쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

허혈 유사 조건이 심방근의 활동전위 특성에 미치는 영향

김재하,주정민,조용범,신동호,안병희,주신배,김상형 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.11

랫드 배양배아에서 ginsenosides가 superoxide dismutase 유전자 발현에 미치는 영향

김재승, 이세라, 김연, 연정민, 백인정, 안병우, 김윤배, 이범준, 윤영원, 남상윤 충북대학교 동물의학연구소 2006 Journal of Biomedical and Translational Research Vol.7 No.2

본문참고

Aluminum 合金材 Frame을 利用한 壁體거푸집工法의 實用化를 위한 工事費 分析에 관한 硏究

안재철,안진봉,정민수,강병희 東亞大學校 建設技術硏究所 2000 硏究論文集 Vol.24 No.2

This study is to investigate economical efficiency of using ALWOOD Form compared with that of EURO Form. ALWOOD Form is improved in the capacity in the wall-concrete structure in stead of using the existing form which has problems such as, the loss of labor when it is constructed or disjointed, and it's economical efficiency compared with that of EURO Form. The price of ALWOOD Form is more expensive than that of EURO Form due to its main material, aluminum-compound metal, composing frames. In a consequence, the cost of materials per unit area is increased. However, labor cost of ALWOOD Form based on the result of mobilization of manpower in construction field is saved due to the reduction of labor in using ALWOOD Form compared with that of EURO Form. As a result, using ALWOOD Form is more economical than that of EURO Form because saving labor cost which plays a major part in cost saving in formwork is more effective in retrenching total cost than increment of material cost. 철근 콘크리트조 건축공사에서 거푸집공사는 전체 공사기간 중에서 25% 정도의 비중을 차지하며, 단일 공종으로서는 상당히 긴공기를 필요로 하는 공사이다. 따라서, 거푸집공사는 주공정 (critica1 path)이 되고 있으며, 구조체 공사비의 30-40%, 전체공사비의10% 정도를 차지하므로 공기단축과 원가절감을 도모하는데 핵심적인 위치를 차지하고 있다. 이러한 거푸집공사는 최근 건설현장의 기능인력 부족과 노무비 상승, 3D업종의 기피,공사규모의 대형화,고층화 등의 사회환경의 변화와 많은 기술환경의 변화에 따라 거푸집의 대형화, 경량화, 기계화, 단순화, Unit화 그리고 높은 전용횟수를 요구하게 되었다. 그러나 현재 RC조 고층 벽식 구조물의 거푸집 공법으로 범용되고 있는 시스템화 거푸집의 일종인 “EURO Form"은 중량이 커서 부재의 크기가 작고 해체, 조립의 반복에 따른 인력의 소모가 많으며, 이음부위 면처리 비용이 많이 드는 등의 단점이 있어 이에 대한 보완이 필요한 실정이다. 따라서 이러한 문제점을 개선하기 위해 비중이 낮고 성형성이 우수하여 합리척인 설계가 가능한 알루미늄 합금재 프레임을 이용한 거푸집공법(이하 ALWOOD Form 공법)이 개발되어 일부 건설현장에서 시범 적용중에 있으나 원가관리를 위한 기초 자료가 부족하여 그 적용이 곤란한 실정이다. 따라서 본 연구는 ALWOOD Form과 EURO Fonn의 공사바 비교 · 분석을 통해 건설현장에서 거푸집공법 선정시 원가관리 측면에서의 기초자료를 제공하는데 그 목적이있다.

질편모충(Trichomonas vaginalis)의 시험관내에서의 용혈능

안명희,류재숙,홍택원,민득영 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.2

To evaluate the hemolytic activity of T. vagindlis from Korean women and fresh human RBC of A type were nsed for hemolytic assay. RBC(1×10 /ml) was added to RPMI-TPS media(RPMI 1840:TPS-1= 20 : 1) containing T. vaginalis(2×10 ) and incubated at 37℃, 5% CO₂incubator for 6hr and hemolysis was measured by spectrophotometer at 412m. We investigated the parasite to erythrocyte ratio and lemperature needed for hemotysis. Optimal erythrocyte lysis by T. vaginalis was achieved at ratio of 1 : 5 and optimol temperature 37℃. Minimal hemolytic activity was detected in lysates of T. vaginalis. No hemolysis occured when a membrane a 3㎛ pore size was nsed to prevent contact between parasites and erythrocytes. These data suggest a need for contact for trichomonol hemolysis. Hemolytic activity did not correlated with the production of subcutaneous abscess in mice.

