폐암에서 혈중 CYFRA 21-1의 진단적 가치

윤현대 ( Hyun Dae Yoon ),김기덕 ( Ki Deok Kim ),정진홍 ( Jin Hong Chung ),이형우 ( Hyung Woo Lee ),이관호 ( Kwan Ho Lee ),이현우 ( Hyun Woo Lee ),조인호 ( Ihn Ho Cho ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.2

갑상선결절의 초음파유도하 세침흡인검사에서 Galectin-3의 진단적 유용성

김현숙 ( Hyun Sook Kim ),조창호 ( Chang Ho Cho ),정의달 ( Eui Dal Jung ),윤현대 ( Hyun Dae Yoon ),배종엽 ( Jong Yup Bae ),손호상 ( Ho Sang Shon ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2

Background and Objectives: Fine needle aspiration biopsy (FNAB) is considered as the most feasible preoperative diagnostic tool for thyroid lesions. However, indeterminate results of FNAB are common, so many methods were developed as supportive preoperative diagnostic modalities in indeterminate results of FNAB. In our previous studies, galectin-3 was expressed preferentially in thyroid malignancies of postoperative tissue specimen. In the present study, we evaluated whether galectin-3 immunohistochemistry (IHC) is useful as a preoperative diagnostic tool in thyroid nodules. Materials and Methods: A total of 151 thyroid nodules were performed US-guided FNAC and obtained from patients who underwent thyroidectomy were evaluated using papanicolaou-stained slides and cell blocks with galectin-3 IHC. IHC for Galectin-3 was performed. Cytologic diagnoses were correlated with the results of galectin-3 and categorized into 3 groups (benign, indeterminate, malignancy) and compared with the corresponding histologic diagnoses. Results: Of 151 specimens, 113 (74.8%) were malignant. When the histologic diagnoses were compared with the galectin-3 IHC, there were 14 (9.2%) discrepant cases. In the result of US-guided FNAB, sensitivity, specificity, positive-predictive value, and negative predictive value of galectin-3 IHC were 90.2, 92.1, 97.1, 76.1%. In the indeterminate result of US-guided FNAB, sensitivity, specificity, positive-predictive value, and negative predictive value of galectin-3 were 50, 91.4, 60, 96.9%. Conclusion: Galectin-3 IHC is a supplementary marker for the preoperative diagnoses of thyroid nodules in the US-guided FNAB. In the indeterminate of FNAB, galectin-3 IHC is not a reliable method for diagnosis, but negative staining of galectin-3 may raise the possibility of benign thyroid nodules.

부랑인 및 정신질환자 수용시설인 희망원에서의 당뇨병 유병률과 위험인자 분석

이지현 ( Ji Hyun Lee ),손호상 ( Ho Sang Son ),양전호 ( Jeon Ho Yang ),윤현대 ( Hyun Dae Yoon ),정성창 ( Sung Chang Chung ),유성수 ( Sung Soo You ) 대한내과학회 2002 대한내과학회지 Vol.62 No.6

