자궁내막증 또는 자궁선근증에 의한 불임환자에서 장기간 GnRH analogue ( Long - term Down DRegulation ) 사용 후 과배란 및 체외 수정 시술의 결과

양광문(K . M . Yang),유근재(K . J . Yoo),최범채(B . C . Choi),김계현(K . H. Kim),이홍복(H . B . Lee),이재훈(J . H . Lee),송인옥(I . O . Song),송지홍(J . H . Song),궁미경(M . K . Koong),전종영(J . Y . Jun),강인수(I . S . Kang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 자궁내막증 또는 자궁선근증을 가진 불임 환자의 치료에 있어 GnRH analogue를 사용한 LTDR의 과배란 유도시 그 효과를 알아보았다. 방법 및 재료 : 복강경과 질식 초음파를 이용하여 자궁내막증 또는 자궁선근증을 진단 받은 불임 여성 43명의 47 LTDR cycles이 연구 대상이 되었다. GnRH analogue를 3개월 이상 장기간 사용하여 down regulation 시킨 후 gonadotropin을 이용하여 과배란 유도를 시행한 경우를 LTDR로 정의하였으며 임신을 위해 자궁강 내 정자 주입술 또는 체외 수정 및 배아 이식이 시행되었다. 결과 : 환자의 평균 연령(meanSD)은 33.83.8이었고 자궁선근증이 10cycles였으며 자궁내막증은 34cycles(1기:12cycles, 2기:9cycles, 3기 :5cycles, 4기:8cycles)이었다. 체외 수정 시 이식된 배아는 평균(meanSD) 3.70.3개였다. 자궁내막증을 가진 34cycles중 17.6%(6/34), 자궁선근증을 가진 10cycles중 40.0%(4/10)의 임신율을 보였다.결론 : 이 연구에서 LTDR은 자궁내막증과 자궁선근증에 의한 불임 환자의 치료에 효과적인 것으로 보이나 연구 대상군의 확대 조사가 필요하리라 사료된다. Objective : To assess the clinical efficacy of long term down regulation (LTDR) for in vitro fertilization (IVF) in infertile patients with endometriosis or adenomyosis.Materials and methods : Analysis were made from data collected from 45 paients who had endometriosis or adenomyosis diagnosed using pelvic laparoscopy and ultrasonography and had undergone intrauterine insemination or in vitro fertilization. LTDR was defined as long term, as long as three months down regulation of ovarian function followed by induction of ovulation using gonadotropins. Of these patients, 43 had undergone LTDR followed by IVF-ET, whereas 30patients in control group had undergone short or long protocol as an ovarian stimulation regimen.Results : The multiple independent parameters such as plasma basal estradiol (E2), plasma E2 level on day of hCG administration, number of oocytes retrived, number of good quality oocytes, number of embryo and number of transfered embryos were not significantly different between LTDR treated group and other control group. The clinical pregnancy rate in women treated with LTDR (17.6% in endometriosis, 40% in adenomysis, and 33.3% in endometriosis combined with adenomyosis) were comparable with those of control group (15.4% in endometriosis, 33.3% in adenomyosis and 40% in endometriosis combined with adenomyosis). Conclusions : In this study the LTDR as a ovarian stimulation regimen for IVF does not seems efficienct in infertile patients having endometriosis or adenomyosis than other protocols such as short or long, however further study with large number may be needed.

염색체 이수성질환을 선별하기 위한 삼중 표지물질 검사의 성과에 관한 연구

최용관(Y. K. Choi),김문영(M. Y. Kim),한정열(J. Y. Han),류현미(H. M. Ryu),양재혁(J. H. Yang),김은성(E. S. Kim),이홍복(H. B. Lee),한인수(E .S. Kim),고명인(M. I. Ko),한호원(H. W. Han) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

