Prognostic Value of Serum Growth Differentiation Factor-15 in Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Kim, Miyoung,Cha, Seung-Ick,Choi, Keum-Ju,Shin, Kyung-Min,Lim, Jae-Kwang,Yoo, Seung-Soo,Lee, Jaehee,Lee, Shin-Yup,Kim, Chang-Ho,Park, Jae-Yong,Yang, Dong Heon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.6

Background: Information regarding prognostic value of growth differentiation factor 15 (GDF-15) and heart-type fatty acid-binding protein (H-FABP) in patients with chronic obstructive pulmonary disease (COPD) exacerbation is limited. The aim of this study was to investigate whether serum levels of GDF-15 and H-FABP predict an adverse outcome for COPD exacerbation. Methods: Clinical variables, including serum GDF-15 and H-FABP levels were compared in prospectively enrolled patients with COPD exacerbation that did or did not experience an adverse outcome. An adverse outcome included 30-day mortality and need for endotracheal intubation or inotropic support. Results: Ninety-seven patients were included and allocated into an adverse outcome (n=10) or a control (n=87) group. Frequencies of mental change and $PaCO_2$>37 mm Hg were significantly higher in the adverse outcome group (mental change: 30% vs. 6%, p=0.034 and $PaCO_2$>37 mm Hg: 80% vs. 22%, p<0.001, respectively). Serum GDF-15 elevation (>1,600 pg/mL) was more common in the adverse outcome group (80% vs. 43%, p=0.041). However, serum H-FABP level and frequency of serum H-FABP elevation (>755 pg/mL) did not differ between the two groups. Multivariate analysis showed that an elevated serum GDF-15 and $PaCO_2$>37 mm Hg were significant predictors of an adverse outcome (odds ratio [OR], 25.8; 95% confidence interval [CI], 2.7-243.8; p=0.005 and OR, 11.8; 95% CI, 1.2-115.3; p=0.034, respectively). Conclusion: Elevated serum GDF-15 level and $PaCO_2$>37 mm Hg were found to predict an adverse outcome independently in patients with COPD exacerbation, suggesting the possibility that serum GDF-15 could be used as a prognostic biomarker of COPD exacerbation.

병원단위의 임상진료지침 개발과정

신영수,김창엽,오병희,한규섭,윤병우,한준구,강영호 한국의료QA학회 1997 한국의료질향상학회지 Vol.4 No.1

Background : With increased concerns about variation among physician a practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to development guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines. Methods : For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 beds. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved. Results : The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary participation by personnels of related departments. All the team expected guidelines to be used as standard protocols in the practice. Conclusion : Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies of the clinical outcomes of the guidelines application and changes in physicians behaviors would be required.

적절성 평가지침과 이유목록의 적용 가능성 평가

신영수,김용익,김창엽,김윤,김은경,송윤미,이영성 한국의료QA학회 1994 한국의료질향상학회지 Vol.1 No.1

Background: An appropriate use of hospital beds can improve productivity of hospital significanlly. The authors previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropritely used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting. Methods: In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Oversall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement. Results: Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days. Conclusion: Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. Thess instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level.

