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.

순천향대학 강의실의 도로교통소음 폭로량에 대한 조사

손부순,이종화,장봉기,박종안 순천향대학교 기초과학연구소 1999 순천향자연과학연구 논문집 Vol.5 No.1

Recently, there has been widespread recognition that traffic noise is a serious social problem. Soonchunhyang university also likely to be suffered by the problem because a busy highway is near the school. In this study, we examined the exposure level to traffic noise in a classroom of Soonchunhyang university. The results were as follows: 1. Total mean exposure level in classrooms was 42.6 dB. The exposure level in college of humanities was higher than that of orther colleges (college of natural sciences and college of medicine) 2. The exposure level in a classroom was 37.5 dB if the windows were kept close, and 42.5 dB if open. The level also influenced by the distance between the classroom and road. 3. After the construction of an antinoise wall, the exposure level was slightly changed from 43.3 dB to 42.3 dB. This suggest that the exposure levels were not affected by the antinoise wall.

측두하악 장애의 정신생리학적 측면에 대한 예비적 연구

손봉기,이정구,최인근 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.6

This study was designed to investigate the psychophysiologic aspects of temporomandibular disorder. Using various test batteries, 67subjects(33 of TMD patients and 34 of controls) were evaluated and the responses were analyzed through SPSS program. The results were as follows : 1) The score of social readjustment rating scale was significantly higher in the female patient group than in the female control group. 2) The patient group was less responsive to the pressure from financial difficulties, and the male patient group was less responsive to the changes in relationship and the pressure from financial difficulties than their respective control group. 3) Compared with the control group, the patient group was unfamiliar with the three coping strategies, namely shared concern, redefinition, and acting-out. Female patients were unfamiliar especially with the redefinition and acting-out, but very familiar with the compliance. 4) The patient group and the female patient group attained significantly higher score in Zung's self-rating depression scale than the control groups, respectively. 5) The scores of Hs. D, and Hy scales of MMPI of the patient group were significantly higher than those of the control group, and 1-3-2 type was most frequently noted in the patient group, though not significant.

아산시 송악저수지의 수질오염 현황 및 부영양화 저감방안 연구

손부순,염윤기,이종화,장봉기,박종안 순천향대학교 기초과학연구소 1998 순천향자연과학연구 논문집 Vol.4 No.2

This study was conducted to estimate the water pollution load, water quantity and quality of inflow stream, status of water pollution and reduction of eutrophication in the Song-ak lake in Asan city. Inflow of branch to Song-ak lake has three streams, one is Eu-gok stream which has the most width of inflow area and another is Dong-hwa stream and the other is Ma-gok stream. The sampling numbers for water quality are 30 points from the sediment of bottom in the Song-ak lake from June, 1997 to ay, 1998. Water quality had been tested for water temperature, pH, dissolved oxygen(DO), chemical oxygen demand(COD), suspended solid(SS), total nitrogen(T-N), total phosphorus(T-P), colony numbers of E. coli, chlorophyll-α. The total nitrogen, total phosphorus and heavy metals(Fe, Pb, Cd) were analyzed by the migration test of the sediment. The results were as follows; The rate of water pollution by the livestock wastewater of the total water pollution load for BOD, SS, T-N and T-P were 59.8%, 82.9%, 56.1% and 90.6%, respectively. Mean daily inflow was 25,369m3. Quantity of inflow was highest at Eu-gok stream. The mean levels of pH, DO, COD, SS, T-N, and colony numbers of E. coli of the inflow water were 7.52, 10.25mg/ℓ, 2.12 mg/ℓ, 3.03 mg/ℓ, 2.25 mg/ℓ, 0.11 mg/ℓ and 1,795/100㎖, respectively. The worst inflow water quality was observed at Dong-hwa stream. The mean levels of pH, DO, COD, SS, T-N, T-P, T-N/T-P and colony numbers of E. coli at Song-ak lake were 8.06, 9.32mg/ℓ, 6.83 mg/ℓ, 4.78 mg/ℓ, 1.66 mg/ℓ, 0.115 mg/ℓ, 20.75 and 64/100㎖, respectively. these are higher than class IV by environmental water quality standards for lake. Mean level of trophic state index was 59.4. The mean levels of T-N, T-P, Fe and Pb by migration test of sediment at Song-ak lake were 259.7ppm, 10.546ppm, 1,704ppm and 8.54ppm, respectively. As the water pollution was mainly caused by livestock waste, the strategy for the reduction of eutrophication of the Song-ak lake should be concentrated on the control of the livestock waste.

