폐경후 여성에서 호르몬 대치요법의 투여기간이 지질과 Lipoprotein ( a ) 에 대한 효과에 미치는 영향

김치정(Chee Jeong Kim),곽미향(Mi Hyang Kwak),김경만(Kyung Man Kim),이광제(Kwang Je Lee),정유석(Yoo Suk Chung),민용기(Young Ki Min),유왕성(Wang Seong Ryu),유언호(Un Ho Ryoo) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectievs: Hormone replacement therapy(HRT) in postmenopausal women decreases lipoprotein(a) [Lp(a)]. The influences of progesterone on Lp(a) and lipids, administered with estrogen, are controversial. However, previous studies had variable duration of therapy, and there was no report evaluating the effect of the duration of medication. Methods: A total 246 postmenopausal women were divided into 4 groups: group A; 0.625mg conjugated equine estrogen(CEE)(n=90), group B; 0.625mg CEE plus 5mg medroxyprogesterone acetate(MPA)(n=35), group C; 0.625mg CEE plus 10mg MPA(n=43), and group D; 2mg estradiol valerate(E2) plus 0.5mg norgestrel(N)(n=76). Lp(a) and lipids levels were measured before, 2, 6 and 12 months after HRT. Results: In total subjects, Lp(a) was decreased with medication for 2 months by 20.7%(p<0,0001). Compared with levels at 2 months after medication, levels at 6 and 12 months revealed further reduction(p<0.001) by 5.3% and 9.0% respectively. Medication for 2 months increased HDL-C in group A, not changed in group B and C, and decreased in group D. After 12 months, HDL-C levels were increased in Group A, B, and C, and not changed in group D, In total subjects, low density lipoprotein- cholesterol(LDL-C) was decreased by 12.2% after 2 months(p<0.001). Compared with levels at 2 months after medication, LDL-C level was decreased by 3.4% after 6 months(p<0.001) and there was no further reduction after 12 months. Conclusion: The effect of hormone replacement therapy on Lp(a) and lipids were dependent upon the duration of medication. Inconsistent results in previous studies can be partially explained by the difference in this parameter.

종설 : 고콜레스테롤혈증; 새천년 한국에서는 어떤 환자를 어떻게 치료할 것인가?

김치정 ( Chee Jeong Kim ),이광제 ( Kwang Je Lee ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6

Cardioprotective effect and the safety of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) has been established in many large-scaled randomized controlled trials encompassing both primary and secondary prevention. Therefore, the market of statins is growing rapidly. In new millennium, several studies have shown the benefit from further reducing already low concentration of low density lipoprotein-cholesterol in high-risk patients. However, these clinical trials have applied selection criteria to protect the internal validity at the expense of reducing the applicability of the trial`s findings to the wider population of patients seen in routine clinical practice. Treatment guideline for Korean hypercholesterolemic patients followed that of American. However, the death rate by coronary artery diseases is much lower in Korean population than in American population. The efficacy of statins in preventing cardiovascular diseases and the pitfalls in recent randomized controlled trails will be reviewed and the personal opinion for the management of Korean hypercholesterolemic patients will be suggested. (Korean J Med 72:580-592, 2007)

폐경후 여성에서 1년간의 호르몬대치요법이 Lp(a)와 지질에 미치는 영향(호르몬대치요법과 Lp(a))

김치정 ( Chee Jeong Kim ),이광제 ( Kwang Je Lee ),정유석 ( Yoo Suk Chung ),민용기 ( Young Ki Min ),유왕성 ( Wang Seong Ryu ),유언호 ( Un Ho Ryoo ) 한국지질동맥경화학회(구 한국지질학회) 1996 韓國脂質學會誌 Vol.6 No.1

증례 : 순환기 ; 경부 종물로 발현된 원발성 경정맥류

김정은 ( Jung Eun Kim ),이왕수 ( Wang Soo Lee ),조은정 ( Eun Jeong Cho ),김상욱 ( Sang Wook Kim ),김치정 ( Chee Jeong Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

Venous ectasia, also called phlebectasia or venous aneurysm, is an isolated saccular or fusiform dilatation of a vein. Ectasia of the internal jugular vein was once considered rare, but is increasing in apparent frequency due to the wide use of noninvasive diagnostic modalities. A 57-year-old woman was referred for right neck discomfort that had developed 1 month earlier. She complained of a non-painful right neck swelling, located anteromedial to the sternocleidomastoid muscle. Computed tomography and color Doppler ultrasonography showed a 2×1.7-cm right internal jugular venous ectasia. The size of the jugular venous ectasia decreased after compression with a probe and increased during the Valsalva maneuver. Here, we report the first Korean case of primary internal jugular venous ectasia, which presented as an asymptomatic right neck swelling. (Korean J Med 77:124-127, 2009)