목적 : 사회 경제적 여건이 열악한 부랑인 및 정신질환자 보호시설인 희망원에서의 당뇨병 유병률을 알아보고 위험인자를 분석해 보고자 본 연구를 시행하였다. 방법 : 대구 시립 희망원에 수용된 20세 이상 원생 1,425명 (남자 905명, 여자 520명)을 대상으로 전날 저녁부터 공복상태에서 지낸 후 정맥혈을 채취하여 혈장 포도당 농도를 측정하였다. 동시에 원생들의 과거병력, 사회력에 대한 문진 및 신체 계측을 하였다. 통계 분석은 SPSS 9.0 프로그램을 이용하였다. 결과 : 미국 당뇨병 학회에서 제시한 새로운 공복혈당 기준을 이용한 당뇨병의 유병률은 13.5% (남=10.1%, 여=19.4%)였으며 공복혈당장애의 유병률은 11.3% (남=8.7%, 여=15.8%)였다. 당뇨병과 관련된 위험인자로는 나이, 성별, 혈청 중성 지방 농도, 수축기 혈압이 분석되었다. 결론 : 희망원생들의 당뇨병 유병률은 최근 보고된 연천지역이나 정읍지역 역학 연구 결과들보다 다소 높은 경향을 보여 주었으나 당뇨병 위험인자는 지역 사회 역학 연구 결과들과 유사한 것으로 분석되었다. Background : Recently, the prevalence of diabetes mellitus in Korea is rapidly increasing. It is known that this increase is related with the change of environmental factors. We performed study to determine the prevalence of diabetes and to investigate their risk factors in Hope Village taking in low socio-economic people. Methods : Total 1,425 subjects (905 men and 520 women) aged over 20 years in Daegu city Hope Village were venipunctured after overnight fasting to measure plasma glucose level and interviewed about their past medical and social history. We also collected standard anthropometric data. All the data were analyzed by SPSS 9.0 program. Results : The prevalence of diabetes by using the revised new American Diabetes Association criteria was 13.5% (male=10.1%, female=19.4%) and the prevalence of impaired fasting glucose was 11.3% (male=8.7%, female=15.8%). It was observed that the significant factors associated with diabetes were age, sex, serum triglyceride level, systolic blood pressure. Conclusion : The prevalence of diabetes in Hope Village was relative higher than that of the previous suggested population based studies in Yonchon County and Jungup District. But the risk factors of newly diagnosed diabetes were similar with those of the previous studies.(Korean J Med 62:633-641, 2002)

원저 : 제2형 당뇨병 환자에서 Voglibose와 Glimepiride의 체중에 대한 효과

정선혜 ( Sun Hye Jung ),김대중 ( Dae Jung Kim ),이관우 ( Kwan Woo Lee ),김범택 ( Bom Taeck Kim ),김성수 ( Sung Soo Kim ),김은숙 ( Eun Sook Kim ),목지오 ( Ji Oh Mok ),안철우 ( Chul Woo Ahn ),윤현대 ( Hyun Dae Yoon ),이상엽 ( Sang Y 대한비만학회 2005 The Korean journal of obesity Vol.14 No.2

연구배경: 당뇨병 환자에서 설폰요소제나 인슐린은 체중 증가를 가져올 수 있는 반면, 메트포민은 체중 감소 효과가 있으며, 알파 글루코시다제 억제제는 체중 증가를 억제하는 효과가 있다고 보고된 바 있다. 본 연구는 초기 제2형 당뇨병 환자를 대상으로 혈당조절의 방법으로 voglibose, glimepiride, 식이요법을 사용하였을 때 각각의 체중 및 혈당조절에 미치는 영향을 비교해 보았다. 방법: 연구 대상은 제2형 당뇨병 환자로 나이는 30~75세이며, 공복혈당은 200 ㎎/dL 미만, 체질량 지수는 23.0 ㎏/㎡ 이상, 최근 2주 이내 혈당 강하제나 인슐린, 체중에 영향을 줄 수 있는 약제를 사용하지 않은 경우로 하였다. Voglibose (Basen(R)), glimepiride(Amaryl(R)), 식이요법 세 군으로 무작위 배정하였고, 신체계측 및 혈당, 당화혈색소, 혈압, 지질 등을 시작 시점과 12주 후에 측정하였다. 결과: 총 448명의 제2형 당뇨병 환자가 연구에 포함되었고, 이 중에 voglibose 군은 223명, glimepiride 군은 176명, 식이요법 군은 49명이었다. 12주 후의 체중은 voglibose 군과 식이요법 군에서 glimepiride 군보다 체중이 유의하게 더 감소하였으며 (voglibose vs glimepiride, P=0.001; diet vs glimepiride, P=0.016), voglibose 군과 식이요법 군 간에는 차이가 없었다. 반면, 당화혈색소는 glimepiride 군에서 voglibose 군이나 식이요법 군보다 유의하게 감소하였으며 (glimepiride vs voglibose, P=0.001; glimepiride vs diet, P=0.004), voglibose 군과 식이요법 군 간에는 차이가 없었다. 결론: Voglibose는 glimepiride에 비해 혈당조절 능력은 다소 떨어지지만, 상대적으로 체중감소의 효과가 있다. Background: Obesity is a major risk factor for type 2 diabetes. Improvement in glycemic control using insulin, sulfonylurea and meglitinide is often accompanied by weight gain. But metformin and α-glucosidase inhibitor have a positive effect(decrease) on weight. In this study, we compared the effect of voglibose, glimepiride, and diet alone on body weight and glycemic control after a period of 12 weeks. Methods: The patients with type 2 diabetes were randomly assigned to one of the following three treatment groups: Patients treated for 12 weeks with voglibose, those treated with glimepiride and those with diet alone. Anthropometric parameters and metabolic parameters were measured at the initial stage and after 12 weeks. The study consisted of 448 patients with type 2 diabetes. There were 223 patients in the voglibose group, 176 in the glimepiride group, and 49 in the diet alone group. Results: The patients treated with voglibose and diet alone showed higher decreased body weight compared with glimepiride group (voglibose vs glimepiride, P=0.001; diet vs glimepiride, P=0.016). In contrast, glimepiride group showed more decreased HbA1C compared with voglibose and diet alone groups (glimepiride vs voglibose, P=0.001; glimepiride vs diet, P=0.004). Conclusion: Voglibose showed more effective on body weight reduction despite the relatively weak glycemic control compared with glimepiride.

