지속성 복막투석의 동물 모델에서 복막휴식이 용질 수송과 복막 섬유화에 미치는 영향

김석재(Seog Jae Kim),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김용진(Yong Jin Kim),김준홍(Jun Hong Kim),김성호(Sung Ho Kim),김찬덕(Chan Duck Kim),남직화(Jick Hwa Nam) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Ultrafiltration failure has been known as a major cause of dropout from long-term peritoneal dialysis and is often related to peritoneal hyperpermeability. This can be explained in part by progressive peritoneal fibrosis. The present experiment has been under- taken to evaluate the effects of peritoneal rest on peritoneal transport and morphology in rat model of peritoneal dialysis. Twenty-four male rats(Sprague-Dawley, 250-300g) were used and divided into three groups : group 1 (control, n=6) without dialysis, group 2(n=9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n=9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Peritoneal dialysis was performed twice a day with 25mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing lipopolysaccharide(5μg/mL) in the dialysis fluid on days 8, 10 and 12 of peritoneal dialysis. Peritoneal equilibration tests were performed before dialysis and repeated on the 4th and 8th week of dialysis. Mor-phometric analysis of the peritoneal membrane and immunohistochemistry for collagen type I and type III were done in tissue specimens obtained at the time of sacrifice. The D/Do ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 were signifi-cantly lower than baseline value, indicating increase in the peritoneal penneability to glucose after 3 weeks of dialysis. D/Do in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drained dialysate volumes in groups 2 and 3 at week 4 were significantly lower than at baseline; however, The drained dialysate volume in group 3 at week 8 was significantly greater than at week 4. The thickness of the parietal peritoneal membraoe in group 2 and 3 were significantly greater than in group 1. Severity of the thickness of the parietal peritoneal membrane in group 3 was not much than that of group 2(group 1, 11.4±7.6; group 2, 37.5±18.4; group 3, 21.4±12.1 pm). Histologically, the thickened peritoneum in group 2 showed a monolayer of mesothelial cells and under-lying multilayer of curled collagen bundles. Mononu-ciear cells and fibroblasts were embedded in these collagen layers and capillary proliferation was present. Immunohistochemistry for collagen type I and Z demonstrated that the distribution of collagen type llI was richer than that of collagen l in group 2 at fibrotic area of submesothelial region. These findings were decreased in group 3. Ultrastructural examination of the peritoneum showed thicker fibrotic zone and the activated fibro-blasts in group 2 compared to group 1 and 3. Meso-thelial cells were plump and the number of meso-thelial microvilli was decreased in group 2. Nucleus was enlarged and irregular. Intracytoplasmic orga-nelles were also richer than those of group I or 3. In conclusion, peritoneal rest improves ultrafil- tration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal fibrosis. These data suggest that dialysis-induced changes in peritoneal transport and morphology are reversible under the condition of peritoneal rest in this experimental model.

인슐린 비의존성 당뇨병 환자에서 말초신경병증과 신기능 및 영양상태와의 관계

남직화,이현정,한정훈,정상원,신병호,서예경,김정국,하승우,김보완 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.1