증례 : 순환기 ; 전신적인 발진성, 결절성 황색종을 동반한 제3형 고지단백혈증 1예

김은영 ( Eun Young Kim ),서기우 ( Ki Woo Seo ),김정은 ( Jung Eun Kim ),조은정 ( Eun Jeong Cho ),이왕수 ( Wang Soo Lee ),김치정 ( Chee Jeong Kim ),이갑석 ( Kap Sok Li ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5

저자들은 55세 여자 환자에서 전신적으로 발생한 발진성, 결절성 황색종을 동반한 제3형 고지단백혈증을 경험하였기에 보고하는 바이다. A 55-year-old female presented with extensive yellowish eruptive plaques over both elbows and the buttocks that she had first noticed 2 years earlier. Yellowish orange discoloration of her palmar creases was noted. Her serum cholesterol and triglyceride were markedly elevated. Lipoprotein electrophoresis showed a broad β band. On apolipoprotein E genotyping, the arginine at position 158 had been replaced by cysteine in both alleles (E2/E2). Under a diagnosis of type III hyperlipoproteinemia, combined atorvastatin and fenofibrate therapy for 2 months normalized the serum cholesterol and triglyceride levels. (Korean J Med 77:620-624, 2009)

확장성심근중 환자에서 Enalapril 치료가 좌심실내경의 순간변화율에 미치는 영향

김철우(Cheol Woo Kim),정유석(Yoo Suk Jung),이광제(Kwang Je Lee),곽미향(Mi Hyang Kwak),김경만(Kyung Man Kim),김태호(Tae Ho Kim),김치정(Chee Jeong Kim),류왕성(Wang Seong Ryu),유언호(Un Ho Ryoo) 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective: Angiotensin-converting enzyme inhibitors have been shown to improve survival in patients with congestive heart failure. To evaluate the efficacy of enalapril in patients with dilated cardiomyopathy during concurrent treatment with digoxin and diuretics, the peak rates of left ventricular movement were assessed after 6 months of follow-up by digitized echocardiography. Methods: Using a high quality digitizer, continuous measurement of left ventricular dimension and its rate of change (dD/dt) were obtained throughout the cardiac cycle. Normalized rates of wall movement (dD/dt/D) were used for comparison. Results: 1) Compared with control subjects, patients with dilated cardiomyopathy showed much lower Peak(-) dD/dt and Peak(-) dD/dt/D. 2) Peak(+) dD/dt and Peak(+) dD/dt/D were also depressed in patients. 3) Peak dD/dt improved significantly (p<0.05) in the enalapril group (n=16), but did not change in the conventional treatment group (n=20) after 6 months. Peak dD/dt/D improved approximately (p<0.005) in the enalapril group. 5) There were no deaths in 2 treatment groups during initial 6 months, but 3 patients in the conventional treatment group died suddenly during 1 year of follow-up. Conclusion: The present study has shown that left ventrieular Peak dD/dt and Peak dD/dt/D are significantly depressed in patients with dilated cardiomyopathy. Enalapril appears to provide well-tolerated and effective long-term therapy by improving peak rates of left ventricular movement in patients with dilated cardiomyopathy.

