연구논문 : 만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교

김선민 ( Sun Min Kim ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),노영욱 ( Young Wook Roh ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ),오영하 ( Young Ha Oh ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

목적: 만성 바이러스간질환에서 병의 경과와 예후를 평가하고 치료반응을 예측함에 있어 간섬유화의 진단은 중요하다. 최근 간섬유화 평가에 표준방법이지만 침습적 간생검을 대신하여 여러 가지 비침습적 진단법이 이용되고 있고, 또한 새로운 검사법들이 개발되고 있다. 저자들은 만성 B형 및 C형간염 환자를 대상으로 임상에서 광범위하게 흔히 시행하는 혈액검사와 임상 소견을 이용한 아래와 같은 진단법들만으로 간섬유화를 얼마나 정확하게 평가할 수 있는지 알아보고, 단일 검사로 간섬유화를 평가하는 데 유용하다고 알려져 있는 hyaluronic acid(HA)와 IV형 콜라겐 농도와 비교하여 그 임상적 유용성을 평가하였다. 대상과 방법: 2002년 3월부터 2007년 2월까지 만성 바이러스간 질환으로 간생검을 시행받은 225명의 환자(HBV 180명, HCV 43명, HBV+HCV 2명)를 대상으로 분석하였다. 간생검을 시행하는 날에 말초혈액검사, 혈액응고검사, 혈청생화학검사를 시행하고, 혈중 HA, IV형 콜라겐 농도를 측정하였다. 간섬유화의 정도는 F0(섬유화가 없음), F1(문맥역 섬유화), F2(문맥주변부 섬유화), F3(섬유성 격막) 및 F4(간경변증)의 4단계로 구분하였다. 대상 환자를 F0-1, F2-4 혹은 F0-2, F3-4의 두 집단으로 분류하여 두 집단을 구분하고자 할 때 AAR(AST/ALT ratio), API(age-platelet index), APRI(AST to platelet index), CDS(cirrhosis discriminant score), platelet count, HA, IV형 콜라겐의 예측능을 area under the receiver operating characteristic curve (AUROC)값을 이용하여 비교하였다. 결과: 대상환자의 섬유화의 단계는 F0 집단은 17명, F1 집단은 40명, F2 집단은 61명, F3 집단은 74명, F4 집단은 33명이었다. 의미 있는 간섬유화를 F2 이상으로 판단할 때, 의미 있는 섬유화의 예측에 대한 AUROC 값은 APRI=0.822, CDS=0.776, platelet count=0.773, API=0.756, HA=0.749, IV형 콜라겐=0.718, AAR=0.642 순이었고, F3 이상의 광범위한 섬유화 예측에 대한 AUROC값은 CDS=0.835, platelet count=0.795, API=0.794, HA=0.766, AAR=0.711, IV형 콜라겐=0.697, APRI=0.691 순으로 관찰되었다. 결론: 만성 바이러스간질환에서 간섬유화를 평가하는 데 임상 소견 및 혈액검사를 이용한 방법들이 비침습적 진단법 중 단독 검사로도 유용한 것으로 알려져 있는 혈중 HA와 IV형 콜라겐 농도와 비교하여 우월하거나 대등하였다. 특히 APRI는 다른 인자들에 비해 F2 이상의 의미 있는 섬유화를 예측하는 데 가장 유용하였고, CDS는 F3 이상의 광범위한 섬유화를 예측하는 데 가장 유용하였다. Background/Aims: The aim of this study was to determine the clinical performances of noninvasive serum markers for the prediction of liver fibrosis in chronic viral liver diseases. Methods: We analyzed a total of 225 patients with chronic viral liver diseases (180 with hepatitis B virus, 43 with hepatitis C virus, and 2 with hepatitis B+C virus) who underwent a liver biopsy procedure at the Hanyang University Guri Hospital between March 2002 and February 2007. Serum was also obtained at the time of liver biopsy. Liver fibrosis was staged according to the scoring system proposed by the Korean Study Group for the Pathology of Digestive Diseases. Various noninvasive serum markers were evaluated, including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP) index, AST/platelet ratio index (APRI), cirrhosis discriminant score (CDS), platelet count, hyaluronic acid (HA), and type IV collagen. Results: There were 17, 40, 61, 74, and 33 patients at stages F0, F1, F2, F3, and F4, respectively. The overall diagnostic accuracies of each marker, as determined by the area under receiver operating characteristics curves, were APRI=0.822, CDS=0.776, platelet count=0.773, AP index=0.756, HA=0.749, type IV collagen=0.718, and AAR=0.642 for predicting significant fibrosis (≥F2); and CDS=0.835, platelet count=0.795, AP index=0.794, HA=0.766, AAR=0.711, type IV collagen=0.697, and APRI=0.691 for predicting extensive fibrosis (≥F3). Conclusions: Conclusions: All noninvasive serum markers evaluated in this study were useful for predicting significant or extensive liver fibrosis in chronic viral liver diseases. In particular, APRI was most useful for the prediction of significant fibrosis, and CDS was most useful for the prediction of extensive fibrosis. (Korean J Hepatol 2009;15:454-463)

