호르몬 대체요법 혹은 칼슘 보충제로 치료한 초기 폐경기 여성에서 골밀도 변화에 대한 골대사 생화학적 지표의 유용성

배광범(Kwang Bum Bai) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2

목적 : 생화학적 골지표가 초기 폐경기 여성의 골 소실 혹은 골 생성의 정도를 예측할 수 있는지를 규명하고자 하였다 . 연구방법 : 초기 폐경기 여성 240명을 호르몬 대체요법 혹은 칼슘보충제로 치료하였으며 이들에게서 치료전 및 치료개시 1, 3, 6, 12개월 경과 후 NTx 및 osteocalcin을 측정하였으며 동시에 골밀도 측정을 병행하였다 . 결과 : 호르몬 대체요법을 받은 110명은 요추(+2.6%) 및 대퇴골 경부(+1.1%)에서 골밀도의 증가를 보인 반면 칼슘 보충제만 사용한 130명에서는 감소를 나타냈다. 호르몬 대체요법 여성들에서는 치료기간이 경과함에 따라서 생화학적 골지표값의 감소를 보였으나 칼슘 보충제만 사용한 여성들에서는 변화가 없었다 . 호르몬 치료전 측정한 생화학적 골지표를 크기에 따라 4분하여 상호 비교시에 최고 4분위군에서 최저 4분위군에 비해서 골밀도 증가가 현저하였다(P<0.05). 1년간의 호르몬 치료후 골밀도가 증가한 여성들에서 감소한 여성들에 비하여 치료전 측정한 골대사인자 평균치가 월등히 높았다 ( P<0 . 001 ) . 칼슘보충제만 사용한 경우 생화학적 골지표 크기가 최고 4분위군에서 최저 4분위군에 비해 골밀도 감소가 현저하였다 ( P < 0 . 05 ) . 결론 : 생화학적 골지표들은 초기 폐경기 여성에서 호르몬 치료에 대한 골밀도의 반응을 예측하는데 유용한 지침자라고 사료된다. Objective : To identify the effectiveness of bone turnover indexes for bone loss or gain in early postmenopausal women. Method : This study was performed in 240 menopausal women(mean age, 50 yr), who were randomized to hormone replacement therapy(HRT) or calcium supplementation(CS, 500mg/day) for 1yr. Urinary N-telopeptide(NTx) and osteocalcin(OC), as well as spine and femoral neck bone mineral density(BMD) were measured at baseline and 1, 3, 6, 12 months after treatment. Results : Women receiving HRT(n=110) showed a significant increase in spine BMD(+2.6% ; P<0.0001) and hip BMD(+1.1% ; P<0.05) compared to women receiving CS, who showed a decline at both sites (-1.0% ; P<0.01). Both markers showed time dependent decreases in women receiving HRT(P<0.001) and no change in women receiving calcium alone. When baseline indexes of turnover were divided by quartile, there was a significantly greater increase in BMD among those with the highest NTx, OC levels compared to that in those with the lowest NTx, OC levles(P<0.05). When subjects receiving HRT were compared by their positive or negative skeletal response at 1yr and their baseline turnover marker, initial NTx values were significantly higher in those that gained bone than in those that lost bone (P<0.001). Calcium supplementation women in the highest quartile for NTx at baseline had significantly greater decreases in spine BMD than subjects with the lowest NTx values(P<0.005). Conclusions : For early postmenopausal women there are differential responses of biochemical markers to HRT and calcium supplementation. Baseline urinary NTx and serum osteocalcin were good predictors of change in spine BMD after 1yr of either HRT or calcium supplementation. It is concluded that markers of bone formation and resorption can be used clinically to predict future BMD in early postmenopausal women.