본 연구 목적은 산모의 나이를 고려한 삼중 표지물질 검사가 다운 증후군과 에드워드 증후군을 선별하는데 효용성이 있는지 보고자 한다. 1994년 3월 1일부터 1996년 2월 28일까지 2년 동안 삼성제일병원에서 임신2기에 모체혈청 표지물질인 AFP, hCG, uE3를 이용한 삼중 표지물질 검사를 시행하였고 본원에서 분만한 5,308례의 단태 임신을 대상으로 하였다. 동시에 삼중 표지물질 검사를 이용한 에드워드증후군의 선별검사 대상은 1995년 11월부터 1996년 2월까지의 1,378례의 단태 임신을 대상으로 하였다. 연구방법은 Radioimmunoassay Kits를 이용하여 모체혈청에서 AFP, hCG, uE3의 농도를 측정하였으며, 또한 3가지 혈청 표지 물질의 농도는 태령에 따라서 MOM( Multiples of the median )으로 산출하였으며 각 표지물질의 기대 중앙값( Expected Median )은 AFP과 uE3은 log y = a + bx의 log linear regression을, 그리고 hcG는 Y = eA+Bx 의 non-linear regression 함수를 이용하여 산출하였다. 그리고, 측정된 각 혈청 표지 물질의 농도와 산모의 나이에 따른 다운증후군과 에드워드 증후군의 위험률은 alpha software version 4.1(Logical Medical system Ltd, London)를 이용하여 산출하였다. 다운증후군 산전검진 결과는, 총 5,308례 중 248례인 4.7%에서 검진(Screening) 양성으로 나와 양수천자를 권유하였고, 126례인 2.4%가 양수검사를 시행하여 최종적으로 7례의 다운 증후군이 진단되었다. 에드워드 증후군 산전검진 결과로서 1,378례가 검진되었고, 4례인 0.3%에서 양성으로 나왔다. 검진 양성인 1례는 삼중 표지물질 검사 직후 IUFD 되었고 태아 표피(skin)를 사용하여 염색체 검사를 시행했으나 실패하였다. 나머지 3례에서 양수천자에 따른 염색체 검사에서 2례의 에드워드 증후군을 진단 할 수 있었다. 다운증후군의 경우 발견률(detection rate)은 발생한 9례 중 7례를 선별하여 77.8%이며, 위양성률(false positive rate)은 4.5% 그리고 OAPR은 1:35이었다. 에드워드증후군의 경우 발견률(detection rate)은 100%이며, 위양성률(false positive rate)은 0.1% 그리고 OAPR은 1:2이었다. 이상의 결과들을 볼 때 이수성 질환의 산전 선별 검사로써 삼중 표지물질 검사가 의미 있는 검사라고 판단된다. Objective: To evaluate the effectiveness of a screening protocol using a combination of maternal age and three biochemical markers for the antenatal detection of fetal chromosomal aneuploidy Materials and methods: In our retrospective, 5,308 women who were screened for Down syndrome at second trimester of pregnancy and delivered between March 1994 and February 1996 at Samsung Cheil hospital were studied. Also, 1,378 women were simultaneously studied for screening for Edward syndrome between November 1995 and February 1996. According to maternal age and the concentration of measured maternal serum markers (α-fetoprotein, unconjugated E3, hCG), the risk ratio of Down syndrome and Edward syndrome were calculated by α-software V. 4.1. The screening positive women were performed amniocentesis for fetal karyotyping after genetic counseling. Results: The average age was 28 years old. The average of the geatational weeks was 16.3 weeks. The followings are equations of expected median for each maternal serum markers. AFP(ng/ml)=10(0.474+0.0652xGestational week) uE3(nmol/L)=10(-0.852+0.0932xGestational week) hCH(IU/ml)=217,523/[1+Exp(5.62+0.17xGestational week)] Among 5,308 cases, screen positive was in 248 cases(4.7%). But amniocentesis was performed in 126 cases(2.4%). Down syndrome was detected in 7 cases. The difference of the prevalance rate for Down syndrome between younger than 35 years old (1.2/1,000) and older than or equal to 35 years old(6.7/1,000) was statistically significant (P=0.035). However, in screen negative cases, Down syndrome was detected in 2cases. Overall, the detection rate, false positive for Down syndrome were 77.8%, 4.5% respectively and the ratio for OAPR was 1:35. In Edward syndrome, screen positive was in 4 cases(0.3%). Edward syndrome was confirmed in 2 cases by amniocentesis The detection rate, false positive for Edward syndrome were 100%, 0.1 % and the ratio for OAPR was 1:2. Conclusion: The prenatal screening test by the combination of maternal age and the concentration of maternal serum markers was effective to detect Down syndrom and Edward syndrome at second trimester of pregnancy.

