비확공성 골수강내 금속정을 이용한 폐쇄성 경골 간부 골절의 치료

정필현,황정수,채동주,문상호 東國大學校 1998 東國論叢 Vol.37 No.-

Most of closed fractures of the tibial shaft can be treated successfully with medullary nails. Reamed intramedullary nailing technique has become a good alternative method in treating the close tibial fracture. Unreamed interlocking intramedullary nailing has been employed successfully in the treatment of open tibial fractures. This study was undertaken to evaluate the result of interlocking intramedullary nailing without reaming in the treatment of closed fractures of the tibial shaft. From 1995 through 1998, fifty four cases of the closed, displace tibial fractures were treated by an unreamed intramedullary nailing and the average follow-up period was 1 year and 5 months(ranged from 12 months to 27 months). The results were as follows : 1. Fifty four cases were treated with closed, unreamed nailing technique and the nail which has 1mm smaller diameter than isthmic width of unaffected tibia was choosen. 2. The average time to bony union was achieved at 17 weeks without abundant periosteal b callus formation. 3. Eight tibiae were required the additional procedure such as autogenous bone graft, skin graft or local skin flap. We also have observed the screw breakage of ten tibiae but there were no intraoperative jamming or incarceration and no significant complicaton such as bending or breakage of the nail, shortening or non-union of the fractures. In conclusion, unreamed technique is an attractive method to treat the close, displaced fractures of the tibial shaft. 경골 간부 골절의 치료에 있어서 견고한 내 고정으로 조기 관절운동 및 체중 부하를 통해 골절 유합 및 기능 회복을 도모할 수 있는 골수강내 금속정 고정술이 널리 사용되어지고 있다. 골수강내 금속정술의 장점은 술 후 조기 관절운동과 체중 부하가 가능하여 이환율(morbidity)을 감소시키며 불유합의 발생률이 낮아는 것이다. 경골 간부 골절의 치료에 있어서 비확공성 금속정 고정술은 주로 심한 연부 조직 손상을 동반한 골절 및 개방성 골절의 치료에 적용되어지고 있으며, 대부분의 폐쇄성 경골 간부 골절의 치료로는 골수강 확공 후 골수강을 충만시키는 금속정을 삽입하는 확공정 금속정 고정술이 시행되어지고 있는 경향이다. 저자들은 폐쇄성 경골 간부 골절에 대해서 비확공성 금속정 고정술의 유용성 여부를 알아보기 위해서 동국대학교 의과대학 정형외과학교실에서 치료했던 54례를 평균 1년 5개월 추시하여 골 유합 기간, 합병증의 발생에 대해서 분석하였다. 본 연구에서 비확공성 금속정 고정술시 골 유합 기간은 확공성 금속정 고정술시와 비교하여 유의한 차이가 없음을 알 수 있었으며, 확공을 하지 않음으로써 발생할 수 있는 jamming이나 가는 직경의 금속정을 선택함으로써 우려되는 금속정의 휨, 부러짐 등의 합병증은 발생하지 않았다. 결론적으로 폐쇄성 경골 간부 골절의 치료에 있어서도 비확공성 골수강내 금속정 고정술은 유용한 방법으로 사료된다.