알코올 중독증 환자 부인의 행동경향과 인성적 특성에 관한 연구

손봉기,정소영,한창환 大韓神經精神醫學會 1992 신경정신의학 Vol.31 No.5

This study was conducted with some questionnaires and psychological tests to investigate the behavioral trends and personality of the alcoholic's wives. The subjects were wives of 43 alcoholics who visited our department from March 1990 to July 1991, and wives of 43 patients with chronic medical illness. The results are as follows: 1) The level of education of the experimental group is lower than that of the control group, though statistically not significant. Alcoholics as a group earned much less money compared to the control group. 2) The differences between the present jobs and those at the time of marriage of the husbands in each group are not significant, and the differences of jobs between two groups in each time are not significant too. 3) Wives of alcoholics seem to have been more passie than the control group in determination to marry. 4) Alcoholics' wives usually treat their husbands either with decisively ordering manner of with indiffeence. 5) The preferred coping measures of the experimental group are shared concern, compliance and self-pity. 6) On MMPI, Hy scale is significantly higher in the experimental group than in the control group. 7) With digital coding of MMPI profile, the cumulation of the scales ofeach codes shows the higher frequency of occurrence of Pd scale and the lesser frequency of Ma scale in the experimental group. The differences are statistically significant. 8) It is suggested that the neurotic trends and the copings of wives of alcoholics are the results of the chronic cumulated alcohol-related stresses, the personality of wives have not effected the alcoholic marriage.

