비만 지표 (Body Mass Index)가 만성 무배란 여성의 혈중 기저 호르몬치와 포도당 대사에 미치는 영향

이정호,정은정,김종인,Rhee, Jeong-Ho,Jeong, Eun-Jeong,Kim, Jong-In 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.1

Objective: To assess the difference of baseline hormonal status and pathophysio logy, and confirm the risk factors for long term complication according to Body Mass Index in women with polycystic ovary syndrome. Materials and Methods: Serum level of LH, FSH, Estradiol, Prolactin, Testosterone, DHEA-S, fasting insulin were measured and 100 gm oral glucose tolerance test and endometrial biopsy were performed in total 75 chronic anovulation patients and 20 normal cycling infertility patients. 95 evaluated patients were divided into 3 groups including patients with chronic anovulation having BMI below 25, BMI beyond 25.1, normal cycling infertility patients, Group 1 (n=39), Group 2 (n=36), Group 3 (n=20), respectively. Statistical analysis was performed respect to relationship between BMI and measured hormone level, sum of glucose level during 100 gm OGTT, insulin resistance using t-test, ANOVA test, Post Hoc test, Mann-Whitney test. p<0.05 was considered as statistically significant. Results: Serum LH level and LH/FSH ratio was significantly higher in Group 1, compared than Group 2 or 3 (p<0.05), BMI and LH, LH/FSH ratio was negatively correlated (r=-0.351, r=-0.318). There was no significant difference according to BMI in FSH, testosterone, estradiol, prolactin, DHEA-S level. Fasting insulin and sum of glucose level during 100 gm OGTT were significantly higher in Group 2 compared than Group 1 or Group 3 (p<0.05), there was no significant difference between Group 1 and Group 3. Insulin resistance was more frequently identified in Group 2 compared than Group 1 (p=0.001). Conclusions: BMI and LH, LH/FSH ratio were negatively correlated, so clinical significance of LH, LH/FSH ratio in diagnosis of PCOS may be attenuated by increasing body weight. Overweight patients with chronic anovulation may be the risk group for developing insulin resistance, hyperinsulinemia, glucose intolerance, later type 2 DM. Hyperinsulinemia may operate mainly in overweight chronic anovulation patients in development of hyperandrogenism.

난자공여를 통한 체외수정 시술에서 성선자극호르몬 유리호르몬 효능제 장기요법과 길항제 단기요법 사이의 임상 결과 비교

이정호,박준철,김종인,Rhee, Jeong-Ho,Park, Joon-Chul,Kim, Jong-In 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.1

Objective : To assess and compare the clinical outcomes between GnRH agonist long protocol and GnRH antagonist short protocol in oocyte donation program. Materials and Methods: Of total 18 oocyte donation cycles, controlled ovarian hyperstimulation (COH) were performed with GnRH agonist long protocol and GnRH antagonist short protocol in initial 9 cycles and later 9 cycles, respectively. Oral estradiol valerate and progesterone in oil we re administrated to all recipients for endometrial preparation. Oral estradiol administration was started from donor cycle day 1 after full shut down of gonadal axis with GnRH agonist in patients with ovarian function. Progesterone was injected from oocyte retrieval day of donor initially, then continuously till pregnancy 12 weeks if pregnancy was ongoing. We compared the parameters of clinical outcomes, such as number of the retrieved oocytes, fertilization rate, high grade embryo production rate, clinical pregnancy rate, implantation rate, ongoing pregnancy rate, COH duration, total gonadotropin dose for COH between GnRH agonist long protocol group and GnRH antagonist group. Statistical analysis was performed using Mann-Whitney test, p<0.05 was considered as statistically significant. Results: The number of retrieved oocytes, fertilization rate, high grade embryo production rate, clinical pregnancy rate, implantation rate, ongoing pregnancy rate were $14.89{\pm}7.83$, 81%, 64%, 78%, 31%, 78%, respectively in GnRHa long protocol group and $11.22{\pm}8.50$, 79%, 64%, 67%, 34%, 56%, respectively in GnRH antagonist group. There was no significant differences in parameters of clinical outcomes between 2 groups (all p value >0.05). Duration and total gonadotropin dose for COH were $10.94{\pm}1.70$ days and $43.78{\pm}6.8$ vials in 18 cycles, $12.00{\pm}1.73$ days and $48.00{\pm}6.93$ vials in agonist group, $9.88{\pm}0.78$ days and $39.55{\pm}3.13$ vials in antagonist group, respectively. In GnRH agonist long protocol group, significantly longer duration and higher gonadotropin dose for COH were needed (p=0.012). Conclusion: In oocyte donation program, clinical outcomes from controlled ovarian hyperstimulation with GnRH antagonist were comparable to those from GnRH agonist long protocol group, so controlled ovarian hyperstimulation with GnRH antagonist may be effective as GnRH agonist long protocol. At least there may not be harmful effects of GnRH antagonist on oocyte development and quality.

