정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

Ultra-energy-efficient analog-to-digital converters based on single-electron transistor/CMOS hybrid technology for biomedical applications

Lee, Jieun,Choi, Changmin,Park, Sungwook,Chung, In-Young,Kim, Chang-Joon,Park, Byung-Gook,Kim, Dong Myong,Kim, Dae Hwan Institute of Physics 2009 Semiconductor science and technology Vol.24 No.11

<P>Ultra-energy-efficient analog-to-digital converters (ADCs) based on single-electron transistor (SET)/complementary metal-oxide-semiconductor (CMOS) hybrid technology are proposed as a solution to sense and process biomedical signals. Our results show the energy efficiency of 0.82 pJ/state, which is lower than that in previously reported energy-efficient ADCs. The performance and dissipated power of proposed ADCs are estimated and compared with those of CMOS ADCs by using Lee's SPICE model including non-ideal effects of the experimental data. While the proposed ADC shows an operating power lower by two orders of magnitude than that of the CMOS flash-type ADC, the number of required transistors is about 10% of that in the CMOS flash-type ADC. The peak-to-valley current ratio in Coulomb oscillation of SETs used in the circuit implementation has the range of 1.15–1.5, which is consistent with the experimental result of top-down approached Si-based SETs at <I>T</I> = 77–100 K. From the perspective of the immunity to the gate capacitance <I>C<SUB>cg</SUB></I> mismatch and the background charge <I>Q</I><SUB>0</SUB> noise, it is shown that the criteria of SET/CMOS hybrid ADCs are Δ<I>C<SUB>cg</SUB></I> ⩽ 0.02 × <I>C<SUB>cg</SUB></I> (with <I>C<SUB>cg</SUB></I> = 0.24 aF) and Δ<I>Q</I><SUB>0</SUB> ⩽ 0.23<I>q</I>, respectively.</P>

유기용제 폭로가 여성 근로자들의 월경에 미치는 영향

김대환,이채관,김휘동,강동묵,문덕환,김정호,손병철,이창희,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

유기용제는 산업장에서 널리 사용되고 있다. 특히 여성근로자들의 폭로기회가 증가하고 있으며 이로 인한 자연유산, 수태능력 감소, 월경이상 등이 보고되고 있다. 따라서 유기용제 폭로가 여성근로자들의 월경에 미치는 영향을 보기 위해 설문조사와 월경주기별 여성생식 호르몬(progesterone, estrogen) 분석을 하였다. 그 결과 폭로군에서 progeterone의 억제효과가 유기용제에 폭로되는 여성근로자들의 다양한 월경이상을 초래할 가능성이 있는 것으로 생각된다. ■ Objectives This study was conducted to evaluate the effects of menstrual function in female workers exposed to organic solvents. ■ Methods Rates of menstrual disorders were studied in 87 female workers with exposure to organic solvents(Cn/Hn-value 0.713) in a factory manufacturing shoes and compared with 83 general female workers who had no exposure to organic solvents, Detailed menstrual and reproductive histories were obtained by personal interview using structured questionnaire, and plasma concentrations of progesterone and estrogen were assayed by radioimmunoassay(RIA). ■ Results The rates for menstrual irregularity, menstrual duration, blood clot in menstrual flow and dysmenorrhea were not significantly different in both groups. Number of using menstrual pad was significantly higher and the plasma level of progesterone during 6-11th day of menstrual cycle was significantly lower in the exposed group compared with non-exposed group(P<0.05). ■ Conclusions It seemed to be suppression effect of organic solvents on the reproductive hormones(progesterone and estrogen) in female workers. But there was no evidence that menstrual disorder was likely to result from exposure to organic solvents, because other behavioral, psychological and work related factors may also affect menstrual function.