한 농촌 지역사회의 성인 임의예방접종 실태조사

신영수,김용익,김창엽 대한감염학회 1994 감염 Vol.26 No.3

성인 임의예방접종의 중요성이 점차 증가함에도 불구하고 이에 대한 실태파악은 매우 미흡한 상태이다. 이에 지역조사를 통하여 성인 임의예방접종의 실태를 파악하기 위한 연구를 시행하였다. 연구는 경기도 1개군을 대상으로 층화집락표본추출에 의해 선정된 가구에 대해 가구방문 및 설문조사를 시행하였다. 조사는 훈련된 면접원이 직접 가정을 방문하여 시행하였고, 조사대상 예방접종은 보건사회부가 정한 정기예방접종을 제외한 B형 간염, 일본뇌염, 장티푸스, 콜레라, 신증후출혈열, 렙토스피라증 등 10종의 예방접종을 15세 이상 인구가 접종한 경우로 하였다. 15세 이상의 총 조사대상자는 3,715명이었다. 주요한 연구결과는 다음과 같다. 1)임의예방접종의 범위에 해당하는 예방접종은 전체 3,715명의 조사대상 중 597명에서 시행하여, 1년간 16.1%의 인구가 임의예방접종을 시행한 것으로 나타났다. 전체 임의예방접종 시행 횟수는 711회였다. 2)711회의 예방접종을 종류별로 구분하면 신증후출혈열이 전체의 43.3%로 가장 많고 일본뇌염과 B형간염이 그 다음으로 많았다. 이는 신증후출혈열이 연간 100명당 8.3회, 전체적으로는 100당 19.1회에 해당하는 것이다. 3)임의예방접종의 횟수를 조사대상의 특성별로 분석한 결과는 다음과 같다. 연령별로는 19세 이하와 40-69세 군이 임의예방접종을 받는 비율이 높고, 20-39세 사이의 청년층에서 시행률이 상대적으로 낮다. 직업별로는 무직을 제외하면 농업에 종사하는 사람에서 24.4%로 가장 높은 시행률을 보였다. 교육수준에 따라서는 대체로 교육수준이 높아질수록 시행률이 높은 경향을 보였다. 그러나 고졸 이상의 고학력군에서는 시행률이 오히려 낮아지는 것으로 조사되었다. 거주지에 따라서는 농촌지역에 거주하는 인구의 시행률이 압도으로 높았다. 가구의 월별 지출수준에 따라서는 지출수준이 낮아질수록 오히려 예방접종의 시행률은 높아지는 경향을 보였다. 이들 특성들은 교차분석 결과 모두 예방접종 횟수와 통계적으로 유의한 관계가 있는 것으로 나타났다.(p<0.01). 4)연령, 성, 직업, 교육수준, 거주지, 가구의 평균 지출 등을 종속변수로 하고 예방접종의 시행여부를 독립변수로 하는 다변량 로짓분석 결과, 높은 연령, 여자, 농업 종사자, 낮은 교육수준, 도시지역 거주자, 저소득자(낮은 월지출액)일수록 예방접종을 시행할 가능성이 높은 것으로 나타났으나, 통계적으로 유의한 변수는 없었다. 신증후출혈열, 렙토스피라증 등 풍토병 예방접종의 시행 여부를 종속변수로 하고 같은 방법으로 로짓분석을 시행한 결과, 낮은 연령, 여자, 농업 종사자, 낮은 교육수준, 도시지역 거주자, 높은 월지출액일수록 예방접종 시행 가능성이 높은 것으로 나타났다. 이 중 연령과 거주지는 통계적으로 유의하게 나타났다. 5)전체 임의예방접종의 65.8%가 보건지소에서 이루어져 압도적인 다수를 차지하였고, 다음이 보건의료원의 8.7%였다. 한편, 546명의 조사대상자가 지출한 임의예방접종 비용은 연간 3,651,900원이었다. 이는 접종자 1인당 평균 6,688원에 해당하는 금액이며, 이를 접종 횟수로 환산하면 1회당 5,621원이다. 향후 성인 임의예방접종에 대해서는 권장지침 개발과 함께 실태 파악이 광범위하게 이루어져야 할 것이며, 특히 농촌지역의 경우 보건지소를 적극적으로 활용한 성인예방접종 관리체계 구축이 필요할 것으로 생각된다. 아울러 임의예방접종에 영향을 미치는 요인으로서의 사회심리적 요인들에 대한 추가 연구가 필요할 것이다. Background : The objective of this survey was to estimate voluntary vaccination status of adults in a rural county in Kyounggi Province Korea and analyze related socioeconomic factors that affected immunization behavior. Methods : For 10 days from July to August in 1993, the survey was conducted with randomly sampled inhabitants aged from 15 years in 20 clusters. Structurred questionnaire were given to a memeber of visited households by trained interviewer and answers were complemented by interview. The total number of subjects was 3,715 adults. Results : Major findings were as follows; 1) Vaccination rate was estimated based on the history of immunization, irrespective of completeness of predetermined immunization rules. The rate on the person-base estimate was 16.1% of total target population in a year, with total numbers of vaccination of 711. 2) Of 711 vaccination, Hemorrhagic Fever with Renal Syndrome vaccine was most frequently administered(43.3% of all), which reflected the nature of survey area, one of the famous endemic area of Hemorrhagic Fever with Renal Syndrome and leptospirosis in Korea. 3)With multiple logistic regression, we could find that variables such as lower age, female farmer(vs. non-farmer), urban inhabitants, and lower income group were positively correlated with the implementation of voluntary vaccination, but without statistical significance. Being vaccination of Hemorrhagic Fever with Renal Syndrome or leptospirosis as dependent variable, age, female, farmer, urban inhabitants, higher income group were positively correlated, with statistical significance(p<0.05) of age and urban inhabitants. 4)Of all voluntary vaccinations of adults, 65.8% were performed in Health Subcenters. Conclusions : Socioeconomic variables included in this study could not completely explain the immunization behavior of adults in rural area. Further study would be in-depth analysis of various factors which are closely related to adult voluntary vaccination in terms of socio-psychological and cultural characteristics as well as other socioeconomic variables.

