60 세 이후에 진단된 노인당뇨병의 임상상

송창호(Chang Ho Song),원영준(Young Jun Won),류정선(Jeong Seon Ryu),신영구(Young Goo Shin),정춘희(Choon Hee Chung),최동훈(Dong Hoon Choi),송영득(Young Duk Song),남문석(Moon Suk Nam),이지현(Ji Hyun Lee),이은직(Eun Jig Lee),임승길(Sung 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Objectives : With increasing the incidence and prevalence of elderly diabetics, there were many reports of elderly diabetics in Korea. But there were few reports of elderly diabetics who were diagnosed at old age. The aim of this study was to elucidate the clinical characteristics of elderly diabetics diagnosed after 60 years old. Methods: On the basis of age when they were diagnosed at first, elderly diabetics(N=105) were more than 60 years old and adult diabetics were 40-59 years old. Some characteristic symptoms, laboratory findings, associated diseases, complications and treatment modalities of elderly diabetics were compared with those of adult diabetics. Results: 1) The prevalences of characteristic symptoms such as polydipsia, polyphagia and polyuria in elderly diabetics were much higher than those of adult diabetics. 2) Hypertension, coronary artery disease, malignancy and gall stone were more frequently associated in elderly diabetics than those in adult diabetics, but fatty liver was more frequent in adult diabetics. 3) The prevalences of diabetic retinopathy and nephropathy in elderly diabetics were similar to those of adult diabetics, but the prevalence of diabetic neuropathy in elderly diabetics was lower than those in adult diabetics, 4) Treatment modalities of elderly diabetics were oral hypoglycemic agents, diet and exercise, and insulin in order at discharge from hospital, and the use of diet and exercise was more frequent in elderly diabetics than in adult diabetics. Conclusion: Some clinical characteristics of elderly diabetics were different from those of adult diabetics. We suggest that these findings should be considered at diagnosis and treatment of Elderly diabetics.

공복 혈당장애 및 내당능장애자에서 홍국의 섭취가 혈중지질 및 혈당 조절에 미치는 영향

강미란(Kang Mi Ran),김지영(Kim Ji Young),현예정(Hyun Yae Jung),김혜진(Kim Hyae Jin),여현양(Yeo Hyun Yang),송영득(Song Young Duk),이종호(Lee Jong Ho) 韓國營養學會 2008 Journal of Nutrition and Health Vol.41 No.1