급성하벽심근경색에서 전흉부유도 ST절 하강의 의의

정병천,배호상,곽동훈,김영태,배용학,황종현,임현주,류재근,조용근,채성철,전재은,박의현 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : 급성하벽심근경색증 환자에서 심전도상 흔히 동반되는 전흉부유도 ST절 하강의 의의를 알아보았다. 방법 : 심근경색후 24시간에서 48시간에 얻은 심전도를 기준으로 52명의 급성하벽심근경색증 환자를 전흉부유도에서 ST절의 하강이 있는 군과 없는 군으로 나누었으며 심도자, 관상동맥조영술, 심초음파도 및 방사성 핵종을 이용한 좌심구혈율 측정 등을 시행하였다. 결과 : 1) 좌심실확장기말압은 전흉부유도에서 ST절의 하강이 있는 경우에서 16.9±5.33mmHg로 없는 경우의 11.0±4.02mmHg보다 유의하게 높았다(p<0.05). 그러나 운동량 및 좌심구혈을은 흥부 유도상 ST절의 하강이 있는 경우 7.6±3.0 METs 및 53.9±9.1%로 없는 경우의 9.1±2.7 METs 및 54.6±9.5%보다 낮았으나 통계적 유의성은 없었다(p=0.180, p=0.823). 2) 관상동맥조영술상 전흉부 ST절의 하강이 동반된 군에서는 유의한 좌전하행지나 좌회선지의 협착이 있는 경우가 60.9% 및 57.9%로 ST절의 하강이 없는 군에서의 34.5% 및 7.7%와 비교해 좌관상동맥에 협착이 동반된 경우가 많았다(p=0.050, p=0.001). 3) 관상동맥조영술상 세 혈관질환의 빈도는 흉부유도상 ST절의 하강을 보인 23예에서 10예로 ST절 하강이 없었던 29예중 2예에 비하여 유의하게 많았고(P=0.007), 단 혈관질환의 빈도는 ST절의 하강을 보인 군에서 23예중 5예로 ST절 하강이 없었던 29예중 17예에 비하여 유의하게 적었다(P=0.002). 두 혈관질환의 경우에는 각각 8예와 10예로 양군간에 유의한 차이가 없었다. 4) 흉부유도상 ST절 하강의 빈도는 단 혈관질환 22예 중 5예에서, 두 혈관질환 18예중 8예, 세 혈관질환 12예 중 10예에서 관찰되어 협착이 있는 관상동맥의 수가 많을수록 ST절의 하강이 나타나는 빈도가 많음을 보였다(p=0.00308). 그러나 흉부유도상 나타난 ST절의 하강을 모두 합하여 구한 ST절 하강의 합은 협착이 있는 관상동맥의 수와 통계적인 유의성이 없었다. 5) 심초음파도상 좌심실 하벽의 벽운동은 ST절 하강을 보인 군에서는 akinesia가 83.3%, hypokinesia가 11.1%, 정상 벽운동이 5.6%로, ST절 하강이 없었던 군에서의 dyskinesia가 3.6%, akinesia가 39.3%, hypokinesia가 25.0%, 정상 벽운동이 32.1%와 비교하여 ST절의 하강이 있는 군에서 유의하게 벽운동의 장애가 빈번함을 보였다(p=0.03891). 그러나 좌심실전벽, 측벽 및 중격부위에서는 유의한 벽운동의 차이가 없었다. 결론 : 급성하벽심근경색증 환자의 전흉부유도에서 ST절의 하강이 동반되는 경우 다혈관 질환의 가능성이 높으며 좌심실확장기말압이 상승되었고 운동능력은 감소되어 있었다. 또한 심초음파도상 좌심실하벽의 벽운동장애도 심하였다. 따라서 전흉부 ST절의 하강을 동반한 급성하벽심근경색증 환자는 전흉부유도에 ST절 하강이 없는 경우보다 예후가 불량할 것으로 생각되며, 보다 적극적인 치료가 필요할 것으로 생각된다. The purpose of this study was to determine the significance of precordial ST segment depression appearing during acute inferior myocardial infarction and to assess the correlation of that with angiographic finding. 52 patients were allocated into two groups based on the existence of precordial ST segment depression : 23 patients with ST segment depression and 29 patients without ST segment depression. The extent of coronary artery disease as well as the prevalence of significant stenosis (≥70%) in left anterior descending artery were more frequent in patients showing precordial ST segment depression than in patients not showing them (p=0.050) and the result were similar in cases of left circumplex artery (p=0.001). On echocrdiographic examination of left ventricular (LV) wall motion, it showed more severely decreased inferior LV wall motion in patients showing precordial ST segment depression than in patients not showing them (p=0.03891) even though the other segment of LV wall motion didn't show the statistical difference between both groups. The other cardiac parameters such as LVEDP, exercise amount (METs) and ejection fraction were tend to showing bad profile in patients with precordial ST segment depression. From the above results, we could deduce that patients with precordial ST segment depression have relatively large infarction or concomitant left coronary artery disease, so they need more caution and intensive theraphy.