관동맥 확장술 후 추적 운동부하 검사에서 관찰되는 QT 분산의 변화

이왕수(Wang Soo Lee),김상욱(Sang Wook Kim),안지현(Ji Hyun Ahn),이상엽(Sang Yub Lee),송영빈(Young Bien Song),김상민(Sang Min Kim),조성원(Sung Weon Jo),이광제(Kwang Je Lee),곽미향(Mi Hyang Kwak),김태호(Tae Ho Kim),김치정(Chee Jeong Kim 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: QT 분산은 불균등한 심실 재분극을 나타내는 지표로 증가된 QT 분산은 허혈성 심질환과 돌연사 등과 연관성이 있다고 알려져 있는데, 관동맥 확장술이 심실 재분극의 불균등성이 양호하게 회복시켜서 성공적인 관동맥 확장술 후에는 QT 분산이 유의하게 감소된다고 알려져 있다. 운동부하 검사는 관동맥 확장술 후 추적검사로 흔히 사용되고 있으나, 관동맥 확장술 후 운동부하 검사에서 QT 분산의 변화에 대한 보고는 많지 않다. 저자들은 스텐트시술 후 추적검사로 운동부하검사시 관찰되는 QT 분산의 변화와 임상적 의미를 알아보고자 하였다. 방법: 허혈성 심질환으로 입원하여 관동맥 조영술을 시행하여 유의한 관상동맥 협착을 보였던 환자들 중, 운동부하 검사를 시행하고 약물치료를 시행하였던 46명과 스텐트시술을 시행한 후 6개월에 운동부하 검사를 시행하였던 41명을 대상으로 두 군에서 QT 분산과 교정 QT 분산을 스텐트시술 전 심전도에서 측정하였고, 6개월 후 추적 운동부하 검사에서 운동부하 전, 최대 운동부하시, 회복기 2분에 digitizer를 이용하여 측정 후 비교 관찰하였다. 결과: 내원시 치료 전 심전도에서 측정한 QT 분산과 교정 QT 분산은 스텐트 시술군 에서 시술 전에 각각 51.2±15.6, 58.4±14.1 msec였고, 약물치료군에서는 내원시 50.9±13.8, 56.7±16.3 msec로 두 군 간에 유의한 차이는 없었다(p>0.05, 그림 1). 6개월 후 추적 운동부하 검사에서 최대 운동부하시 QT 분산 및 교정 QT 분산은 스텐트시술군에서 각각 28.2±11.9, 39.3±16.2 msec였고, 약물치료만 받은 군에서 40.4±20.5, 57.8±30.0 msec로 스텐트시술군에서 유의하게 감소하였으며, 운동부하 검사 시작 전과 회복기 2분에도 스텐트시술군에서 약물치료군보다 유의하게 짧았다(p<0.05, 표 3, 그림 1). 하지만 병변 위치와 병변 혈관 수에 따른 QT 분산과 교정 QT 분산의 변화는 관찰되지 않았다. 결론: 본 연구에서는 허혈성 심질환 환자에서 스텐트시술 후 6개월에 추적 운동부하검사를 시행한 결과 QT 분산과 교정 QT 분산이 유의하게 감소되어 스텐트시술이 심근허혈의 완화와 심실재분극상태의 향상에 효과적이고 운동부하검사시 교정 QT 분산의 측정이 유용한 지표가 될 수 있음을 알 수 있었다. 향후 관동맥 확장술 후 추적 운동부하 검사에서 QT 분산의 의미에 대해서는 체계적인 연구가 필요하다고 사료된다. Background: QT dispersion (QTd) represents inhomogeneous ventricular repolarization. Increased QTd has been reported to be associated with ischemic heart disease and sudden cardiac death. Successful percutaneous coronary angioplasty (PTCA) produces a favorable recovery of inhomogenous repolarization and reduces QTd. Although treadmill exercise test is commonly used for follow-up test after PTCA, limited data are available about QTd during treadmill test. The purpose of this study was to evaluate the change in QTd and determine its clinical role in follow-up treadmill exercise test after coronary stenting. Methods: 41 patients with significant coronary artery disease underwent successful coronary stenting, while 46 patients were medically treated. Treadmill exercise test was performed to compare QTd between two groups as a follow-up test at 6 months after coronary stenting and medical therapy. Treadmill exercise test was recorded in pre-test, peak exercise, and recovery 2 minutes phase. QTd and corrected QT dispersion (QTcd) were measured in these ECGs using a digitizer. Results: Coronary stenting significantly reduced QTd and QTcd at 6 months after coronary stenting. QTd and QTcd did not show significant difference between coronary stenting and medical therapy group at initial EKG before treatment. After coronary stenting, QTd and QTcd were significantly reduced than those of medical therapy group. And the changes in QTd and QTcd were more marked at peak exercise (28.2±11.9 and 39.3±16.2 msec in coronary stenting group vs 40.4±20.5 and 57.8±30.0 msec in medical therapy group). Lesion location and diseased vessel number were not associated with changes in QTd and QTcd. Conclusion: Coronary stenting reduced QTd and QTcd significantly in follow-up treadmill exercise test. Coronary stenting appears to be more effective to relieve myocardial ischemia and to improve inhomogenous ventricular repolarization than medical therapy. The measurement of QTcd during treadmill exercise test may be a useful index to evaluate myocardial ischemia after coronary stenting. Clinical relevance of these finding will require further study. (Korean J Med 63:186-194, 2002)

풍선도자에 의한 흰쥐의 경동맥 손상 후 phospholipase C-γ1 발현의 변화

임성훈(Seong Hoon Lim),허영선(Young Sun Heo),김학진(Hak Jin Kim),이왕수(Wang Soo Lee),안지현(Ji Hyun Ahn),송영빈(Young Bien Song),김상욱(Sang Wook Kim),김태호(Tae Ho Kim),김치정(Chee Jeong Kim),류왕성(Wang Seong Ryu),유언호(Un Ho Ryo 대한내과학회 2001 대한내과학회지 Vol.60 No.3

