아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

보조호르몬요법을 받는 여성 유방암 환자의 모발 변화와 치료 실태에 대한 기초 연구

이재경 ( Jae Kyung Lee ),김창현 ( Chang-hyun Kim ),홍동균 ( Dongkyun Hong ),정경은 ( Kyung Eun Jung ),서영준 ( Young-joon Seo ),김창덕 ( Chang-deok Kim ),이진선 ( Jin Sun Lee ),권인선 ( In Sun Kwon ),박상현 ( Sanghyun Park ),이영 대한피부과학회 2021 대한피부과학회지 Vol.59 No.7

Background: Hormone therapy, which includes tamoxifen and aromatase inhibitors, is the most common adjuvant therapy used for breast cancer. However, only a few studies have reported endocrine therapy induced alopecia. Objective: We investigated the effects of long-term adjuvant hormone therapy on hair in patients with breast cancer, in addition to patients’ concerns and current treatment for hair loss. Methods: Patients completed a questionnaire that included information on self-perceived hair changes after each adjuvant therapy session, distress, and current treatment for hair loss. Using a folliscope, we measured hair density and thickness in each patient and in healthy controls. Results: The study included 93 patients with breast cancer (mean age 51.9±9.8 years). The density and hair thickness were 106.36±21.85 hairs/cm2 and 0.07±0.01 mm in the patient group and 147.86±30.67 hairs/cm2 and 0.07±0.01 mm in the control group (n=98, mean age 52.10±8.40 years), respectively. The mean hair density was significantly lower in the patient group than in the control group; however, no statistically significant intergroup difference was observed in hair thickness. Among 76 patients who perceived hair changes after adjuvant therapy, 71.1% (n=54) were distressed with regard to hair changes. However, only 7.8% of the patients, including two who were treated by dermatologists, currently received treatment for hair changes. Conclusion: Dermatologists should be familiar with hair changes in patients with breast cancer and provide appropriate education to encourage patients to consult dermatologists for hair loss and thinning after breast cancer treatment. (Korean J Dermatol 2021;59(7):521∼526)

Overexpression of Insulin Degrading Enzyme could Greatly Contribute to Insulin Down-regulation Induced by Short-Term Swimming Exercise

Min Sun Kim,Jun Seo Goo,Ji Eun Kim,So Hee Nam,Sun Il Choi,Hye Ryun Lee,In Sik Hwang,Sun Bo Shim,Seung Wan Jee,Su Hae Lee,Chang Joon Bae,Jung Sik Cho,Jun Yong Cho,Dae Youn Hwang 한국실험동물학회 2011 Laboratory Animal Research Vol.27 No.1

Exercise training is highly correlated with the reduced glucose-stimulated insulin secretion (GSIS), although it enhanced insulin sensitivity, glucose uptake and glucose transporter expression to reduce severity of diabetic symptoms. This study investigated the impact of short-term swimming exercise on insulin regulation in the Goto-Kakizaki (GK) rat as a non-obese model of non-insulin-dependent diabetes mellitus. Wistar (W/S) and GK rats were trained 2 hours daily with the swimming exercise for 4 weeks, and then the changes in the metabolism of insulin and glucose were assessed. Body weight was markedly decreased in the exercised GK rats compare to their non-exercised counterpart, while W/S rats did not show any exercise-related changes. Glucose concentration was not changed by exercise, although impaired glucose tolerance was improved in GK rats 120 min after glucose injection. However, insulin concentration was decreased by swimming exercise as in the decrease of GSIS after running exercise. To identify the other cause for exercise-induced insulin down-regulation, the changes in the levels of key factors involved in insulin production (C-peptide) and clearance (insulin-degrading enzyme; IDE) were measured in W/S and GK rats. The C-peptide level was maintained while IDE expression increased markedly. Therefore, these results showed that insulin down-regulation induced by short-term swimming exercise likely attributes to enhanced insulin clearance via IDE over-expression than by altered insulin production.

