인슐린 비의존형 당뇨병 환자에서 PABA 검사에 의한 췌장 기능의 평가

정춘희(Choon Hee Chung),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),최광준(Kwang Jun Choi),송영득(Young Duk Song),임승길(Sung Kil Lim),정재복(Jae Bok Chung),이상인(Sang In Lee),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh) 대한내과학회 1992 대한내과학회지 Vol.43 No.1

N/A Background and Methods: Exocrine pancreatic dysfunction is frequently seen in patients with fibrocal-culous pancreatic diabetes and insulin dependent diabetes mellitus. Also decreased pancreatic size in those patients has been reported. But exocrine dysfunction in patients with non-insulin dependent diabetes mellitus (NIDDM) is controversial. Simple tubeless PABA test has been widely used to test the chymotrypsin activity. In order to investigate the exocrine dysfunction in patients with NIDDM and to find out the factors affecting it, we performed PABA test and pancreatic size measurement in 20 diabetic patients and 8 controls. Results: 1) Excretion rate PABA in diabetic patients was significantly lower than that of healthy controls (58.3±17.5vs 76,5±11.49p, p<.0,05). 2) Among diabetic patients, underweight diabetics showed significantly lower excretion rate of PABA than non-underweight diabetics (50.2±18.5% vs 66,4±12,7%, p<0.05). 3) In non-underweight subjects, excretion rate of PABA was 66.4±12.7%, which is significantly lower than that of healthy controls (82.0±10.59%)(p<0.05), 4) In diabetic patients, urinary PABA excretion rate was not correlated with age, duration of diabetes mellitus, HbA1C and pancreatic size, but positively correlated with the ratio of ideal body weight. Conclusion: Exocrine pancreatic function was decreased in NIDDM patients and it seems to be negatively correlated with underweight

RAPD 마커를 이용한 무의 유전자지도 작성

안춘희,최수련,임용표,정해준,예병우,윤화모,Ahn, Choon-Hee,Choi, Su-Ryun,Lim, Yong-Pyo,Chung, Hae-Joon,Yae, Byeong-Woo,Yoon, Wha-Mo 한국식물생명공학회 2002 식물생명공학회지 Vol.29 No.3

