고혈압 환자의 삶의 질 측정도구 개발

김건엽,감신,이상원,박기수,채성철,천병렬,Kim, Keon-Yeop,Kam, Sin,Lee, Sang-Won,Park, Ki-Soo,Chae, Shung-Chull,Chun, Byung-Yeol 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objectives : To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. Methods : A sample of 1,115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests(Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. Results : The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant(p<0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. Conclusions : The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.

급성 심근경색 환자에서 예후 예측인자로 혈청 감마-글루타밀 트랜스퍼라제가 유용한가?

이장훈 ( Jang Hoon Lee ),채성철 ( Shung Chull Chae ),이현상 ( Hyun Sang Lee ),박용휘 ( Yong Whi Park ),류현민 ( Hyeon Min Ryu ),이순학 ( Soon Hak Lee ),배명환 ( Myung Hwan Bae ),양동헌 ( Dong Heon Yang ),박헌식 ( Hun Sik Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3

목적: 혈청 감마-글루타밀 트랜스퍼라제(GGT)는 관상동맥 죽상경화반 내의 저밀도 지단백(LDL)의 산화과정을 촉매 하여 관상동맥 질환의 진행에 관여하며, 관상동맥 질환의 과거력이 있는 환자에서 심장사와 재경색의 독립적인 예후 예측인자로 알려져 있다. 저자는 관상동맥 질환의 과거력이 없는 급성 관상동맥 증후군 환자에서 예후 예측인자로서의 혈청 GGT의 효용성을 연구하였다. 방법: 흉통을 주소로 응급실을 방문하여 급성 심근경색으로 진단받은 환자의 혈청 GGT 값을 측정하여 응급실 방문당시 혈청 GGT 값이 정상범위(남자: 8-61 U/L; 여자: 5-31 U/L)에 있었던 192명(남/여=143/49, 평균 연령: 60.8±11.8세)의 환자를 대상으로 하여, 추적기간(16.5±10.8개월) 내 심장사건이 재발한 환자에서의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교 하였다. 결과: 급성 심근경색 환자 192명중 추적 기간 내 17명의 환자에서 심장사와 재경색이 있었으며, 23명의 환자에서 불안정협심증이 있었다. 이 환자들의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교하였을 때 통계적으로 유의한 차이를 보였다(29.5±10.0 U/L 대 25.0±11.2 U/L p=0.024). 그러나 다변량 분석에서 혈청 GGT에 영향을 줄 수 있는 혼란변수들과 알려진 심혈관계 질환의 위험인자로 보정하였을 경우 독립적인 예후 예측인자가 되지 못했다. 결론: 심질환의 과거력이 없는 심근경색 환자의 예후 예측인자로 심근경색의 급성기에 측정한 혈청 GGT 값은 통계적으로 유의한 차이는 있으나, 독립적인 예후 예측인자가 되지 못했다. Background: Serum gamma-glutamyl transferase activity (GGT) is able to catalyse low-density lipoprotein oxidation in coronary atherosclerotic plaques and has a role in the pathogenesis of atherosclerosis. GGT has been shown to be an independent risk factor for cardiac mortality in patients with a previous myocardial infarction. The purpose of this study is to determine the prognostic value of GGT within its normal range at an acute stage in patients with acute myocardial infarction. Methods: In a retrospective study, GGT and other cardiac risk factors were evaluated in 192 patients (M/F=143/49; mean age: 60.8±11.8 years) who were diagnosed with an acute myocardial infarction at the emergency room. We compared the serum GGT values for each patient with or without a cardiac event, including cardiac death, non-fetal myocardial infarction and unstable angina, after an acute myocardial infarction for a mean follow-up of 16.5±10.8 months. Results: During the follow-up period, 17 patients underwent cardiac death and experienced an acute myocardial infarction and 23 patients had unstable angina. Although the mean GGT values were significantly different from patients with cardiac events (29.5±10.0 U/L vs 25.0±11.2 U/L, p=0.024), serum GGT was not an independent cardiac risk factor for a cardiac event based on multivariate analysis adjusted for age, sex, alcohol and known cardiovascular risk factors. Conclusions: Serum GGT within its normal range at an acute stage in patients that experienced an acute myocardial infarction is not an independent prognostic marker. (Korean J Med 72:281-289, 2007)

