당뇨병 환자에서 RR 간격의 변화에 관한 연구

김완중(Wan Jung Kim),김중남(Jung Nam Kim),김호중(Ho Jung Kim),문철웅(Chul Oong Moon),이승일(Soung Il Lee),장경식(Kyoung Sig Chang),홍순표(Soon Pyo Hong) 대한내과학회 1990 대한내과학회지 Vol.39 No.4

N/A Heart rate variability is a noninvasive index of the neural, especially parasympathetic, activity of the heart. Autonomic neuropathy is frequently observed in diabetic patients, and a 5-year survival rate of this kind of patient is low. To evaluate autonomic neuropathy in diabetic patients, 35 diabetic patients (proliferative retinopathy: 14, neurogenic bladder:8, postural hypotenion:6) measured for RR intervals and Valsalva ratios compared with 77 persons of the normal control group. RR variations (standard deviation: SD, coefficient of variation: CV, max-min, max/min) during deep respiration and Valsalva ratios (Vmax-Vmin, Vmax/Vmin) during Valsalva maneuver were significantly lower in the diabetic patients than in the normal control group (p<0.001, respectively). RR variations and Valsalva ratios decreased progressively with an increase of age in the control group and in diabetic patients (p<0.001, respectively). RR variations and Valsalva ratios were significantly lower in the diabetic patients with retinopathy, neurogenic bladder, and postural hypotension compared to diabetic patients without such conditions (P value <0.01, <0.05, <0.05, respectively). It is concluded that diabetic autonomic neuropathy can be indicated by the measurement of RR variations and Valsalva ratios.

혈액투석중인 만성신부전증 환자에서 심전도상 RR 간격의 변화

장경식(Kyoung Sig Chang),이승일(Seung Il Lee),문철웅(Chul Oong Moon) 대한내과학회 1992 대한내과학회지 Vol.43 No.4

N/A Background: Heart rate variability is a noninvasive index of the neural activity of the heart. Peripheral neuropathy, especially autonomic dysfunction, may be present in patients with chronic renal failure treated with hemodialysis. Heart rate variatios (RR interval) response to deep breathing and the Valsalva maneuver enable accurate, reproducible, and noninvasive evaluation of autonomic dysfunction. Method: To evaluate autonomic neuropathy in CRF patients, 41patients (postural hypotension: 7) who had been treated with hemodialysis were compared with 39normal subjects. Result: The findings were as follows. RR variations (Mean, Max, Min, SD, CV, Max/Min) during deep breathing were significantly lower in the CRF patients than in the normal control group (p<0,01, p<0.01, p< 0.05, p<0,05, p<0.05, respectively), RR variations (Vmax, Vmax-Vmin, Vmax/Vmin) during Valsalva maneuver were significantly lower in the CRF patients than in the normal control group (p < 0.01, p<0.01, p<0.05, respectivley). RR variations and Valsalva ratio were more significantly lower in the CRF patients with and without postural hypotension compared to normal control group (p<0.01, p<0.05, respectively). But there was no significant correlation between any measures of heart rate variations and postural hypotention of CRF patients. RR variations and Valsalva ratio (SD, CV, Max/Min, Vmax/Vmin) decreased progressively with advancing age in the normal control group (p<0.01, p<0.05, respectively), but a lack of correlation in CRF patients treated with hemodialysis. Conclusion: From the above findings, it is concluded that measurement of RR variation during deep breathing and Valsglva maneuver allows assessment of the integrity of autonomic dysfunction in chronic renal failure treated with hemodialysis.

소화성 궤양환자의 흡연여부에 따른 혈청 Pepsinogen 1 치의 변화

오재선(Jae Sun Oh),김평남(Pyung Nam Kim),나한식(Han Sik Na),김중남(Jung Nam Kim),문철웅(Chul Oong Moon),김만우(Man Woo Kim),양성훈(Sung Hun Yang) 대한내과학회 1990 대한내과학회지 Vol.39 No.4

