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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.
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고령자에서 고인슐린혈성 저혈당을 나타낸 nesidioblastosis 1예
서예경,남직화,김정국,하승우,정상원,조창호,신병호,김보완,윤영국,서인수 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.3
Nesidioblastosis is characterized by a diffuse proliferation of islet cells arising from pancreatic ducts and is the most common cause of hyperinsulinemic hypoglycemia in newborns and infantile. It is exceedingly rare in adults and no concensus regarding its diagnosis and management is available. We herein describe an elderly man with fasting hypoglycemia, inappropriate insulin hypersecre- tion. And pathologic examination of his pancreas revealed the characteristic finding of nesidioblastosis confirmed by immunohistochemical stain. (J Kor Soc Endocrinol 12:485-490, 1997)
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Superoxide dismutase 가 Oxygen Free Radical에 노출된 당뇨병 백서 대동맥의 EDRF 및 EDHF 중계성 이완능의 변화에 미치는 효과
김동희,서예경,남직화,김정국,하승우,신병호,김보완 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.2
Background: The relaxative response of blood vessels to acetylcholine(ACh) is known to be abnormal in diabetic rat due to changes in endothelium-derived relaxing factor(EDRF)- and/or endothelium-derived hyperpolarizing factor(EDHF)- mediated action. Oxygen free radical(OFR) interferes with endothelium dependent relaxation to ACh in diabetic rats; this effect rnay be prevented by superoxide dismutase(SOD), OFR scavenger. Then, we determined the effect of SOD on modulation of OFR-induced damage to EDRF- and EDHF-mediated relaxations to ACh in diabetic rat aortas. Methods: After aortas were incubated with free radical generating system for 15 min with or without SOD pretreatment(150 U/mL) and contracted submaximally by norepinephrine(10(-5) M), relaxative responses to cumulative concentrations(10(-9) M to 10(-5) M) of ACh were measured in aortas isolated from the control and 6-8 week streptozotocin-induced diabetic rat. We measured relaxative responses to ACh in these aortas treated with calmidazolium(100uM) or N-nitro-L- arginine methyl ester(luM) after exposure to OFR with/without SOD pretreatment, Results: The ACh-induced relaxation(10(-9)M to 10(-5) M) was significantly decreased in diabetic than in control rat aortas(p$lt;0.05). ACh-induced relaxation in diabetic rat aortas was significantly impaired from 79.3% to 71.2% after exposure to OFR(p$lt;0.05), and the degree of ACh-induced relaxation was recovered from 71.2% to 84.0% after pretreatment with SOD(p$lt;0.05). EDRF- mediated relaxation to ACh in diabetic rat aortas was significantly impaired from 71.2% to 61.6% after exposure to OFR(p$lt;0.05), and the degree of impairment of ACh-induced EDRF-mediated relaxation was recovered from 61.6% to 76.0% after pretreatment with SOD. After exposure to OFR, EDHF-mediated relaxation to ACh in diabetic rat aortas was not significanlty impaired. However, the degree of impairment of EDHF-mediated relaxation to ACh was recovered from 46.0% to 59.5% after pretreatment with SOD. Conclusion: This study suggests that OFR may impair mainly EDRF-mediated relaxation to ACh and SOD may protect rnainly OFR-induced damage to EDRF-mediated relaxation to ACh in diabetic rat aortas. (J Kor Soc Endocrinol 12:265-274, 1997)
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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.
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