작물의 신품종 육성 과정에 있어서 선발은 육종의 성패를 좌우하는 중요한 과정이다. 하지만 개체가 나타내는 표현형은 유전적 요인과 환경적 요인이 동시에 작용하여 나타나기 때문에 유전적인 효과만 구분하여 선발하는 것은 매우 어렵다. 최근에 분자생물학 분야의 연구가 급속도로 발전함에 따라 분자 수준의 표지 인자를 유용 유전자의 간접선발 지표로 활용하여 선발 효율을 높일 수 있게 되었다. 작물의 유전자 지도 및 분자 표지인자는 작물 육종에 매우 유용하게 활용될 수 있다. 따라서 본 연구에서는 무에서 양친인 '835'와 'B$_2$'에서 유래한 여교잡 집단 82개체를 이용하여 RAPD 유전자군 지도를 작성하고 관련 마커를 탐색하여 육종에 이용하고자 연구를 수행하였다. Primer 375종류를 이용하여 양친, 835와 B$_2$ 사이의 다형화 밴드 128개를 찾았다. BC$_1$F$_1$집단 조사를 통해 MAPMAK ER/EXP를 이용하여 연관군 지도를 작성하였다. 분리 분석된 RAPD 표지인자 128개 중 126개는 멘델의 이론 분리비 1:1에 적합하였으며. 2개는 동형접합체 (모본형) 쪽으로 편중되어 분리되었다. LOD 3.0 수준에서 128개의 표지인자가 9개의 연관군으로 나뉘어졌고 전체거리는 1,688.3 cM이었으며, 표지인자 간 평균거리는 13.8 cM으로 Lefebvre 등 (1996)이 발표한 자료를 참고하여 무 genome 전체의 유전적 거리를 계산한 결과 무의 유전자지도는 무 genome전체의 68.7%~80.1%를 포함하는 것으로 추정할 수 있었다. RAPD 마커에서 문제시되는 재현성 문제를 검정하기 위해 이를 STS 마커로 변환하고자 OPE10 primer에 의해 증폭된 특정 밴드를 클로닝하고 염기서열을 분석한 다음 얻어진 염기서열을 기본으로 하여 primer를 제작하여 PCR 하였다. 그 결과 10mer인 OPE10을 이용하여 분석했을 때와 동일하였으며 목적 밴드 외 다른 밴드는 생성되지 않아 앞으로 분자 마커로서 충분히 이용될 수 있음을 보여주었다. Genetic map and molecular marker have a great importance in improving and facilitating crop breeding program as well as in genome analysis and map-based cloning of genes representing desirable characters. This study aimed at developing RAPD markers and constructing a genetic linkage map using 82 BC$_1$F$_1$individuals originated from the cross between '835' and B$_2$in radish (Raphanus sativus L.). One of the parents for genetic linkage map construction, '835'(P$_1$) of egg type is susceptible to Fusarium wilt and have medium resistance to virus infection and the other parent, B$_2$(P$_2$) of round type, is susceptible to Fusarium wilt and virus, Screening of 394 RAPD primers in BC$_1$F$_1$) population resulted in selecting 128 polymorphic markers which displayed 1:1 segregation pattern. Two markers failed to display 1:1 segregation and showed the segregation ratio skewed to maternal genotype. Selected markers were categorized into 14 linkage group based on LOD score represented by MAPMAKER/EXP program. Five groups composed of single marker among them were excluded from the linkage map, and consequently, the remaining groups are well matched with the number of radish chromosome (n=9). The linkage map constructed with 128 markers covers 1,688.3 cM and the average distance between markers was 13.8 cM. For developing STS marker, we determined the partial nucleotide sequence of OPE10 marker at both ends and designed a oligonucleotide primer pair based on this sequence. STS PCR using the primer pair displayed a single, clear band of which segregation is perfectly matched with that of OPE10 marker. This implies that RAPD markers could readily convert into clear and reliable STS markers.

인슐린 비의존형 당뇨병 환자에서 안지오텐신 전환효소 유전자 다형성과 신증 발현 및 신부전 진행과의 관계