HMG-CoA 환원효소 억제제에 의한 ICAM-1 유전자의 발현조절

김현진,정효균,홍우정,김군순,조영석,김도희,채수흥,구본정,송민호,노흥규,김영건 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Background : ICAM-1 act as one of major adhesion molecules in the atherosclerotic lesion. ICAM-1 expression is mainly regulated at the level of transcription and depend on IFN-γ signal transduction pathway in which the STAT1 transcrption factor is a critical intermediate. IFN-γreceptor not only initiates tyrosine 701 phosphorylation of STAT1 by Jak1 and Jak2, but also phosphorylates serine 727 through the activation of Raf-1/MAP kinases. HMG-CoA reductase inhibitors have anti-atherosclertic effects, beyond normalization of hypercholesterolemia, by directly acting on endothelial cells, macrophages and vascular smooth muscle cells. HMG-CoA reductase inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibitors suppress the synthesis of isoprenoid intermediates such as geranylgeranyl-pyrophosphate or farnesylpyrophosphate. These effects results inhibition posttranslational farnesylation and geranyl-geranylation processing of small GTP-binding preoteins and inhibition of normal signaling activities. Method : We made several 5'-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after transfection into ECV304 cells and smooth muscle cells. We checked the level of total and phosphorylated STAT1 protein by immunoblot analysis using specific antibodies. Results : Lovastatin inhibits IFN-γ-induced ICAM-1 gene expression in the ECV304cell. The cells pretreated with PD98059, MEKK inhibitor showed significantly low ICAM-1 RNA induction with IFN-γ stimulatio. IFN-γ induced phosphorylation of tyrosine 701 was not significantly changed by the pretreatment of lovastatin. But lovastatin suppresses IFN-γ-induced phosphorylation of ERK1/ERK2 which are responsible for the seine 727 phosphorylation in STAT1. Conclusion : We showed that HMG-CoA reductase inhibitors, lovastatin, suppresses IFN-γ mediated ICAM-1 gene expression through the inhibition of transcription. HMG-CoA reductase inhibitor suppresses IFN-γ-induced phosphorylation of serine 727 in STAT1 through the modulation of MAP kinases.

산청군 산림지가 형성요인에 관한 연구

권철현,이상태,신현철,최재채,정영관 경상대학교 농업생명과학연구원 2003 농업생명과학연구 Vol.37 No.1

본 연구는 산청군 남부와 북부지역 361개소의 공시지가와 일반시가에 대하여 분석하였다. 지가 형성요인에 대하여 단계별 회귀분석을 실시하였으며, 그 결과는 다음과 같다. 남부지역에 대한 공시지가와 관련된 5변수 모형에 의한 추정식은 Y = 332.1973 +0.0099X_26 - 0.3577 X_8+ 0.0291X_24 - 2.6768X_2 - 26.1452X_3 이며, 회귀식에 대한 설명력은 90%로 높게 나타났으며, 일반시가에 대한 추정식은 Y = 1035.7976 -185.8280X_21 -3.3937X_1 + 405.6658X_19 -0.4703X_8 이며, 추정식에 대한 설명력은 92%롤 비교적 높게 나타났다. 북부지역에 대한 지가 형성요인에 의한 공시지가 추정모형은 Y = 176.7875 + 0.0205X_25 -0.1168X_8 + 0.0015X_26 -46.3447X_21 로 추정되었으며, 회귀식에 대한 설명력은 96%, 일반시가의 추정 모형은 Y = 203.0697 + 0.0430X_25 + 0.0027X_26 -28.8276X_4 -46.7856X_21 -0.0007X_23 으로 추정되었으며, 회귀식에 대한 설명력은 90%로 나타났다. 이상과 같이 접근요인은 부의 영향을, 그 외 다른 요인들은 지가에 양의 영향을 미치는 것으로 나타났다. This study was carried out to analyze the publicly announced land price and actual land price compared to the northern and southern region of 361 forest land place in Sanchung county. To decipher factors for making forest land price it used the stepwise regression analysis. And the result of analysis are followings; Y = 332.1973 +0.0099X_26 - 0.3577 X_8+ 0.0291X_24 - 2.6768X_2 - 26.1452X_3 (R^2=90%) and the estimation equation of actual price analyze the publicly announced and actual price compared to the northern and southern regions of Sanchung county of price was obtained as Y = 1035.7976 -185.8280X_21 -3.3937X_1 + 405.6658X_19 -0.4703X_8(R^2=92%). In the northern region, the estimation equation of publicly announced land price by the factors for making forest land price was obtained Y = 176.7875 + 0.0205X_25 -0.1168X_8 + 0.0015X_26 -46.3447X_21(R^2=96%) and the estimation equation of actual price was obtained as Y = 203.0697 + 0.0430X_25 + 0.0027X_26 -28.8276X_4 -46.7856X_21 -0.0007X_23(R^2=90%). In the result of the stepwise regression analysis, it was a showed negative effect of the proximity factor and the positive effect between others factor and land price.