체외수정시술 환자에서 난소 주위 유착이 과배란유도 중의 난소 난포 발달에 미치는 영향에 관한 연구

배광범,김석현,이진용,Bai, Kwang-Bum,Kim, Seok-Hyun,Lee, Jin-Yong 대한생식의학회 1988 Clinical and Experimental Reproductive Medicine Vol.15 No.2

It has been suggested that the presence of periovarian adhesions might impair the ovarian response to gonadotropins. Total 136 patients who underwent IVF-ET from February to June 1988(88-1 and 88-2 series) at SNUH were classified into three groups according to total ovarian access score, sum of each ovarian availability, estimated by diagnostic laparoscopy : group I(N=43,0%-50%), group II(N=49, 50%-150%) and group III(N=44, 150%-200%). To evaluate the effects of periovarian adhesions on follicular development in controlled ovarian yperstimulation for IVF-ET, serum E2 levels on the day of hCG dministration (Day 0) and the day after hCG administration (Day+1), the number of ovarian follicles with mean diameter${\geqq}$12mm on Day 0, and the number of oocytes retrieved by transvaginal aspiration were measured and compared among groups. There were no significant differences in age of patients, cancellation rate due to inadequate ovarian response, serum E2 levels, the number of ovarian follicles, the number of oocytes retrieved, and oocytes retrieval rate per follicle. In the same patients(N=31) in group II in whom the difference in ovarian availability between two ovaries is more than 50%, there was also no significant difference in the number of ovarian follicles between them. These data suggest that pelvic adhesions including periovarian adhesions have no adverse effects on the ovarian response to gonadotropins stimulation and the outcome of IVF-ET.

황체기능 평가에 관한 연구

배광범,김정구,문신용,이진용,장윤석,Bai, Kwang-Bum,Kim, Jung-Gu,Moon, Shin-Yong,Lee, Jin-Yong,Chang, Yoon-Seok 대한생식의학회 1986 Clinical and Experimental Reproductive Medicine Vol.13 No.2

The present study was designed to assess the relationships between the methods to evaluate adequacy of luteal function. We measured mid-luteal serum progesterone levels by radioimmune assay, luteal phase lengths and mean post-ovulatory basal body temperature rise rates by basal body temperature charts in 40 in-phase-cycle infertile patients and 38 out-of-phase-cycle patients who underwent late-luteal endometrial biopsies at the sterility clinic of Department of Obstetrics and Gynecology, Seoul National University Hospital from Jan. 1986 to Aug. 1986. The results were summarized as follows: 1. No significant differences were found in mean age, mean duration of infertility, mean mid-luteal serum progesterone levels, and mean post-ovulatory temperature rise rate between in-phase-cycle patients and out-of-phase-cycle patients, but significant difference in mean luteal phase length between 2 groups was identified. 2. 91% of total patients sho had luteal phase lengths of less than 11 days showed out-of-phase-cycles. 3. In out-of-phase-cycle group with luteal phase lengths of less than 11 days, 50% had an endometrial lag of at least 4 days, but 10.7% had an endometrial lag of 4 or more days in group with luteal phase lengths of more than 11 days. 4. There was no significant correlation between mid-luteal serum progesterone level and endometrial lag of late luteal phase endometrial biopsy.

난소적출술 환자에서 Estrogen 단독요법 및 Estrogen-androgen 병합요법에 관한 연구

배광범,Bai, Kwang-Bum 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.4

Objective : To evaluate the difference between estrogen only therapy and estrogen-androgen combination therapy in surgical menopause patients. Materials and Method: Surgical menopause patients received 0.625 mg conjugated equine estrogens or 0.625 mg conjugated equine estrogens plus 1.25 mg methyltestosterone for 2 years. Bone mineral density, menopausal symptoms, lipoprotein profiles were measured. Results: Both groups showed increased bone mineral density. In the combination group, total cholestero l, high density lipoprotein cholesterol and triglycerides decreased. In the estrogen only group, low density lipoprotein cholesterol decreased but high density lipoprotein cholesterol increased significantly. In both groups, menopausal symptoms were much improved. Side effects were easily tolerated in both groups. Conclusions: Estrogen-androgen combination therapy had comparable benefits compared with estrogen only therapy.

