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- 저자 : 박병규(Byung Ku Park (검색결과 2 건)
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인슐린비의존형 당뇨병환자에서 허혈성 심장질환의 선별검사로서 관상동맥 칼슘침착수치 측정의 유용성
임승길(Sung Kil Lim),이종호(Jong Ho Lee),이현철(Hyun Chul Lee),송영득(Young Duk Song),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),윤용석(Yong Seok Yun),이유미(Yu Mie Rhee),심대근(Dae Keun Sim),신성관(Sung Kwan Sin),박병규(Byung Ku Park 대한내과학회 1999 대한내과학회지 Vol.56 No.3
N/A Patients with NIDDM are at increased risk for the development of coronary atherosclerosis and experience more silent myocardial infarction than non-diabetic subjects. The screening tools for early detection of coronary artery disease without significant narrowing has been requested in diabetic patients. Coronary artery calcification (CAC) score, quantified by electron beam computed tomography (EBT), have been reported to correlate with the amount of atherosclerotic plaque and vascular luminal narrowing. We investigated the distribution of CAC score and associated risk factors in asymptomatic NIDDM patients and patients with ischemic heart disease to estimate the usefulness of CAC as a screenig tool for ischemic heart disease in asymptomatic diabetes. Method : 136 NIDDM patients without any symptom of coronary artery disease and 37 patients with significant coronary artery stenosis were included. CAC were measured by electron bean tomography (ultrafast CT). Forty contiguous 3-mm thickness transverse two-dimensional sections were obtained through root of aorta and heart. Coronary calcification were defined as the presense of at least two adjacent pixel within the border of visualized coronary artery with CT number of at least 130 HU. Body mass index, waist-hip ratio were measured and body fat components were counted by impedence method. Visceral fat versus subcutaneous fat ratio were calculated by abdominal computed tomography. Plasma lipid profile, fasting insulin, C-peptide level, HbA1c concentration were measured. Correlations between natural log of CAC score and clinical parameters were evaluated and multiple regression analysis with natural log of CAC score as a independent variable was performed. Coronary angiography were performed in 17 asymptomatic NIDDM patients.. Result : CAC score was significantly higher in male than female subjects and increased significantly with aging (p<0.01). In patients with hypertension, previous history of cerebrovascular or peripheral vascular disease (p<0.05), CAC score was significantly increased. The CAC score showed significant positive correlations with smoking amount, duration of diabetes and a negative correlation with HDL-cholesterol (p<0.05). There were no association between CAC score and total cholesterol, LDL-cholesterol, waist to hip circumference ratio, or fasting insulin levels. After adjustment of compounding variables (age, sex), duration of diabetes, amount of smoking and previous history of atherosclerotic vascular disease were shown to be associated with CAC score. In multiple logistic regression analysis with natural log of CAC score as dependent variable, age, HDL-cholesterol, duration of diabetes, male gender were found to be significant independent variables. Seventeen diabetic patients with high CAC score, were taken coronary angiography and significant luminal narrowings (more than 50%) of coronary artery were documented in 16 patients. But, In 7 out of 17 patients with coronary one-vessel disease, coronary calcification were not detected by EBT. Conclusion : coronary artery calcium score quantified by electron beam computed tomography may be useful for screening of preclinical or asymptomatic coronary artery disease in asymptomatic NIDDM patients.