병원표준화심사의 질 향상 관련 항목에 대한 평가와 개산방안

김창엽,이상일,이건세,신영수 한국의료QA학회 1995 한국의료질향상학회지 Vol.2 No.1

Background: Korean Hospital Standardization Program(KHSP), as a hospital accreditation program initiated and promoted by Korean Hospital Association since 1981, has played a key role in the hospital quality improvement in structural aspect particularly. Recently, however, KHSP has been critisized by hospitals and health personnels in that it is unpractical to be utilized as an initiative to improve hospital quality. In particular, the section of quality assurance in KHSP, strongly influenced by old version of Hospital accreditation of Joint Commission in U.S.A., has been required to be fundamentally sevised. For design of new criteria in quality assurance section, a survey for evaluation of existing program and collection of opinions for ideal one was conducted. Methods: For a month in 1994, structured questionnaires were administered by mailing to 470 hospital staffs from 200 hospitals, participated in the survey for the 1994 KHSP in each hospital. The total number of respondents was 116. Results: Less than half of the respondents(34.5%) value positively on the impact of current KHSP in general on the quality improvement of their hospitals. Moreover, most responses indicated that KHSP should be reorganized towards more practical and applicable one. Current KHSP criteria for quality activities in hospitals were regarded as a unpractical one which should be basically renewed. For new criteria and standards, most respondents emphasized the importance of applicability of those in real siuations. Conclusion: For the KHSP to be effective, new evaluation criteria for quality activities should be more practical and fully accommodated to hospital situations in reality.

고용상태 변화가 정신건강에 미치는 영향

박세홍(Park Se-Hong),김창엽(Kim Chang-Yup),신영전(Shin Young-Jeon) 비판과 대안을 위한 사회복지학회 2009 비판사회정책 Vol.- No.27

