제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

SD Rats를 이용 1-hexene의 흡입독성 연구

김현영,임철홍,정용현,이권섭,이성배,이준연,한정희,전윤석,이용묵 한국환경독성학회 2001 환경독성보건학회지 Vol.16 No.4

The purpose of this study was to investigate the acute (4 hours) and repeated-dose (6 hours a day, 5 days a week, 4 weeks) toxic effects of I -hexene on Sprague- Dawley (SD) rats which were treated by inhalation. The results were as follows; I. The median lethal concentration (LC_(50)) was estimated 52,694 ppm (confidence limit 95%; 49,494~55,447 ppm) in acute inhalation. Abnormal clinical signs related to the l-Hexene were not observed with the acute inhalation dose. Gross findings of necropsy revealed on evidence of specific toxicity related to the 1-hexene, II. By repeated inhalation exposure the body weight of male were more or less reduced by the dose of 2,500 ppm and 5,000 ppm compared with control group. However there were no significant variation hematology and blood biochemistry for the exposed rats compared with the control rats. Abnormal clinical signs and gross findings of necropsy related to the 1-hexene were not shown. In conclusion when we exposed I-hexene to SD rats for 4 weeks, 5 days per week, 6 hours per day, the Lowest observed effect level (LOEL) was over 2,500 ppm and Non observed effect level (NOEL) was below 500 ppm.

크롬(Ⅵ)의 체내 흡수와 소실속도에 관한 연구

김현영,이성배,임철홍,이권섭,정용현,이종성,한정희,전윤석,황호순,이용묵 한국산업위생학회 2003 한국산업보건학회지 Vol.13 No.1

The CrO3 mostly used in plating. metal surface disposal, leather, cosmetic manufacturing, as an experiment material by repeatedly inhaling and exposure the male S.D. rats at a 0.00, 0.2., 0.50, 1.25 mg/㎡ concentration(particle size: 0.5-0.5 aerosol)6hours a day, 5day a week in 13weeks comparing with 2weeks, 8weeks of recovery group about the noxiousness of the experiment animal and the reduce scale of the CrO3 in the internal organ especially in blook and respiratory organ with the period of convalescent and clearance. The experiment results which we received are as follows. 1. In blood the RBC, HGB and HCT experiment, rats with 0.20, 0.50 mg/㎡ concentration showed that there were some decreases but not dependent. The kidneys absolute weight compared with control group was reduced intentionally(p〈0.05) and the lungs absolute weight compared with control group showed intentional increase(p〉0.05). 2. After the exposure of the experiment material, the whole blook, l\blood plasma and red blood cell in blood by (x): the period of convalescent, per (y); the decreasing of Cr concentration, was y=66.51 e -0.057x, y=67.2 e-0.101x, y=70.01 e-0.030 in 0.50 mg/㎡ exposure concentration by calculating the clearance coefficient of correlation, and the half life (day)was estimated 12.0, 6086, 23.0 each. 3, After the exposure of the experiment material, the experiment animals lung, liver and kidneys by(x); the period of convalescent, per (y); the decreasing of Cr conentration, was y=1808 e-0.00493x, y=12.02e-0.0297x, y=67.61 e-0.0292x in 0.50mg/㎡ exposure concentration by calculating the clearance coefficient of correlation, and the half life(day)was estimated 140.6, 23.3, 23.7, each, and including lung, liver with all of the experiment internal organs, the Cr clearance decreased as the exposure concentration increased.

Morgagni 탈장 : 1례 보고

오연희,이창욱,김승현,이성우,정병욱,이준희,박동일,권영무,신현종 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

Morgagni 탈장은 횡격막의 전내측 부위의 발달이상으로 열공을 통하여 장관이나 대망과 같은 복강내 구조물이 흉곽내로 빠져나가는 드문 질환으로 알려져 있다. 저자들은 호흡곤란을 주소로 내원하여 방사선학적 검사와 수술로 확진된 1례를 보고한다. Morgagni hernia is improperly located abdominal viscera into the thoracic cavity through the foramen of Morgagni which is a congenital defect at the anterornedial portion of diaphragm. We report a case of Morgagni hernia diagnosed by radiologic examination and operation.