갑상선환자에서의 5분 99mTc - Pertechnetate 섭취율과 방사성옥소섭취율의 상관관계

이찬우(Chan Woo Lee),원규장(Kyu Chang Won),윤현대(Hyun Dae Yoon),조인호(In Ho Cho),김태년(Tae Nyeun Kim),신동구(Dong Gu Shin),이형우(Hyoung Woo Lee),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2

N/A The 20-minute Tc-99m-pertechnetate uptake became readily available for routine use and it replaced 131I for thyroid imaging. However measuring thyroid uptake during a 5-minute minimizes pertechnetate uptake by the salivary glands and presence of contaminated saliva from those glands in to the pharynx and esophagus. A study was carried out to determine the suitability of the utility of a 5-minute and 20-minute interval from administration of Tc-99m-pertechnetate to imaging and uptake measurement as a replacement for the 24 hour standard originally established with 131I, and to evaluate the relationship between 5-minute Tc-99m-pertechnetate uptake and other thyroid functions. A 5-minute and 20-minute uptake of Tc-99m-pertechnetate were measured in 70 patients with thyroid disease at Yeungnam University Hospital from March 1, 1991 to Feb. 29, 1992. The results were as follows. 1) The 5-minute Tc-99m-pertechnetate uptake in Graves' disease, Hashimoto's thyroiditis, simple goiter non toxic nodular goiter, subacute thyroiditis and euthyroid were 18.2%, 14.6%, 2.8%, 3.2%, 1.2% and 1.1%, respectively. There was a significant difference between the mean of the euthyroid group and the mean of the Graves' disease. So differenciation between them can be easily made. 2) The 5 minute Tc-99m- pertechnetate thyroid uptake was well correlated with 24 hour 131I thyroid uptake (r=0.75, p〈0.001). These data provided an equation for estimating the 24 hour uptake of iodide given the 5 minute pertechnetate uptake: Estimated 24-hour 131I thyroid Uptake = 7.188*ln (5 minute Tc-99m- Pertechnetate uptake)+16.94 3) The 20-minute Tc-99m-pertechnetate thyroid uptake was well correlated with 24-hour 131I uptake (r=0.72, p〈0.001) and 5-minute Tc-99m-pertechnetate thyroid uptake (r=0.96, p〈0.001). 4) In the Graves' disease, The 5-minute Tc-99m-pertechnetate thyroid uptake was well correlated with serum T3-resin uptake (r=0.46, p〈0.01), serum total T3 (r=0.55, p〈0.05), serum total T4 (r=0.46, p〈0.05). These results suggest that 5-minute Tc-99m- pertechnetate thyroid uptake has been found at least as useful as 24-hour 131I uptake for diagnostic confirmation at our hosptial, the logistical advantages of completing the diagnosis. The exam in 5-minutes led us to abandon the 24-hour study in the majority of patients, but the 24-hour 131I uptake is still obtained in patients with planned or potential radioiodine therapy.