65세 이상 노인 급성 심근경색증 환자의 사망에 영향을 미치는 인자들

정봉기,양금열,손준혁,주시내,남홍우,전용덕,이홍순 대한노인병학회 2001 대한노인병학회지 Vol.5 No.2

조혈모세포이식 후 골성장인자의 변화 및 골대사에 미치는 영향 : Impact on Bone Mineral Metabolism

백기현,오은숙,오기원,이원영,김혜수,권순용,한제호,강무일,차봉연,이광우,손호영,강성구,김춘추 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 각종 장기이식의 시행이 많아지고 이식 후 생존율이 증가함에 따라 이식 후 합병증에 대한 관심 또한 높아지고 있다. 조혈모세포이식 후에도 다양한 내분비적 합병증이 발생할 수 있으며 골격에 대한 합병증도 문제점으로 대두되고 있다. 조혈모세포 이식 후 발생하는 골소실에는 이식 후 초기의 골형성 저하와 골흡수 증가가 중요한 역할을 담당하리라고 추측되는데 이러한 골재형성불일치(biochemical uncoupling)에 골 성장인자들이 미치는 영향에 대해서는 알려진 바가 없다. 본 연구에서는 조혈모세포이식 전, 후로 말초 혈액에서 IGF-I, FGF-2, M-CSF같은 성장인자의 변화를 알아보고, 이들 성장인자의 변화가 조혈모세포이식 후의 골형과 골흡수에 미치는 영향 및 이식 후 발생되는 골량 소실과의 연관성을 확인해 보고자 하였다. 방법: 여러 가지 혈액질환으로 인해 동종 골수이식을 시행 받은 환자들을 전향적으로 관찰하였으며 이식 전 및 이식 후 1주, 2주, 3주, 4주 및 3개월, 6개월 1년에 말초 혈액에서 골교체표지자를 측정하였다. 이식 전 및 이식1년 후에 요추골 및 대퇴골 골밀도를 측정할 수 있었던 36명의 환자들을 대상으로 냉동 보관되어 있던 혈청을 이용하여 IGF-I, FGF-2 및 M-CSF를 시기별로 측정하였으며 이들 성장인자와 골교체표지자의 변화 및 골밀도 변화 사이의 상관관계를 확인하였다. 결과: 골흡수 표지자인 혈청 ICTP는 이식 전에 비해 이식 후 4주까지 점차 의의 있게 증가하다가 이후 6개월까지 더욱 증가한 후 감소하였다. 골형성 표지자인 osteocalcin은 이식 후 3주까지는 점차 감소하다가 이후 증가하여 이식 후 3개월 및 6개월에 기저치보다 통계적으로 유의하게 증가한 후 감소하였다. 혈청 IGF-I과 FGF-2는 각각 이식 후 3주 및 1주까지 의미있게 감소하다가 이후 증가하였으며 혈청 M-CSF는 이식 후 1주째에 기저치에 비해 의미 있게 증가하였다가 이후 기저치로 회복되었다. 이식 1년 후 평균 요추부 골밀도는 5.2% 감소하였고 평균 근위대퇴골 골밀도는 11.6% 감소하였다. 이식 전 및 이식 후 3주에 측정한 IGF-I과 같은 시기에 측정한 오스테오칼신 사이에 유의한 상관관계가 관찰되었으며 이식 후 3주째의 M-CSF와 골흡수표지자인 M-CSF 사이에서 의미 있는 양의 상관관계를 관찰할 수 있었다. 이식 후 3주 및 3개월에 IGF-I이 낮은 환자일수록 이식 1년 후 근위대퇴골에서의 골소실이 많은 것으로 분석되었다. 결론: 조혈모세포이식 후 발생하는 골소실에는 기존에 알려진 기저질환의 영향, 성호르몬의 감소, 면역억제의 투여, 골수기질세포와 조골세포의 손상 및 이식초기 사이토카인의 변화이외에도 골성장인자가 관련이 있음을 확인하였고, 이는 이식 후 발생되는 골량소실에 중요한 역할을 할 것이라고 사료된다. Background: A loss of bone mass is usually detected after a bone marrow transplantation (BMT), especially during the early post-transplant period. We recently reported that enhanced bone resorption following a BMT was related to both the steroid dose and the increase in IL-6. We also suggested damage to the marrow stromal microenvironment, by myoablation, partly explains the impaired bone formation following a BMT. It is well known that some growth factor play important role in bone growth and osteogenesis. However, the pathogenetic role of bone growth factors in post-BMT bone loss is unknown and data on the changes in the growth factors, in accordance with bone turnover markers and bone mineral density (BMD) changes are scarce. We investigated changes in bone growth factors such as IGF-I (Insulin-like growth factor-I), fibroblast growth factor-2 (FGF-2) and Macrophage colony stimulating factor (M-CSF), during the post-BMT period, and assessed whether the growth factor changes influenced the bone turnover and post-BMT bone loss. The present study is the first prospective study to describe the changes in bone growth factors following a BMT. Methods: We prospectively investigated 110 patients undergoing a BMT, and analyzed 36 patients (32.4±1.3 years, 17 men and 19 women) whose BMDs were measured before, and 1 year after, the BMT. The serum biochemical markers of bone turnover were measured before, 1, 2, 3 and 4 weeks, 3 and 6 months, and 1 year, after the BMT. The serum, FGF-2, IGF-I and M-CSF levels were measured before and 1 and 3 weeks, and 3 months after the BMT. The correlation between the changes of growth factors and various bone parameters was analyzed. Results: The mean bone losses in the lumbar spine and total proximal femur, calculated as the percentage change from the baseline to the level at 1 year, were 5.2(p<0.05) and 11.6%(p<0.01), respectively. the serum type I carboxyterminal telopeptide(ICTP), a bone resorption marker, increased progressively until 6 months after the BMT, but thereafter decreased, to the base value after 1 year. Serum osteocalcin, a bone formation marker, decreased progressively, until 3 weeks after the BMT but then increased transiently, and finally returned to the base level at 1 year. The serum IGF-I and FGF-2 also decreased progressively until 3 weeks 1 week after the BMT, respectively, then increased to the base values at 3 months. The serum M-CSF increased briskly at 1 week post-BMT, then decreased to the base level. There were positive correlations between the percentage changes from the baseline proximal femur BMD and the IGF-I levels 3 weeks and 3 months (r=0.52, p<0.01, r=0.41, p<0.05) post BMT. A significant correlation was found between the IGF-I and osteocalcin levels pre-BMT, and 3 weeks after the BMT. Another positive correlation was found between the M-CSF and the ICTP levels at 3 weeks post BMT (r=0.54, p<0.05). Conclusion: In conclusion, there were significant changes in the serum IGF-I, FGF-2 and M-CSF levels in the immediate post-BMT period, which were related to a decrease in bone formation and loss in the proximal femoral BMD during the year following the BMT (J Kor Soc Endocrinol 17:664∼674, 2002).

