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말단비대증 환자에게서 성장호르몬과 인슐린유사성장인자-I 농도 간의 불일치
윤지완,강미연,안화영,안지현,김상완,신찬수,박경수,장학철,조보연,이홍규,김성연 대한내분비학회 2008 Endocrinology and metabolism Vol.23 No.6
Background: This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. Methods: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was ≥ 2.5 μg/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. Results: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). Conclusion: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration. Background: This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. Methods: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was ≥ 2.5 μg/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. Results: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). Conclusion: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration.
윤지완,하용찬,김경민,문재훈,최성희,임수,박영주,임재영,김기웅,박경수,장학철 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.2
Background: The study aimed to investigate the influence of hyperglycemia on muscle quality in older men with type 2 diabetes. Methods: This was a subsidiary study of the Korean Longitudinal Study of Health and Aging. Among 326 older men consenting to tests of body composition and muscle strength, 269 men were ultimately analyzed after the exclusion because of stroke (n=30) and uncertainty about the diagnosis of diabetes (n=27). Body composition was measured using dual-energy X-ray absorptiometry and computed tomography. Muscle strength for knee extension was measured using an isokinetic dynamometer. Muscle quality was assessed from the ratio of leg strength to the entire corresponding leg muscle mass. Results: The muscle mass, strength, and quality in patients with type 2 diabetes did not differ significantly from controls. However, when patients with diabetes were subdivided according to their glycemic control status, patients with a glycosylated hemoglobin (HbA1c) level of ≥8.5% showed significantly decreased leg muscle quality by multivariate analysis (odds ratio, 4.510; P=0.045) after adjustment for age, body mass index, smoking amount, alcohol consumption, physical activity, and duration of diabetes. Physical performance status was also impaired in subjects with an HbA1c of ≥8.5%. Conclusion: Poor glycemic control in these older patients with diabetes was associated with significant risk of decreased muscle quality and performance status. Glycemic control with an HbA1c of <8.5% might be needed to reduce the risk of adverse skeletal and functional outcomes in this population.
F-89 Sarcopenia 와 폐기능 감소의 연관성에 대한 종적 연구
허은영,정고은,윤지완,오소희,이정규,김덕겸,정희순,최승호 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.0
목적: sarcopeina는 노화 과정으로 골격근육의 퇴행으로 인한 골격근량이 감소하는 상태이다. 만성 호흡기 질환자에서 호흡근의 강도는 폐기능과 밀접한 연관이 있다고 알려져 있다. 본 연구는 검진 받은 수검자를 대상으로 sarcoepnia가 연속적으로 측정한 폐기능과 관련성을 보이는지 확인하고자 하였다. 방법: 서울대학교 병원 강남센터에서 2012년 체질량 분석 및 폐기능 검사를 포함한 검진을 시행하고 2016년 폐기능 검사를 연속적으로 추적하여 시행한 자들을 대상으로 하였다. Sarcopenia의 기준은 ASM/Height^2의 값이 남성은 7.09Kg/m2, 여성은 5.27Kg/m2 이하일 때로 정의하였다. 성적: 총 2,038 명의 수검자들이 분석 대상이 되었으며 이들 중 161명에서 sarcopenia 기준을 만족하였다. Sarcopenia 가 있는 군은 2012년 폐기능 검사에서 FEV1 은 2.88 ± 0.67L 로 대조군의 3.12 ± 0.69L (P <0.01) 에 비해 유의하게 떨어져 있었다. 년당 FEV1 감소 속도를 보았을 때 Sarcoepnia 군은 0.07 ± 0.41 ml/year , 대조군은 0.07 ± 0.05 ml/year 로 유의한 차이는 없었지만 (P=0.436), BMI로 보정하였을 때 Sarcopenia 군이 BMI 가 25Kg/m2 이상인 비만이 동반된 경우 대조군에 비해 매년 0.011ml/year 씩 유의하게 폐기능이 감소하였다. (P=0.003). 결론: 비만이 동반된 Sarcopenia 가 있는 경우 폐기능 감소가 유의하게 증가하였다.
제주도에서 브루셀라에 의해 발생한 특발성 세균성 복막염
허상택,조유경,김영리,이근화,윤지완,고관수,박미연,최영실 대한감염학회 2007 감염과 화학요법 Vol.39 No.1
Spontaneous bacterial peritonitis is the common infectious disease in liver cirrhosis patients with a fever. Brucellosis is a rare cause of bacterial peritonitis. A case indigenous to a citizen of Jeju, he ate a raw veal of cow four times in last 2 months prior to admission. The gram-negative bacilli were isolated from blood and peritoneal fluid cultures. He was confirmed brucellosis by serologic work- ups. This isolate was confirmed as Brucella abortus by using PCR amplification of 16S ribosomal RNA (rRNA) and omp2. This is the first case of bruellosis that was diagnosed spontaneous bacterial peritonitis in liver cirrhosis patient among native korean citizens. Successful treatment was obtained by using a regimen of doxycycline and gentamicin. Brucella should be suspected as a cause of spontaneous bacterial peritonitis in cirrhotic patients with no response to standard spontaneous bacterial peritonitis treatments. 브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중의 하나로, 국내에서도 해마다 환자가 증가하고 있는 상황이다. 본 증례는 간경화 환자에서 환자의 잘못된 지식을 바탕으로 소 태아 육회를 섭취한 이후 복수와 발열을 주소로 내원한 환자이다. 상기 과거력이 환자의 질환과의 직접적인 연관성을 밝히기는 어려우나 환자의 진단을 추정하는데 도움이 되었으며, 이러한 가능성을 배제하기 위해서라도 국내 유통에 있어서 좀더 적극적인 대체가 필요하다 하겠다. 상기 환자는 브루셀라에 의해 발생한 특발성 세균성 복막염 환자로 제주도에서 발생한 내국인의 첫 증례이기에 문헌 고찰과 함께 보고하는 바이다.