우리 나라 보건관리대행서비스 평가 연구

하은희,조수헌,김선민,주영수,한상환,하미나,권호장,홍윤철,김창엽 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially in continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions,. Quality in terms of accessibility and continuity highly varied among institutions., To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.

동국대학경주병원에서 분리된 각종 병원성 세균 및 항생제 감수성 양상

하경임,고은하,전창호,정병욱,안우섭,김우택,배정수,어경윤 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

We investigated characteristics of bacterial infection and antimicrobial suscerptibility patterns of clinical specimens in Dong Guk University Kyong Ju Hospital from october 1991 to december 1992. The types of clinical specimens requested for culture were as follows ; pus(34.2%), urine(29.6%), sputum(25.2%), blood(9.2%), etc. The most frequently isolated organisms were E. coli(17.6%), Pseudomonas(12.7%), S. aureus(12.2%), and CNS(11.2%), orderly. Predominant organisms from pus, urine and sputum were S.aureus, E. coli and Pseudomonas. Blood culture was requested 1,244 samples from 614 patients, 91 pathogeni organisms were isolated(14.8% from patient and 7.3% from requested clinical samples). E. coli was most frequently isolated(29.7%) and Salmonella typhi was noted 8.8% from the requested samples. The patterns of isolated organisms according to departments were as follows ; E.coli and Klebsiella were frequently isolated in internal medicine and general surgery, E.coli and Pseudomas in Neurosurgery, S. aureus and Pseudomonas in orthopedic surgery. In ICU, Pseudomonas was predominatly isolated and the rate of mixed infection was also high(16.4%). Most of gram-negative bacilli revealed relatively high susceptibility to Chlorampenicol, Amikacin, Tobramycin and Carbenicillin, but Acinetobacter were only susceptible to Carbenicillin and Tetrecyclin, and Serratia were to Carbenicillin and Amikacin while Salmonella were susceptible to all tested first drugs. The proportions of multi-drug resistant bacteria were 34.9% of Acinetobacter, 21.1% of Serratia, 20.0% of Pseudomonas and 15.4% of Citrobacter but Aztreonam was highly susceptible(84∼100%) except Acinetobacter. S. aureus and CNS were susceptible to Chlorampenicol, Oxacillin, Cephalothin and Vancomycin, especially, 100% susceptible to Vancomycin. But Methicillin reistant Staphylococcus aureus were very high(49%) inspite of new constructed hospital. Pneumococcus and Streptococcus species were relatively high susceptible to all tested drugs.

PC를 이용한 소아과 퇴원환자 관리시스템

하태선,이태수,차은종,박범수,한헌석,채수일 충북대학교 의과대학 충북대학교 의학연구소 1993 忠北醫大學術誌 Vol.3 No.1

본원 소아과 입원환자의 퇴원요약 기록을 전산관리하는 시스템을 개발하였다. 소아과 환자관리에 적합하도록 퇴원요약지를 설계하였고 개인용 컴퓨터를 사용하여 관리하도록 구성하였다. 주 기억장치 4MB와 보조기억 장치 120MB HDD을 장착한 PC-386DX 시스템을 기반으로 개발하였고 소프트웨어로는 FoxPro v2.0을 사용하였다. pull-down menu 방식과 window방식을 적용하여 비전문가라 할지라도 손쉽게 사용할수 있도록 하였고 정보입력 및 수정시 사용자 편의를 최대한 반영하고자 하였다. "AND"와 "OR"연산자를 사용하여 다양한 검색이 가능하였다. 본 시스템은 현재 본원 소아과에서 실무에 적용하고 있으며 향후 통계분석과 임상연구에 크게 활용할 수 있으리라 생각된다. A PC-based system was developded to manage discharge summary records of pediatric patients. It is based on a PC-386DX system equipped with 4MB memory and 120MB HDD, and its software was written in FOXPRO V2.0. Any users unfamiliar with computer can make an easy access to the data through pull-down menu and windows system. Logical operators of "AND" and/or "OR" enabled a flexible and various search conditions. The present system is being under clinical use in the Department of Pediatrics, and warrants future applications to statistical analysis as well as clinical research projects.

