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        한국인 임신부에서 Factor V 유전자 돌연변이와 중증 전자간증의 관계

        이주롱 ( Joo Long Lee ),이순곤 ( Soon Gone Lee ),이정재 ( Jeong Jae Lee ),이해혁 ( Hae Hyeog Lee ),정집광 ( Jib Kwang Chung ),최규연 ( Kyu Yeon Choi ),이임순 ( Im Soon Lee ),이권해 ( Kwon Hae Lee ) 대한주산의학회 2002 大韓周産醫學會雜誌 Vol.13 No.4

        연구목적:단백 C는 활성화 단백 C(Activated protein C, APC)로 활성화되어 응고인자중 factor Va와 factor Ⅷa를 불활성화시키는 항응고 물질이다. 활성화 단백 C 내성이 유전성 혈전증의 중요한 원인이라는 사실이 밝혀졌으며, 이 대부분이 factor V 유전자의 돌연변이(factor V Leiden mutation)에 의한 것임이 알려졌다. 본 연구에서는 factor V 유전자 돌연변이로 야기되는 활성화 단백 C에 대한 내성이 중증 임신 전자간증의 임신부에서 관찰된 보고가 있고 병태 생리에 역할을 한다는 가설을 접하고 중증 전자간증 임신부에서의 factor V Leiden mutation의 빈도를 조사해 정상 임신부와 비교해 보고자 하였다. 방법:정상 혈압을 가진 403명의 임신부와 중증 전자간증으로 진단된 158명의 임신부의 혈청을 대상으로 factor V 유전자의 506번 아르기닌(arginin) 구간에 대한 중합 효소 연쇄 반응을 시행한 후 Mnl 1 제한 효소로 절단하여 절단 여부를 관찰하여 factor V Leiden mutation여부를 관찰하였다. 결과:정상 임신부 403명과 중증 전자간증 임신부 158명중 factor V Leiden mutation은 한 예에서도 관찰되지 않았다. 결론:본 연구결과 백인에서와는 달리 한국인에서는 활성화 단백 C 내성 및 factor V Leiden mutation이 발견되지 않았으며, 한국인에서의 중증 전자간증에 대한 위험요소중 유전자에 대한 다른 연구가 필요할 것으로 생각된다. Objective: A study showed that resistance to activated protein C may develope some cases of severe preeclampsia. A common missense mutation in the factor V gene, the Leiden mutation, is the most frequent genetic cause of resistance to activated protein C. Our objective was to determine whether this mutation is more prevalent in patients with severe preeclampsia than in normotensive controls. Method: Deoxyribonucleic acid was extracted from whole blood of 158 gravid women of severe preeclampsia and 403 normotensive gravid women. The polymerase chain reaction was used to amplify exon 10 of the factor V gene, followed by allele-specific restriction with Mnl 1 for mutation detection. Results: No patients were homozygous for the Leiden mutation. We could not find any positive case with FV: Q506 in the normal or patient group. Conclusion: We could not find that carriers of the factor V Leiden mutation are increased risk for severe preeclampsia. In contrast to the reports in Caucasian, the prevalence of APC resistance and FV: Q506 might be very low or absent in the Korean population. But, carriers of this common thrombophilic mutation may be identified so that other causes and risk factors for inherited thrombophilia should be investigated in the Korean population.

      • 갱년기 여성의 호르몬 대치 요법에 대한 수용율

        이임순,장진영,이정재,이순곤,이권해,이해혁,김승형 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

        Purpose: We have evaluated the compliance of hormone replacement therapy. Method: There are 185 climacteric women who are divided into three groups (Group I, Group II, Group III). Group I is given conjugated equine estrogen(CEE, 0.625mg, day 1-30) plus medroxyprogesterone acetate(MPA, 5mg, day 1-12). Group II is given conjugated equine estrogen (CEE, 0.625mg, day 1-30) plus medroxyprogesterone acetate (MPA, 2.5mg, day 1-30), Group III is given only conjugated equine estrogen(CEE, 0.625mg, day 1-30). Results: 1) The compliance rate of hormone replacement therapy during three months is 77.9% including each Group I : 77.7%, Group Ⅱ : 76.1%, Group Ⅲ :80.4%. 2) The compliance rate of hormone replacement therapy during six months is 60.7% including each Group Ⅰ:52.9%, Group Ⅱ: 56.4%, Group Ⅲ: 79.5%. 3) The compliance rate of hormone replacement therapy during nine months is 49.7% including each Group Ⅰ: 45.5%, Group Ⅱ:41.7%, Group Ⅲ: 64.3%. 4) The compliance rate of hormone replacement therapy during a year is 44.4% including each Group Ⅰ: 40.2%, Group Ⅱ:35.3%, Group Ⅲ: 59.5%. Conclusion : It is vital that we maximize compliance if patients are to receive the full benefits from hormone replacement therapy. We think that physicians who prescribe hormone replacement therapy for climacteric women should enough explain the purpose, risks, and side effect of treatment for maximizing compliance of hormone replacement therapy.