관동맥질환 치료의 최신 지견

양동헌 ( Dong Heon Yang ),채성철 ( Shung Chull Chae ) 대한핵의학회 2005 핵의학 분자영상 Vol.39 No.2

Doppler 초음파를 이용한 Nitroglycerin 의 말초혈유량에 미치는 영향에 관한 검토

박희명 ( Hi Myung Park ),채성철 ( Shung Chull Chae ) 대한내과학회 1983 대한내과학회지 Vol.26 No.11

농촌지역 고혈압 전단계 성인의 혈청 Gamma-Glutamyltransferase와 고혈압 발생률간의 관련성

황준현,신지연,천병렬,이덕희,김건엽,박의현,채성철,Hwang, Jun-Hyun,Shin, Ji-Yeon,Chun, Byung-Yeol,Lee, Duk-Hee,Kim, Keon-Yeop,Park, Wee-Hyun,Chae, Shung-Chull 대한예방의학회 2010 예방의학회지 Vol.43 No.1

Objectives: Prehypertension is associated with a higher risk of developing hypertension compared with normotension. Yet, factors predicting the development of hypertension among prehypertensive people are ill-understood. This prospective cohort study was performed to examine if serum gamma-glutamyltrasferase (GGT) within a normal range can predict the future risk of hypertension among prehypertensive adults. Methods: Study subjects were 293 prehypertensive persons >30-years-of-age who participated in a community-based health survey in 2003 and who were followed up in 2008. Sex-specific quartiles of baseline serum GGT were used to examine association with 5-year hypertension incidence. Results: Baseline serum GGT within normal range predicted the risk of developing hypertension for 5 years only in prehypertensive women. Adjusted relative risks were 1.0, 3.7, 3.6, and 6.0 according to quartiles of baseline serum GGT (P for trend <0.01). This pattern was similarly observed in non-drinkers. However, serum GGT was not associated with incident hypertension in men. Different from serum GGT, baseline serum alanine aminotransferase, another well-known liver enzyme, did not predict the risk of incident hypertension in both genders. Conclusions: Even though baseline serum GGT within normal range strongly predicted the future risk of hypertension, it was observed only in women, Although underlying mechanisms of this association are currently unclear, serum GGT can be used to select a high risk group of hypertension in prehypertensive women.

정상인 심근의 Thallium - 201 섭취 및 제거 : Adenosine , Dipyridamole Dobutamine 정맥주사와 운동부하시의 비교

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),정병천(Byung Chun Chung),채성철(Shung Chull Chae),곽동석(Dong Suk Kwak),최정일(Jung Il Choi),정진홍(Chin Hong Chung) 대한핵의학회 1993 핵의학 분자영상 Vol.27 No.1

정상 남성에서 음주 및 흡연과 혈청 총 콜레스테롤치와의 관계

정의룡(Eui Ryong Cheong),류재근(Jae Kean Ryu),전상중(Sang Joon Jun),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun Park) 대한내과학회 1996 대한내과학회지 Vol.50 No.4

N/A Objectives : We conducted our study to establish the mean values of total serum cholesterol in healthy Korean male adults and find out the relationship between the cholesterol levels and life styles(eg. smoking and drinking habits). Methods: Eight hundred seventy-nine men involved in a health screening program in May, 1992, in Kyungpook University Hospital, were studied. The total cholesterol levels are determined by enzymatic method. And the life styles of the study groups were examined by answering written questionnaires. Results: The mean value of total cholesterol 189.6±30.6 mg/dl. The total cholesterol levels are higher in the age groups of fourth and fifth decades than in the age groups of second and third decades. The cholesterol levels show the tendency to increase according to age. The cholesterol levels are 189.8±30.7 mg/dl in smokers and 189.0±30.6 mg/dl in nonsmokers. They are not statistically different in either group. But heavy smokers who smoke more than 20 cigarettes per day have higher total cholesterol values than non-smokers. The cholesterol levels are 19431.0 mg/dl in heavy drinkers who drink alcoholic beverages 3-4 times per week and 187.2±31.7 mg/dl in non-drinkers. The group who are both heavy smoker and drinker have significantly higher cholesterol levels than in the group who do not smoke and drink alcoholic beverage. The cholesterol levels in the former and in the latter group are !?0629.0 mg/dl and 18331.2 mg/dl, respectively. Conclusion : The total cholesterol values somewhat related to the age and the life styles such as smoking and alcohol consumption. Generally speaking, the more increased levels of total cholesterol is shown when the person is getting older, the amounts of cigarettes smoked are increased and the frequencies of alcoholic drinks are increased.