원발성 무월경의 임상적 고찰

이정호(Jeong Ho Rhee) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

목적 : 원발성 무월경의 원인적 진단의 호발 빈도를 평가하고 원인에 따른 임상적 중요성을 고찰해 보고져 한다 연구 방법 : 1998년 1월부터 2001년 12월까지 원발성 무월경의 진단으로 계명대학교 의과대학 동산의료원에 전원된 57명의 환자를 연구 대상으로 하여 원인적 진단을 위해 골연령, 염색체 검사, 호르몬 검사 (갑상선 자극호르몬, 유즙분비호르몬, 황체화호르몬, 난포자극호르몬, 에스트라디올, 테스토스테론, 부신 남성호르몬), 영상 진단 등을 시행하였으며 저성선자극호르몬성 무월경에서는 시상하부와 뇌하수체 원인을 구분하기 위하여 성선자극호르몬유리호르몬 자극 검사를 추가하였다. 저에스트로겐성 무월경 환자 28명에서는 골다공증의 위험성을 평가하기 위하여 골밀도 검사를 실시하였다. 위의 임상 연구를 통해 얻은 결과 자료를 토대로 원발성 무월경의 원인적 분류와 염색체 이상에 따른 임상적 중요성, 골다공증의 발생 위험성에 관한 임상적 고찰을 실시하였다. 결과 : 원발성 무월경의 진단시의 나이는 13-34세였으며 진단시 가장 흔한 나이는 17-18세로 전체 환자의 26.3%였다. 원발성 무월경의 가장 흔한 원인은 46,XX 성선기능부전증과 시상하부기능부전으로 각각 19.3%였으며 다음의 발생 빈도 순으로는 터너증후군과 관련된 세포-유전학적인 이상 (17.5%), 뮬러관 형성부전 (12.3%), 완전형 남성호르몬불감증후군 (10.5%) 등이었다. 세포-유전학적인 연구에서 38명의 환자 (66.6%)는 정상 46,XX 핵형을 보였으며 비정상 핵형을 보이는 환자 중에는 터너증후군과 관련된 염색체 이상과 46,XY 핵형이 각각 52%, 31.5%로 가장 높은 발생 빈도를 보여주었다. 저에스트로겐증 환자군에서 시행한 골밀도 검사에서는 거의 모든 환자에서 골밀도 감소의 소견을 보였다. 결론 : 본 연구에서 보여주는 원발성 무월경의 가장 흔한 원인은 46,XX 성선기능부전증과 시상하부기능 부전증, 터너증후군과 관련된 염색체 이상 등으로 이런 환자들은 골결핍증과 골다공증에 심각하게 노출되어 있으므로 즉각적인 호르몬 대체요법과 적절한 지지 치료가 필요할 것이다. Objective : To assess the etiologic diagnosis of primary amenorrhea and review the clinical significance in management of primary amenorrhea. Methods : To make the accurate etiologic diagnosis of primary amenorrhea, karyotype, hormone study (TSH, Prolactin, LH, FSH, Estradiol, Testosterone, DHEA-S), various imaging techniques were performed in total 57 patients. And additional GnRH stimulation test and bone densitometry were also performed in group of hypogonadotropic amenorrhea with normal sella and brain imaging for discriminating the hypothalamic and pituitary cause and in patients with low estrogenic state for identifying the risk of osteoporosis, respectively, then reviewed as to clinical significance according to etiologic classification, karyotypical abnormalities, and risk of osteoporosis in low estrogenic group. Results : The range of age at diagnosis was from 13 to 34 years, most commonly, 17-18 years, 26.3%. The most common causes of primary amenorrhea was 46,XX ovarian failure and hypothalamic failure, 19.3% and 19.3%, respectively. The next common causes were genetic disorder related with Turner syndrome (17.5%), Mullerian agenesis (12.3%), complete androgen insensitivity syndrome (10.5%), orderly. In cytogenetic study, 19 patients (34%) showed abnormal karyotype, of abnormal karyotypes, Turner genotype was most common (52%), and 46,XY was second most common (31.5%). Almost all patients with low estrogenic state showed osteopenia or osteoporosis. Conclusion : The most common causes of primary amenorrhea were 46,XX gonadal failure, hypothalamic failure, Turner syndrome. These all patients were at high risk of osteoporosis or osteopenia.