목적 : 당뇨병성 신경병증은 당뇨병의 이환기간 및 혈당조절정도와 상관성을 보이며 병인적 기전으로 대사성 요인 및 미세혈류장애성 허혈을 들 수 있으나 대사 이상에 따른 영양상태의 변화나 미세혈류장애를 반영하는 신기능의 장애 정도와의 관계에 대한 연구는 많지 않은 실정이다. 이에 저자들은 당뇨병 환자에서 이환기간에 따라 말초신경병증의 합병이 신기능의 변화 및 영양상태와 관련이 있는지를 검토하였다. 대상 및 방법 : 인슐린 비의존성 당뇨병 환자 400명을 당뇨병의 이환기간에 따라 Ⅰ군(1년 이하), Ⅱ군(1-5년), Ⅲ 군(5년 초과)으로 나누고 말초신경병증의 임상 증상 및 신경전도검사에 의거하여 각 군별로 다발성 말초신경병증 합병군과 비합병군사이의 요중 알부민 배설률을 포함한 신기능및 영양상태 반영지표들을 후향적으로 비교하고 신경병증의 합병과 임상 인자들과의 상관성을 다중 로짓 회귀분석법 및 X^2-test로 분석하였다. 결과: 1) 전체 대상환자에서 이환기간이 길수록, 당화혈색소(HbAlc) 및 요중 알부민 배설률이 높을수록, 혈청 알부민 농도가 낮을수록 다발성 말초신경병증의 발생위험율이 높았다(p<0.05). 또한 이환기간이 길수록 망막병증 및 신병증도 빈번하게 합병되었다. 특히 이환기간이 5년을 초과한 Ⅲ 군에서는 말초신경병증이 있는 군에서 대조군에 비해 이들 미세혈관성 합병증의 발생빈도가 통계학적으로 유의하게 높았다(p<0.05). 2) 다발성 말초신경병증의 유병률은 Ⅰ 군에서 52.5%, Ⅱ 군에서 67.7%, Ⅲ 군에서 83.3%였다. 3) Ⅰ 군중 말초신경병증이 합병된 환자군에서 연령, 공복혈당, 식후 2시간 혈당이 대조군에 비해 높았으며, 혈청 알부민 농도는 낮았다. 위험인자의 비교에서는 연령이 많을수록, 혈청 알부민 농도가 낮을수록 말초신경병증이 발생할 위험율이 높았다(p<0.05). 4) Ⅱ 군중 말초신경병증 합병군에서 비합병군에 비해 당화혈색소(HbAlc), 공복혈당, 요중 알부민 배설률이 높았으며, 헤모글로빈, 헤마토크리트, 혈청 알부민 농도, 체용적지수는 낮았다. 위험인자의 비교에서는 당화혈색소치가 높을수록, 체용적지수 및 혈청 알부민 농도가 낮을수록 말초신경병증이 발생할 위험율이 높았다(p<0.05). 5) Ⅲ 군중 말초신경병증 환자군에서 대조군에 비해 당화혈색소(HbAlc), 공복혈당, 식후 2시간 혈당이 높았으며, 헤모글로빈, 헤마토크리트, 혈청 총단백 및 알부민 농도가 낮았다. 위험인자의 비교에서는 당화혈색소치가 높을수록, 혈청 알부민 농도가 낮을수록 말초신경병증의 발생위험율이 높았다(p<0.05). 결론 : 인슐린 비의존성 당뇨병 환자에서 다발성 말초신경병증의 합병은 혈당조절의 정도 및 이환기간과 밀접한 관계가 있으며, 이환기간에 관계없이 혈청 알부민 농도의 저하와도 관련이 있을 가능성을 시사한다. Bakground : Peripheral polyneuropathy (PPN), the most common complication of diabetes, has been known to relate to the duration of diabetes and degree of glycemic control. However, studies for the relationships between PPN and nutritional status and/or changes of renal function in non-insulin dependent diabetics were uncommon. In patients with NIDDM, the differences in prevalence of PPN and the relationships between PPN and nutritional status and/or changes of renal function according to duration of diabetic state were analyzed. Mehods : Four hundred non-insulin dependent diabetics were allocated into 3 groups according to diabetes duration; group Ⅰ consisted of 59 subjects with ≤ 12 months of NIDDM; group Ⅱ 96 with 12 months to 5 years of NIDDM; group Ⅲ 245 with > 5 years of NIDDM. In each group, indices of glycemic control and nutritional status were compared between those with and without PPN, defined by measuring nerve conduction velocity (unpaired t-test). Correlation of PPN with clinical variables including age, diabetes duration, BMI, waist/hip ratio, indices of glycemic control and nutritional status, and renal function were stuied by multiple logistic regression analysis. Results : 1) In total NIDDM subjects, as the duration, HbAlc, albumin excretion rate were increased and serum albumin was decreased, the development of PPN was increased(p<0.05). As the duration was increased, diabetic retinopathy and nephropathy were also complicated. Particularly, in group Ⅲ, the prevalences of diabetic microvascular complications were statistically significantly increased in diabetics with PPN than those without(p<0.05). 2) The prevalence of PPN was 52.5% in group Ⅰ, 67.7% in Ⅱ and 83.3% in Ⅲ. 3) In group Ⅰ, the age, fasting blood glucose, 2 hour postprandial blood glucose were increased and serum albumin was decreased in diabetics with PPN than those without. As the age was increased and serum albumin was decreased, the development of PPN was increased (p<0.05). 4) In group Ⅱ, HbAlc, fasting blood glucose, erythrocyte sediment rate, albumin excretion rate were increased and body mass index(BMI), hemoglobin, hematocrit, serum albumin were decreased in diabetics with PPN than those without. As HbAlc was increased and serum albumin, BMI were decreased, the development of PPN was increased(p<0.05). 5) In group Ⅲ, HbAlc, fasting blood glucose, 2-h postprandial blood glucose, erythrocyte sediment rate, albumin excretion rate were increased and hemoglobin, hematocrit, serum total protein, serum albumin were decreased in diabetics with PPN than those without PPN. As HbAlc was increased and serum albumin was decreased, the development of PPN was increased (p<0.05). Conclusion : In non-insulin dependent diabetics, peripheral polyneuropathy (PPN) is closely related to the duration of diabetes and degree of glycemic control. Regardless of the duration, peripheral polyneuropathy may be related to nutritional status, i.e., decreased serum albumin.