      • 폐경기 여성에서 호르몬 대치 요법시 병행 투여된 프로제스토젠 투여 방법에 따른 혈청 지질 및 지단백에 미치는 영향

        이임순,전섭,이순곤,이해혁,이권해,정집광,이석민 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

        Objective : The purpose of our study is to evaluate the effect of different administration method of progestogen on lipid profiles including total cholesterol, LDL(low density lipoprotein)-cholesterol, HDL(high density lipoprotein)-cholesterol, triglycerides during hormone replacement therapy in postmenopausal women. Methods and Materials : Seventy-one postmenopausal women who were assigned to following groups (Group I : conjugated equine estrogen(CEE), 0.625 mg/day plus continuous medroxyprogesterone acetate (MPA), 2.5mg/day, Group II : CEE, 0.625 mg/day plus cyclic MPA, 5mg/day for 12days/month. And we measured serum total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglycerides before hormone replacement therapy(HRT) and 12 months later after hormone replacement therapy. Results: 1. Total cholesterol decreased in group I,III. 2. HDL-cholesterol increased in group I,II,III. 3. LDL-cholesterol decrease in group I,II. 4. Triglycerides increased in group I,II,III. There was significance in serum total cholesterol and LDL-cholestrerol among three groups. Conclusions : Estrogen alone or in combination with progestogen both in cyclic and continuous use improves lipid profiles, so medroxyprogesterone acetate(MPA) does not seem to blunt estrogenic effect on lipid profiles.

      • 자궁내 태아사망의 임상적 고찰

        이권해,이정재,조현철,이석민,이임순,이해혁,김권대,이순곤,남계현 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

        Objective: This study was designed to evaluate diagnosis and complication, prognosis during clinical study of cases of intrauterine fetal death. Methods and materials: This is a clinical study of 56 cases of the intrauterine fetal death among 8064 deliveries at Seoul Sunchunhyang university hospital during 5 years from January, 1994 to December, 1998. Results: The incidence was 0.7%. The age distribution of mothers was 18 - 44 years and was highest in the 25 - 29 years range(46.4%). The parity was the most highest in the nulliparous group(51.8%). The most common gestational weeks was 20 - 28 weeks gestational period(46.4%), and most common presentation was cephalic(73.5%). The most common weights of the intrauterine fetal death was from 5,00gm to 1,000g(48.2%). The mode of the most common delivery was the induction of delivery(57.2%). The etiologic factors were: unknown(42.9%), preeclampsia(17.9%), chorioamnionitis(14.3%), congenital anomaly(12.5%), abruptio placenta(7.1%), cord complication(3.6%), placenta previa, death of one for twin. There were 2 cases of maternal complication(DIC, Uterine atony). Conclusion : Intrauterine fetal death should be diagnosised early and treated properly to reduce risk of the maternal complication.

      • 자궁선근증의 고찰

        조환성,이해혁,정성윤,김성욱,이순곤,남계현,이임순,이권해 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

        Objective: This study was designed to estimate the frequency and risk factor for edenomyosis Methods: The clinical records of 623 women undergoing hysterectomy were retrieved in the Department of Obstetrics and Gynecology, Soonchunhyang University Hospital, during 5 years, from Jan. 1995 to Dec. 1999. Results: The following result were obtained. 1. Adenomyosis was found in 247 of 623 patients(39.6%) 2. The highest incidence was 40-49 years of age group, an incidence of 46.6% and mean age was 44.7 years. 3. Adenomyosis was more frequently observed in parous women than non-parous women, such as 93.1% and 6.9%, respectively. 4. Dysmenorrhea, metrorrhagia, pelvic pain and vaginal bleeding were common symptom of adenomyosis, an incidence of 28.7%, 19.0%, 18.2% and 16.2%, respectively. 5. Myoma was the most combined disease in adenomyosis, showing the incidence of 54.7%. 6. Grossly, the size of uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 61.9%. 7. Preoperative diagnostic accuracy of adenomyosis was 6.9%. Conclusion: The results show that deeply understanding of the common symptoms and epidemiology of adenomyosis improve the preoperative diagnostic accuracy.