신주위 공간 및 요근을 침범한 췌장성 가성낭포 1례 : 진단및 경피적 배액술 Diagnosis and Percutaneous Drainage

이현경,오연희,이원재,한동선,오민구,이성우,박수성 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Pancretic pseudocyst is a well-known complication of pancreatitis and may occur in unusual locations. Involvement of the left perirenal space and psoas muscle is rare. Radiologic findings and management of a surgically proven case of pancreatic pseudocyst extending to left perirenal space and psoas muscle is described.

정모두부방사선사진 촬영시 두부의 수직회전에 따른 투사오차

고은희,이기헌,황현식,성재현 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.4

This study was performed to find out how much projection errors in the cephalometric measurements were made by vertical head rotation in taking posteroanterior cephalograms. 25 adults without any apparent facial asymmetry or severe sagittal skeletal discrepancy were selected and the posteroanterior cephalograms were taken with the head rotated 5˚, 10˚ superior and inferior each to the reference position(0˚), The 7 height. 5 width and 6 angular measurements were taken at each 5 positions. Through the statistical analysis of all measurements taken at each rotated position, following results were obtained. 1. The projection errors of height measurements were remarkably larger than those of width or angular measurements. 2. Among the height measurements, the farther to the rotation axis the measurements were. the larger the projection errors were. 3. Among the width measurements. mandibular width and intermolar width of mandibular first molars showed significant differences between the values taken at each rotated position. while nasal width, maxillary width and intermolar width of maxillary first molars did not. 4. Among the angular measurements. the angle between horizontal reference line and the line that is connected to crista galli and antegonion or maxillare showed significant differences between the values taken at each rotated position. The above results suggest that it is needed to the effort to keep constant head rotation for taking the useful posteroanterior cephalogram, because projection errors are caused by vertical head rotation.

생쥐 뇌조직 체외배양법을 활용한 향산화제의 향독성효과에 관한 연구

이수현,박정은,김희옥,서혜원,조경혜 서울여자대학교 자연과학연구소 2000 자연과학연구논문집 Vol.12 No.-

In an effort to establish an in vitro model of Parkinson's disease (PD), we prepared slice cultures of midbrain from newborn mouse. The slice section containing substantia nigral region was cultured for 10days. The striatal culture was grown to preserve the distribution of interneurons with minimal contamination of any other brain tissue. Using this explant culture containing both glial cells and nitro-striatal dopamine neurons, the protective effect of antioxidant pineal hormone and melatonin on 1-methyl-4-phenyl-1, 2,3,6-tetrahydropyridine (MPTP) -induced loss of the dopamine neurons was investigated. MPTP selectively damaged dopaminergic neurons, as indicated by immunoblot and immunohistochemistry for glial fibrillary acidic protein (GFAP) and tyrosine hydroxylase, the marker enzymes for glial and dopaminergic neurons, respectively. Twenty-four-hour treatment of MPTP (50 μM) in the explant culture induced 37% loss of dopaminergic neurons while no apparent damage was observed in glial region. Type B monoamine oxidase (MAO-B) that resides in glial cells, produces free radicals during catecholamine metabolism and also oxidizes MPTP to its active form, MPP+, was activated by 2.2 times after MPTP treatment. Melatonin was able to recover both the dopaminergic neuronal loss and the elevated MAO-B activity level fully to the untreated control level. Similar observation was made bur the co-treatment of vitamin E with MPTP, suggesting the generation of oxygen radical species by MPTP. On behalf of pursuing molecular mechanisms of Parkinsonism, the data illustrate the proposed mechanism of MPTP-induced dopaminergic cell death ; namely, MPP+ that is processed by MAO-B in glial cells is taken up avidly by dopaminergic neurons and causes a toxic effect at least partly, if not mostly, through oxidative stress. The culture system, therefore, can serve as an experimental model of PD in which the putative neuroprotective effects of antioxidants can be investigated. This model is also useful for screening novel drugs and growth factors without a massive sacrifice of animals, and ultimately for developing neuroprotective therapies.