컨테이너複合運送의 保險制度에 관한 硏究

李廷浩(Rhee Jeong Ho) 조선대학교 지식경영연구원 1990 기업과 혁신연구 Vol.13 No.1

DEA技法에 의한 韓國輸出入港灣의 效率性 測定에 관한 硏究

이정호(Rhee Jeong-Ho) 한국항만경제학회 1998 韓國港灣經濟學會誌 Vol.14 No.-

The purpose of this thesis is to investigate ports and efficiencies analytically in the theoretical side by reviewing previous studies conducted in Korea and America, and also to make an attempt to construct the dynamic model and to analyze empirically the efficiency of the 11 main ports in Korea by using DEA(Data Envelope Analysis) for the general export and import cargo with policy implications.<br/> For the empirical analysis on the efficiency of 11 main ports in Korea, statistical data are quoted from "Statistical Yearbook of Shipping and Ports" during 1992-1996 . And to investigate customers' satisfaction of individual ports, questionnaires to 55 companies which have used the related ports were done by using the telephone interview.<br/> The empirical results for the efficiency of main export-import ports in Korea can be summarized as follows: <br/> First, DEA results during 1992-1996 by using 3 input variables and 3 output variables showed us that Ulsan, Jeju, Yeosu kept the efficiency point 1.0 continuously, Donghae, Mogpo increased the efficiency and continued 1.0, Masan, Kunsan, Incheon, Busan showed relative efficiency higher than 0.50, and Kwangyang, Pohang showed efficiency below 0.50.<br/> Second, efficiency ranking according to the weighted average of yearly DEA efficiency is as follows:<br/> 1. Ulsan, 1. Jeju, 1. Yeosu, 1. Mogpo, 5.Donghae, 6. Masan, 7. Kunsan, 8. Incheon, 9. Busan, 10. Kwangyang, 11. Pohang.

생쥐 배아 동결보존시 발생 단계에 따른 해동 후 생존율

이정호(Jeong Ho Rhee),김미정(Mi Jeong Kim),김종인(Jong In Kim) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

N/A Object : To compare the viability after thawing of cryopreserved embryos according to developmental stage and decide the cryopreservation strategy. Methods : Total 538 mouse embryos(One, 2, 4, 8-cell, blastocyst, each 151, 136, 101, 98, 52, respectively) were cryopreserved and thawed using 1,2-propanediol and glycerol as cryoprotectant with slow cooling and rapid thawing technique, and compared the recovery, cleavage, blastocyst development rate, and calculated the recovery and reexpansion rate in blastocyst cryopreservation. Results : Highest recovery, cleavage and blastocyst development rate were obtained from one cell, 8-cell stage freezing, 90.1%, 89.5% and 76.7%, respectively. In recovery rate, there was no significant difference among developmental stage, but in cleavage rate, there was significant difference between 2 and 8-cell group(p<0.05). In blastocyst development rate, there was significant difference between 2 and 8 cell, 4 and 8-cell group(p<0.05). Recovery and reexpansion rate of frozen-thawed blastocyst was 73.1%, 52.6%, respectively. Conclusion : Eight-cell embryo may be the best developmental stage for cryopreservation and blastocyst freezing also may be the promising technique.