천연자원을 이용한 간기능 증진제 개발 연구 : Benzo(a)pyrene에 의해 유도된 간기능 장해에 미치는 천궁 추출액의 영향 The Effect of cnidii Rhizoma on Benzo(a)pyrene Induced Hepatotoxicity

윤수홍,이송애,하헌,박은주,오관현 효성여자대학교 부설 한국환경위생연구소 1993 환경위생연구 Vol.3 No.1

민간에서 주로 사용되는 약용식물들 중 간독성 의 발현 저해 및 간기능 보호 효과가 우수한약물을 찾아 임상적인 약효를 밝혀보고자 하는 실험과정으로 탄소화합물의 불완전 연소및 열분해에 의해 생성되는 간장해 물질인 benzo(a)pyrene으로 유도한 rats의 간독성발현에 미치는 천궁 수침액의 예방 및 치료 효과를 실험하여 다음과 같은 결과를 얻었다. 1. 천궁 수침액의 투여는 B(a)P 투여로 현저하게 증가된 혈청 및 간장의 AST, ALT,LDH, ALP 활성을 유의성 있게 감소시켰다. 2. B(a)P 투여로 증가한 혈청 total cholesterol 및 phospholipid 함량은 천궁 수침액의투여로 감소시킬 수 있었으나 그 효과는 현저하지 않았다. 3. 천궁의 투여는 B(a)P에 의한 간독성 발현을 유의성 있게 감소시켰으며 그 효과는전처리가 후처리에 비해 우수하였다. The present study was undertaken to compare the pharmacologicalactivity of crude Cnidii Rhizoma reported with the clinical uses in the orientalmedicine. Crude Cnidii Rhizoma used for the treatment of anemia, body chill,menstural irregularity and menstural pain as hematic, tonic effector, sedative,adodyne and clear extravasated blood. Therefore we tested the effects of Cnidii Rhizoma water extract on the liver-protective activities in the rats. The results obtained from liver microsomal enz-yme assay, measurement of serum and liver alanine, aspartate aminotransferaseand lipid accumulation indicated that Cnidii Rhizoma extract showed significantliver-protective activies against benzo(a)pyrene poisoning.

웹을 이용한 자원 수집 및 활용 시스템에 관한 연구

김은식,하수철 대전대학교 산업기술연구소 1999 산업기술연구소 論文集 Vol.10 No.1

웹(Web)의 수많은 정보들 중에서 검색 사용자가 자신이 활용할 수 있는 유용한 정보를 정확히 찾기란 용이하지 않으며 시간이 많이 소비되는 작업이다. 본 논문에서는 웹상에서 사용자가 원하는 정보를 시스템이 판단하여 찾아 주는 여러 종류의 기술에 대하여 분석하고, 정보 검색 시스템에서 널리 유행하고 있는 각종 기술들 중 에이전트 기술과 웹 로봇 기술의 기능에 대하여 논하며, 검색 서버의 특징 및 기능을 비교 분석한다. 또한, 기존의 검색 엔진 중에서 일부를 선택하여 메타 검색 엔진을 설계 및 구현한 방법에 대하여 설명하며, 메타 검색 엔진 등으로 검색한 자원들을 관리하기 위한 트리 브라우저를 설계 및 구현하여 자원관리의 효율성을 높일 수 있도록 한다. It is not easy and time-consuming that the query user searches for the useful information correctly from a lot of information on the web. In this paper, we analyze several technologies that a system makes a decision and search for user-desired information on the web, and especially describe on the agent and the web robot. We compare with the features and functions of search servers and discuss the design and implementation method on a part of the existing search engines. For the purpose of managing resources retrieved, we suggest a design and implementation of tree browser to enhance the effectiveness of resource management