국내 10개 대학병원의 관동맥질환자의 고콜레스테롤혈증 치료 현황

성지동 ( Ji Dong Sung ),김상현 ( Sang Hyun Kim ),김영대 ( Young Dae Kim ),백상홍 ( Sang Hong Baek ),안영근 ( Young Keun Ahn ),임도선 ( Do Sun Lim ),조홍근 ( Hong Keun Cho ),채성철 ( Shung Chull Chae ),한기훈 ( Ki Hoon Han ),김효수 대한내과학회 2005 대한내과학회지 Vol.69 No.4

목적 : 기존 연구들은 고콜레스테롤혈증 치료 지침이 충실히 지켜지지 않는 소위 치료 간극(treatment gap)을 보여 주고 있다. 국내에서 어느 정도의 치료 간극이 존재하는가에 대해서는 체계적인 연구가 전혀 없는 실정으로 앞으로 대책 수립을 위해서는 이에 대한 현황 파악이 필요하다. 본 연구는 국내의 10개 대학병원들에서 관동맥질환자의 고콜레스테롤혈증 관리에 있어서 NCEP ATP III 치료 지침에 근거하였을 때 어느 정도의 치료 간극이 존재하는가를 조사하고자 하였다. 방법 : 국내 10개 수련 병원에서 순환기내과 진료를 받은 총 1,048명의 환자에 대하여 의무기록을 조사하였다. 대상 선정 기준은 관동맥조영술 또는 심장부하검사 소견상 관동맥질환자로 판명된 경우, 외래병록지 또는 퇴원요약지 등에 협심증, 심근경색 등의 진단 또는 관동맥 성형술 또는 관동맥우회로술을 받은 병력이 명기되어 있는 경우로 하였다. 각 병원마다 3인 이상의 의사에서 각 의사마다 30인 이상의 환자를 추출하는 것을 기준으로 하여 순차적으로 의무 기록을 검토하도록 하였다. 다른 특정한 연구를 위하여 모집된 명부에서 환자를 추출하는 것은 금지하였다. 사용된 모든 고지혈증치료제의 명칭과 용량을 최초와 가장 최근의 경우로 나누어 기록하였고, 혈중 지질 검사 결과는 약물 복용 이전과 가장 최근의 결과를 기록하였다. 결과 : 연구의 결과는 10~50% 법칙으로 요약될 수 있다. 10% : 약물치료를 시행치 않는 경우의 평균 LDL 콜레스테롤 감소, 20% : 치료 전에 이미 치료 목표에 도달해 있는 비율, 30% : 약물치료시 평균 LDL 콜레스테롤 감소, 40% : 지질저하제 약물치료를 받지 않고 있는 관동맥질환자 비율, 50% : 치료 후 치료 목표에 도달하는 비율 결론 : 관동맥질환자의 고콜레스테롤혈증 치료에 있어서의 치료 간극 현상은 국내의 3차 병원의 순환기내과 의사들의 진료에 있어서도 존재하는 것이 확인되었다. 앞으로 다른 진료 환경에서의 치료 간극에 대한 추가 연구와 함께 치료 목표 달성율을 높이기 위한 조치들이 필요할 것으로 보인다. Background : Previous studies showed treatment gap phenomenon in the treatment of hyperlipidemia, meaning failure to adhere to the recommendation in the treatment guideline. In Korea, systematic research on this issue has never been done. This investigation was to estimate the hypercholesterolemia treatment gap in coronary artery disease (CAD) patients in tertiary care centers according to NCEP ATP-III guideline. Methods : Ten Korean educational hospital participated in the survey, reviewing medical record of 1,048 patients. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or medical history of myocardial infarction, percutaneous coronary intervention or bypass surgery. Thirty or more medical records per each of 3 or more cardiologists were reviewed in each hospital. Sampling was done sequentially based on outpatient or inpatient list. Pharmacological treatment for hyperlipidemia included the first and last records of prescription. Baseline and the most recent lipid profiles were collected. Results : Findings from the survey was summarized as 10 to 50% rule: 10%: mean LDL-cholesterol reduction without lipid-lowering drug, 20%: LDL-cholesterol level at the treatment goal before any treatment, 30%: mean LDL-cholesterol reduction with lipid-lowering drug treatment, 40%: proportion of CAD patients without lipid-lowering drug, 50%: treatment goal achievement after treatment. Conclusions : Significant treatment gap exists in Korean cardiology practice in tertiary care centers. Systematic approach to reduce this gap is warranted.(Korean J Med 69:371-378, 2005)