유도 업어치기 패턴에 따른 하지의 운동학적 분석

김의환,정재욱,강선영,윤현 龍仁大學校 武道硏究所 2002 武道硏究所誌 Vol.13 No.1

The purpose of this investigation was to analyze the changes of the lower limbs angle, when performing Morote-Seoinage(M.S.N.:two arm shoulder throw) in judo who was 5 females university representative judokas of light weight category in judo, and filmed on video cameras(60field/s). The data of this study digitizied by KWON3D 2.1 program computed the average and standard deviation calculated individual 5 trials with Programing Lab view 6i. From the data analysis & discussion, the following conclusions were drawn : 1) A pattern : Right vknee angle was flextion and extension Kuzushi phase and flexed in Tsukuri to Kake phase. Light knee angle flexed in the whole phase. Right·Light hip angle weren't difference changle of angle. 2) B pattern : R. knee angle had flextion and extension in Kuzushi phase and flexed in Tsukuri to kake phase. Light knee angle slowly flexed in the whole phase. Suddenly, flexed in Kake 1·2 stage. Right hip angle raised flextion and extension in Kuzushi phase and suddenly flexed in Tsukuri to Kake phase. Light hip angle slowly raised in the whole phase. 3) C pattern : C pattern was larger than A, B pattern's change of Right knee angle, this time angle was 30.4˚. Light knee angle was flextion in the whole phase. Right hip angle flexed in Kuzushi phase and largely extended, again flexed. Light hip angle firstly flexed and extended, flexed on the Tsukuri to Kake phase.

간 세포암에서 VEGF, TGF-β1, b-FGF 발현의 의의

김성용,남충현,주종우,채만규,백무준,이문수,김형철,안현철,김홍수,김창진,김창호 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: Angiogenesis is important for the proliferation and the metastasis of solid tumors. The growth of a solid tumor is widely recognized to depend on the process of neovascularrozation. Without angiogenesis, tumors cease to grow beyond even a few milimeters in diameter. It has been shown that tumor vascular density is an independent prognostic marker in several types of human tumors and is known to correlate with poor prognosis. To date, many angiogenic factors have been identified, such as transforming growth factor-α(TGF-α), transforming growth factor-β(TGF-β), fibroblast growth factor family(FGF), vascular endothelial growth factor(VEGF), platelet derived endothelial cell growth factor(PD-ECGF), tumor necrosis factor-α(TNF-α), and angiogenin. Hepatocellular carcinoma(HCC) is the second most common tumor in Korean males and is known as a typical hypervascular tumor with frequent portal vein invastion. The authors identified the expreesion of VEGF, TGF-β1, and b-FGF in HCC specimens and evaluated the relationship between these growth factors and the clinicopathologic characteristics of HCC. Method: We reviewed the medical records of 30 patients who were diagnosed as hepatocellular carinoma treated with hepatic resection between January 1994 and December 1998 in Soonchunhyang University Chunan Hospital. The selection of the cases was decided according to the condition of paraffin block fixation. The prognostic factors such as age, sex, tumor size, concentration of serum α-fetoprotein, presence of liver cirrhosis, presence of tumor emboli in portal vein, TMN stage, amount of transfusion during the operation, hepatitis B virus(HBV) infection, and Edmonson-Steiner(E-S) grade were investigated. Relationship between the prognostic factors and the immunopathologic expression of the TGF-β1, b-FGF, and VEGF was examined. Result: Thirty patients (24 males, 6 females) were included in the current study. The patient's mean age was 50.6 years and the age ranged from 36 to 65 years. The mean size of the tumor was found to be 5.2cm. All the patients were follewed up for 7 to 63 months. Child's classification A patients were 23(76.7%)cases, B patients were 7(23.3%)cases, and C was none. Immunohistochemical staining of HCC tumor mass in VEGF expression patients were 17(56.7%), b-FGF expression patients were 10(33.3%), and TGF-β1 expression patients were 10(33.3%). VEGF expression or more than one positive expression among the three factors correlated with tumor size and the stage of HCC but did not correlated with other clinicopathological characteristics. TGF-β1 and b-FGF did not correlate with any clinicopathological characteristics. Conclusion: The results suggest that the expression of VEGF or more than one positive expression among the three factors in HCC cells may be a significant prognostic factor of HCC.