내당능 장애와 공복혈당장애는 장차 당뇨병으로 진행되거나 심혈관 질환을 일으키는 위험인자로 간주되어 적절한 혈당 및 혈중지질수치의 조절이 필요하다. 홍국의 기능성 분인 모나콜린-K는 statin계열 약물의 주원료로서 이미 지질 강하제로 잘 알려져 있다. 홍국의 지질 강하제 이외의 다른 효과로서 동물 자체 효력 시험과 문헌 고찰을 통해 혈당 강하 효과가 보고되고 있으므로 이중 맹검, 무작위배정, 위약 대조 인체시험을 통하여 홍국의 혈중 지질 및 혈당 개선에 대한 효능을 확인하는 목적으로 본 연구를 실시하였다. 18~80세 사이의 남녀를 대상으로, 스크리닝 시 공복혈당이 110 ㎎/㎗이상 126 ㎎/㎗ 이하인 공복 혈당 장애이거나 경구 당 부하 검사 2시간 후 혈당이 140 ㎎/㎗ 이상 199 ㎎/㎗ 이하인 내당능 장애자이거나 당화혈색소 수치가 6% 이상 7% 이하인 자로서 심각한 합병증이 없는 사람을 대상으로 하였으며, 홍국 저용량군 21명, 고용량군 23명, 위약군 20명으로 총 64명을 대상으로 12주간 검사에 대한 결과분석을 실시하였다. 1차 유효성 지표로 혈중 지질관련 지표인 중성지방, 총 콜레스테롤, LDL 콜레스테롤, HDL 콜레스테롤, Atherogenic index (AI)를 측정하였으며, 2차 유효성 지표로 혈당 지표인 공복 혈당, 경구 당부하 검사 2시간 혈당치, 당화혈색소, 인슐린, HOMA-IR, 유리지방산을 측정하였다. 시험군에서 홍국제제 섭취 전후로 중성지방, 총콜레스테롤, LDL 콜레스테롤, HDL콜레스테롤 수치가 유의적으로 개선되었으며 동맥경화지수도 유의적으로 향상되었다. 홍국 고용량군의 총콜레스테롤, HDL 콜레스테롤과 LDL 콜레스테롤 및 동맥경화지수 개선 정도는 위약군의 변화량과 비교하여 유의적으로 개선되는 것으로 나타났고, 저용량군의 경우에도 LDL 콜레스테롤과 동맥경화지수 개선 정도가 위약군의 변화량과 비교하여 유의적으로 개선되었다. 홍국의 섭취가 혈당조절에 미치는 영향은 모든 시험군에서 제제 섭취 12주 후 공복혈당이 감소하였고, 시험군이 위약 군에 비해 더욱 감소하였으나 통계적으로는 유의하지 않았다. 주평가지표인 공복혈당을 기준으로 공복혈당 110 ㎎/㎗ 이상인 피험자만을 대상으로 당대사 관련 지표를 분석한 결과, 홍국 고용량군에서 공복혈당의 감소경향이 관찰되었고, 홍국 저용량군에서는 당화혈색소의 유의적인 감소 효과를 확인하였으나 위약군의 변화량과 비교하여 유의적이지 않았다. 공복혈당 장애자 또는 내당능 장애자에서 하루 홍국 분말 2.52 g (저용량군) 또는 5.04 g (고용량군)을 포함한 건강기능식품을 12주간 섭취시킨 결과 혈중 지질 농도와 동맥경화 지수의 개선으로 심혈관 질환의 위험도를 낮출 수 있을 것으로 보이며, 고용량군일 경우 더 효과적일 것으로 사료된다. This study was aimed at evaluating the effect of red-yeast-rice supplementation on cholesterol-lowering and glucose control in subjects with impaired fasting glucose (IFT) or impaired glucose tolerance (IGT). We conducted a double-blind, placebo-controlled study with 3 groups; placebo, low dose group (red yeast rice 210.0 ㎎/capsule, 2.52 g/day) and high dose group (red yeast rice 420.0 ㎎/capsule, 5.04 g/day), which were randomly assigned to subjects with impaired fasting glucose or impaired glucose tolerance. We measured fasting serum concentrations of total-, LDL-, HDL-cholesterol, triglyceride, glucose, insulin, free fatty acid (FFA) and 2 h oral glucose tolerence test (OGTT) before and after the supplementation. Both low dose and high dose groups had significant decrease in LDL cholesterol and atherogenic index (AI) compared with placebo group (p<0.05). Additionally, total and HDL cholesterol improved significantly in high dose group compared with placebo group (p<0.05). Fasting serum glucose decreased in test groups and increased in placebo group after intervention. However, it was not significant differences. In subjects which fasting blood glucose is more than 110 ㎎/dL, fasting glucose had a tendency to decrease in high dose group (p<0.1) and Hemoglobin Alc (HbAlc) had significant decrease in low dose group (p<0.05), while insulin and HOMA-IR had a tendency to increase in placebo group after intervention. Mean changes of glucose related parameters (fasting glucose, insulin, HOMA-IR) compared with placebo group did not show significant differences. In conclusion, subjects with impaired fasting glucose or impaired glucose tolerance were significantly improved in serum lipid profile by red yeast rice supplementation without serious side effects. These are more effective in the case of a high dose. The effects of red yeast rice supplementation on glucose control were insignificant. (Korean J Nutr 2008; 41 (1): 31~40)

한국 중년 성인에서 관상동맥경화증의 위험요인들과 혈청 인슐린 농도와의 관계

허갑범(Kap Bum Huh),이현철(Hyun Chul Lee),임승길(Sung Kil Lim),송영득(Young Duk Song),박은주(Eun Ju Park),윤지영(Jee Young Yoon),이종호(Jong Ho Lee),이영해(Young Hae Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.6