산업재해 환자의 삶의 질, 자살사고 및 우울증상

김수인,연규월,하은희,우행원,김영철 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.3

연구목적 : 최근 산업재해(이하 산재) 및 교통사고 발생이 증가하면서 사고 후유증으로 치료받는 환자들이 늘어나고 있다. 산재를 포함한 각종 사고들은 환자의 신체적 상태를 변화시킬 뿐 아니라 이로 인한 사회적, 직업적, 경제적 문제들을 초래하게 되고 환자의 삶 전체를 변화시킬수 있다. 본 연구에서는 산재가 환자들에게 미치는 정신적 영향을 알아보기 위해 산재 환자들과 대조군에서 삶의 질, 자살사고 및 우울증상을 비교하였다. 방 법 : 연구대상은 1999년 12월 21일부터 12월 30일 사이에 경상남도 울산 마산·창원지역의 입원한 산재환자 169명이었고 정상 대조군은 울산의 공업단지 내 일반근로자 166명이었다. 평가군과 대조군 모두 남성이었고, 19세에서 60세였다. 모든 대상에서 일반 인구학적 특성, 삶의 질, 자살사고, 우울 증상을 평가하였고, 산재 환자군의 경우 사고일시, 사고원인, 치료기간, 손상부위를 추가로 조사하였다. 주관적 삶의 질은 한국판 스미스클라인 비챰 삶의 질척도로 평가하였고, 자살사고는 Beck의 자살사고(思考)척도로 평가하였으며, 우울증상은 PRIME-MD를 개선한 Patient Problem Questionaire의 우울증 척도로 평가하였다. 결 과 : 산재환자군과 대조군간 일반 인구학적 요인에서 통계적으로 유의한 차이 없었다. 산재환자군이 대조군에 비해 유의하게 낮은 삶의 질 척도 점수를 나타냈고, 유의하게 높은 자살사고와 우울증상을 나타냈다(p<.05). 산재환자군에서 연령, 결혼상태, 치료기간과 삶의 질 점수는 관련이 있었다. 30대 이상의 연령에서 유의하게 낮았고 10∼20대 연령에서 유의하게 높았으며, 미혼이거나 이혼, 별거중인 경우 유의하게 삶의 질 점수가 낮았고, 치료기간이 길수록 낮았다. 치료기간과 자살사고가 관련있었으며, 치료기간이 길수록 자살사고가 많았다. 산재환자군에서 손상부위에 따라 삶의 질 점수, 자살사고 점수와 우울증상이 유의한 관련이 있었다. 삶의 질 점수는 요추부 손상군에서 높았고, 경추부 손상군과 다발성 좌상환자군에서 낮았다(p<0.01). 자살사고 점수는 경추부손상군과 다발성 좌상 환자군에서 높았고, 요추부 손상군에서 낮았다(p<0.01). 연구 대상군에서 삶의 질 점수, 자살사고 점수, 우울증상간 유의한 상관관계가 있었다. 결 론 : 본 연구 결과 산재환자들은 일반 근로자들과 비교하였을 때 삶의 질이 낮다고 느끼고 있었으며, 주관적으로 우울감과 자살사고를 많이 나타냈다. 따라서 산재로 인한 우울 및 자살등의 증상을 예방하기 위해서는 조기 정신과적 치료 중재가 반드시 필요하다고 생각된다. Objective : As the occupational and traffic accidents are increased, patients who are treated for complications of accidents have been increased in recent years. Accidents including industrial injury affect the physical state of the patients and make social, vocational, and economic problems, so that they can affect the whole life of the patients. We performed this study to compare subjective evaluation of quality of life, depressive symptoms, and suicide ideation in both industrial injury patients and control subjects in order to know how industrial injury affect patients in psychiatric aspect. Method : The subjects were 169 inpatients who met the inclusion criteria of industrial injury patients and 166 healthy control subjects. All subjects were male and their age is from 19 to 60 years old. Demographic variables, quality of life, depressive symptom, suicide ideation were assessed in subjects. The types of injury and duration of treatment were assessed in patients. The quality of life was measured using the Korean version of SmithKline Beecham 'Quality of Life' Scale(KvSBQOL), and the suicide ideation was measured using the Scale for Suicide Ideation(SSI), and the depressive symptom was measured using the Dpression scale of Patient Problem Questionaire(PPQ) which were devised from Primary Care Evaluation of Mental Disorder(PRIME-MD). Results : 1) There were no significant differences in the general demographic variables between industrial injury patients and control subjects. 2)Scores of KvSBQOL were significantly lower, and SSI and Depression scale of PPQ were significantly higher in the industrial injury patients than control subjects(p<0.05). 3) In industrial injury patients, there was a correlation between the age and the scores of KvSBQOL(p<0.01). The scores of KvSQOL were lowest in older than 30's, highest in 10's-20's. No significant correlation was recognized between the age and the suicide ideation, the depressive symptoms. Threre was a correlation between the marital status and the scores of KvSBQOL(p<0.01). In unmarried, divorced or separated state, the scores of KvSBQOL were significantly lower than married state. There was a correlation between the the duration of treatment and the scores of KvSBQOL, the suicide ideation. As the duration of treatment was longer, the scores of KvSBQOL were significantly lower(p<0.01), and the scores of SSI were significantly higher(p<0.01). 4) In industrial injury patients, there was a significant correlation between the type of injury nd the scores of KvSBQOL, the suicide ideation, and the depressive symptoms. The scores of KvSBQOL were highest in the L-spine injury patients, lowest in the C-spine injury and multiple contusion patients(p<0.01). The scores of SSI were higher in the C-spine injury and multiple contusion patients, lowest in the L-spine injury patients(p<0.01). 5) In subjects, there was significant correlation between the scores of KvSBQOL, the scores of SSI, and the Depression scale of PPQ. Conclusion : Industrial injury patients feel bad about the quality of life and have more depression and suicide ideation. As a results, psychiatric intervention is needed for prevention of depression and suicide due to industrial injury.