알쯔하이머형 치매와 혈관성 치매환자에서의 ALDH2와 APOE 유전자의 다형성에 관한 연구

김동홍,김영돈,이창화,엄기춘,김은식,윤경식,김동희 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

연구목적: 본 연구는 국내 치매환자들을 대상으로 치매발병의 위험요소가 될 수있는 ALDH2와 APOE 유전자형이 어떤 양상으로 나타나는지 알아보기 위하여 시행되었다. 방 법: 충남 부여군에 위치한 부여노인병원에 입원중인 65세 이상의 알쯔하이머형 치매와 혈관성 또는 혼재성 치매환자 59명(남:19, 녀:40)을 대상으로 ALDH2와 APOE 유전자형을 제한효소법에 의하여 조사하였고 치매유형에 따른 유전자형과 대립유전자의 빈도를 비교하였다. 결 과: 1) 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성 치매환자군보다 ALDH2*(-/2)유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 2) 알쯔하이머형 치매화자군에서 혈관성 또는 혼재성 치매환자군보다 APOE*(-/ε4) 유전자형의 빈도가 높았으나 통계학적으로 의미있는 차이는 없었다. 3) APOE*ε4와 ALDH2*2를 알쯔하이머병의 균등한 위험대립유전자로 가정하고 각 유전자형의 대립유전자의 수를 점수화하여 각 치매환자군의 위험유전자 전체점수를 비교한 결과 알쯔하이머형 치매환자군에서 점수가 더 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. 결 론: 알쯔하이머형 치매환자군에서 혈관성 또는 혼재성치매치매환자군보다 ALDH2*2와 APOE*ε4 대립유전자의 빈도가 높게 나왔으나 통계학적으로 의미있는 차이는 없었다. A study on gene polymorphism of ALDH2 and APOE in patients with alzheimer's disease and vascular or mixed dementia. Objective : This study was designed to investigate gene polymorphism of ALDH2 and APOE, reported the risk factor of Alzheimer's disease, in korean dementia patients. Method : 59 Patients(male:19, female:40) with dementia, aged 65 and older in Buyeo geriatric hospital located in Buyeo-gun, chungnam, were finally included in this study. gene polymorphism of ALDH2 and APOE was typed with polymerase chain reaction in patients with Alzheimer's desease and vascular or mixed dementia. Results : 1) There was no difference in allelic frequency of ALDH2 gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 2) There was no difference in allelic frequency of APOE gene polymorphism between patients with Alzheimer's disease and vascular or mixed dementia. 3) Supposing APOE*ε4 and ALDH2*2 were equal risk allele of Alzheimer's disease, the sum of score by counting each risk allele was higher in patients with Alzheimer's disease than vascular mixed dementia, however there was no significant difference. Conclusion : The genotype frequency of ALDH2*(-/2) and APOE*(-/ε4) was higher in patients with Alsheimer's disease than vascular or mixed dementia, however there was no significant difference in allelic frequency of gene polymorphism of ALDH2 and APOE between patients with Alzheimer's disease and vascular or mixed dementia.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

BEZ235 (PIK3/mTOR inhibitor) Overcomes Pazopanib Resistance in Patient-Derived Refractory Soft Tissue Sarcoma Cells

Kim, Hee Kyung,Kim, Sun Young,Lee, Su Jin,Kang, Mihyeon,Kim, Seung Tae,Jang, Jiryeon,Rath, Oliver,Schueler, Julia,Lee, Dong Woo,Park, Woong Yang,Kim, Sung Joo,Park, Se Hoon,Lee, Jeeyun Neoplasia Press 2016 Translational oncology Vol.9 No.3

<P><I>BACKGROUND:</I> Although pazopanib treatment has become the standard chemotherapy in salvage setting for metastatic sarcoma patients, most patients progress after pazopanib treatment in 4 to 6 months. After failure to pazopanib, patients have limited options for treatment. Therefore, subsequent therapy in patients who failed to pazopanib is urgently needed and the use of patient derived cells or patient derived tumors for accompanying testing with various pharmacological inhibitors could offer additional treatment options for these patients. <I>METHODS:</I> Patient derived tumor cells were collected from ascites at the time of progression to pazopanib and a 13-drug panel was tested for drug sensitivity. We confirmed the results using <I>in vitro</I> cell viability assay and immunoblot assay. We also performed the genomic profiling of PDX model. <I>RESULTS:</I> The growth of patient derived tumor cells was significantly reduced by exposure to 1.0 μM AZD2014 compared with control (control versus AZD2014, mean growth = 100.0% vs 16.04%, difference = 83.96%, 95% CI = 70.01% to 97.92%, <I>P</I> = .0435). Similarly, 1.0 μM BEZ235 profoundly inhibited tumor cell growth <I>in vitro</I> when compared to control (control versus BEZ235, mean growth = 100.0% vs 7.308%, difference = 92.69%, 95% CI = 78.87% to 106.5%, <I>P</I> < .0001). Despite the presence of CDK4 amplification in the patient-derived tumor cells, LEE011 did not considerably inhibit cell proliferation when compared with control (control vs LEE011, mean growth = 100.0% vs 80.23%, difference = 19.77%, 95% CI = 1.828% to 37.72%, <I>P</I> = .0377). The immunoblot analysis showed that BEZ235 treatment decreased pAKT, pmTOR and pERK whereas AZD2014 decreased only pmTOR. <I>CONCLUSION:</I> Taken together, upregulation of mTOR/AKT pathway in sarcoma patient derived cells was considerably inhibited by the treatment of AZD2014 and BEZ235 with downregulation of AKT pathway (greater extent for BEZ235). These molecules may be considered as treatment option in STS patient who have failed to pazopanib in the context of clinical trials.</P>