N/A Objectives: Hyperinsulinemia has been reported as a risk factor for coronary artery disease in western society. However, Koreans have shown about half of western people in fasting insulin and insulin secretion levels during oral glucose tolerance test (OGTT). The purpose of this study was to determine the relationship of serum insulin levels to various cardiovascular risk factors in healthy middleaged Koreans. Methods: We studied 143 subjects including 97 women and 46 men. Subjects had not received any medication for diabetes, hypertension or hyperlipidemia and had normal liver and kidney function. Anthropometric parameters and abdominal fat areas by computed tomography at the umbilical level were measured. Blood pressure, nutrient intake, total energy expenditure, serum levels of lipids and the levels of glucose, C-peptide, insulin and free fatty acid during OGTT were determined. Hyperinsulinemia was defined as both fasting and 2-hour serum insulin levels above the 80th percentile of respective serum insulin distributon in study subjects after an oral glucose load. Characteristics of hyperinsulinemic subjects were compared to normoinsulinemic subjects matehed for age, sex, and body mass index. Results: In subjects with normal glucose tolerance, hypertriglyceridemic subjects showed significantly higher serum insulin levels at 30, 60, 120 minutes during OGTT than normotriglyceridemic subjects. Similar results were observed in hypertension and low HDL cholesterolemia. A less significant difference was shown in the insulin pattern during OGTT between subjects with high LDL cholesterol and subjects with normal LDL cholesterol. Hyperinsulinemic subjects had significantly higher levels of systolic blood pressure, serum triglycerides, total cholesterol and glucose than normoinsulinernic subject. HDL cholesterol level was significantly lower in hyperinsulinemic subjects than in normoinsulinrnic subjects. No significant difference in the serum LDL cholesterol was found between two groups. Hyperinsulinernic subjects showed an increase in visceral fat area and percent calorie intake per total energy expenditure, compared with normoinsulinemic subjects. Conclusion: Our results showed that insulin levels in middle-aged Koreans are closely related to serum triglycerides and HDL cholesterol levels. In addition, healthy Koreans with normal glucose tolerance and hyperinsulinemia have an increase in risk factors for coronary artery disease such as hypertension, hypertriglyceridemia and low HDL cholesterol levels as compared with healthy subjects with normal insulin level. Therefore, it is recommended that insulin resistance subjects increase insulin sensitivity and decrease serum insulin level through lifestyle modification to prevent coronary artery disease.

뇌하수체선종 환자에서 감마나이프를 이용한 정위적 방사선 치료

차봉수(Bong Soo Cha),이현철(Hyun Chul Lee),최동훈(Dong Hoon Choi),송영득(Young Duk Song),이은직(Eun Jig Lee),임승길(Sung Kil Lim),박용구(Yong Gu Park),김경래(Kyung Rai Kim),정상섭(Sang Seop Chung),허갑범(Kap Bum Huh),정윤석(Yoon Sok 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives : Stereotactic radiosurgery using gamma-knife in adjunct to transsphenoidal pituitary surgery is recently being used for treatment of pituitary adenomas and it poses as an effective and safe treatment modality. We present our experience and preliminary results of gamma-knife treatment of the patients with pituitary adenomas. Methods: Between May, 1992 and March, 1994, 20 patients with pituitary adenoma were treated with gamma-knife at Yonsei Medical Center. Among them, 15 cases who have had follow-up for more than 6 months were included in our study. 13 of 15 cases had endocrinologically active tumors(4 prolactin secreting, 4GH secreting, 5 ACTH secreting), and two patients had clinically non-functioning adenomas. Hormonal and radiological studies and clinical features were followed up. Results: After gamma-knife surgery, the hormonal level was decreased in eleven of thirteen patients with functioning pituitary adenomas and the size of tumor was decreased in seven of fifteen patients and eleven of fifteen patients were improved clinically. There was more favorable results in Cushing's disease than in other pituitary adenomas. There was no severe complication associated with gamma-knife surgery, Conclusion : Based on our initial clinical experience, we believe that gamma-knife stereotactic radio surgery is safe and effective alternative to conventional neurosurgery in selected patients with pituitary adenomas and further study might be warranted.

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.