식이섬유질원이 포함된 식이가 흰쥐의 장내 균총조성에 미치는 영향

이상선,이현아,김연희 漢陽大學校 韓國生活科學硏究所 1996 韓國 生活 科學 硏究 Vol.- No.14

This study was performed to investigate the influence of dietary fiber from the whole food on the composition of intestinal microflora in rats. The fiber sources of experimental diets were prepared by drying and milling of small water dropwort(WD), mugwort(MW), butterbur(BB) and apple(AP). Each fiber sources was mixed at the 15% level of the diet. The level of dietary fiber in WD, MW, BB diets was simillar but that in AP diet was slightly low. Male rats of Sprague-Dawley strain were blocked into 5 groups: WD, MW, BB, AP, FF(fiber free), The animal was fed ad libitum each of experimental diets for 37 days. Total viable counts and the numbers of Lactobacillus, Bifidobacterium, Bacteroidaceae, Eubacterium, Peptococcaceae, Streptococcus, Clostridium, Staphylococcus, E. coli were determined by nonselective and various selective media. Food intake of AP and FF groups were lower than the other groups, FF group was lower than the other groups in flood efficiency ratio. Total viable counts were the highest in FF group. The number of Bacteroides, Eubacterium were higher in AP group compared with other groups and that of streptococcus was lower in MW, BB, AP groups than others. The number of Lactobacillus was higher in WD, MW, BB groups than the other groups and that of Bifidobacterium was higher in BB, AP groups. A decrease in the intestinal population of Clostridium was shown in MW, BB groups. These findings suggests that the samll water dorpwort, mugwort butterbur are effective in improving intestinal flora of rats.

3,4-Dihydroxyphenyl-L-alanine의 효소적 생산에 대한 반응첨가물의 영향

이승구,노현수,홍승표,성문희 한국미생물생명공학회 ( 구 한국산업미생물학회 ) 1996 한국미생물·생명공학회지 Vol.24 No.2

재조합 대장균에서 과발현된 Citrobacter freundii KCTC 2006 유래의 tyrosine phenol-lyase(E.C.4.1.99.2) 이용 3,4-dihydroxyphenyl-L-alanine (L-DOPA)의 생산에 대한 반응첨가물의 영향을 조사하였다. 반응액 중 효소 및 조효소 농도의 영향을 조사한 결과, 효소농도는 약 2 units/ml이 적합하였으며, 조효소인 pyridoxal -5-phosphate 는 0.1 mM 이상이 필요하였다. Pyrocatechol과 결합하여 안정한 복합체를 형성하는 sodium borate는 pyrocatechol에 의한 효소의 불활성화를 감소시키는 효과가 있었으나, 효소의 반응성을 현저히 저하시켜 L-DOPA 생산의 관점에서는 불리한 단점도 있었다. 한편, 알콜류 등의 유기용매가 L-DOPA 합성반응에 미치는 영향을 조사한 결과 methanol을 5% 농도로 반응액에 첨가하였을 때, 효소의 반응과 안정성이 크게 증가하여 L-DOPA 합성반응이 지속적으로 수행됨으로써 고농도의 L-DOPA를 효율적으로 생산할 수 있게 되었다. 생산된 L-DOPA의 약 77%가 불용성 상태로 침전되어 쉽게 회수할 수 있었으며, 침전된 L-DOPA를 1N HCI에 용해한 후 재결정화 함으로써 최종적으로 99.96%의 고순도 L-DOPA를 생산할 수 있었다. The enzymatic synthesis of 3,4-dihydroxyphenyl-L-alanine (L-DOPA) was examined for the effects of the reaction additives such as sodium borate, alcohol, and organic solvents. The enzyme used was tyrosine phenol-lyase of Citrobacter freundii KCTC 2006 produced in Escherichia coli. The amounts of tyrosine phenol-lyase and pyridoxal -5-phosphate were optimized to 2.0 units/ml and 0.1 mM, respectively, for the synthetic reaction. Sodium borate, a substance that forms a complex with pyrocatechol, reduced the enzyme deactivation by pyrocatechol although it seriously inhibited the enzyme activity. Among the organic solvents tested, dimethylsulfoxide, dimethylformamide, and alcohol increased the productivity of the L-DOPA synthesis. In a reaction system with 5% methanol, L-DOPA concentration increased up to 210 mM after 24 hours, and 77.1% of which was separated as precipitates. The L-DOPA was purified to 99.96%