N/A Serum group I Pepsinogen (sPG I) levels were measured by radioimmunoassay in 159 patients undergoing endoscopy, then all patients were classified by endoscopic diagnosis, gastric mucosal histology, and smoking habits. The results were as follows: 1) Both nonulcer dyspepsia and duodenal ulcer smokers had significantly higher sPG I levels than their nonsmoking controls (p<0.005). 2) The frequency distvibution of superficial gastritis in the nonulcer dyspcpsia group with smoking habits revealed significantly higher levels than that of the nonsmoking controls (p<0.0025). 3) Serum PG Iin nonulcer dyspepsia patients revealed significantly higher levels in patients with superficial gastritis but there were not related to cigarette smoking. 4) The relationship between the mean level of serum PG I and fundic mucosal histology in duodenal ulcer patients was found to be statistically insignificant, but the mean level of sPG I in the smoking group showed a higher value than that of the nonsmoking controis (p< 0. 05). 5) The frequency distribution of high serum PG I level (> 80 ng/ml) in duodenal ulcer smokers was higher than that of the nonsmoking control group (chi square test: p<0.). From the above findings, it is concluded that the smoking induced increase in sPG I in duodenal ulcer is proposed to release an augmented pepsin secretory capacity, which can have aetiologic significance in association between smoking and duodenal ulcer.

정상인과 고혈압 환자에 있어서 혈청 및 적혈구내 과산화지질과 Superoxide Dismutase 변동에 관한 연구

조건국 ( Kun Kook Cho ),정춘해 ( Choon Hae Chung ),정복기 ( Bok Key Chung ),채종구 ( Jong Koo Chae ),이승일 ( Seung Il Lee ),문철웅 ( Chul Oong Moon ),오금탁 ( Keum Tak Oh ) 대한내과학회 1984 대한내과학회지 Vol.27 No.9

만성 신부전증 환자에서 혈액 글루타치온의 변화

김태균(Tae Kyun Kim),임현성(Hyeon Seong Lim),배학연(Hak Yun Bae),정춘해(Choon Hae Chung),정종훈(Jong Hoon Chung),문철웅(Chul Oong Moon),이병래(Byoung Rae Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.1

N/A Background: The development of uremic symptoms in patients with chronic rena1 failure is related to the decreased blood glutathione levels and RBC antioxidant activities. So, we performed this study to observe the levels of blood glutathione and RBC antioxidant activities in patients with chronic renal failure. Method: The levels of blood glutathione, RBC antioxidants (e.g., superoxdie dismutase, catalase) were examined m twenty one patients with chronic renal failure undergoing maintenance hemodialysis on two to three days interval (CRF group) and fifteen normal person (control group). The CRF group was divided into two groups, high glutathione (HG) group (higher than mean value) and low glutathione (LG) group (lower than normal value). Result: Blood total glutathione levels were significantly lower in CRF group and the ratio of oxidized glutathione (GSSG) were significantly increased compared to control group. In CRF group, catalase activities were significantly increased in LG group compare to HG group. Conclusion: This result suggested that decreased glutathione level probably contribute to increased damage to cell in patient with chronic renal failure.

혈액 투석중인 만성 신부전증 환자에서 혈청 Apolipoprotein A - I 과 B 의 변화

조경상(Kyeong Sang Cho),권희식(Hee Sik Kweon),신정철(Jeong Cheol Sin),전용준(Yong Jun Jeon),박유환(Yu Hwan Park),문철웅(Chul Oong Moon),박찬국(Chan Gook Park) 대한내과학회 1991 대한내과학회지 Vol.40 No.1

N/A Cardiovascular complications are frequently observed in patients with chronic renal failure on hemodialysis. The role of the disorder of apolipoprotein composition has been emphasized. Serum concentrations of apolipoprotein A-I and apolipoprotein B were determined by radioimmunodiffusion in 44 patients with chronic renal failure on hemodialysis. The results were compared with those obtained in asymptomatic normolipidemic subjects and patients with chronic nephritis. Chronic renal failure patients on hemodialysis had reduced concentration of apolipoprotein A-I (107.1±25.54㎎/dl) compared with chronic nephritis (116.9±20.51㎎/dl) and the normal controls (137±25.54㎎/dl) as well as increased concentration of apolipoprotein B (123.5±20.54㎎/dl) compared with chronic nephritis (102.4±26.04㎎/dl) and the normal control (98.0±20.12㎎/dl), respectively (p<0.01). The ratio of apolipoprotein A-I to apolipoprotein B (0.87±0.514) was decreased compared with chronic nephritis (1.13±0.601) and the normal controls (1.39±0.513), respectively (p<0.01). These findings suggest that cardiovascular complications observed in chronic renal failure patients receiving hemodialysis may be related with the abnormalities in serum apolipoprotein A-I and apolipoprotein B level.