난관임신에서 영양배엽세포의 침투 깊이의 예측

이정호(Jeong Ho Rhee),강석선(Seok Seon Kang),김종인(Jong In Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

목적: 난관임신에서 임상적 진단 요소들과 영양배엽세포의 침투 깊이와의 관계를 평가하고 가장 예측능이 우수한 임상적 진단 요소를 확인하기 위하여 본 연구를 실시하였다. 연구방법: 조직 병리학적으로 확진된 50명의 난관임신 환자를 연구 대상군으로 설정 하였다. 임신기간과 임신 위치의 크기 및 혈중 β-hCG 가 측정 되었고 수술 표본 조직의 병리학적소견에 따라 두 군으로, 즉 영양배엽세포의 난관내 성장군(군I)과 근육층내 침투군(군II)으로 분류하였으며 각각 22, 28명이었다. 세가지 임상적 진단 요소 간과 각각의 진단요소와 영양배엽세포의 침투 깊이 사이의 관계에 대하여 통계학적 검증을 실시하였으며 통계적 분석은 SPSS 프로그램을 이용하여 Student's t-test, Chi square, 선형회귀(linear regression), 선형상관(linear correlation)을 통하여 연관성과 유의성을 검증하였고 통계학적 유의성은 P<0.05일 때로 정했다. 결과: β-hCG의 정량은 군 I에서는 1843.7±1524.7 mIU/ml(평균±표준편차), 군 II에서는 12144.3±10561.6 mIU/ ml(평균±표준편차) 이었다. 임신 위치의 크기와 β-hCG 사이에는 연관성이 있었으나(P<0.05), β-hCG와 임신기간, 임신위치의 크기와 임신 기간 사이에는 연관성이 없었다. β-hCG의 혈중치는 영양배엽세포의 침투 깊이를 예측하는데 통계적 유의성이 있었으며(P<0.05) 기준치 3,500 mIU/ml가 가장 높은 민감도, 특이도, 양성 예측도, 음성 예측도를 보였고 각각 0.79, 0.86, 0.88, 0.76 이었다. 임신 기간이나 임신 위치의 크기는 영양막세포의 침투 깊이를 예측하기 위한 요소로는 통계적 유의성이 없었다. 결론: 난관임신에서 내과적 치료의 성공은 약제 전달을 위한 병변 부위 혈관 구조의 완전성에 의존할 것으로 추측됨으로 내과적 치료를 위한 환자의 선택에서 영양배엽세포의 침투 깊이를 예측하는 것이 매우 중요하리라 사료된다. 본 연구에서는 난관임신 진단을 위한 여러 가지 임상 요소 중 β-hCG만이 유일하게 영양배엽세포의 침투 정도를 예측하는데 유의성이 있었으며 그 기준치 3,500 mIU/ml가 가장 이상적이라고 사료된다. Objectives: To evaluate the relation between diagnostic clinical parameters and the depth of trophoblastic invasion in tubal pregnancy and decide the most predictable parameter. Methods: Total 50 patients who were confirmed as tubal pregnancy pathologically, from Jan. to Dec. 1997, were included in this study. Menstrual missed periods was calculated by clinical history, volume of gestational mass was calculated as sphere, β-hCG was titered with preoperative blood sample. All surgical specimens were examined pathologically and divided into two groups such as intraluminal and extraluminal, defined as intact tubal musculature and trophoblastic invasion beyond musculature, n=22 and n=28, respectively. Statistical analysis was performed among three parameters and between each parameter and the depth of trophoblastic invasion. Statistical analysis included were Student's t-test, Chi square, linear regression, and linear correlation analysis using SPSS statistical package and statistical significance was determined as P<0.05. Results: There was a correlation between volume of gestational mass and β-hCG(P<0.05), but not between β-hCG and missed period or volume of gestational mass and missed period. β-hCG level was 1843.7±1524.7 mIU/ml(Mean±SD) in intraluminal and 12144.3±10561.6 mIU/ml(Mean±SD) in extraluminal. There was a predictive correlation between β-hCG and the depth of trophoblastic invasion(P<0.05), and cut off level 3,500 mIU/ml showed the highest sensitivity, specificity, positive predictive value, negative predictive value, 0.79, 0.86, 0.88, 0.76, respectively. Two parameters(volume of gestational mass and missed period) had no ability to predict whether intraluminal or extraluminal. Conclusion: We suggest that successful medical treatment of tubal pregnancy depend on lesional intactness of vasculature for drug delivery. In patient selection for medical treatment, it should be important to predict intraluminal type because of intact vasculature. Of clinical parameters, β-hCG is single most predictive parameter, cut off level of 3,500 mIU/ml was the most reasonable level in this study.