이은영(Eun Young Lee),정춘희(Choon Hee Chung),최승옥(Seung Ok Choi) 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objective : Diabetic nephropathy is an important cause of end-stage renal disease and associated with morbidity and mortality of the patients with diabetes mellitus. It has been reported that the genetic susceptibility may be an important factor in the development of nephropathy in diabetic patients, but the genes responsible for the predisposition to diabetic nephropathy are not known. The genes of the renin-angiotensin systems are plausible candidate genes and the genetic polymorphism of angiotensin-converting enzyme(ACE) gene has been extensively studied for its possible role. Recently, the association of the ACE gene polymorphism with nephropathy as well as myocardial infartion was reported in diabetic patients. To elucidate the contribution of ACE gene polymorphism to the initiation and progression of diabetic nephropathy, we typed the alleles of the ACE gene in 139 patients with non-insulin dependent diabetes mellitus (NIDDM). Methods : After the extraction of genomic DNA from peripheral blood leukocytes, PCRs were performed using the flanking and insertion specific primers, respectively. The PCR products were electrophoresed in 1.5% agarose gels, and DNA was visualized directly with ethidium bromide staining. Results : Subjects were consisted of 139 patients with diabetes mellitus and male to female ratio was 63:76, mean age 55.8±12.0 years, mean duration of diabetes 9.5±7.8 years. ACE genotypes in whole population were 37.4% DD genotype, 51.1% ID genotype and 11.5% II genotype. The ACE genotype distributions, age, sex, blood pressure and body mass index were not different in diabetic subjects with or without nephropathy. No significant differences on the clinical parameters such as age, sex, blood pressure, body mass index, duration of diabetes, incidence of hypertension, cardiovascular complication, diabetic neuropathy and retinopathy, serum creatinine and 24hour albumin excretion were noted according to the ACE genotypes. Forty-six patients with NIDDM were followed over 3 years. The mean follow-up duration was 6.4±2.7 years, mean age was 54.4±10.2 years, and mean duration of diabetes was 14.7±6.1 years. ACE genotypes were 36.9% DD genotype, 52.2% ID genotype and 10.9% II genotype. The ACE genotype distributions were not different in the patients among DD, II or II genotypes. There were also no significant differences in terms of age, sex, duration of diabetes, blood pressure, body mass index, prevalence of hypertension, cardiovascular complication, diabetic neuropathy and diabetic retinopathy. But the rate of decline of creatinine clearance(Δcreatinine clearance, ml/min/year) was higher in DD genotype than ID or II genotypes(3.3±7.2 vs 2.8±6.2 vs 2.7±9.8), and the rate of change of 24-hour protein excretion(Δurinary protein excretion, mg/24hours/year) was higher in DD genotype than ID or II genotypes(89.3±220.0 vs 74.1±156.8 vs 70.9±546.3). But they did not reach to statistical significance. Conclusion : We found that insertion/deletion polymorphism of ACE gene is not implicated in the initiation of diabetic nephropathy of Korean NIDDM patients, but also found the possibility that progression of diabetic nephropathy may be associated with it. We need large scaled prospective follow-up studies on the effects of ACE polymorphism in the progression of diabetic nephropathy.