백서 심장 및 현장독성에 대한 Doxorubicin 과 Epirubicin 의 영향

박유환(You Hwan Park),정희상(Hoe Sang Jung),김완중(Wan Jung Kim),권희식(Hee Sik Kwon),김용태(Young Tae Kim),문철웅(Chul Oong Moon),박찬국(Chan Kook Park),이승일(Seung Il Lee),홍순표(Soon Pyo Hong) 대한내과학회 1991 대한내과학회지 Vol.41 No.3

N/A Doxorubicin is an antibiotic of the anthracycline group which has proven effective in treating a variety of malignant disorders. Its use in cancer chemotherapy has been limitd, however, because of the its cardiotoxic side effects. Attempts to reduce the cardiotoxicity of anthracycline antibotics include the synthesis of structural analogs, e.g., epirubicin, the coupling of active drugs to carriers, and the discovery of new types of anthracyclines. In this experiment, the toxicity of epirubicin was examined in various organs of rats for levels of malondialdehyde and activity of free radical scavengers (superoxide dismutase and catalase) and compared with the toxicity of doxorubicin. The following results were obtained: 1) Doxorubicin increased the quantity of malondiadehyde by 519% (p<0.01) in the heart, 45% (p<0.01) in the kideny, 35%(p<0.05) in the lung, and 41% (p<0.05) in the liver. Epirubicin increased the quantity of malondiadehyde by 10%(p<0.05) in the heart and 26%(p<0.01) in the kidney, but there was little change in the lung and liver. 2) Doxorubicin and Epirubicin decreased the activities of catalase in the heart by 11% and 17% but increased the it in the kidney by 27% and 19%, respectively (p<0.05). 3) Doxorubicin and Epirubicin increased the activities of SOD in the heart by 24% (p<0.01) and 199%(p<0.05) and in the kidney by 23%(p<0.01) and 34% (p<0.05) respectively. In conclusion, Epirubicin shows less toxicity in the heart than the kidney and has less cardiorenal toxicity in rats compared to Doxorubicin for same doses.

백서에서 신 허혈성 손상에 미치는 칼슘 길항제의 효과

문철웅,정종훈,박천국,이승일,배학연,장경식,김만우,정춘해,홍순표,이병래,김호중 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Renal ischemia is one of the most common causes of acute renal failure. Four factors related to the pathogenesis of acute renal failure are vasoconstriction, decreased glomerular filtration rate, tubular back leak of filtrate, and intratubular obstruction. The cellular response to renal ischemic insults include decreased content of adenosine trihosphate, lipid peroxidation induced membrane degradation, alteration in cellular pH, and calcium or phospholipase induced mitochondrial dysfunction. Much attention has been given to the role of increased cellular calcium as a pathogenetic contributor to cell injury during ischemia. Author studied the protective effects of calcium antagonists on cellular injury during renal ischemia in rat. To investigate the protective role of these agents, author measured the amount of malondialdehyde(MDA) and the enzyme activities of free radical scarvengers-superoxide dismutase(SOD), catalase and glutathione peroxidase from non-pretreated group and calcium antagonists pretreated groups in control, ischemia and reflow subgroups. The results were summerized as follows: 1) The amount of MDA in non-pretreated group was higher in the reflow compared with the control(<p<0.01). But, in all pretreated groups, there was no statistically difference in the amount of MDA. 2) The SOD activity in non-pretreated group was lower in both the ischemia and the reflow compared with the control (P<0.05). But, in both verapamil and trifluoperazine-pretreated groups, there was no statistically difference in the SOD activity. 3) Both catalase and glutathione peroxidase activities in non-pretreated group were lower in both the ischemia and the reflow compared with the control (P<0.05). But in all pretreated groups, there was no statically difference in both catalase and glutathione peroxidase activities. These results suggest that free radical mediated ischemic injury by renal artery clamp in rat can be protected by intraperitoneal pretreatment with calcium antagonists. As trifluoperazine has a protective effect in renal ischemia, the calcium activated calmodulin dependent enzyme may play a role in renal ischemic injury.