한국사회에서 우울을 호소하는 인구가 날로 증가하고 있으며 자살문제가 심각한 사회문제로 대두되고 있다. 이들의 원인 중 하나로 삶의 불안정, 고용의 불안정 문제가 대두된다는 측면에서 고용문제가 인구집단의 정신건강에 미치는 영향에 주목할 필요가 있다. 이 연구는 정규-비정규-실업 간 고용상태의 변화와 우울감의 변화를 함께 추적하여 고용상태 변화와 정신건강의 인과적 관계를 파악해 보고자 하였다. 한국복지패널의 1,2차 조사에 모두 응답한 가구원 중 2005~2006년간 주된 경제활동 참여 상태가 각각 정규직 임금노동자, 비정규직 임금노동자, 실업자이며 응답에 결측치가 없는 3833명을 연구의 대상으로 하였으며, 이들이 2005~2006년 사이 겪은 고용상태 변화가 2007년의 우울감에 영향을 미친다고 가정하고 1년간의 고용상태 변화에 따라 대상자의 특성을 분석하였다. 기술분석 결과, 남녀 모두에게서 2006년 현재 고용상태뿐 아니라 2005년도의 고용상태가 정규-비정규-실업 순으로 낮아질수록 낮은 사회경제적 위치를 가지며, 건강상태가 나쁜 것으로 나타났다. 정규직을 유지하거나 정규직으로 편입한 집단은 소득수준이 높으며 건강한 것으로 나타났다. 로지스틱 회귀모형을 적용하여 고용상태 변화가 우울감에 미치는 영향을 분석한 최종 분석에서는 남성의 경우, 고용상태가 우울감에 유의하게 영향을 주는 것으로 나타났으며 고용변화에 의한 효과는 나타나지 않았다. 여성의 경우 고용상태와 고용변화가 각기 우울감에 유의한 영향을 주는 것으로 나타났으며, 두 변수를 동시에 투입한 모형에서 고용상태에 의한 효과만이 유의하게 나타났다. 연구 결과, 고용상태가 임금노동자와 실업자의 정신건강에 영향을 미치는 중요한 요인임을 확인하였다. 불안정한 고용과 우울감이 연관성을 가진다는 연구결과는, 노동이 생존과 직결되는 한국 사회에서 안정적인 일자리가 개인의 정서적 안녕에 영향을 미치며, 일자리에의 위협 및 상실은 개인의 삶에 위협으로 작용한다는 것을 시사한다. This study aimed to determine associations between mental health and changes in employment status. We designed a longitudinal study following up employment status and mental health for 2 years. Subjects of this study were 3833 participants from 1st and 2nd Korea Welfare Panel Study(KOWEPS) whose employment status were standard waged-workers, precarious waged-workers, or unemployment. We defined precarious employment as contingent, part-time, temporary, seasonal, casual, or daily works. Participants's mental health were measured by 11 items of CES-D K, and we considered reporting more than 8 points as suffering depression symptoms. We studied with descriptive analysis and logistic regression. Descriptive analysis showed that there were differences in the employment status changes by gender. Precarious employment and unemployment were associated with low-socioeconomic status and high prevalence of depression symptoms. Logistic regression statistics showed that precarious employment and unemployment (OR=1.46, 95% CI 1.125-1.894) and unemployment(OR=1.644, 95% CI 1.035-2.611) were associated with depression symptoms, but employment status changes and depression symptoms were not statistically significant after adjusting for socioeconomic positions in male participants. Both employment status and changes of employment status were significantly associated with depression symptoms each in female participants. After adjusting current employment status, the effects of employment status changes were disappeared in female participants. Employment status is an important social determinant of health in South Korea, and underemployment could increase inequalities in population's mental health.

한국 폐경여성에서 osteoprotegerin (OPG)-receptor activator of NF-kB Ligand (RANKL) 유전자 다형성과 호르몬치료 후 골밀도 변화 사이의 연관성

김정구 ( Jung Gu Kim ),구승엽 ( Seung Yup Ku ),지병철 ( Byung Chul Jee ),서창석 ( Chang Suk Suh ),김석현 ( Seok Hyun Kim ),최영민 ( Young Min Choi ),문신용 ( Shin Yong Moon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.6