환자복 디자인 개선에 관한 연구

안민영;서미아;박재옥;이연희 한양대학교 2004 韓國 生活 科學 硏究 Vol.- No.24

The purpose of this project was to find out design elements of patients' uniform which satisfied needs and wants of patients and nurses. Data were obtained via a self-administered questionnaire from 127 patients who were admitted and nurses who employed to Hanyang University Hospital. The questionnaires were composed of dissatisfaction of exiting patient's uniform, evaluation criteria, design preference, and demographic factors. For data analysis, Descriptive statistics, one-way ANOVA, and Duncan test were employed. The results of this study were as follows; 1. Patients and nurses considered important design elements of neckline, sleeve length, waistband of the pants, and number of pocket. 2. There were differences in dissatisfaction of exiting patient's uniform related to role types. Patients considered factors related to movement such as comfort, easy to dress more importantly, while nurses considered factors related to affairs such as convenient for medical treatment, classification of size, and colorfastness to the laundry more importantly. 3. There was a significant difference in evaluation criteria of patients' uniform related to role types. Nurses considered more important expressive and economic criteria, while patients considered more important functional criteria than others. 4. There was a difference in deign preference of patients' uniform related to role types. Patients preferred uniform design which composed of U-neckline, sleeve of three-quarter length, pants of ankle length, elastic-band with a drawstring, and colors of pink and light green, while nurses preferred design which composed of round neckline, long sleeve length, pants of floor length, and colors of light green and light blue.

항혈청으로 처치된 질트리코모나스(Trichomonas vaginalis) 미세구조의 변화

민득영,류재숙,안명희,박승정,조휘율 한양대학교 의과대학 1994 한양의대 학술지 Vol.14 No.2

Trichomonas vaginalis is a parasitic flagellate found in the urogenital tract of humans. The present study was performed to evaluate the effect of antiserum from rat and rabbit on fine structure of T. vaginalis. Trophozoites were subcultured in TPS-1 medium(Diamond, 1968) at 37℃, CO₂incubator. T. vaginalis were inoculated in mixed medium containing of antiserum for 10 and 30 minutes, then observed with transmission and scanning electron microscope. The results are as follows: 1. T. vaginalis was ellipsoidal or ovoidal in shape with 4 flagella, an undulating membrane and an axostyle. The plasma membrane of body surface was smooth and furrowed. Pseudopodia(filopods) were often observed by SEM. Ultrastructure of trophozoites consisted of an elliptical shaped nucleus, RERs and Golgi complex around the nucleus, hydrogenosomes, glycogen granules, polysomes and vacuoles in cytoplasm. As the organelles for supporting and movement, an axostyle, kinetosomes, flagella, undulating membrane, costa and parabasal filaments were observed. 2. T. vaginalis treated with antiserum, its surface appeared destruction of plasma membrane, alteration and/or disappearance of axostyle, flagella and undulating membrane under the SEM and showed fine structural changes such as the nucleus surrounded by many vacuoles, decreased ribosomes, which attached to nuclear membrane and RER, vesiculated RER and Golgi complex. The area of filamentous cell coat and a number of coated vesicles were increased on plasma membrane with partial damage. According to going by the incubation time, the progressive destructions of cytoplasmic organelles, nuclear membrane, hydrogenosomal membrane, kinetosome and rootlet fiber were noted. With above results, it is presumed that specific antiserum induced the disturbance of protein systhesis and the damage of cytoplasm resulting lysis of T. vaginalis.

廢 EPS 再生 잉고트의 輕量 잔骨材 活用方案에 관한 實驗的 硏究

안재철,정민수,강병희 동아대학교 건설기술연구소 2000 硏究報告 Vol.24 No.1

This study is to investigate the possibility of using recycled EPS ingot as fine aggregate and to set basic data of the efficient mixing design for making lightweight concrete. The condition of the most efficient mix design for making lightweight concrete is that under the replacement ratio of 100%, if cement content is 400㎏/㎥ W/C ratio is 55%, if cement content is 450㎏/㎥ W/C ratio is 50%, 55%. From the result of the experiment under conditions, we could make the concrete whose qualities are slump value of over 18.2㎝, unit weight of less 2.00t/㎥, and compressive strength of over 222.57㎏f/㎠ when the cure duration is 28 days.

직교함수를 이용한 이산 시스템의 모델 축소에 관한 연구

안두수,김윤상,김민형,안비오,이재춘 成均館大學校 科學技術硏究所 1995 論文集 Vol.46 No.1

In this paper, A method on model reduction of discrete systems via otthogonal functions is presented. The low order systems obtained by this proposed method preserves not only the stability but also the dynamic characteristics of the high order systems. From examples, we can see the reduced model by this method approximates the dynamic characteristics of high order model satisfactorily with respect to various inputs.

Aluminum 合金材 Frame을 利用한 壁體거푸집工法의 實用化를 위한 工事費 分析에 관한 硏究

안재철,안진봉,정민수,강병희 동아대학교 건설기술연구소 2000 硏究報告 Vol.24 No.2

This study is to investigate economical efficiency of using ALWOOD Form compared with that of EURO Form. ALWOOD Form is improved in the capacity in the wall-concrete structure in stead of using the existing form which has problems such as, the loss of labor when it is constructed or disjointed, and it's economical efficiency compared with that of EURO Form. The price of ALWOOD Form is more expensive than that of EURO Form due to its main material, aluminum-compound metal, composing frames. In a consequence, the cost of materials per unit area is increased. However, labor cost of ALWOOD Form based on the result of mobilization of manpower in construction field is saved due to the reduction of labor in using ALWOOD Form compared with that of EURO Form. As a result, using ALWOOD Form is more economical than that of EURO Form because saving labor cost which plays a major part in cost saving in formwork is more effective in retrenching total cost than increment of material cost.