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장티푸스 진단에 있어서 Vi-Indirect Fluorescent Antibody Test의 민감도 및 특이도
장경희,류동렬,박성하,박병규,이준구,염준섭,최영화,송영구,김현숙,정윤섭,김준명 대한감염학회 1998 감염 Vol.30 No.4
목 적 : 장티푸스는 체액의 세균배양검사에서 Salmonella typhi의 분리로 확진하지만 조기진단을 위해서는 혈청학적인 검사가 도움이 된다. 저자 등은 1989년 이후 장티푸스진단에 S. typhi의 Vi항원을 이용한 간접형광항체법 (Vi-indirect fluorescent antibody test : Vi-IFAT)을 도입하였다. 이에 지난 7년간의 검사결과를 토대로 Vi-IFAT의 민감도 및 특이도를 규명하고자 하였다. 방 법 : 1989년부터 1996년까지 연세대학교 의과대학 세브란스 병원에 발열을 주소로 내원하여 Vi-IFAT가 의뢰된 환자 중 발열의 원인이 확진된 744명의 환자를 대상으로 하였으며, Vi-IFAT에 있어서 양성반응은 1:64이상으로 하였다. 결 과 : 1) 세균배양검사에서 확진된 장티푸스 환자 178예 중 168예에서 양성반응을 보여 민감도는 94.4%이었다. 항체가는 1:64가 89예, 1:128이 36예, 1:256이 27예, 그리고 1:512가 16예이었다. 위음성이었던 10예의 항체가는 1:32가 7예, 1:16이하가 3예이었다. 2) 발열을 주소로 내원한 환자 중 장티푸스 이외의 다른 질환으로 확진된 566예 중 538예에서 음성반응을 보여 특이도는 95.1%이었다. 항체가는 1:32가 117예, 1:16이하가 421예이었다. 위양성이었던 28예의 항체가는 1:64가 23예, 1:128이 5예이었으며, 장티푸스 이외의 살모넬라증이 4예, 요로계감염이 10예, 소화기계감염이 6예, 호흡기 계감염이 5예, 악성 종양이 2예, 그리고 바이러스 감염이 1예이었다. 3) Vi-IFAT 양성인 196예 중에서 장티푸스는 168예로 양성예측율은 85.7%이었으며, Vi-IFAT 음성인 548예 중 장티푸스 이외의 발열질환은 538예로 음성예측율 98.2%이었다. 4) 배양검사와 Widal test 사이의 일치율 (Kappa value)는 0.28로 poor agreement를 보였으며 Vi-IFAT와 Widal test 사이의 Kappa value는 0.74로 good agreement를 보였다. 그러나 배양검사와 Vi-IFAT 사이의 Kappa value는 0.86으로 excellent agreement를 보여 일치율이 가장 높은 검사는 배양검사와 Vi-IFAT라 할 수 있겠다. 5) 장티푸스 환자에 있어서 Vi-IFAT의 양성율은 발열기간이 1중 미만인 환자에서는 68%, 1내지 2주인 환자에서는 89.5%, 2주이상인 환자에서는 100%이었다. 결 론 : Vi 항원을 이용한 간접형광항체법 (Vi-IFAT)은 장티푸스 진단에 높은 민감도 및 특이도를 가지며, 또한 조기진단에 있어서도 임상적으로 유용함을 확인할 수 있었다. Background : Typhoid fever is diagnosed by culture or serological study. The confirmative diagnosis of typhoid fever is made by culture of the causative organism usually from body fluids. Serological test is a supportive diagnositic tool, which is useful for early diagnosis. In Severance Hospital, Vi-indirect foluorescent antibidy test(Vi-IFAT) using the Vi-antigen of Salmonella typhi has been used in the diagnosis of typhoid fever since 1989. We investigated the test results from the past 7 years, in order to clarify the sensitivity and specificity of Vi-IFAT. Methods : A retrospective study was done on patients whose chief complaint was fever and who were tested using Vi-IFAT in the Severance Hospital from 1989 to 1996. The positive value for Vi-IFAT was defined as 1:64 or higher. Results : The sensitivity and specificity of Vi-IFAT for typhoid fever was 94.4% and 95.1%, respectively. The positive and negative predictive values were 85.7% and 98.2% respectively. Positive rates of Vi-IFAT after fever onset increased with time and 68% were positive before the first week. From the first to the second week, 89.5% were positive and after the second week, 100% were positive. Conclusion : Vi-IFAT is not only a valuable serologic test for the diagnosis of typhoid fever, but also useful in the early diagnosis of the disease.
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