과체중 및 비만 다낭성 난소 증후군 환자에서의 Metformin과 Rosiglitazone의 효용성

배광범,Bai, Kwang Bum 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.4

Objective: The purpose of this study was to evaluate and compare the effects of metformin and rosiglitazone in overweight or obese women with polycystic ovarian syndrome. Methods: Twenty Six overweight or obese patients with polycystic ovarian syndrome were randomly treated with either metformin (500 mg three times daily, n=13) or rosiglitazone (4 mg once daily, n=13) for 6 months. Hormonal studies were performed before and after treatment. Insulin resistances were calculated by computerized HOMA 2 Calculator v2.2. Results: Testosterone decreased while SHBG increased after 6 months treatment in both metformin and rosiglitazone treatment groups. Fasting glucose decreased after metformin or rosiglitazone treatment. HOMA insulin resistance improved after treatment with either drug. There was no differences in hormonal changes and insulin resistance between 2 treatment groups. Conclusions: This study shows that metformin and rosiglitazone are effective in improving insulin sensitivity and ameliorating hyperandrogenism in overweight/obese polycystic ovarian syndrome women.

자연폐경 여성에서 골량감소 예측에 있어서 혈청 인슐린유사 성장인자들의 유용성에 관한 연구

안귀범(Ki Bum Ahn),김정구(Jung Gu Kim),배광범(Kwang Bum Bai),이진용(Jin Yong Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 자연폐경 여성에서 순환 IGF가 골밀도로 표현된 골조직내 미세상황을 판별할 수 있는 지침자로서의 이용 가능성을 알아보고자 하였다.연구 방법 : 전향적 무작위적으로 추출된 자연폐경 여성 146명과 폐경전 정상여성 43명을 대상으로 Bio-spin P-10 분리법 후 방사면역법으로 혈청 IGF-I, IGF-II 농도을 측정하고 DEXA로 척추, 대퇴골 근위부의 골밀도를 측정하였다.결과 : 자연폐경 여성만을 대상으로 하였을 때 연령과 폐경기간은 혈청 IGF-I, 골밀도와 유의한 음성 상관관계가 있었던 반면 체질량지표는 양성 상관관계가 있었다. 혈청 IGF-II 농도는 연령과 폐경기간 및 체질량지표에 따른 유의한 변화가 없었고 골밀도과도 상관관계가 없었다. 연령, 체질량지표, 폐경기간, 혈청 IGF-I을 비의존적 변수로하고 골밀도를 의존적 변수로 한 복합 회귀직선 분석법상 혈청 IGF-I농도는 대부분의 골부위에서 골밀도의 독립적 결정인자이었다. 골다공증을 가진 자연폐경 여성에서의 혈청 IGF-I농도는 정상골밀도 또는 골감소증을 가진 자연폐경 여성, 폐경전 정상여성에서의 것보다 유의하게 낮았던 반면 혈청 IGF-II농도는 이러한 여성군에 따른 차이가 없었다. 골다공증 예측에 있어서 혈청 IGF-I 측정의 민감도는 67%, 특이도는 약 70%이었다.결론 : 순환기내 IGF-I이 골다공증의 위험이 있는 여성 또는 골다공증을 가진 여성의 선별검사로 이용될 수 있다 Objectives : To evaluate if circulating insulin-like growth factors(IGFs) levels may provide an indirect information on the microenvironment in bone expressed as bone minerial density(BMD). Methods : IGF-I and IGF-II were measured by radioimmmunoassay after Bio-gel P-10 preparation of serum samples obtained from natural postmenopausal women(n=146) and normal healthy premenopausal women(n=43) and BMD at the lumbar spine and proximal femur by dual energy X-ray absorptiometry. Results : In natural postmenopausal women age or menopause duration correlated negatively with serum IGF-I and BMD at all skeletal sites measured while body mass index(BMI) correlated positively. However, there was no significant correlation between serum IGF-II and these demographic parameters, and between serum IGF-II and BMD. When multiple regression analysis was performed including age, BMI, menopause duration and serum IGF-I as independent variables, serum IGF-I was an independent predictor of BMD at the lumbar spine, trochanter and Ward's triangle. Serum IGF-1 levels were significantly lower in postmenopausal women with osteoporosis than in normal premenopausal women and postmenopausal women with normal BMD or osteopenia. Serum IGF-II levels did not show any difference among these groups. The sensitivity of serum IGF-I assay in determining osteoporosis was 67 %, while the specificity was around 70%. Conclusions : Circulating IGF-I measurements may be useful as a screen method in identifying women with osteoporosis and at risk for osteoporosis.