급성 전벽 심근경색증 환자에서 심전도 하벽 유도 ST 절 하강의 임상적 의의

최정현(Jeong Hyun Choi),전영주(Young Joo Jeon),정병기(Byung Ki Jung),최희만(Hee Man Choi),이중기(Choong Ki Lee),전재은(Jae Eun Jun),김항재(Hang Jae Kim),채성철(Shung Chull Chae),박의현(Wee Hyun Park) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A To determine the significance of inferior ST segment depression during the early stages of acute transmural anterior myocardial infarction, we examined cardiac enzymes, in-hospital complications and indices of ST segment elevation in 51 patients presenting with acute anterior myocardial infarction. The patients were allocated to two electrocardiographic groups. Group I consisted of 19 patients (37%) with a 1 mm or more ST segment depression in at least two of leads II, III, and aVF, Group II consisted of 32 patients without this finding. Compared with group II, patients in group I had a higher peak creatine kinase and lactic dehydrogenase and experienced congestive heart failure, shock, arrhythmias requiring treatment, and death more frequently. Indices of ST segment elevation did not show a significant difference in both groups. The degree of inferior wall ST segment depression correlated weakly with the magnitude of the anterior ST segment elevation(r=0.63, p<0.01). Thus, the inferior ST depression during acute anterior infarction is a reliable marker of more extensive myocardial damage and an adverse hospital course. Such an inferior ST depression might reflect not only reciprocal change, but also ischemia in a remote inferior region.

한국 정상 성인에서 생활습관과 Cholesterol 치와의 관계

강승원(Seung Wan Kang),이붕렬(Bong Ryeol Lee),박현식(Heon Sik Park),김신우(Shin Woo Kim),우언조(Eon Jo Woo),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun Park) 대한내과학회 1992 대한내과학회지 Vol.43 No.3

N/A Background: Hypercholesterolemia has been attracting a great deal of attention epidemiologically and clinically because of its close association with coronary artery disease (CAD). In recent years, the incidence of CAD is increasing in Korean population, being attributed to increasing longevity, the changes in diet and environmental circumstances Methods; Serum total cholesterols were measured by the enzymatic method and their levels were analysed in relation to lifestyle obtained by interview in 1075males and 526females in Taegu, Korea. The study group includes docters, professors, nurses, assistants and technicians who were considered to be clinically healthy. Results: Total cholesterol levels of male end female adults were 182±30.9mg/dl and 175±29.4mg/dl, respectively. The total cholesterol levels of males were significantly higher than those of females (p<0.001). Serum cholesterol levels of male non-smokers (593cases, 184±29.5mg/dl) were significantly higher than those of male non-smokers (333cases, 180±31.3mg/dI) (p<0.05), especially in the age group of 30~39(p<0.01). There were no significant differences in the cholesterol levels in terms of drinking habits, exercise habits and dietary habits in male. Concluions; In conclusion, total cholesterol levels of our study subjects are largely influencd by age, sex, smoking habits and weakly influenced by exercise habits but not by drinking habits.