일차성 남성 골다공증의 원인 및 임상적 특성

임승길(Sung Kil Lim),이용호(Yong Ho Lee),이현철(Hyun Chul Lee),송영득(Young Duk Song),허갑범(Kap Bum Huh),김미경(Mi Kyung Kim),장준호(Jun Ho Jang),남재현(Jae Hyun Nam),안철우(Chul Woo Ahn) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

N/A Osteoporosis in men has recently been recognized as an important public health problem. In women, pathophysiology, risk factors, etiology and treatment of osteoporosis have become well defined. However, less information has been availabe concerning men until now. Male osteoporosis has been known to be associated with drugs and diseases that threaten bone health. However, the causes of male osteoporosis are not apparent in some instances. This study was designed to evaluate the clinical characteristics and causes of primary osteoporosis in Korean men. Methods : The BMD was measured with DEXA in 327 healthy adult Korean men who were employed by the same company in Seoul. Among them, we studied 20 patients who visited the department of internal medicine at Yonsei University Medical Center for evaluation of osteoporosis. Osteoporosis was defined by WHO criteria for women. We performed history taking, physical examination, nutritional assessment and laboratory examination. Results : The mean age of patients was 52 years. None of them have taken corticosteroid or any other medicine. None of them had suffered from any other medical illness. The mean BMI was 22.1 kg/m2 and the values of 7 patients were less than the age-matched normal value of healthy Korean men. Six patients were current smokers and there were no heavy drinkers. Urinary calcium excretion was elevated in 5 patients and dietary calcium intake was less than 400mg/day in 4 patients. Vitamin D deficiency, as evidenced by serum 25(OH) D levels below 12 ng/mL, was detected in 2 patients, however, subclinical hypovitaminosis D (below 20 ng/mL) was observed in 8 patients. Serum free testosterone levels below normal value were observed in 5 patients. The mean serum IGF-I level was 183.7 ng/mL and that was lower than for normal Korean men. Lower IGF-I levels than age-matched normal values were observed in 5 patients. Conclusion : The clinical characteristics of Korean male osteroporosis were heterogenous in many aspects of its features. Several factors could be suggested as possible causes of idiopathic male osteoporosis. Men with osteoporosis in this study revealed low BMI(7 patients), family history of osteoporosis(1 patient), low calcium intake(4 patients), hypercalciuria(5 patients), Vitamin D deficiency(2 patients), subclinical hypovitaminosis D(8 patients), testosterone deficiency (5 patients) and low IGF-I level(5 patients). Multiple causes of osteoporosis were found in 6 patients. (Korean J Med 57:304-312, 1999)

한국인 인슐린 비의존형 당뇨병 및 이차성 당뇨병 환자에서 글루코키나제 유전자 변이

남재현(Jae Hyun Nam),이현철(Hyun Chul Lee),김연의(Youn Euy Kim),권석호(Suk Ho Kwon),윤용석(Yong Suk Yoon),박석원(Suk Won Park),원영준(Young Jun Won),차봉수(Bong Su Cha),송영득(Young Duk Song),이은직(Eun Jig Lee),임승길(Sung Kil Lim) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objectives: Mutations in the glucokinase (GCK) gene are considered a possible cause of maturity-onset diabetes of the young. The purpose of this study was to evaluate the contribution of this gene to the development of non insulin dependent diabetes mellitus (NIDDM), gestational diabetes mellitus (GDM) and post-renal transplantation diabetes mellitus (PTDM). Method: Identification of GCK mutation was attempted on 39 NIDDM patients, 2 GDM patients and 58 selected renal allograft recipients with PTDM and 45 normal controls. The exons in the GCK gene were examined by polymerase chain reaction (PCR), followed by analysis of single-stranded DNA conformational polymorphism (SSCP). The abnormal bands were also confirmed by DNA sequencing analysis. The exons of affected family members were also investigated for mutations of the GCK gene. Results: Two of the 58 PTDM patients (3.4%) were found to have CKK mutations. One had the mutation on exon 5 and the other on intron 7. One control subject had the mutation on intmn 9. The mutation of exon 5 was identified as a substitution of CCT (proline) for CTT (leucine) at codon 164, which has not ever reported before. The family members of the PFDM patient with mutation of exon 5 were analyzed by PCR followed by SSCP, and two of them revealed the same mutation. The abnormal band on the SSCP analysis of exon 7 was identified as the insertion of base C/T at the 39th nucleotide in intron 7. Two family members of this patients also had same band on SSCP. The one mutation of 45 normal controls was CT located at the 8th nucleotide in intron 9, which was a common polymorphism. Conclusion: We found GCK mutations in subjects with PTDM and we speculate that these mutations may be one of the contributing cause of PTDM.