임신중절에 대한 사회적 여건 변화에 따른 임신 중기 양수검사의 감소

전혜원 ( Hye Won Jeon ),이택상 ( Taek Sang Lee ),배광범 ( Kwang Bum Bai ),황규리 ( Kyu Ri Hwang ),김병재 ( Byung Jae Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.12

목적: 임신중절에 대한 사회적 여건변화가 임신 중기 양수검사 수용에 미치는 영향을 알아보고자 하였다. 연구 방법: 2009년 2월 1일부터 2010년 8월 31일까지 외래에 방문한 임신 20주 미만의 단태임신 산모를 대상으로 의무기록을 후향적으로 조사하였다. 2009년 11월까지(2009년 군)와 그 이후 기간(2010년 군)의 양상을 비교하였고, 개인병원에서 의뢰된 산모와도 비교하였다. 결과: 임신중절이 엄격하게 제한되기 시작한 2009년 12월 이후 임신중기 양수검사 빈도가 이전의 19% (19/101)에서 11% (10/93)로 감소하였으나 통계적 차이는 없었다(P=0.16). 35세 이상인 산모에서는 2010년 군(5/30, 25%)이 2009년 군(15/30, 50%)보다 유의하게 양수검사 수용도가 낮았고(P=0.01), 선별검사에서 고위험군으로 양수검사를 권유 받은 경우를 포함하여 분석하였을 때에도 유의하게 낮았다(9/35, 26% vs 19/34, 56%; P=0.02). 개인병원에서 이상소견이 있었거나, 고령으로 양수검사를 권유 받아 의뢰된 35명의 산모에서는 2009년 군(15/21, 71%)에 비해 2010년 군(13/14, 93%)에서 양수검사를 시행하는 빈도가 오히려 증가하는 양상이었지만, 유의한 차이는 없었다(P=0.20). 결론: 임신중절에 대한 사회적인 여건의 변화로 염색체 이상 및 신경관결손증의 고위험군에서 양수검사를 수용하는 빈도가 유의하게 감소하였는데, 외부병원에서 의뢰된 경우에는 변화가 없었다. Objective: To investigate the effect of alteration of social conditions towards pregnancy termination on the acceptance of genetic amniocentesis. Methods: Retrospective review of medical records was conducted for women (<20 weeks` gestation, singleton pregnancy) who visited our outpatient department between February 1, 2009 and August 31, 2010. Acceptance of genetic amniocentesis was compared between two groups of women: one from February 1, 2009 to November 30, 2009 (2009 group) and the other from December 1, 2009 to August 31, 2010 (2010 group) after strict regulation of pregnancy termination. The acceptance rate of those who were referred to our center for genetic amniocentesis in same time period was also evaluated. Results: Overall, 19 of 101 (19%) women in the 2009 group and 10 of 93 (11%) in the 2010 group, opted for invasive diagnostic methods (P=0.16). Women > 35 years in the 2010 group (5/30, 17%) were less likely to accept genetic amniocentesis than 2009 group (15/30, 50%; P=0.01). Similar results were observed in those who were indicated for genetic amniocentesis. (9/35, 26% vs 19/34, 56%; P=0.02). Acceptance rate of genetic amniocentesis was increased for those who were referred from private clinic, but without statistical significance (15/21, 71% vs 13/14, 93%; P=0.20). Conclusion: After strict regulation of pregnancy termination, acceptance rate of genetic amniocentesis was significantly decreased among women who had increased risk for chromosomal abnormalities or neural tube defect at our center. Whereas, there were no significant change in acceptance rate for those who were referred for amniocentesis from private clinic.

자궁내막증 환자에서 혈중 CA19-9 농도

최영민 ( Young Min Choi ),손유경 ( Yoo Kyung Sohn ),김태준 ( Tai Jun Kim ),구승엽 ( Seung Yup Ku ),배광범 ( Kwang Bum Bai ),서창석 ( Chang Suk Suh ),김석현 ( Seok Hyun Kim ),김정구 ( Jung Gu Kim ),문신용 ( Shin Yong Moon ),이진용 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12