목적: 한국 폐경여성에서 OPG와 RANKL 유전자 다형성양상과 호르몬치료 후 골밀도 및 순환계내 OPG, sRANKL 농도 변화사이에 연관성이 있는가를 분석하고자 하였다. 연구 방법: 주기적 호르몬치료를 1년간 받은 자연폐경여성 236명에서 PCR-RFLP, 염시서열분석으로 OPG T245G, G1181C 다형성양상과 RANKL rs2277438 A/G 다형성양상을 분석하고 혈청 OPG, sRANKL, BAP, OST, CTX, calcitonin, PTH, 칼슘, 인 농도를 효소면역법, 면역측정법, 원자흡광법으로, 요추 및 대퇴 근위부에서의 골밀도를 DXA로 측정하였다. 결과: OPG와 RANKL 유전자형 및 이들의 복합 유전자형에 따른 호르몬 치료를 1년간 시행한 후의 골밀도 변화율에는 차이가 없었고 호르몬치료 반응군에서의 이러한 유전자형의 분포양상은 비반응군 (골밀도가 3% 이상 치료 전보다 감소된 경우)에서의 분포와 차이가 없었다. RANKL 유전자 다형성의 GG 유전자형에서 호르몬치료 후 혈청 sRANKL이 변화율아 AA, AG 유전자형의 변화율보다 유의하게 높았다 (p<0.05). 그러나 다른 OPG 유전자다형성의 단일 또는 복합 유전자형에 따른 OPG를 포함한 다른 골대사인자의 차이는 없었다. 결론: 한국 폐경여성에서 OPG T245G, G1181C 다형성과 RANKL rs2277438 A/G 다형성은 호르몬 치료 후 골밀도 변화양상과 연관성이 없으나 이 중 RANKL다형성은 순환계에서의 sRANKL 농도에 영향을 미친다. Objective: To investigate the relationship of polymorphisms in osteoprotegerin (OPG)-receptor activator of NF-kB ligand (RANKL) gene to changes in circulating OPG and soluble RANKL (sRANKL) levels and in bone mineral density (BMD) after hormone therapy (HT) in postmenopausal Korean women. Methods: The OPG T245G, and G1181C polymorphisms and RANKL rs2277438 A/G polymorphism were analyzed by polymerase chain reaction-restriction fragment length polymorphsim (PCR-RFLP) or direct DNA sequencing in 236 postmenopausal Korean women receiving sequential HT for 1 year. Serum OPG, sRANKL, bone alkaline phosphatase, CrossLaps (CTX), osteocalcin, clacitonin, parathyroid hormone, calicum, and phophorus were measured using enzyme-linked immunosorbent assay (ELISA), immunoassay and atomic absorptiometry respectively. BMD at the lumbar spine and proximal femur was determined by dual energy X-ray absorptiometry. Results: The annual percent changes of BMD were not associated with single or combined genotypes of OPG and RANKL gene polymorphisms, and the distributions of these genotypes were not different between HT-responders and HT-nonresponders (women who lose more than 3% of bone mass per year). After HT of 6 months, change in serum sRANKL levels was significantly higher in GG genotype than in other genotype of RANKL gene polymorphism. No differences in the 6 month changes of other bone turnover markers including circulating OPG levels after HT were noted across single OPG genotype and combined genotypes of OPG and RANKL polymorphisms. Conclusions: The OPG T245G, and G1181C polymorphisms, and RANKL polymorphism did not associate with change in BMD after HT in postmenopausal Korean women, and RANKL polymorphism affects change in circulating sRANKL levels after HT.

민간의료기관을 이용하는 결핵환자의 의료이용 분석

강길원,윤석준,김창엽,신영수,Kang, Gil-Won,Yoon, Seok-Jun,Kim, Chang-Yup,Shin, Young-Soo 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

한국 폐경 여성에서 호르몬 대체요법시 치료 제제에 따른 유방 치밀도의 변화

이동윤 ( Dong Yun Lee ),김상돈 ( Sang Don Kim ),최영식 ( Young Sik Choi ),지병철 ( Byung Chul Jee ),구승엽 ( Seung Yup Ku ),서창석 ( Chang Suk Suh ),최영민 ( Young Min Choi ),김정구 ( Jung Gu Kim ),문신용 ( Shin Yong Moon ),김석현 대한폐경학회 2003 대한폐경학회지 Vol.9 No.3