천연자원을 이용한 간기능 증진제 개발 연구 : Benzo(a)pyrene에 의해 유도된 간기능 장해에 미치는 천궁 추출액의 영향 The Effect of Cnidii Rhizoma on Benzo(a) Pyrene Induced Hepatotoxicity

尹水弘,이송애,하헌,박은주,오관현 대구효성가톨릭대학교 1993 연구논문집 Vol.46 No.1

The present study was undertaken to compare the pharmacological activity of crude Cnidii Rhizoma reported with the clinical uses in the oriental medicine. Crude Cnidii Rhizoma used for the treatment of anemia, body chill, menstural irregularity and menstural pain as hematic tonic effector, sedative, adodyne and clear extravasated blood. Therefore we tested the effects of Cnidii Rhizoma water extract on the liverprotective activities in the rats. The results obtained form liver microsomal enzyme assay, measurement of serum and liver alanine, aspartate aminotransferase and lipid accumulation indicated that Cnidii Rhizoma extract showed significant liver-protective activities against benzo(a)pyrene poisoning.

흡입물질이 흰쥐 Lactate Dehydrogenase와 Cholinesterase 활성변화에 미치는 영향

윤수홍,박병윤,하헌,박은주 한국환경독성학회 1995 환경독성보건학회지 Vol.10 No.1

The effects of volatile substances inhalation on lactate dehydrogenase and cholinesterase in rats were investigated. Male Sprague-Dawley rats were exposed to marketed odorant, ethyl acetate and ethyl ether for 15 days. Enzyme activities were measured in serum and several tissues such as liver, lung, brain, heart, kidney and muscle to find differences of effects according to the organ. Cholinesterase activity in serum and most of tissues revealed time-dependent decrease in the case of marketed odorant inhalation. Especially in heart and kidney significant decrease was observed. Ethyl acetate exposure to rats revealed also decrease in serum and all tissues by 40% to 60%. Ethyl ether inhalation showed significant decrease by 30% to 50°,%. Lactate dehydrogenase activity was markedly increased in serum and similarly in heart, brain and kidney by exposure to marketed odorant. No changes were observed in liver. Ethyl acetate exposure to rats revealed increase in serum by about 200%, compared to normal group and in other tissues by 40% to 70% except in liver and muscle. Ethyl ether inhalation showed significant increase in serum by about 100%. There was no change in liver and slight increase in muscle.

뇌동맥류 파열에 의한 급성 경막하 혈종이나 뇌내혈종을 동반한 혼수상태 환자에 대한 뇌혈관 조영술을 시행하지 않은 응급수술

황수현,박용규,백선하,박인성,김은상,정진명,한종우 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Neurologically based clinical grading scales offer excellent prognostic information for the patient suuffering diffuse subarachnoid hemorrhaging. These grading scales are less applicable to patients with life-threatening intraparenchymal or subdural hematomas after aneurysmal rupture. During 2 and half years. 9 patients(ICH;5.SDH:1. ICH+SDH:3) in a comatose state with brain stem compression syndromes documented by computerized tomographic scans have undergone emergent operation without angiography in our neurosurgical departement. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the detection to operation was 2 hours. The origin of the hematoma was identified as a berry aneurysm of the middle cerebral artery bifurcation in seven patients and a posterior communicating artery aneurysm in two patients. One patient had a good recovery. two patients recovered with hemipardsis and mild cognitive dysfunction. two patients were vegetative and died due to pneumonia. and four patients died due to brain swelling within two weeks postoperatively. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving management in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.