노화가 인체 중간엽 줄기세포로부터 조골세포로의 증식 및 분화에 미치는 영향

백기현,태현정,오기원,이원영,조정기,권순용,강무일,차봉연,이광우,손호영,강성구,김춘추 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.3

연구배경: 일반적으로 골다공증과 연관된 위험인자로는 연령, 폐경, 약물, 불충분한 칼슘섭취, 만성질환 및 운동부족 등이 있는데, 특히 노화가 진행할수록 골밀도가 감소하는 것은 잘 알려져 있다. 노화와 관련하여 진행되는 골소실은 조골세포 및 전구조골세포의 기능적 결핍에 의한 골형성의 감소가 주요한 요인으로 여겨지고 있다. 그 동안 연령이 조골모 세포의 양과 조골모 세포로부터 성숙조골세포로의 분화 및 증식에 미치는 영향에 대한 일부 보고들이 있었으나 아직 일치된 견해는 없는 형편이다. 방법: 다양한 연령의 사람으로부터 골수를 채취, 중간엽 줄기세포가 포함된 단핵세포를 분리한 후 조골세포로 분화하기 좋은 조건하에서 배양하였다. 대상군은다시 젊은군과 노령군으로 구분하여 다양한 변수를 비교 분석하였다. 일차배양에서는 CFU-F를 계수하여 골수내 중간엽 줄기세포의 수를 추산하였고, 칼슘측정을 통하여 기질의 무기화 정도를 비교하였다. 계대배양후 이차배양에서는 시기별로 알카리성 포스파타제 활성도를 측정하고 오스테오칼신 mRNA의 발현을 관찰하여 젊은군과 노령군 사이의 증식능 차이를 비교하였다. 또한 이차배양 시기별로 MTT 측정을 하여 양군간에 증식능 차이가 있는지 알아보았다. 결과: 1. 일차배양 15일째에 평균 CFU-F의 수는 젊은군에서 유의하게 많았다(젊은군 148.3±28.9, 노령군 54.3±9.1, p=0.02). CFU-F의 평균면적은 젊은군에서 넓은 경향을 보였으나 통계적으로 유의하지는 않았다. 2. 일차배양 17일 경과 후 양군간에 기질 칼슘 침착정도는 유의한 차이를 보이지 않았다(젊은군 103.6±50.6, 노령군: 114.0±56.5, p=NS). 3. 이차배양 10일째에 젊은군에서 알카리성 포스파타제 활성도가 고령군에 비해 유의하게 높았다(젊은군: 935.5±115.0 U/mg, 노령군: 578.4±115.7U/mg,p.0.05). 고령군에서는 시간 경과에 따른 변화가 미약했으며 전반적으로 알카리성 포스파타제의 활성도가 젊은군에 비해 낮았다. 4. 이차배양도중 오스테오칼신 mRNA의 발현은 배양시기별로 젊은군에 비해 고령군에서 더 낮은 경향을 관찰할 수 있었다. 5. 이차배양 10일과 15일에 젊은군에서 노령군보다세포증식이 유의하게 증가된 양상을 보였다(10앓 젊은군 0.73±0.05, 노령군 0.58±0.04, p=0.05, 15일; 젊은군 0.80±0.05, 노령군 0.70±0.03, p=0.05).결론: 이상의 연구에서 저자들은 노령군에서 젊은군보다 골수 내 중간엽줄기세포의 수가 적고, 노령군에서 유래한 전구조골세포의 성숙조골세포로의 증식 및 분화가 젊은군 보다 감소해 있는 것을 관찰할 수 있었다. Background: Osteoblasts originate from osteoprogenitor cells in bone marrow stroma, termed mesenchymal stem cells (MSCs) or bone marrow stromal cells. Each MSC forms colonies (colony forming units-fibroblasts [CFL-Fs]) when cultured ex vivo. There are some reports about the age-related changes of the number and osteogenic potential of osteoprogenitor cells, but any relationship has not been clearly established in humans. In this study, we counted MSCs using CFU-Fs count and examined the proliferative capacity and differentiation potential of osteoprogenitor cells. Finally, we analyzed how these parameters varied with donor age. Methods: Bone marrow was obtained from the iliac crest of young (n=6, 27.2±8.6 years old) and old (n= 10, 57.4k6.7 years old) healthy donors. Mononuclear cells, including MSCs, were isolated and cultured in osteogenic medium. In primary culture, we compared the colony-forming efficiency of MSCs between the two groups and determined the matrix calcification. When primary culture showed near confluence, the cells were subcultured. Alkaline phosphatase activity, osteocalcin expression by RT-PCR and proliferative potential by MTT assay were examined by the time course of secondary culture. Results: At the 15th day of primary culture, the mean number of CFU-Fs was significantly higher in the younger donors (young: 