유도 전방회전낙법 동작의 키네메틱 분석

김의환,윤현,정재욱 龍仁大學校 武道硏究所 2003 武道硏究所誌 Vol.14 No.1

The purpose of this study was to analyze kinematic variable at the time of Judo obstacle forward rolling breakfall. To do so, three dimensional kinematic variable at the time of Judo forward rolling breakfall motions was calculated on five model males of Y university, and, time C. O. G. variable were established. That was standardized using cubic spline interpolation based on the maximum motions time by calculating average value and standard deviation per each factor. As a result of this analysis, I reached following conclusion. 1. Time variable At the time of Judo forward rolling breakfall motions, the total required time was 0.93 seconds, and to describe per phase: at the second phase, air phase, 0.50 seconds(54%): at the third phase, completion phase, 0.36 seconds(38%); and the first phase, take-off phase, 0.08(8%) seconds. 2. C. O. G. variable Left(0.01m)·front(0.26m)·up(0.13m) moved at take-off phase, and left(0.09m)·front(1.46m)·up(0.32m) moved at air phase, and left(0.15m)·front(3.79m)·down(0.71m) moved at breakfall phase. In conclusion, all the subjects conducted bending and stretching exercise and made the center move for jumping higher at take-off phase, assumed motions to keep balance at air phase, and assumed motions for widening base surface by lowering the center and extending the joint of the knee to reduce an impact and assume stable posture at breakfall phase.

기저귀 사용실태와 피부자극도 조사 : Cost, Environment, and Skin Irritability

한정석,김동건,신현숙,정예리,정태석,채선미 한국모자보건학회 2000 한국모자보건학회지 Vol.4 No.1

組織素 分解酵素를 生成하는 高溫性 곰팡이의 分離 및 特性

성낙계,강인수,박채규,정영철,김두현 慶尙大學校 1990 論文集 Vol.29 No.1

고온에서 잘 생육하고 cellulose 및 xylan 분해력 이 우수한 곰팡이를 분리할 목적으로 pH5.0, 50℃, Czapek-Dox pulp 배지에서 celluase complex와 xylanase생산이 우수한 곰팡이 H-702균주를 최종선정하여 균학적 성상을 조사한 결과, Aspergillus속과 거의 일치하였으며, 본 공시균주가 효소 생산에 미치는 영향과 효소학적 성질의 결과를 요약하면 다음과 같다. 생육 및 효소생성의 최적온도는 50℃이고, 균체증식 최적 pH는 5.0, cellulase 생산 최적 pH 는 4.5 xyanases는 4.0으로 나타났으며, 효소최대 생성 배양 4일째에, 균체증식은 약 3일경에 최대에 도달하였다.또한 α-1, 4-linkage를 가진 섬유성 물질 왕성하였으며 glucose 와 같은 저분자물질에서는 효소생합성이 현저히 저해되었는데 이런 결과로 볼때 이균주는 carbon catabolite repression을 받고 있었다. 효소생산에 적합한 탄소원으로는 α-cellulose,avicel, filter paper 등 이였으며, 질소원으로는 암모니아가 효과적이었으며 무기염류는 Ca??, Mg??, Mn??, Co??에서 효소생합성이 좋은것으로 나타났다. 계면활성제는 0.15% Tween 80이 좋았다. 개선된 KD배지에서는 각종 효소활성도가 1.2-1.6배 증가하였으며 또한 KD배지에서 각종탄소원을 지질로하여 효소 생합성을 조사한 결과 3% a-cellulose 에서 효소활성도가 좋았고 값싼 기질인폐신문지에서도 효소활성이 높게 나타났다. 조효소의 최적 온도는 cellulas complex 는 70℃, xylanase는 60℃로 나타났으며 열안정성은 cellulas complex 70℃까지는 30분간 , 80℃에서는 잔존활성이 약 93%였고 xylanase는 70℃에서도 거의 안정하였다.최적 pH는 cellulas complex는 5.0, xylanase는 5.5였으며, pH안정성은 3.0-8.0까지 안정하였다.조효소의 미치는 금속이온의 영향은 Ca??,Mg?? Mn??에의해 활성화 되었으며 Pb??, Cu??, Mg?? 에 의해 현저히 저해 현상을 나타냈다. In order to isolate a fungus which grow well in the high temperature and has the excellent decomposing power of cellulose and xylose a fungus. H-702 which produced potently cellulase complex(CMCase,avicelase and β-glucosidase) and xylanase in Czapek-Dox pulp medium (pH 5.0, 50℃) was finally selected. Then as a result of its bacteriological properties investigated it was almost the same properties as Apergillus sp.. The effect influencing to the enzyme production of the isolated strain and enzymological properties are followed. The optimal temperature and pH for cell growth and enzyme production were 50℃, 5.0, 4.5 and 4.0.respectively . The highest production of enzyme was shown when the culture time was three days and the greatest growth of cell was shown about after two days. In the cellulosic materials(CMC.avicel and α-cellulose etc.) containing α-1.4-linking the vigorous production if enzyme was shown and in the small molecular substance such as glucose was remarkably repressed. According to these results, this stain was under the control of carbon catabolite repression.α-cellulose , avicel and filter paper were suitable for carbon source in the enzyme production and NH? for nitrogen source and Ca??, Mg??, Mn?? and Co?? for inorganic salt. 0.15% Tween 80 was a good surface active agent. In improved KD medium each enzyme activity was increased 1.2 to 1.4 times. As a result of investigating enzyme biosynthesis, which each carbon source was used as substrate in the KD medium, it was shown a good enzyme activity. The optimal temperature of crude enzyme in cellulase complex and xylanase were 70 ℃and 60℃, respectively. Thermal stability was shown for 30 minutes until 70℃in cellulase complex and its residual activity at 80℃ was about 93%. It almost was stable at 70℃in xylanase. The optimal pH for cellulase complex and xylanase were 5.0 and 5.5.respectively and they were stable in the range of pH 3.0 TO 8.0. The crude enzyme was activated by Ca?? , Mg??and Mn?? but inhibited by Pb??, Cu?? and Ag?? remarkably.