종설 : 당뇨병성 신증 연구의 최신지견

이은영 ( Eun Young Lee ),정춘희 ( Choon Hee Chung ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6

Diabetic nephropathy is the most serious complication of diabetes mellitus and the most common cause of end-stage renal disease. It can be possible to dissect the exact mechanism of development and progression of diabetic nephropathy because the new biomedical tools for studying disease have been developed. This review explores the new insights into the pathogenesis of diabetic nephropathy, focusing the newly recognized pathways which include growth factors and inflammatory cytokines. (Korean J Med 75:646-650, 2008)

제2형 당뇨병환자에서 대사증후군과 만성 합병증과의 관계

정혜수 ( Hye Soo Chung ),서지아 ( Ji A Seo ),김신곤 ( Sin Gon Kim ),김난희 ( Nan Hee Kim ),김두만 ( Doo Man Kim ),정춘희 ( Choon Hee Chung ),최동섭 ( Dong Seop Choi ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.5

연구배경: 제2형 당뇨병환자에서 만성 합병증의 유병률은 종족 간에 차이가 있는 것으로 알려져 있고 한국인에서 대사증후군의 유무에 따른 당뇨병성 만성 합병증의 발생에 대한 보고는 적은 실정이어서, 한국인 제2형 당뇨병환자에서 대사증후군 및 그 구성인자에 따른 대혈관 및 미세혈관합병증의 발생 정도를 조사하였다. 방법: 이 연구는 10개의 종합병원에서 새로이 당뇨병을 진단받고 5년 이상 추적관리를 받은 환자(진단 당시 연령 만 30세 이상, 75세 미만)를 대상으로 후향적 연구로 진행되었다. 603명의 환자가 본 연구에 포함되었고 대사증후군 진단은 NCEP-ATP III의 진단 기준은 사용하였으며 자료는 증례기록서 작성 지침을 기준으로 의무기록과 가능한 경우 면담을 통해 수집되었다. 결과: 당뇨병 진단 당시 대사증후군의 유무에 따른 당뇨병성 만성 합병증의 발생률에 대하여 분석하였을 때 대혈관 및 미세혈관 합병증의 발생률이 증가되는 결과를 얻어서 한국인에서의 대사증후군이 당뇨병 합병증에 미치는 영향이 다른 인종과 다르지 않다는 것을 보여주었다. 또 당뇨병환자가 대사증후군의 구성인자를 많이 가질수록 관상동맥질환과 당뇨병성 신증의 유병률이 유의하게 증가되었다. 결론: 한국인 제2형 당뇨병환자에서 대사증후군이 동반되었을 때 대혈관 및 미세혈관 합병증이 증가하였다. 이는 당뇨병환자에 있어서 엄격한 혈당조절뿐만 아니라 대사증후군의 구성인자 개선이 중요하다는 것을 시사한다. Background: We examined the relationships between components of metabolic syndrome at the time of diagnosis of type 2 diabetes, and the development of chronic complications in Korean patients with type 2 diabetes. Methods: The medical records of patients with type 2 diabetes who had undergone treatment for at least five years prior were collected from 10 general hospitals in Korea. Among a total of 1,418 patients reviewed for possible inclusion in this study, 603 patients were selected, and the occurrence of complications among these patients was evaluated. Results: Among the 603 patients (male, 253; female, 350), 154 males (60.8%) and 266 females (76.0%) were diagnosed with metabolic syndrome at the time of initial diagnosis of type 2 diabetes. The incidence of chronic complications (average follow-up 15.2±4.9 years) included 60 cases of coronary artery disease (CAD), 57 cases of cerebrovascular accident (CVA), 268 cases of diabetic retinopathy (DR), 254 cases of diabetic nephropathy (DN), and 238 cases of diabetic peripheral neuropathy (DPN). As compared to patients without metabolic syndrome, the adjusted relative risks (95% CI) of incidental diabetic complications in patients with metabolic syndrome were 3.28 (1.40~7.71) for CAD, 2.04 (0.86~4.82) for CVA, 1.53 (1.10~2.14) for DR, 1.90 (1.29~2.80) for DN, and 1.51, (1.06~2.14) for DPN. With the addition of just one constituent of metabolic syndrome, the relative risk of developing CAD, CVD, DR, DN, and DPN increased by 2.08 (95% CI, 1.27~3.40), 1.16 (0.80~1.66), 1.09 (0.93~1.26), 1.29 (1.06~1.57) and 1.06 (0.87~1.26), respectively. Conclusion: Metabolic syndrome in Korean patients with type 2 diabetes increases the risk of developing both macrovascular and microvascular complications. (Korean Diabetes J 33:392-400, 2009)

당뇨병성 족부병변에서 임상경과와 동맥경화증 지표

신장열 ( Jang Yel Shin ),정춘희 ( Choon Hee Chung ) 대한내과학회 2006 대한내과학회지 Vol.70 No.4

당뇨병성 신증에서 사구체 발세포(Glomerular Podocyte)의 역할

이은영 ( Eun Young Lee ),정춘희 ( Choon Hee Chung ) 대한당뇨병학회 2007 Diabetes and Metabolism Journal Vol.31 No.6

한국인 임신성 당뇨병의 임상적 특성

안광진(Kwang Jin Ahn),정윤석(Yoon Sok Chung),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),김유리(Yoo Lee Kim),안명옥(Myong Ock Ahn),김문종(Moon Jong Kim),차경섭(Kyung Sub Cha),정춘희(Choon Hee Chung),곽인평(In Pyung Kwak) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy irrespective of whether or not insulin is used for treatment or the condition persist after delivery. Little has been known of the clinical characteristics of GDM in Korean wiomen. This study was done to investigate the clinical features of GDM of Korean women. Methods: Screening test was performed on pregnant women between 24th and the 28th week of gestational age or when showing glycosuria. Venous plasma glucose was measured 1 hour after 50 gm oral glucose load, A value of 130 mg/dl or above was indicated for 100 gm 3-hour oral glucose tolerance test after standard preparation. According to O`Sullivan and Mahan`s criteria, 45 women were diagnosed as having GDM. Results: Maternal age and parity of GDM patients (31.7±4.5, 0,66±0,65) was significantly higher than those in controls (28.6±3.4, 0.21±0,07). Pregnant body weight of GDM patients (109.3±16.0%) was significantly higher than that of controls (92.6±27.04). The incidence of macrosomic infant (≥ 4kg) was 26,8% in GDM patients and 6. 5% in controls. Among 35 GDM patients 7 showed impaired glucose tolerance and 6 showed overt diabetes mellitus 6 weeks after delivery. The fasting blood sugar at diagnosis of GDM were higher in those patients whose glucose intolerance persist than in the patients whose glucose intolerance recovered to normal 6 weeks after delivery (126.8±70. 0 vs 79.9+±7,7). Conclusion: Screening test for GDM is needed to all pregnant women and to investigate clinical course of GDM, further follow up study is needed.