Carotenoids 식이와 알코올이 혈액학적 성분과 간조직에 미치는 영향에 관한 연구

조만희,김연선,이상한,우기민,장예진,김창세 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Alcohol is well known agent which can damage the human tissues such as liver via stimulating lipid peroxidation and storage, denaturation of macromolecules, and inhibiting protein metabolism. On the other hand, carotenoids in addition to vitamins A, C, E and lipoic acid, play important roles in protecting these oxidative damages as well as preventing the production of free radicals. This study was carried out to elucidate the precise effects of alcohol administration into rats on the antioxidative functions of dietary carotenoids and isolated β-carotene, and to find out any parameters to uncover more detailed biochemical mechanisms of these agents. For these purposes, two different approaches were performed: 1) examination of the changes in hematological parameters (e.g., total proteins, A/G ratio, ALT/AST et. al) and statistical correlations among inter- and intragroups, 2) examination of the histopathological changes by an electron microscope. The results were analyzed and summarized as following; (1) Carrot diet for one week caused a slight increase in albumin. A/G ratio and AST levels, and a slight decrease in ALT, ALP, BUN and uric acid levels. Two-week alcohol administration following carrot diet increased total proteins, albumin A/G ratio and BUN levels. However, both groups were shown to have little significant changes in cholesterol concentrations. (2) Cheese diet for one week caused a significant increase in total proteins, albumin, AST, ALP, uric acid and total cholesterol levels, and a significant decrease in A/G ratio and glucose concentrations. However, two-week β-carotene diet following cheese intake increased total proteins albumin, A/G ratio, BUN and total cholesterol levels, whereas AST, ALT, ALP and uric acid levels were decreased. (3) Alcohol administration for one week caused an increase in AST activities and a decrease in total proteins, albumin, ALT, ALP and BUN levels. A successive β-carotene diet following alcohol administration increased total proteins, albumin, ALT, ALP and BUN levels, whereas decreased AST and uric acid levels. However, there were not significant changes in A/G ratio, glucose and total cholesterol levels in both groups. (4) β-carotene diet for one week caused a slight increase in albumin, glucose, AST and uric acid levels, and a slight decrease in ALP and BUN levels. Two-weeks alcohol administration following β-carotene diet increased albumin, glucose, BUN and total cholesterol levels, whereas decreased AST, ALT, ALP and uric acid levels. (5) Although the pathological investigation on the liver did not reveal significant changes, cheese diet group (CH-BC/1-CH) was shown to have some lipid deposits. Some results were unexpected and different from typical hematological changes shown by other researchers. Nonetheless, these results strongly suggest that the liver damage or hepatism caused by alcohol intake affects many kinds of biochemical metabolisms, which results in significant changes in many hematological parameters. In addition, dietary carotenoid and isolated β-carotene were shown to have protective roles against the biochemical changes by alcohol intake.

정상면역을 가진 성인에서 발생한 식도 방선균증

김현수 ( Hyun Soo Kim ),천종운 ( Jong Woon Cheon ),김민수 ( Min Su Kim ),정창길 ( Chang Kil Jung ),김경록 ( Kyung Rok Kim ),최재원 ( Jae Won Choi ),강동우 ( Dong Woo Kang ),김선영 ( Sun Young Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2

Hyun Soo Kim, Jong Woon Cheon, Min Su Kim, Chang Kil Jung, Kyung Rok Kim, Jae Won Choi, Dong Woo Kang and Sun Young Kim1 Departments of Internal Medicine and Pathology1, DongKang Medical Center, Ulsan, Korea Actinomycosis is a chronic suppurative disease and caused by Actinomycosis species, principally Actinomyces israelii, which are part of the normal inhabitant on the mucous membrane of the oropharynx, gastrointestinal tract, and urogenital tract. It usually affects cervicofacial, thoracic and abdominal tissue. Cervicofacial type has the highest percentage of occurrence with 50%. Actinomycosis frequently occurs following dental extraction, jaw surgery, chronic infection or poor oral hygiene. It may also be considered as an opportunistic infection in immunocompromised patients such as malignancy, human immunodeficiency virus infection, diabetes mellitus, steroid usage or alcoholism. But, actinomycosis rarely occurs in adults with normal immunity and rare in the esophagus. We report an unusual case of esophageal actinomycosis which was developed in a patient with normal immunity and improved by therapy with intravenous penicillin G followed oral amoxicillin, and we also reviewed the associated literature.