하지마비 환자에서의 섬유소 용해능의 변화

양수현,양영표,이근,박봉철,채동호,이홍복,변종훈,계경채,박선양 대한내과학회 1992 대한내과학회지 Vol.42 No.1

혈전증과 색전증의 발생빈도는 하지마비 환자에서 높은 것으로 알려져 있다. 이런 환자들에서 혈전 발생에 섬유소 용해계의 변화가 어떤 작용을 하는가를 밝히기 위해 저자들은 1년에서 21년 동안 하지마비 상태에 있는 환자 11명의 혈중 섬유소 용해계 변화를 조사하였다. 환자군과 정상대조군 16명의 상지와 하지로부터 정맥혈을 채혈했다. PA 활성도는 ^(125)I-fibrin plate 방법으로 PAI 활성도는 Z-Lys-S-B키 assay로 각각 측정하였다. tPA와 PAI-1 항원은 ELISA법으로 측정했다. 환자군에서 상지와 하지 PA 활성도는 정상대조군에 비해 의미있게 감소했다. (상지 ; 0.13±0.09AU/㎖ vs 0.45±0.25AU/㎖, P=0.0001 : 하지 ; 0.18±0.18AU/㎖ vs 0.31±0.24AU/㎖, P=0.025). 환자군의 PAI-1 농도는 정상대조군에 비해 상지에서만 증가하는 경향을 보였다(23.46±10.39AU/㎖ vs 16.67±8.70AU/㎖, P=0.061). 환자군의 tPA 농도와 PAI 활성도는 정상대조군에 비해 의미있는 차이는 없었다. SDS-PAGE와 섬유소 Auto-graphy 분석에서 환자군에서 섬유소 용해대의 감소를 보였으나 분포형태는 본질적으로 정상대조군과 같았다. 하지마비 환자의 PA 활성도는 감소되고 PAI-1 농도는 증가하는 경향이 있는 것으로 나타나서 하지마비 환자에서 심부정맥 혈전증 발생과 관련이 있을 것으로 생각하였다. The incidence of thromboembolic complication has been shown high in paraplegic patients. To elucidate the possible role of changes in the fibrinolytic system in these patients to the development of thrombotic disorders, we evaluated the parameters of the blood fibrinolytic system in 11 patients who had been suffering from paraplegic limbs for one to 21 years. Venous blood samples were obtained from the upper and lower extremities of the patients and 16 normal volunteers as a control. Plasminogen activator (PA) and plasminogen activator inhibitor (PAI) activities were measured by the ^(125)I-fibrin plate method and Z-Lys-SBzl assay, respectively. Plasma concentrations of tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) were determined by ELISA methods. PA activities in both upper and lower extremities of the paraplegic patients were significantly decreased compared to those in normal controls (upper extremities; 0.13±0.09AU/㎖ vs 0.45±0.25AU/㎖, P=0.0001: lower extremities; 0.18±0.18AU/㎖ vs 0.31±0.24AU/ ㎖, P=0.025). Plasma PAI-1 concentrations of the paraplgic patients showed increasing tendency only in the upper extrmities compared to those in normal subjects (23.46±10.39AU/㎖ vs 16.67±8.70AU/㎖, P=0.061). Plasma tPA concentrations and PAI activities in paraplegic patients were not significantly different from those in normal controls. SDS-PAGE and fibrin autographic analysis of the euglobulin fractions demonstrated decreased fibrinolytic bands in paraplegic patients. However, the patterns of distribution for the fibrinolytic bands were essentially the same as those in normal subjects. In conclusion, plasma PA activities from the paraplegic patients were demonstrated to be decreased with the increasing tendency in PAI-1 concentrations. We suggest that decreased fibrinolytic activity possibly resulting from an increase in PAI-1 concentrations might be a predisposing factor to deep vein thrombosis frequently associated in paraplegic patients.

한국에서의 Human T-Cell Leukemia Virus Type-1(HTLV-1)에 대한 혈청학적 및 역학에 관한 연구

이영열,이성열,김은실,이홍복,김병국,이문호,박선양,김노경,서철원,규경채,최강원,조한익,고월청,야마구찌이찌세이 대한내과학회 1986 대한내과학회지 Vol.31 No.2

Type-C retrovirus, human T-cell leukemia virus type-l(HTLV-1), has been shown to be associated etiologically with adult T-cell leukemia, which is an endemic disease in southwestern parts of Japan. We examined the seroepidemiological characteristics of antibody to adult T-cell leukemia virus associated antigen (anti-ATLA-antibody) by the indirect immunofluorescent assay and ELISA from the healthy individuals and various diseased patients in the Republic of Korea, a country adjacent to Japan in which HTLV-1 is endemic. The results were as follows. 24 out of 9,603 individuals(0.25%) were seropiositive. The positve rate was 0.17% in males and 0.36% in females, the sex difference was female predominent relatively. HTLV-1 carriers were found 16 individuals in Seoul, 5 in Kyonggi area, 1 in Chungnam and Jonbuk, respectively, but found only 1 individual in Busan city and Jaejoo area close to southwestern parts of Japan. Positive rate to anti-ATLA-antibody seemed to be high in older age, especially at the 50s(0. 4Yo). In conclusion the prevalence rate of anti-ATLA- antibody seemed to be very low in the Republic of Korea adjacent to Japan in which HTLV-1 is endemic and no patient with adult T-cell leukemia has been found as yet. Also we noted that the Republic of Korea is not an endemic area to HTLV-1.

급성 전골수구성 백혈병에 병발한 파종성 혈관내 응고병증에서 Gabexate mesilate(FOY^®)의 임상효과

이홍복,김병국,이영열,김승택,허대석,박선양,김노경 大韓血液學會 1987 大韓血液學會誌 Vol.22 No.1

재생불량성 빈혈에 관한 임상적 고찰 -과거 10년간의 통계를 중심으로-

서철원,이홍복,이영열,김승택,박선양,김병국,김노경 大韓血液學會 1987 大韓血液學會誌 Vol.22 No.1

전신성 홍반성 낭창(Systemic lupus erythematosus)의 혈액학적 소견

서철원,고은미,이홍복,이영열,김승택,최성재,김병국 大韓血液學會 1987 大韓血液學會誌 Vol.22 No.1