한국인 제2형 당뇨병 환자의 골격근에서 인슐린 신호전달체계의 결함

최준혁,이관우,김효정,이동훈,이종우,김정은,엄현채,김경미,최성이,정윤석,김현만 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 제2형 당뇨병에서 나타나는 인슐린 저항성은 간, 지방, 근육 같은 말초조직에서 인슐린의 작용이 떨어지는 것을 말한다. 제2형 당뇨병의 발생기전에 인슐린 저항성과 인슐린 분비능 저하가 같이 관여함은 잘 알려진 사실이다. 인슐린의 세포내에서의 저항성을 규명하기 위한 인슐린의 세포내 신호전달체계에 대한 연구가 활발히 진행되고 있으며 몇몇 연구에서 인슐린 저항성을 가진 골격근육에서 IRS와 관련된 PI3-kinase의 활성감소와 Akt kinase의 활성감소를 보고하고 있으나 아직까지 명확하게 그 기작이 설명되어지지 않고 있다. 본 연구에서는 정상성인, 제2형 당뇨병 환자를 대상으로 경구당부하검사 및 인슐린 클램프검사를 시행하고 인슐린 클램프 검사시 대상인의 근육을 채취하여 인슐린 신호전달 체계(IR-β, IRS, Akt(PKB, Rac) kinase, GSK-3)를 연구하였다. 방법: 연구대상자는 한국인으로서 경구당부하검사상 정상인 및 당뇨병 환자 각각 11명, 9명을 대상으로 하였으며, 정상인은 건강인으로 과거력상 당대사에 영향을 줄 질환이 없고, 현재 당대사에 영향을 줄 약물 복용 및 다른 소견이 없는 경구당부하검사상 정성 내당능을 보이는 대상자로 하였다. 당뇨병환자는 모두 제2형 당뇨병 환자로 이환기간이 만 5년 이내인 경우로 하고, 인슐린으로 치료하는 대상자는 제외하도록 하였다. 대상자의 연령, 체질량지수, 체지방량, 공복시 총콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤 및 HbA1c, 인슐린, C-peptide를 측정하였고, "HOMA model"을 이용하여 베타세포의 기능와 인슐린저항성 정도를 평가하였다. 정상혈당클램프 검사(euhlycemic hyperinsulinemic clamp test)를 시행하고 인슐린 투입 전과 인슐린 투입 30분후, 두차례에 걸쳐 대퇴부 근육생검을 실시한후 western 법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 측정하였다. 결과: 정상인 11명과 당뇨병 환자 9명을 대상으로 하였으며 대상자의 평균 연령, 평균 체질량지수, 체지방량, 허리/엉덩이 둘레의 비(waist hip ratio; WHR)는 두 군간에 차이가 없었다. 평균 공복혈당은 정상군 98.0±0.3㎎/dL, 당뇨병군 208.1±16.5㎎/dL(p<0.05), HbA1c는 정상군 5.4±0.5%, 당뇨병군 9.2±0.6%(p<0.05)였다. "HOMA model"을 이용한 베타세포의 기능과 인슐린저항성은 정상군 56.4±8.5%, 1.4±0.2, 당뇨병군 72.2±52.3%(p<0.01), 10.2±6.3(p<0.01)였으며 정상혈당클램프 검사상 포도당 이용률은 정상군 8.2±0.6㎎/㎏/min, 당뇨병군 3.7±1.1㎎/㎏/min(p<0.01)로 정상군과 당뇨병군간에 유의한 차이를 나타내었다. Western blot법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 인슐린 투입전과 인슐린 투입 30분후 측정하였을 때 IR-β에서는 정상군이 103.9±2.3에서 241.3±18.6, 당뇨군이 108.9±2.2에서 198.7±6.3으로 증가하였다(p=NS). 이는 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 통계적인 차이가 없었다. IRS에서는 정상군이 111.6±7.3에서 295.6±17.2, 당뇨군이 114.5±6.1에서 222.0±23.2로 증가하였으며(p<0.05), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 24% 감소하였다. Akt kinase에서는 103.4±6.0에서 416.8±29.5로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 43% 감소하였다. GSK-3에서는 정상군이 107.7±6.7에서 595.7±28.1, 당뇨군이 104.3±4.8에서 443.3±12.9로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 25% 감소하였다. 