age, body mass index (BMI), fasting blood glucose levels and fasting c-peptide levels, and CHO-to-insulin ratios were influenced by gender, age, BMI, post-prandial blood glucose levels and post-prandial c-peptide levels. Conclusions : CSII treatment can make blood glucose levels maintain in normal ranges in Korean type 2 diabetic patients, and can improve insulin sensitivity. Basal insulin requirements were lower and prandial insulin requirements were higher than those calculated from FITTM. This difference between Korean and the Western can be related to difference of insulin secretion from pancreas and nutrient intake.(Korean J Med 59:602-611, 2000)
창자 가로절단-재문합 실험모델에서 창자신경계통의 형태계측학적 변화
오수연(Soo-Youn Oh),박웅채(Ung-Chae Park),김경래(Kyung-Rae Kim),왕준호(Jun-Ho Wang),이재동(Jae-Dong Lee),김순제(Soon-Je Kim),송우철(Wu-Chul Song),박승화(Seung-Hwa Park) 대한체질인류학회 2007 해부·생물인류학 (Anat Biol Anthropol) Vol.20 No.1
작은창자의 손상 후 시간경과에 따른 재생과정에서 근육층신경얼기와 제1형 카할사이질세포가 각각 어떻게 변화하는지를 살펴보고자 돌창자 가로절단-재문합 실험모델을 제작하여 형태계측학적 방법으로 비교분석 하였다. 형태계측학적 분석을 하기위해 Sprague Dawley계 성숙흰쥐의 돌창자를 가로절단한 후 재문합시킨 실험군과 가로절단을 하지 않고 개복 후 봉합수술만을 시행한 대조군에서 수술 후 3일, 7일, 15일, 30일군의 근육층신경얼기와 제1형 카할사이질세포의 변화를 영상분석기를 이용하여 계수하고 통계처리 하였다. 작은창자의 가로절단으로 인한 손상효과는 근육층신경얼기와 제1형 카할사이질세포에서 동시에 일어났으며 손상부위를 중심으로 앞쪽과 뒤쪽(구강쪽과 항문쪽) 양 방향으로 고르게 나타났다. 손상효과는 수술 후 3일군과 7일군에서 가장 심하게 나타나 근육층신경얼기의 경우 신경세포의 형태적 변성과 아울러 세포수가 약 40% 감소하였다. 제1형 카할사이질세포는 세포수가 20~37% 감소하였으며 대부분 세포의 세포질에는 많은 공포가 형성되어 있었다. 수술 후 15일 이후부터는 재생이 일어나기 시작하여 근육층신경얼기에서 신경세포의 감소정도는 20~25%로 줄어들었으며 세포의 염색정도나 형태가 정상으로 회복되는 양상을 보였다. 제1형 카할사이질세포 수의 감소정도도 13~20%로 줄어들었으며 세포질 내 공포가 형성된 세포의 수도 감소하였다. 수술 후 30일군에서 근육층신경얼기를 이루는 신경세포의 형태는 대조군과 유사하였으며 신경세포의 수는 수술 면을 기준으로 구강쪽과 항문쪽에서 각각 12.3%, 15.6% 씩 감소하여 (p<0.01) 정상으로의 완전한 회복은 이루어지지 않았다. 제1형 카할사이질세포 수는 구강쪽과 항문쪽에서 각각 7.5%, 4.2%씩 감소하였으나 유의한 차이는 없었으며(p>0.01) 세포 형태도 정상이었다. 이로서 작은창자의 가로절단으로 인한 손상효과는 근육층신경얼기에서 좀 더 심하게 나타나며 정상으로의 회복도 제1형 카할사이질세포에 비해 더디게 나타남을 알 수 있었다. This study was performed to investigate the morphometric changes of myenteric plexus and type 1 interstitial cells of Cajal (ICC-I) in regeneration process of small intestine transection. Sprague Dawley rats (200~250 g) were anesthetized with ether; then the full thickness of ileal wall were semitransected; and subsequent end-to-end anastomosis were performed by using 6-0 silk suture thread. Sham-operated rats, which only underwent the laparotomy, were used for control group. Experimental animals were sacrificed at 3 days, 7 days, 15 days, and 30 days after the operation. In each group myenteric plexus and ICC-Is were prepared by histochemical method (NADH-TR stain for myenteric plexus, ZIO stain for ICC-Is) and cell numbers were counted by image analyzer (Image plus pro-5.0, Media Cybermedics, USA). Degeneration of myenteric neurons and ICC-Is occurred simultaneously and it was similar in oral and anal to the site of transection. Degeneration effects were most prominent at 3 days and 7 days after intestinal transection. In myenteric plexus, many neurons had degenerated appearances and about 40% of them were lost. Most of ICC-Is had cytoplasmic vacuoles and 20~37% of the cells were lost. At 15 days after transection, there were no more degeneration in myenteric neurons (20~25% cell loss) and ICC-Is (20~13% cell loss). At 30 days after transection, numbers of myenteric neurons were not recovered as that of the control group. However numbers of ICC-Is were as similar as that of the control group. In conclusion, we confirmed that degeneration effects of intestinal transection are more severe in myenteric plexus than in ICC-Is, and recovery of cell loss occurs more slowly in myenteric plexus.