      • 조산의 예측 지표로서의 fetal fibronectin의 유용성

        정집광,이해혁,이정재,이석민,이순곤,남계현,이임순,이권해 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

        Objective: The purpose of this study was to evaluate clinical efficacy of fetal fibronectin as a marker to predictor of preterm labor. Materials & Methods: The study group consisted of sixty-eight healthy pregnant women, at gestational age between 24 and 36 weeks, who visited our department with vaginal discharge from April, 1995 to December, 1997. For comparison, we divided all of the pregnant women into two groups by the result of ROM-Check^®, positive groups(N=21) and negative groups(N=47). When preterm labor appeared, 50mg of ritodrine hydrochloride(Yutopar^®) mixed I liter of 5% dextrose solution was administered slowly intravenously. Results: 1) The gestational age at delivery and the interval time from admission to delivery in the positive groups were significantly shorter than those of the negative groups(p<0.05). 2) The positive groups had significantly lower birth weight and Apgar scores than the negative groups(p<0.05). 3) Among the negative groups, in case of tocolytics administration, the interval time from admission to delivery significantly delayed more than that time in case of no tocolytics administration(p<0.05). Conclusions: The detection of the fetal fibronectin in vaginal discharge had a useful method as a predictor of preterm labor. Tocolytics was more effective in the negative groups than in the positive groups.

      • 2차원 및 3차원 초음파를 이용한 태아표면의 해부학적 선별 검사에 관한 연구

        윤석범,이해혁,이정재,최경훈,이순곤,이임순,이권해 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

        Objective : Our purpose of this study was to determine the clarity and consuming time of fetal surface screening in thirty-eight fetuses from 24 to 32 weeks of gestation by use of two and three-dimensional ultrasonography. Methods : From May 1998 to July 1998, we performed the fetal surface screening of the fetal face, extremities, and spine. Thirty-eight fetuses of 24-32 weeks of gestation (thirty-seven normal fetuses and one abnormal fetus) were studied by use two-dimensional (AI 5200S, 3.5-5.0MHz; Acoustic Imaging Technologic Cooperation, U.S.A.) and three-dimensional ultrasonography (Volusion 530D, 3.5-5.0 MHz ; Kretz-Medicine, Korea). On the fetal face, we evaluated both orbits, nose, lips and brow. Both hands and feet, five digits and toes should be seen in this study. We evaluated cervical spine and lumbosacral junction of the spine. Results : The maternal average age of 38 patients was 29.9 years and the average gestational age was 29.7 weeks. The results of fetal surface screening were as follows : face (both orbits 89.5%, lips 92.1%, nose 92.1%, and brow 89.5%), extremities (both hands 68.4% and feet 73.7%), and spine (cervical spine 94.7% and lumbosacral junction 97.4%) by use of two-dimensional ultrasonography. By use of three-dimensional ultrasonography, results were as follows : face (both orbits 76.3%, lips 81.6%, nose 81.6%, and brow 78.9%), extremities (both hands 76.3% and feet 78.9%), and spine (cervical spine 71.1% and lumbosacral junction 73.7%). Consuming time for two-dimensional ultrasonography were 4.7 minutes for face, 11.6 minutes for extremities, and 5.7 minutes for spine. Using three-dimensional ultrasonography results were 12.8 minutes for face, 17.9 minutes for extremities, and 11.7 minutes for spine. Average consuming time of all fetal anatomic screening was 22.0 and 42.4 minutes by use of two and three dimensional ultrasonography. In one abnormal fetus had cleft lip and polydactyly of right foot which were detected all by three-dimensional ultrasonography, but we couldn't detect the polydactyly by two-dimensional ultrasonography. Conclusion : Three-dimensional ultrasonography was more time-consuming method, but we suggested that three-dimensional ultrasonography was superior than two-dimensional ultrasonography in fetal surface screening.

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