148.3±28.9, old: 54.3±9.1, p=0.02) and the mean size of CFL-Fs was also larger in the younger donors than the older donors. However, matrix calcification was not different between the two groups (young: 103.6±50.6, old: 114.0±56.5, p=NS). In secondary culture, alkaline phosphatase activities were significantly lower in the older donors. The younger donors showed peak alkaline phosphatase activity at day 10, while the older donors didn't showed a remarkable peak (young: 935.5±115.OU/mg, old: 578.4±115.7U/mg, p<0.05). Total cell number as a proliferative index increased progressively during the secondary culture and a significantly greater cell number was noted in the younger donors. Osteocalcin expression was generally upregulated in the younger donors, but this was not statistically significant. Conclusion: Our study shows that the number of osteoprogenitor cells is decreased during aging and that the proliferative capacity and differentiation potential of osteoprogenitor cells seem to be reduced during aging (J Kor SOC Endocrinol 18:296-305, 2003).

하계 실내 및 실외환경의 공기 중 휘발성 유기화합물 농도 및 개인노출

양원호,손부순,박종안,장봉기,박완모,김윤신,어수미,윤중섭,류인철 한국환경과학회 2003 한국환경과학회지 Vol.12 No.9

Volatile organic compounds (VOCs) are present in essentially all natural and synthetic materials from petrol to flowers. In this study, indoor and outdoor VOCs concentrations of houses, offices and internet-cafes were measured and compared simultaneously with personal exposures of each 50 participants in Asan and Seoul, respectively. Also, factors that influence personal VOCs exposure were statistically analyzed using questionnaires in relation to house characteristics, time activities, and health effects. All VOCs concentrations were measured by OVM passive samplers (3M) and analyzed with GC/MS. Target pollutants among VOCs were Toluene, o-Xylene, m/p-Xylene, Ethylbenzene, MIBK, n-Octane, Styrene, Trichloroethylene, and 1,2-Dichlorobenzene. Indoor and outdoor VOCs concentrations measured in Seoul were significantly higher than those in Asan except Ethylbenzene. Residential indoor/outdoor (I/O) ratios for all target compounds ranged from 0.94 to 1.51 and I/O ratios of Asan were a little higher than those of Seoul. Relationship between personal VOCs exposure, and indoor and outdoor VOCs concentrations suggested that time-activity pattern could affect the high exposure to air pollutant. Factors that influence indoor VOCs level and personal exposure with regard to house characteristics in houses were building age, inside smoking and house type. In addition insecticide and cosmetics interestingly affected the VOCs personal exposure. Higher exposure to VOCs might be caused to be exciting increase and memory reduction, considering the relationship between measured VOCs concentrations and questionnaire (p<0.05).