목적 : 자궁내막증의 진단에 있어 혈중 CA19-9를 측정하는 것의 유용성을 알아보기 위함. 연구 방법: 수술적 또는 조직학적으로 자궁내막증이 진단된 53명의 환자들의 수술전 혈중 CA19-9와 CA125 농도를 측정하여 비교하였으며, 자궁내막증의 중증도는 revised American Fertility Society (1985)의 자궁내막증 병기를 적용하였다. 결과 : 자궁내막증 환자 53명 중 13명 (24.5%)에서 혈중 CA19-9가 상승되어 있 Objective : To explore the efficacy of serum CA19-9 determination for the detection of endometriosis. Designs : A retrospective analysis Materials and Methods : Preoperative serum CA19-9 and CA125 concentrations were measured in 53 patients with surgicall

난자 세포질내 정자 주입술을 이용한 체외수정시술시 누적임신율에 관한 연구

김석현(Seok Hyun Kim),심순섭(Soon Sup Shim),지병철(Byung Chul Jee),최성미(Sung Mi Choi),김희선(Hee Sun Kim),류범용(Buom Yong Ryu),오선경(Sun Kyung Oh),서창석(Chang Suk Suh),최영민(Young Min Choi),배광범(Kwang Bum Bai),김정구(Jung Gu 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

N/A Objective : To evaluate the cumulative pregnancy rate(CPR) of in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). Methods : Medical records of 260 infertile patients undergoing 519 cycles of IVF-ET with ICSI from January, 1994 to December, 1999 were retrospectively reviewed. The CPR beyond 12 weeks of gestation was estimated by Kaplan-Meier method. The CPRs were compared by log-rank test between groups divided by age of patients, indication of ICSI, and method of sperm retrieval for ICSI. Results : As 70 patients achieved an on-going pregnancy after IVF-ET with ICSI, the PR was 26.9% per patient and 13.5% per cycle. The overall CPR was 54.9% after 6 cycles of IVF-ET with ICSI. As expected, age had a significant strong effect on the CPR; CPRs afer 4 cycles of ICSI were 61.8% in the age group of 30 years(n=81), 43.7% in 31-35 years(n=106), and 15.3% in 36 years(n=73). There was no significant difference in the CPR between abnormal semen analysis group(n=184) and prior low fertilization rate group(n=66). In abnormal semen analysis group, the CPR of surgically retrieved sperm subgroup(n=60) was not significantly different from that of ejaculated sperm subgroup(n=124). Conclusions : The CPR of IVF-ET with ICSI was presented, and it could be of much help in the clinical counseling of IVF-ET patients. ICSI technique could be used successfully for IVF-ET in infertile couples who had the male factor infertility or the past history of low fertilization rate in the previous cycles.

자궁경부 세포진 검사 ASCUS 의 질적 분류 및 HPV 검사의 임상적 의의

전혜원,배광범 대한부인종양 콜포스코피학회 2000 Journal of Gynecologic Oncology Vol.11 No.4

Objective: To evaluate qualification and determine the usefulness of human papillomavirus(HPV) DNA testing in women with cytologic smears read as atypical squamous cell of undetermined significance (ASCUS). Method: The study was based on 88 women with cytologic smears reported of ASCUS favoring either a reactive process or squamous intraepithelial lesion (SIL) from July 1999 to June 2000. Cytologic examination by Papanicolaou smear was based on the Bethesda System and cervical biopsy was done via coloscopy. the presence of high risk HPV DNA was determined with Hybrid capture assay. Results: The overall incidence of cervical intraepithelial lesion (CIN) was higher in the group with ASCUS favoring SIL than in the group with ASCUS favoring reactive process(42.2 % vs 18.6 %; p$lt;0.05). Women with ASCUS favoring SIL were 9.1 times more likely to have high grade SIL(CIN II/III) develop than were women group with ASCUS favoring reactive process(95% confidence interval, 1.08-76.0). High-risk HPV DNA was demonstrated in 39.8%(35 cases) and was associated a 8.8 times increased likelihood of histologic conformation of CIN(95% confidence interval, 3.09-24.7). The sensitivity of HPV assay for any CIN was 74% and specificity was 75%, whereas the corresponding values for the repeat Pap smear was 67% and 33%, respectively. Conclusion: Women with ASCUS favoring SIL was associated with a relatively high risk that the women was harboring SIL. The addiction of a high-risk HPV DNA assay to cytologic examination appears to provide for early detection of high grade CIN in women with ASCUS.