혈청 anti - HCV 양성자의 역학 및 가족내 감염과 HBV 표지자에 관한 조사

이헌주(Heon Ju Lee),강호정(Ho Jung Kang),김기덕(Kee Duck Kim),박찬원(Chan Won Park),윤현대(Hyun Dae Yoon),전진종(Jin Chong Chun),최교원(Kyo Won Choi),최희진(Hee Jin Choi) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Transfusion is a well-known source of hepatitis C virus (HCV) infection but over half of the hepatitis C patients do not have any suspicious source of infection. Epidemiological survey and serological test for HBV marks were done among anti-HCV positive chronic liver disease patient and their family members. Method: 74 cases of anti-HCV postitive chronic liver disease patients were evaluated for the evident source of HCV infection and 188 of their family members were consulted for the infection of HCV. To compare the mode of HBV infection with HCV, serum HBsAg, anti-HBc and anti-HBs were checked in 43 of HBsAg positive chronic liver disease patients, 190 of their family members, 64 anti-HCV postive chronic liver disease patients and 239 of normal control persons. Results: 35cases (47.3%) of 74 anti-HCV positive chronic liver disease patients had no suspicious source of infection and only 16 cases (21.6%) had the history of past transfusion. No family members except 3 (one infant, one IV drug abuser and one wife) in 3 families among 74 families were anti-HCV positive. 29 of 43 (67. 4%) families of HBsAg positive chronic liver disease patients had at least one of HBsAg positive member. Characteristically, HBsAg was positive in almost all cases of offsprings born to mothers of HBsAg and HBeAg positive chronic liver disease. 2 of 64 (3.1%) serum anti-HCV positive patients had HBsAg in their sera. Anti-HBs positive cases were 11 of 64 (17.2%.) anti-HCV positive chronic liver disease patients and isolated anti-HBc positive cases were 40 of 64 (62.5%). On the other hand, in normal control, the positive rate of anti-HBs and isolated anti-HBc were 57,4% and 24.3%(> in each (p<0,005, in both). Conclusion: In Korea, vertical transmission was the main source of HBV infection but HCV disease might be horizontal and sporadic. No remarkable difference in HBV infection rate between anti-HCV positive chronic liver disease patients and control persons. Superinfection of HCV on person who already was exposed to HBV may occur but this assumption could be depend on accurate testings for HBV and HCV. Some derangement in immune system and reaction or interaction between HBV and HCV should be considered in anti- HCV positive patients but before, isolated serum anti- HBc positive sera of chronic liver disease patients should be examined by confirmatory tests. To reduce the number of HCV patients, defining the evident source of the sporadically infected HCV cases could be helpful.

이소갑상선 19예의 신티그라피 소견

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),이찬우(Chan Woo Lee),원규장(Kyu Chang Won),윤현대(Hyun Dae Yoon),조인호(In Ho Cho),이형우(Hyoung Woo Lee),이현우(Hyun Woo Lee) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.2

N/A Abnomalities in the embryologic development and migration of the thyroid gland can result in ectopic thyroid tissue, which may occur on the midline in any position from the base of the tongue to the mediastinum. Although ectopic thyroid may be asymptomatic, local obstructive, hemorrhagic or other complication may occur. Radinuclide thyroid scan is confirmatory when the diagnosis is suspected. Hypothyroidism is common in lingual thyroid, and thyroid supplementation is generally required. In order to evaluate the features of ectopic thyroid, we investigated the scintigraphic findings, thyroid function test and clinical symptoms of 19 patients with ectopic thyroid. 1) The frequency of ectopic thyroid was about 5. 3 times more common in female than in male. Then patients were mostly below 30 years old (79%). 2) The frequency of location of ectopic thyroid were as follows: 10 cases in the tongue base, 1 case in suprahyoid, 5 cases in infrahyoid and 3 cases over 2 areas. 3) The thyroid function test was done in 16 cases of the ectopic thyroid patients. The hypothyroidism was detected in 7 cases, subclinical hypothyroidism in 4 cases and normal thyroid function in 5 cases. 4) The rate of hypothyroidism is 90% in the lingual thyroid and 33% in the others. The thyroid dysfunction was related with the location of the ectopic thyroid (p〈0.05). 5) The clinical manifestations include a mass in the tongue base, the foreignbody sensation of a throat and a swallowing difficulty in lingual thyroid. The palpable mass was the chief complaint in the others. 6) We prescribed the thyroid hormone to 10 cases with hypothyroidism. The ectope thyroid was removed in 2 cases with normal thyroid function. The rest is following up through OPD. We must consider the possibility of the ectopic thyroid and take the thyroid scan when the patient has a amass in the tongue base, the sublingual and the prelaryngeal area. Then we have to check the thyroid function and follow up when the ectopic thyroid is diagnosed, because the patient with normal thyroid function can result in the hypothyroidism. Except these, we must mind of the possibility of occurence of the cancer in the ectopic thyroid tissue.