암세포 증식에 대한 YB-1 안티센스 올리고핵산염의 영향

김명성 ( Myung Sung Kim ),이완식 ( Wan Sik Lee ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),유종선 ( Jong Sun Rew ),정영도 ( Young Do Jung ),김세종 ( Sei Jong Kim ),안봉환 대한내과학회 2006 대한내과학회지 Vol.71 No.3

목적: YB-1은 PCNA, DNA 중합효소 및 MDR 유전자 등의 전사인자로 작용한다. YB-1 유전자는 정상 어른의 간에서는 발현되지 않지만 태아의 간이나 재생 중인 간에서는 발현이 현저히 증가되어서 세포의 증식과 밀접한 관련이 있음이 보고되었다. 본 연구에서는 YB-1 유전자의 안티센스 올리고핵산염을 이용하여 YB-1의 발현을 억제함으로써 암세포 증식을 차단 할 수 있는지를 실험하고 암치료를 위한 유전자 요법으로서의 가능성을 알아보았다. 방법: 세포주로는 Chang liver, HepG2, CT-26 세포를 사용하였고, 사람의 정상세포로는 섬유아세포와 내피세포가 혼재된 조직을 사용하였다. YB-1 유전자의 안티센스 올리고핵산염으로는 YB-1 cDNA의 변역 시작 부위에 상보적인 21mer 올리고핵산염을 제작하여 사용하였다. 세포의 성장은 MTT assay를 이용하였고, 유전자 발현은 Northern blot으로 분석하였으며, 세포주기 변화는 propidium iodide로 염색하여 유식세포분석기로 분석하였다. 동물실험에서는 CT-26 세포를 1.0×10(5)개씩 Balb/c 생쥐의 피하에 접종하여 종양을 유도하였다. 종양이 유도된 Balb/c 생쥐에 YB-1 안티센스 올리고핵산염을 꼬리정맥이나 종양조직에 주사한 후 종양의 크기를 측정하여 종양억제 효과를 관찰하였다. 결과: YB-1 안티센스 올리고핵산염은 CT-26 세포에서는 50 nM 이상 농도에서 Chang liver와 HepG2 세포에서는 10 nM 이상 농도에서 세포주의 성장을 강하게 억제하였지만 정상 조직세포의 성장에는 아무런 영향을 미치지 않았다. 안티센스 올리고핵산염을 DOTAP에 담지한 경우 세포성장 억제에 미치는 효과가 안티센스 올리고핵산염 단독 처치 보다 강하였다. 이때 YB-1의 발현은 증식이 억제된 세포주(Chang liver 및 CT-26)에서는 감소하였으나 정상조직세포에서는 변화가 없었다. 증식이 억제된 세포주에서 세포주기를 살펴보면 초기에 S phase가 감소함을 관찰 할 수 있었다. 꼬리정맥이나 종양조직에 YB-1 안티센스 올리고핵산염을 주입 시 종양의 크기가 유의하게 감소하였다. 결론: 이상의 실험 결과 YB-1 안티센스 올리고핵산염은 암세포의 성장을 저해하며 종양 동물모델에서 종양의 성장을 억제할 수 있음을 시사하였다. Background: Human YB-1 is a transcription factor that binds to the inverted CCAAT box in the promoter region of a variety of genes such as PCNA, DNA polymerase and MDR. In this study we evaluated the effect of YB-1 antisense oligonucleotides on tumor cell growth. Methods: Chang liver, HepG2 and CT-26 cells were cultured as immortalized cell lines. The MTT (3-[4,5-dimethylthiazol-2-yl] 2,5-diphenyltetrazolium bromide) assay, Northern blot and flow cytometric analyses were used to determine cell growth, gene expression and cell cycle changes. In an animal model, CT-26 cells were injected into Balb/c mice to induce tumor; YB-1 antisense oligonucleotides were injected into the tail vein or tumor tissue of the mice; change of tumor size was then measured. Results: Phosphorothioated YB-1 antisense oligonucleotides suppressed the proliferation of the immortalized liver cells (Chang liver cells) and a variety of cancer cells (HepG2 and CT-26 cells); however, it did not inhibit normal cell growth. The DOTAP/antisense oligonucleotide mixture showed stronger effects on cell proliferation than did the antisense oligonucleotide alone. The YB-1 antisense oligonucleotide decreased specific expression of the YB-1 mRNA in the immortalized cancer cell lines. Flow cytometric analysis revealed that the inhibition of cell proliferation might have been due to a decrease in the S phase of the cell cycle. We found that in an animal tumor model, the administration of the YB-1 antisense oligonucleotide, in the vein or tumor tissues, decreased the tumor size significantly. Conclusions: These results suggest that the YB-1 antisense oligonucleotide may inhibit growth of a variety of cancer cells.(Korean J Med 71:293-301, 2006)

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.