당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Multiple Markers of Contrast Induced Nephropathy after the Percutaneous Coronary Intervention

Byoung-won Park,Seong Soon Kwon,Min Ho Lee,Do Hoi Kim,Min Su Hyon,Duk Won Bang 순천향대학교 순천향의학연구소 2018 Journal of Soonchunhyang Medical Science Vol.24 No.1

Objective: Contrast-induced nephropathy (CIN) frequently occurs after percutaneous intervention. Objective of this study was to investigate the usefulness of serum cystatin C, neutrophil gelatinase-associated lipocalcin (NGAL), urinary kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) as early predictors for CIN after percutaneous coronary intervention (PCI). Methods: In 53 patients who underwent PCI were enrolled. Serum creatinine and cystatin C level were measured immediately before, and 24 hours and 48 hours after catheterization. Serum NGAL, urinary KIM-1, and IL-18 were measured immediately before, and 4 hours, 24 hours, and 48 hours after catheterization. CIN was defined as a rise in creatinine 0.5 mg/dL or 25% above baseline. Results: CIN occurred in four patients (7.5%). Serum cystatin C levels were higher at 24 hours and 48 hours in CIN patients than in those without CIN (P<0.05). Serum NGAL levels were higher at 48 hours in CIN patients than in those without CIN. Urinary KIM-1 levels were higher at 48 hours in CIN patients than in those without CIN. There were no significant markers of CIN on multi-variate analysis. Conclusion: In this study, the occurrence of CIN after PCI was 7.5%. Although there were some time-course changes in serum cystatin C and urinary KIM-1 after PCI, there was no significant predictor for CIN after PCI.

Arabidopsis cell death in compatible and incompatible interactions with Alternaria brassicicola

Su’udi, Mukhamad,Kim, Min Gab,Park, Sang-Ryeol,Hwang, Duk-Ju,Bae, Shin-Chul,Ahn, Il-Pyung Springer-Verlag 2011 Molecules and cells Vol.31 No.6

초음파 비선형 음향 효과 및 X-선 회절법을 이용한 2.25Cr-1Mo 강의 열화 손상 평가

김덕희,박은수,박익근,변재원,권숙인 한국산업안전학회 2002 한국안전학회지 Vol.17 No.4

It was attempted to evaluate the degree of degradation of thermally aged 2.25-1Mo steel by ultrasonic nonlinear parameter(UNP) measurement and X-ray diffraction analysis of extracted carbide. Artificial aging was performed to simulate the microstructural degradation in 2.25Cr-1Mo steel arising from long time exposure at 540℃. Microstructural analysis (number of carbides per unit area) and measurements of mechanical properties(Vickers hardness, DBTT) and degradation evaluation parameters(UNP and intensity ratio of X-ray diffraction peak of electrolytically extracted carbied) were performed. Both of UNP and intensity ratio of X-ray diffraction peak for M6C carbied to that of M23C6 carbied(IR) increased abruptly in the initial 100 hour of aging and then changed little. UNP and IR were proposed as potential parameters to evaluate the degree of aging degradation of 2.25Cr-1Mo steel.

천주교 납골 문화 정착의 필요성

김득수 가톨릭대학교 사목연구소 2002 司牧硏究 Vol.10 No.-

복부 대동맥 가성동맥류를 동반한 Behcet 씨 병 : 증례 보고

김동익,이병붕,조진현,이순정,도영수,김덕경 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.1

Behcet's disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. The etiology and pathogenesis of this disease remain obscure; it is considered an autoimmune disease since vasculitis is the main pathologic lesion and circulating autoantibodies to human oral mucous membrane are found in approximately 50 percent of the cases. Vascular lesions with Behcet's disease may include deep venous thrombosis, superficial thrombophlebitis, arterial obstruction, or arterial aneurysms. Although arterial aneurysmal lesions are uncommon in patients with Behcet's disease, they may pose serious, life-threatening therapeutic problems due to the risk of rupture. Here, we report a case of Behcet' s disease, involving abdominal aorta with review of literature.

안검에 발생한 단발성 성인형 근섬유종 1예

김성준,박현수,서승리,이용석,전덕규 대한피부과학회 2003 대한피부과학회지 Vol.41 No.2

Solitary myofibroma is an uncommon myofibroblastic neoplasm, presenting as an asymptomatic nodule of the skin, which mainly occurrs in adults. It was thought to be the adult counterpart of infantile myofibromatosis. Although it has histopathological similarity to infantile myofibromatosis, it shows a discrete clinicopathological entity compared with infantile form on the basis of its much later onset, superficial location, invariable solitary occurrence and uniformly benign behavior. A 45-year-old woman had a skin lesion on the right upper eyelid for 2 years, which was a solitary, painless nodule with eyelid retraction. The excised tumor was diagnosed as myofibroma by light microscopy and immunohistochemistry. (Korean J Dermatol 2003;41(2) : 272∼275)

의료시설 디자인의 복잡성과 필요전문지식의 인식

김덕수 한국의료복지시설학회 2005 의료·복지 건축 Vol.11 No.1

Healthcare design has been considered as one of the most complex design types. In this study, healthcare design complexity is analysed by the following categories: (1) function; (2) medical technology; (3) scientific knowledge; (4) aesthetics; and (5) interest group complexity. The central questions here are: (1) What is the impact of specialized know edge on the professional practice; and (2) What are the relationships between design complexity and specialized knowledge. To answer these questions, this study utilizes two approaches, including mail-out cuestionnaires survey and in-person and focus group interviews. This study found that healthcare design architects emphasize the technical component of specialized healthcare design knowledge. Thus they perceive that architectural research, as a tool to increase specialized healthcare design knowledge, is beneficial to solve the technical components including medical technology and functional problems. In the professional practice, however, architectural research is hardly conducted due mainly to the lack of money and time for it. Different perceptions regarding healthcare design complexity and architectural research among the firms exist, depending on the firm size. These results imply that the knowledge management strategy of large firms can be more efficient to the organizational growth than the small firms.

원불교 인간관

김덕수 圓光大學校 圓佛敎學硏究會 1994 圓佛敎學硏究 Vol.24 No.-