유지혈액투석을 받는 신부전 환자의 정서적 변인과 치료순응도와의 관계

이연국,손봉기 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

목 적 : 본 연구는 혈액투석을 받는 말기 신부전환자의 정서적 변인과 치료 순응도와의 관계를 알아보고 이들의 치료대책 수립에 도움이 되고자 수행되었다. 방 법 : 12개월 이상 장기간 혈액투석 중인 43명의 말기 신부전 환자들을 대상으로 Cook-Medly 적개심척도, Beck 우울증척도, 자가 평가 불안척도로서 적개심, 우울 및 불안을 측정하였고, 식이요법, 투약, 염분섭취에 대한 순응도를 혈중칼륨, 인의 농도, 투석간 체중 증가량으로 측정하였다. 결 과 : 1) 투석을 받고 있는 환자들은 정상인에 비해 우울의 정도가 심하였고 불안과 적개심의 정도는 비슷하였다. 2) 정서상태와 투석 순응도와의 관계에 있어 불안과 우울점수가 높았을 때 혈중칼륨에 의한 순응값은 의미있게 저하되었으며 그 정도는 순응값=4.656×(우울점수)+2.592×(불안점수)-0.13×(우울점수)×불안점수)-9.742식으로 표현할 수 있었다. 3) 1개월간 지지적 면담을 실시한 결과 불안과 우울의 척도가 감소되었으며 따라서 순응값이 상승했으나 연구 방법의 미숙으로 혈증칼륨의 감소는 확인할 수 없었다. 결 론 : 치료순응도는 정서적 변인중 우울과 불안에 의존하고 치료순응도를 높이는 방법으로 지지적 면담이 유용한 것으로 생각된다. Objectives : The purposes of this study were to evaluate the relationship between therapeutic compliance and emotional variables in the patients on maintenance hemodialysis and to make a help in planning the treatment in order to promote the therapeutic outcomes. Methods : Subjects consisted of 43 end-stage renal disease patients who had been treated with hemodialysis for more than one year. Hostility was measured with Cook-Medly Hostility Scale and depressive symptom, with Beck Depression Inventory(BDI) and anxiety, with Self-rating Anxiety Scale of Zung(SAS). Serum potassium(K), and phosphorus(P) level, and interdialytic weight gain(IWG) were selected as compliance indices, for they were said to reflect of diet, medication and salts restriction, respectively. Results : 1) While the patients on hemodialysis got the scores within the normal range in their anxiety and hostility scale, they showed higher score of BDI than normal person, which was statistically significant. 2) Considering the relationship between therapeutic compliance and emotional variables, diet compliance was significantly associated with the emotional variables such as depression and anxiety. The relationship would be drawn with the equation listed below : Compliance Value=4.656×(Depression)+2.592×(Anxiety) -0.13×(Depression)×(Anxiety) -9.742 3) When the patients were given a series of supportive psychotherapy for about I month, they showed the decrease in the scores of anxiety and depression scales, and the elevation in compliance value. However, there was no room for saying that the compliance ratio was improved, because of the limitation in the research methodology. Conclusion : Therapeutic compliance depended on between depression and anxiety among the emotional variables, the supportive psychotherapy was useful method to improved the therapeutic compliance.