우리나라 輸出保險制度의 現況과 發展方案에 관한 硏究

李廷浩(Rhee, Jeong Ho) 조선대학교 지식경영연구원 1994 기업과 혁신연구 Vol.17 No.1

WTO體制下에서의 國際貿易과 環境 連繫에 따른 韓國의 對應方案에 관한 硏究

李廷浩(Rhee, Jeong-Ho),金鍾得(Kim, Jong-Deuk) 조선대학교 지식경영연구원 1996 기업과 혁신연구 Vol.19 No.1

무증상 자궁외임신에서 경질초음파의 진단 정확도

이정호 ( Jeong Ho Rhee ),박준철 ( Joon Cheol Park ),김종인 ( Jong In Kim ) 대한주산의학회 2004 Perinatology Vol.15 No.2

목적 : 경질초음파의 자궁외임신 진단 정확도를 평가하고 최종 진단으로서의 임상적 안정성을 확인하기 위함. 연구방법 : 58명의 자궁외 임신 의증 환자 중 급성 증상으로 응급 수술을 시행한 14명을 제외하고 재태기간 37일 이상 또는 융모성성선자극호르몬 혈중치 1,500 mIU/ml 이상에서 경질초음파 진찰상 자궁내 임신낭이 확인되지 않은 44명의 환자를 연구 대상으로 정하였다. 모든 대상 환자에서 복강경과 초음파 소견을 비교하고 수술 표본은 병리조직 검사를 통해 확인하였다. 초음파, 복강경 소견, 병리조직 검사 결과가 일치하는 경우를 바른 진단으로 간주하여 경질초음파의 진단 정확도를 계산하였다. 결과 : 44명의 연구 대상군 중 42예에서 경질초음파상 자궁외임신 부위로 의심할 수 있는 소견이 있었으며 우측 난관, 좌측 난관, 우측 자궁간질부, 좌측 자궁간질부가 각각 20, 15, 3, 4예씩이었고 정상 초음파 소견이 2예이었다. 42예 중 41예에서 복강경 및 병리조직 검사상 자궁외임신이 확인되었는데 1예에서는 자궁외임신 부위가 일치하지 않았고 1예에서는 자궁외임신 부위를 확인할 수 없었다. 정상 초음파 소견을 보였던 2예에서는 복강경 소견도 정상 소견을 보였다. 경질초음파의 자궁외임신 진단에 대한 민감도, 특이도, 양성예측도, 음성예측도는 각각 100%, 50%, 98%, 100%였다. 결론 : 경질초음파는 매우 유용하고 신뢰할 수 있는 진단 수단이며 융모성성선자극호르몬과 경질초음파를 혼용한 진단 결과는 진단 복강경을 대체할 수 있으리라 사료된다. Objective : To assess diagnostic accuracy of the transvaginal ultrasonography and confirm the clinical safety as a final diagnosis in the asymptomatic ectopic pregnancy. Methods : Total 58 women which were suspected with ectopic pregnancy were recruited during 1 year period. Women without sonographic evidence of the intrauterine gestational sac with serum β-hCG level beyond 1,500 mIU/ml or gestational periods beyond 37 days were included (n=44), and women with acute symptom were excluded (n=14). We performed the laparoscopy and compared them with the ultrasonographic findings. We regarded the cases with accordance between two findings as an accurate diagnosis, and calculated diagnostic accuracy. All surgical specimens were confirmed by the pathological examination. Results : Of 44 subjects, we suspected ectopic pregnancy by ultrasonography in 42 patients and classified as right fallopian tube (20 cases), left fallopian tube (15 cases), right interstitial (3 cases), left interstitial (4 cases), normal finding (2 cases). Of 42 cases, 41 cases were confirmed as an ectopic pregnancy by laparoscopical and pathological examination. There were two cases of inaccurate diagnosis, in one case, suspected site was not concordant, in another case, ectopic pregnancy focus was not identified in laparoscopy. In 2 cases with normal ultrasonographic findings, any other findings suspicious of ectopic pregnancy were not identified in laparoscopy. By 2X2 contingency table analysis, sensitivity, specificity, positive predictive value, negative predictive value of the transvaginal ultrasonography for diagnosis of the ectopic pregnancy were 100%, 50%, 98%, 100%, respectively. Conclusion : Diagnostic capability of the transvaginal ultrasonography in the ectopic pregnancy was very powerful and reliable, and sonographical diagnosis may replace the diagnostic laparoscopy if medical treatment is intended.