류마티스 관절염 환자에서 Methotrexate 사용 중 발생한 악성 림프종

김무곤 ( Moo Gon Kim ),이준엽 ( Juhn Yeob Lee ),배종석 ( Jong Seok Bae ),서영진 ( Young Jin Seo ),임경진 ( Kyung Jin Lim ),정승혜 ( Seung Hie Chung ),윤현대 ( Hyun Dae Yoon ),김은영 ( Eun Young Kim ),윤원찬 ( Wern Chan Yoon ),류 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.1

Rheumatoid arthritis (RA) is a multisystemic inflammatory disease with a prevalance of approximately 1% of the population. The use of disease modifying anti-rheumatic drug (DMARD) is an essential regimen for the treatment of RA. Among DMARDs, methotrexate (MTX) is used worldwide with confirmed effectiveness. However, cytopenia, pulmonary injury, and hepatic toxicity are a few side effects limiting its use. In addition, although the oncogenic potential of MTX is low, several cases have been reported. Recently an increased risk of developing lymphoproliferative disorders has been reported in patients with RA. The incidence is higher in elderly individuals with severe longstanding seropositive RA, those with Sjoren`s or Felty`s syndrome, and in patients with RA treated with prolonged low dose MTX. We describe a case of RA who developed non-Hodgkin`s lymphoma during low dose MTX therapy.

한국인 폐경 후 여성에서 골관절염과 비타민 D 수용체의 다형성과의 연관관계의 부족

임경진 ( Gyung Jin Lim ),김무곤 ( Moo Gon Kim ),배종석 ( Jong Seok Bae ),유길종 ( Kil Jong Yu ),조유리 ( You Lee Cho ),윤현대 ( Hyun Dae Yoon ),김은영 ( Eun Young Kim ),윤원찬 ( Wern Chan Yoon ),김채기 ( Chae Gi Kim ),송용호 ( Yon 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.1

Objective: To determine whether polymorphisms of the Vitamin D receptor (VDR) gene, known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians, might also relate to the risk of OA and osteoporosis in Korean postmenopausal women Methods: A population of 130 postmenopausal women, including 76 healthy controls and 54 knee OA patients, were studied using anteroposterior radiographs of the knee, which were graded for OA according to the Kellgren classification system. The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I, Bsm I, and Apa I. Femoral neck bone mineral density (BMD) was assessed in all participants by dual energy X-ray absorptiometry. Results: VDR genotype frequency distributions in Koreans were much different from Caucasian`s both in the OA group and the control group. Especially, tt, BB and AA genotype were very rare, prominently differentiating from Caucasians. But within Koreans, no significant differences in VDR genotype frequencies were observed between OA cases and controls. VDR genotype was not significantly associated with the radiographic grades of OA. And there were no significant relationships of VDR genotype with BMD scores in each group. Conclusion: In Korean postmenoposal women, the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD. VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because: (1) there is no correlation of VDR genotypes with the radiographic severity of OA; and (2) there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian`s.