신장허혈백서에서 투여 시기에 따른 캄슘길항제의 효과

이승일,문철웅,장경식 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

During ischemia, the cellular ATP concentrations quickly decline due in part to the absence of an adequate electrone acceptor and in part to the continued utilization of previously sythesized ATP by energy-dependent functions and the levels of ADP and AMP rise rapidly and these were further catabolised to hypoxanthine. Hypoxanthine and xanthine catabolized to uric acid by xanthine oxidase and in these metabolic step, free radicals were produced. The levels of intracellular calcium were increased due to the impared faction of membrane pump such as Na-K ATPase and Ca-ATPase because of decresed ATP levels in ischemia. Calcium promote cell injury including the plasma membrane, mitochondria, endoplasmic reticulum and the cytoskeleton but the precise roles of calcium in ischemic cell injury were unknown. In this experiment, effects of trifluoperazine(calmodulin antagonist) and allopurinol(xanthine oxidase inhibitor) on ischemic-reflowed rat kidney was investigated by the contents of malondialdehyde(MDA) as a indicator of lipide proxidation, the activities of antioxidant enzymes including superoxide dismutase(SOD), glutathione peroxidase and catalase, and the levels of glutathione. Allopurinol(50㎎/㎏ of body weight) was administrated by orally 12 hours before ischemia and trifluoperazine(2㎎/㎏ of body weight) was administrated 10 minutes before ischemia or 10 minutes after ischemia by intravenous injection. The contents of MDA was significantly increased by ischemia-reflow but significantly reduced by allopurinol pretreatment. The decrement of SOD and catalase activities were significantly reduced by allopurinol and trifluoperazine regardless of adminstration time compared with allopurinol pretreated group. The changes of glutathione peroxidase activity was significantly reduced by allopurinol and trifluoperazine. But the levels of glutathione was significantly decreased by allopurinol and trifluoperazine. These result suggested that xanthine oxidase and calcium paticipate in ischemic-reflow cell injury in rat kidney and calcium induced cell injury occure mainly during reflow period.

인슐린 비의존형 당뇨병 환자에서 혈장 Endothelin-1농도의 변화

신양수,조희충,김원식,국기용,김용화,정종훈,문철웅,배학연,양성훈 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.2

Endothelin(ET) is a 21-residue peptide originally isolated from the cultured porcine endothelial cells. There are at least three genes for endothelin:endothelin-1(ET-1), endothelin-2(ET-2), and endothelin-3(ET-3). Endothelins are present in various human biological fluids including plasma, urine, breast milk, and saliva and have been found elevated plasma ET concentrations in patients with diabetes mellitus, Patients undergoing maintenance hemodialysis due to chronic renal failure, patients with acute myocardial infarction, and patients with subarachnoid hemorrhage. Endothelial cell damage is suspected to occur in diabetic patients and may be one important cause of angiopathy, a major complication in diabetes mellitus. The elevation of ET in diabetic patients may be a marker of, and further exacerbate, their vascular disease. We measured the levels of ET-1 in plasma of 50 patients with non-insulin dependent diabetes mellitus(NIDDM) and 25 normal subjects by radioimmunoassay. The plasma ET-1 concentration (mean±S.D.) in NIDDM was 6.461 A2.510 f㏖/ ㎖, and was significantly higher than in normal subjects (4.567±1.155f㏖/㎖) (P<0.05). The plasma ET-1 concentration (mean±S.D.) in diabetic retinopathy group( 7.15±2.454 f㏖/ml) was significantly elevated than those in otherwise uncomplicated groups (5.348±2.390 f㏖/㎖)(P<0.01). The correlation between any clinical parameters and plasma ET-1 levels in NIDDM was not significant, In conclusion, this study suggest that the elevated levels of ET-1 in diabetic patients may be play a important role in the pathogenesis of diabetic complications.