목적 : 본 연구는 한국 폐경 여성에서 호르몬 대체요법과 연관된 유방 치밀도의 변화를 평가하기 위하여 시행되었다. 연구 대상 및 방법 : 본 연구에서는 호르몬 대체요법을 시행 받은 폐경 여성 294명을 대상으로 치료 제제에 따라 매일 tibolone 2.5 mg을 투여 받은 군(n=119), conjugated equine estrogen(CEE) 0.625 mg/medroxyprogesterone(MPA) 2.5 mg으로 지속적 병합요법을 시행 받은 군(n=93), CEE 0.625 mg으로 단독요법을 시행 받은 군(n=40) 및 raloxifene 30 mg을 투여 받은 군(n=42)으로 대변하였으며, 호르몬 대체요법을 시행 받지 않은 폐경 여성 36명을 대조군으로 설정하였다. 대상 여성에서 유방촬영술(mammography)을 호르몬 치료 시작 전과 치료 1년 후에 각각 시행한 후 유방 치밀도(breast density)의 변화를 후향적으로 각 군에서 비교 관찰하였다. 결과 : 대상 여성의 연령, 분만력, 폐경 연령, 폐경 후 기간, 체중, 신장 및 체질량지수(BMI)는 각 군간에 통계학적으로 유의한 차이가 없었다. 호르몬 대체요법 1년 후 유방촬영술에서 관찰된 유방 치밀도의 증가는 지속적 병합요법군에서 25.8%(24/93)로서 tibolonerns의 11.8%(14/119), raloxifene군의 2.4%(1/42)에 비하여 각각 유의하게 높았다(p<0.05). 결론 : 본 연구 결과 호르몬 대체요법을 시행 받은 폐경 여성에서 관찰된 유방 치밀도의 변화는 치료 제제에 따라 상이하다는 것을 확인하였으며, 특히 progestogen을 이용한 지속적 병합요법이 유방 치밀도 변화에 중요한 영향을 미치는 것으로 사료된다. Objective : This study was performed to evaluate the mammographic changes in breast density that were associated with hormone replacement therapy(HRT) in Korean postmenopausal women. Materials and Methods : In this retrospective study, 294 postmenopausal women were classified as the four groups according to the regimen of HRT; a daily treatment of tibolone 2.5 mg(n=119), conjugated equine estrogen(CEE) 0.625 mg/medroxyprogeserone(MPA) 2.5 mg(n=93), CEE 0.625 mg only(n=40) or raloxifene 60 mg(n=42), and they were compared with the control group of postmenopausal non-HRT users(n=36). Mammography was performed at baseline and after 1 year of treatment, and the incidence of changes in mammographic density was evaluated and compared among the groups. Results: There were no significant differences in age, parity, age at menopause, years after menopause, weight, height, and body mass index(BMI) among the groups. The risk of an increase in mammographic density after 1 year of treatment was significantly higher in CEE/MPA group(24/93, 25.8%), compared with tibolone(14/119, 11.8%) and raloxifene(1/42, 2.4%) group(p<0.05). Conclusion : This study showed that the changes in mammographic breast density related to postmenopausal HRT were dependent on the regimen of HRT. The continuous administration of progestogen as a component of the combined HRT seems to affect the breast density significantly.

부정교합의 치료를 위해 동반되는 corticotomy : 문헌 고찰

신호범(Ho Beom Shin),염창엽(Chang Yup Yum),노기성(Gi Sung Noh),조세열(Se Yul Cho),김병옥(Byung Ok Kim),한경윤(Kyung Yoon Han) 조선대학교 구강생물학연구소 1999 Oral Biology Research (Oral Biol Res) Vol.23 No.1

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