제2형 당뇨병에서 대혈관합병증 유무에 따른 경동맥 내막-중막 두께와 죽상동맥경화증 위험인자에 대한 연구

윤현대,진명인,유성수,정덕수,이지현,손호상 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.4

연구배경: 당뇨병 환자에서 대혈관합병증을 조기에 발견하여 진단을 내리는 데에는 어려움이 많은데 최근 고해상도 B-mode 초음파를 이용한 경동맥의 내막-중막 두께의 측정은 조기에 죽상동맥경화증의 정도를 반영하는데 매우 유용함이 알려져 있다. 이에 저자들은 제2형 당뇨병 환자에서 대혈관합병증의 예측에 경동맥 내막-중막 두께의 유용성을 분석하고 경동맥 내막-중막두께와 죽상동맥경화증 위험 인자와의 연관성을 알아보기 위하여 연구를 시행하였다. 방법: 본 연구는 대구가톨릭대학병원에서 추적, 경과관찰 중인 103명의 제2형 당뇨병 환자를 대상으로 대혈관합병증 (관상동맥질환, 뇌혈관질환) 의 기왕력이 있는 군과 기왕력이 없는 군으로 나누어 시행하였다. 고해상도 B-mode 초음파기기를 이용하여 경동맥 내막-중막 두께를 측정하였으며, 문진, 이학적 검사 등을 시행하여 키, 체중, 당뇨병의 유병기간, 흡연 및 고혈압의 기왕력에 대한 정보를 얻었다. 10∼12시간 금식후 정맥에서 혈액을 채취하여 지질성분 (중성지방, 총콜레스테롤, HDL-콜레스테롤, LDL-콜레스테롤, Lp(a), Apo(A), Apo(B)), 당화혈색소를 측정하고 24시간 요중 알부민과 단백질을 측정하였다. 결과: 대혈관합병증이 있는 군에서 연령, 혈압, 당화혈색소가 더 높았으며 당뇨병성 신증이 의미있게 증가되어 있었다. 또한 대혈관합병증이 있는 군에서 경동맥 내막-중막 두께의 최고치 및 평균치가 의미있게 증가되어 있었으며 경동맥 내막-중막 두께의 최고치는 대혈관합병증의 독립적인 위험인자로 분석되었다. 경동맥 내막중막의 두께와 관련된 위험인자로는 연령, 당뇨병의 이환기간, 수축기혈압, LDL-콜레스테롤이 유의한 상관관계를 보였다. 결론: 당뇨병성 대혈관합병증의 조기발견에 있어서 고해상도 B-mode 초음파로 측정한 경동맥 내막-중막 두께의 측정은 유용하며, 특히 연령이 많고, 당뇨병의 이환기간이 오래 되거나, 고혈압이나 고지혈증이 동반된 환자일수록 더욱 도움이 될 것으로 생각된다. Background: Macrovascular complications such as cardiovascular and cerebrovascular accidents are major causes of diabetes mellitus-related morbidity and mortality. However, it is difficult to diagnose such macrovascular complications before clinical symptoms are evident. In many previous studies, the measurement of carotid intima-media thickness (IMT) has been a useful, non-invasive method to detect early atherosclerotic vascular changes. Methods: We measured carotid IMT by using high resolution B-mode ultrasonography in 103 type 2 diabetes patients with and without macrovascular complications. At the same time, we analyzed the patients' characteristics including height, weight, body mass index (BMI), blood pressure, duration of diabetes, and past history of hypertension and smoking. Laboratory parameters such as HbA1c, triglyceride, total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein (A), apolipoprotein (B), Lp (a) and 24-hour urine microalbumin and protein were included in this study. Results: Age, blood pressure, glycosylated hemoglobin and diabetic nephropathy were significantly increased in type 2 diabetes patients with macrovascular complications. And type 2 diabetes patients with macrovascular complications showed significantly thicker maximal and mean carotid IMT than those without macrovascular complications. Maximal carotid IMT was an independent risk factor of macrovascular complication in type 2 diabetes patients, and was positively correlated with age, duration of diabetes, systolic blood pressure and LDL-cholesterol. Conclusion: The measurement of carotid IMT by using high resolution B-mode ultrasonography is a useful method for the early detection of macrovascular complications in type 2 diabetes patients.