결론: 제2형 당뇨병 환자에서 정상인과 비교하여 인슐린 자극후 IR-β는 인산화량의 증가정도가 큰 차이가 없었으나, IRS, Akt kinase, GSK-3에서는 인산화량의 증가 정도가 감소되는 것으로 보아 상위 인슐린 신호전단체계부터 결함이 있는 것으로 생각된다. Background: The glucose uptake rate is the limiting step in glucose utilization and storage. The failure of insulin to stimulate glucose uptake in muscle appears to be a primary defect of insulin resistance. This study was undertaken to examine the effect of physiological hyperinsulinemia on the phosphorylation of the insulin receptor (IR-β), insulin receptor substrate (IRS), Akt kinase and GSK-3 in isolated skeletal muscle, in people with type 2 diabetes(n=9) and control subjects(n=11). Methods: 75g OGTT and euglycemic hyperinsulinemic clamp test were done. And vastus lateralis muscle was obtained before and 30 min into the euglycemic clamp. Western blots were performed for tyrosine phosphroylation of insulin receptor substrate (IRS) and phosphorylation of the insulin receptor(IR-β), Akt and GSK-3. Result: There were no statistical differences in the mean age, BMI and body fat between the control subjects and diabetic patients. The fasting blood sugar and HbA_1c in controls and diabetic patients were 98.0±0.3 and 208.1±16.5ng/dl, and 5.4±0.5 and 9.2±0.6%, and 1.4±0.2 in the control subjects, and 72.2±52.3%(p<0.01) and 10.2±6.3(p<0.01) in the diabetic patients, respectively. The insulin resistance from the euglycemic hyperinsulinemic clamp test were 8.2±0.6㎎/㎏/min and 3.7±1.1ng/㎏/min in the control subjects and in the diabetic patients, respectively(p<0.01). Compared with the normal controls, insulin-stimulated IR phosphorylation was no different to that in the diabetic patients. However, insulin-stimulated IRS phosphorylation, insulin-stimulated Akt phosphorylation and insulin-stimulated GSK-3 phosphorylation were reduced in the diabetic patients compared with the normal controls by 24, 43 and 25%, respectively(p<0.05). Conclusion: In Korean type 2 diabetic patients, the insulin resistance may be due to the impairment of the upstream insulin signal molecular network. Further studies will focus on determining whether these signaling defects are the cause of the development of insulin resistance, or secondary to the altered metabolic state, associated with type 2 diabetes mellitus (J Kor Soc Endocrinol 17:685∼697, 2002).