인천지역 TDI 노출 작업자에서 직업성천식 유병율

김형렬,김철우,홍윤철,전형준,김치년,김현수,이지나,신주연,고동희,노재훈 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.2

목적 : TDI는 직업성천식을 일으키는 대표적인 물질로 알려져 있다. 과거 TDI에 노출된 작업자들의 천식 발생률을 5~6%가량 보고하였고, 국내에서도 2-20%에 이르는 유병율을 보고한바 있다. 작업환경이 많이 개선되고, 노출량이 감소된 최근에도 TDI에 의한 직업성천식에 대한 보고가 많이 이루어지고 있어, 이에 대한 적극적인 조사와 진단과정을 통해 유병율을 구하고 질병발생의 변화양상을 파악해 보고자 하였다. 방법 : 인천지역에서 특수건강진단을 수행하는 2개 기관의 TDI 노출 근로자 400여명 중, 사업장의 규모가 50인 이상이며 사업주가 연구진행을 허락한 사업장에서 근무하는 근로자 중 직접적으로 TDI에 노출되는 작업에 종사하는 근로자 170명을 연구대상으로 하였다. 이들에 대해 설문지와 산업의학의사의 면담을 통한 작업관련성 평가를 근거로 정밀대상자를 선정하고 이들에 대해 메타콜린 유발시험, TDI 유발시험 등을 수행하여 직업성천식을 확인하였다. 결과 : 설문조사 결과 11명이 직업과 관련하여 천식증상을 보이는 것으로 나타났고(6.9%), 이중 7명에서 메타콜린 유발검사 양성소견을 보였다. TDI에 의한 특이유발시험 결과 1명에서 양성반응이 나타나, 이 집단에서 TDI에 의한 직업성천식의 유병율은 0.58%였다. 결론 : 과거 국내연구에서 TDI에 의한 직업성천식의 유병율이 2~20%에 이르렀던 데 비해, 본 연구에서는 0.58%로 나타났다. 이는 국외 논문에서도 나타나는 경향으로 작업장 노출량 감소로 점차 발생률이 감소하는 양상을 보이고 있다. 그러나 이미 증상이 나타난 근로자들이 부서를 옮기거나, 직장을 그만둠으로 인해 그 유병율이 과소평가되었을 가능성도 있다고 판단된다. Objecdives: This study was carried out to estimate the prevalence of isocyanate-induced occupational asthma in toluene diisocyanate (TDI) exposed workers. Methods: We examined 170 workers who had been directly exposed to TDI through a medical questionnaire, physical examination, and pulmonary function test. Based on screening examination, workers with suspected occupational asthma were selected for further evaluation such as methacholine and TDI challenge tests. Results: Eleven (6.9%) among 170 workers complained of symptoms of occupational asthma. and 7 among these 11 symptomatic workers showed positive responses to the methacholine challenge test (4.1 %). One spray painter was confirmed as having the TDI induced occupational asthma following a positive response to TDI challenge test. Conclusions: The prevalence of TDI-induced asthma was at 0.58% was lower than that for former studies (2-20%). Improved workplace environment, lower level of TDI exposure compared to the past, and the healthy workers effect may have contributed to this low rate of asthma prevalence in workers with TDI exposure.