혈액투석 환자에서 혈청 부갑상선 호르몬 농도의 임상적의미

이은영(Eun Young Lee),한병근(Byoung Geun Han),정춘희(Choon Hee Chung),김진수(Jin Soo Kim),최승옥(Seung Ok Choi) 대한내과학회 2000 대한내과학회지 Vol.59 No.4

Background : Secondary hyperparathyroidism is a common complication of chronic renal failure. The only reliable method for distinguishing patients with high turnover from those with low turnover bone disease is bone histomorphometric study, but its clinical utility is restricted. Because of its invasive nature, efforts have been made to predict indirectly the type and severity of this metabolic bone disease by serologic assays. This study was undertaken to evaluate the determinants and clinical significance of intact parathyroid hormone(iPTH) in end-stage renal disease patients on regular hemodialysis. Methods : Ninety-eight patients on regular hemodialysis patients were included in this study. Laboratory data included blood urea nitrogen, serum creatinine, albumin, calcium, phosphate, alkaline phosphatase and iPTH. Serum iPTH was checked by immunoradiometric assay. We also evaluated age, sex and underlying renal diseases.Results : The mean age was 50.3±13.8 years, duration of dialysis 42.7±40.1 months, duration of follow-up 38.3±10.9 months. Thirty patients had an iPTH level more than three times of normal (≥195 pg/mL). Patients with iPTH level of ≥195 pg/mL had longer duration of dialysis, younger age, lower incidence of diabetes, higher serum creatinine, albumin, alkaline phosphatase, lower calcium and arterial HCO3- concentration. In patients with iPTH level of <195 pg/mL, there was significant correlation between serum iPTH and calcium level(r=-0.43, p<0.001), whereas there was no significant correlation in those with iPTH level of ≥195 pg/mL. Conclusion : In patients with iPTH level of ≥195 pg/mL (three times of normal level), normal calcium-parathyroid feedback mechanism are not maintained. Serum iPTH level seems to be affected by nourishment, age, acidosis and the presence of diabetes.(Korean J Med 59:404-412, 2000)

IPSS 검사로 진단된 TSH 분비 뇌하수체 미세선종 1예

성중경 ( Joong Kyung Sung ),김은미 ( Eun Mi Kim ),남수민 ( Su Min Nam ),신영구 ( Young Goo Shin ),정춘희 ( Choon Hee Chung ),황금 ( Kum Whang ),고장현 ( Jang Hyun Koh ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

갑상선자극호르몬 분비 뇌하수체 선종은 전체 뇌하수체선종의 1~2%에 해당하는 드문 질환이다. 그 중에서도 뇌하수체 미세선종은 호르몬 분비량이 적기 때문에 말초 정맥에서 측정한 알파 소단위가 정상을 나타내는 경우가 많다. 저자들은 이러한 환자에서 아래바위정맥동굴에서 갑상선자극호르몬유리호르몬 자극 검사를 시행하여 말초혈액과의 차이를 통해 뇌하수체 미세선종의 진단에 효과적으로 사용한 증례를 경험하였기에 문헌고찰과 함께 보고한다. Thyroid stimulating hormone (TSH)-secreting pituitary adenomas are rare tumors of the pituitary gland and represent 1~2% of all pituitary adenomas. A TSH-secreting pituitary adenoma shows as a normal or elevated thyrotropin level in a hyperthyroid patient. We present a 32-year-old woman who was diagnosed with a TSH-secreting pituitary microadenoma. She had a high free T4, with a normal TSH and α-subunit. Bilateral inferior petrosal sinus sampling (IPSS) was done to confirm the α-subunit secreting adenoma, and the concentration of the α-subunit was high on the tumor side. The pituitary microadenoma was removed, and her TSH and free T4 levels decreased to normal. IPSS may help give an accurate diagnosis in the patient with a normal α-subunit. (Korean J Med 76:752-757, 2009)