인슐린 비의존형 당뇨병 환자에서 PABA 검사에 의한 췌장 기능의 평가

정춘희(Choon Hee Chung),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),최광준(Kwang Jun Choi),송영득(Young Duk Song),임승길(Sung Kil Lim),정재복(Jae Bok Chung),이상인(Sang In Lee),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh) 대한내과학회 1992 대한내과학회지 Vol.43 No.1

N/A Background and Methods: Exocrine pancreatic dysfunction is frequently seen in patients with fibrocal-culous pancreatic diabetes and insulin dependent diabetes mellitus. Also decreased pancreatic size in those patients has been reported. But exocrine dysfunction in patients with non-insulin dependent diabetes mellitus (NIDDM) is controversial. Simple tubeless PABA test has been widely used to test the chymotrypsin activity. In order to investigate the exocrine dysfunction in patients with NIDDM and to find out the factors affecting it, we performed PABA test and pancreatic size measurement in 20 diabetic patients and 8 controls. Results: 1) Excretion rate PABA in diabetic patients was significantly lower than that of healthy controls (58.3±17.5vs 76,5±11.49p, p<.0,05). 2) Among diabetic patients, underweight diabetics showed significantly lower excretion rate of PABA than non-underweight diabetics (50.2±18.5% vs 66,4±12,7%, p<0.05). 3) In non-underweight subjects, excretion rate of PABA was 66.4±12.7%, which is significantly lower than that of healthy controls (82.0±10.59%)(p<0.05), 4) In diabetic patients, urinary PABA excretion rate was not correlated with age, duration of diabetes mellitus, HbA1C and pancreatic size, but positively correlated with the ratio of ideal body weight. Conclusion: Exocrine pancreatic function was decreased in NIDDM patients and it seems to be negatively correlated with underweight

원저 : 한국 성인 대사증후군 환자에서 허리둘레의 기준치수에 관한 연구

최성희 ( Sung Hee Choi ),김대중 ( Dae Jung Kim ),이광은 ( Kwang Eun Lee ),김유미 ( Yoo Mee Kim ),송영득 ( Young Duk Song ),김하동 ( Ha Dong Kim ),안철우 ( Chul Woo Ahn ),차봉수 ( Bong Soo Cha ),허갑범 ( Kap Bum Huh ),이현철 ( Hyun 대한비만학회 2004 The Korean journal of obesity Vol.13 No.1

연구 배경: 대사증후군의 진단 기준은 현재 National Cholesterol Education Program Adult Treatment Panel III(NCEP ATP III) 의 기준이 세계적으로 받아들여지고 있다. 그러나, 서양인의 체형에 근거한 이러한 진단기준은 동양인에게 부적합한 것으로 보고되고 있다. 2000년 WHO 서태평양 지부에서는 동양인의 비만의 진단 기준으로 체질량 지수는 25.0㎏/㎡ 이상, 복부비만의 허리 둘레의 기준치는 남 Backgrounds: The metabolic syndrome is the clustering of cardiovascular risk factors such as glucose intolerance, hypertension, dyslipidemia and visceral obesity. The National Cholesterol Education Program Adult Treatment Panel III(NCEP ATP III) criterion

폐경전 40대 한국 여성들의 영양 섭취 상태와 골밀도와의 관계

이종호(Lee Jong-Ho),최미숙(Choi Mi-Sook ),백인경(Paik In-Kyoung ),문수재(Moon Soo-Jae),임승길(Lim Seong-Kil),안광진(Ahn Kwang-Jin),송영득(Song Young-Duk),이현철(Lee Hyun-Chul),허갑범(Huh Kap-Bum) 韓國營養學會 1992 Journal of Nutrition and Health Vol.25 No.2