N/A Background : While inositol phospholipid-specific phospholipase C (PLC) plays a central role in signal transduction pathways, little is known about its role in the vascular response to injury. Recent studies have shown that phospholipase C-γ1 (PLC-γ1) is required for PDGF-induced DNA synthesis and angiotensin II signaling. This study was undertaken to determine the potential involvement of PLC-γ1 in the in vivo response to vascular injury. Methods : Vascular injury was achieved in the left common carotid artery of six-month-old male Wistar rats. The expression of PLC-γ1 was evaluated at serial time points by immunohistochemistry and Western blot analysis following balloon de-endothelialization of the rat carotid artery. Results : In the denuded carotid artery at 1 week, the neointima became thicker in a symmetrical manner with respect to the long axis. A strong expression of PLC-γ1 at one week after injury was seen primarily in the thin layers of neointima. This increased immunoreactivity of PLC-γ1 persisted at 2-3 weeks after injury, coinciding with the time when neointima gains of its mass. At 4 weeks after injury, staining intensity slightly declined but levels remained elevated. As determined by Western blot analysis, the amount of PLC-γ1 was about 3-fold higher at 3 weeks after injury compared to uninjured vessels (p<0.01). Conclusion : These results suggest that the amplification of traffic within signal transduction pathways involving PLC-γ1 occurs and may play a significant role in neointima formation following arterial injury.(Korean J Med 60:234-241, 2001)

Q 파 심근경색과 비 - Q 파 심근경색의 임상경과 및 관동맥조영술 소견의 비교

정기영(Ki Young Chung),홍석근(Suk Keun Hong),이명룡(Myung Yong Lee),조주희(Joo Hee Zo),김준수(June Soo Kim),김치정(Chee Jeong Kim),조명찬(Myeong Chan Cho),박영배(Young Bae Park),이명묵(Myoung Mook Lee),최윤식(Yun Shik Choi),서정돈(Ju 대한내과학회 1991 대한내과학회지 Vol.40 No.1

N/A Despite of having smaller infarct size and better left ventricular function, patients with non-Q wave myocardial infarction has been reported to have an high late cardiac event rate, and long term prognosis is ultimately comparable to that of patients with Q wave myocardial infarction. This is because there is more viable tissue in the perfusion zone of infarct-related artery rendering myocardium more prone to reinfarction. To compare the prognosis and clinical characteristics of Q wave myocardial infarction with those of non-Q wave myocardial infarction, 390 patients with acute myocardial infarction were reviewed and analyzed retrospectively. Patients were classified according to electrographic results into Q wave infarction (n=336) and non-Q wave infarction (n=54). Predischarge coronary angiography, gated blood pool scan, end treadmill exercise test were performed. There was no significant difference in sex, age, angina history, previous myocardial infarction, location of infarction, and severity of coronary disease; Q wave myocardial infarction did have higher peak CK (1733.9±1432.6 vs. 511.1±588.8 IU; P<0.01) and CK-MB fraction level (334.2±371.5 vs. 78.7±128.5; P<0.01). Predischarge treadmill exercise test showed no significant difference in the exercise duration, ST segment change, and chest pain. In gated blood pool scan, ejection fraction of left ventricle did not show significant difference, but proportion of normal left ventricular wall motion was significantly higher in non-Q wave infarction. (21/257 vs. 19/42; P<0.01). The extent of coronary artery disease and degree of coronary artery stenosis was not different between two groups, but high degree obstruction (>90%) of infarct related artery was more frequent in Q wave myocardial infarction (134/187 vs. 19/35; P<0.05). During follow-up, in-hospital mortality was significantly higher in Q wave myocardial infarction (13% vs. 2%, p<0.01). But postdischarge mortality and the rate of reinfarction did not different between two groups. Further prospective studies should be performed to clarify the clinical behaviors and long-term prognosis in patients with non-Q wave myocardial infarction.

고혈압의 임상적 고찰

이영우 ( Young Woo Lee ),이명묵 ( Myoung Mook Lee ),오병희 ( Byung Heui Oh ),서봉관 ( Bong Kwan Seo ),김치정 ( Chee Jeong Kim ),김성국 ( Seong Gook Kim ),유왕성 ( Wang Seoung Ryu ) 대한내과학회 1985 대한내과학회지 Vol.29 No.5