미세알부민뇨를 동반한 인슐린 비의존성 당뇨병 환자에서 혈장 Endothelin의 변화

서예경,정상원,남직화,신병호,전종민,김정국,김동희,하승우,김보완 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 혈관내피세포에서 생성되는 endothelin(ET)는 강력한 혈관수축작용을 가진 펩타이드로 당뇨병 환자에서 혈관내피세포의 손상여부에 따라 혈중 농도가 증가할 수 있으며 혈관합병증과 관련이 있다는 보고가 있다. 그러나. 혈중 ET치의 상승과 당뇨병성 합병증의 상관성에 대해서는 논란이 많다. 이에 저자들은 인슐린 비의존성 당뇨병 환자에서 미세알부민뇨의 동반유무에 따른 혈중 ET치의 변화 및 혈장 ET치와 요중 알부민 배설률과의 상관성을 검토하였다. 대상 및 방법 : 인슐린 비의존성 당뇨병 환자중 미세알부민뇨를 보인 22명과 정상알부민뇨를 보인 43명을 대상으로 하였으며 혈장 ET를 측정하여 요중 알부민 배설률, 당뇨병성 망막증 및 당뇨병 관련인자들과의 관계를 비교하였다. 결과 : 당뇨병성 망막증이 합병된 군에서 망막증이 합병되지 않은 군에 비하여 혈장 ET치가 유의하게 높았던 반면 (각각 1.9±0.66, 1.5±0.76pg/㎖, p<0.05) 미세알부민뇨를 보인 군과 정상알부민뇨를 보인 군사이에 혈장 ET치는 통계학적으로 유의한 차이가 없었다(각각 1.9±1.14, 1.7±0.69pg/㎖). 또한 요중 알부민 배설률과 혈장 ET치 사이에 유의한 상관관계는 없었으며 미세알부민뇨를 동반한 인슐린 비의존성 당뇨병 환자군에서 혈장 ET치는 당뇨병의 관련인자들과도 유의한 상관관계가 없었다. 결론 : 인슐린 비의존 당뇨병 환자에서 혈장 ET치가 초기 당뇨병성 신증의 합병여부나 미세알부민뇨의 정도를 반영하기는 어려울 것임을 시사한다. Background : Endothelin(ET), a potent vasoconstritor peptide released from vascular endothelial cells, is known to be increased in diabetic patients with vascular damage and related with diabetic angiopathy. However, whether plasma ET levels may be related to diabetic complications is controversial. We studied the change of ET levels in non-insulin dependent diabetics with microalbuminuria and relation between ET and urinary albumin excretion rate. Methods : Plasma ET levels of 22 non-insulin dependent diabetics with microalbuminuria and 43 patients with normoalbuminuria were measured and relations of plasma ET to diabetic complications such as urinary albumin excretion rate, retinopathy and other associated factors were studied. Results : Plasma ET levels were significantly higher in patients with diabetic retinopathy than those without retinopathy(1.9 ± 0.66 vs 1.5 ± 0.76 pg/㎖. p<0.05). The difference, however, between diabetics with and without microalbuminuria was not significant(1.9 ± 1.14 vs 1.7 ± 0.69 pg/㎖). There were no correlations of plasma ET to urinary albumin excretion rate and to the other associated factors in non-insulin dependent diabetics. Conclusion : These results suggest that plasma ET levels may not seem to act as a predictor of diabetic nephropathy or microalbuminuria in non-insulin dependent diabetics.

인슐린비의존형 당뇨병 환자의 만성 합병증 유병률

이현정,김보완,김정국,하승우,남직화,이순희,한정훈 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.5

인슐린비의존형 당뇨병 환자에서 심혈관계 자율신경병증과 심전도상 QTc 간격분산(QTc dispersion)의 의의

김보완,신병호,김정국,하승우,남직화,구성모,박헌식 대한당뇨병학회 1998 Diabetes and Metabolism Journal Vol.22 No.2

인슐린비의존형 당뇨병 환자에서 당뇨병성 말초신경병증과 심혈관계 자율신경병증의 관련성

이현정,권삼,김보완,신병호,김정국,하승우,정상원,남직화,구성모,한정훈 대한당뇨병학회 1997 Diabetes and Metabolism Journal Vol.21 No.4

말단비대증 환자의 미만성 갑상선종에서 발생된 갑상선 유두암 1예

김동희,김보완,서예경,신병호,김정국,하승우,남직화,이영하,서인수 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.3

Patients with acromegaly have a reduced life expectancy rnainly due to cardiovascular, respiratory or cerebrovascular diseas-. Malignancy also seems to occur with greater than the expected incidence. In particular, the published retrospective or prospective studies have suggested a strong association of colonic neoplasia with acromegaly. But, there were a few reports of thyroid cancer in acrornegaly. We report a case of thyroid papillary cancer derived from diffuse goiter in acromegaly, sugge- sting the possible carcinogenic role of growth hormone(J Kor Soc Endocrinol 11:311-317, 1996)

대동맥 평활근세포에서 인슐린 및 포도당의 농도에 따라 Transforming Growth Factor-B와 Platelet Derived Growth Factor가 콜라겐 및 비콜라겐 단백 합성과 유전자 발현에 미치는 영향

김인산,손건영,김보완,김정국,하승우,남직화,구성모,권삼,박낭운 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.4

고삼투압성 비케톤성 혼수의 임상상과 예후 인자

이현정,김보완,김정국,하승우,정상원,남직화,박시형,이순희,한정훈 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.4