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.

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.

하악 자가 이식골에서의 임프란트

김용각,이태희,김철,김성진,김혁 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.4

In mandibular tumor treatment case,mandibulectomy is frequently performed.This mandibulectomy may result in facial changes, esthetic and phonetic problems, reduced mastication and swallowing functions. When we treat this patients, using primary reconstruction with autogenous bine graft or secondary reconstruction with delayed bone graft after applied bridge plate removal. After bone graft is done, prosthodontic treatment is essential for the rehabilitation of facial esthetics, phonetics and mastications. But, tissue-supported prostheses have the problems of frequent breakdown of underlying bone anf soft tissue, increasing risk of intraoral infection, mobility of prostheses, unsatisfactory function, problems in esthetics, poor patient co-operation. Now, osseointegrated implants are used as the main treatment of fully or partially edentulois state of mandible, long term clinical data are satisfactory, too. So, we may choose the implant,as the useful prosthodontic treatment method of mandibular reconstruction using autogenous bone graft. Regardless of this harmful situation, as astivity(in malignant madibular tumor), and relatively poor condition of grafted bone, thoughtful treatment plan, delicate and technique, persistent follow-ups make much more satisfactory results than those of removable prostheses. So. we reported a good results in the case of implat-retained protheses after mandibulectomy and autogenous bone graft.

학생청소년의 불안성향과 문제행동 유형간의 상관분석

김헌수,이재우,나철,김영돈,김민호,김은희,권지란,박광식,이길홍,민병근 중앙대학교 의과대학 의과학연구소 1987 中央醫大誌 Vol.12 No.4

The purpose of the present study was to examine the relationship between their problem behavioral pattern and anxious trends among Korean student adolescent. Zung's measurement of anxiety level undergone through used of the self-rating anxiety scale. the data were collected through the questionaire survey which was conducted on Dec.1, 1983. Subjects served for this atudy consisted of 1,404 syudents in Korea, randomly sampled from Korean student population by means of census method. The data were analysed by CDC-174 computer of KAIST, using SPSS pogram. Statistical methods empoyed were χ^2 test and Eta measures. the results of this study were as follows. 1. It showed that students psychological anxious trends had greatest significant correlation with adolescent student's problem brhavioral pattern, but the cardiovascular, respiratory, gastrointestional and genitourinary anxious trends has not significantly related with student's problem behavioral pattern. 2. Students group with undersocialized aggressive, undersocialized nonaggressive,undersocialized school-norm avoidant, or socialized nonaggressive behavioral patterns were less anxious, whereas those with socialized latent aggressive, socialized sexual, or socialized modellong behavioral patterns were higher anxious.

산후에 발병한 특발성 부갑상선 기능저하증 I 예

김정인,김상용,신병철,김경남,서영욱,이범주,김진화,배학연 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Hypoparathyroidism is usually the result of an inadvertent surgical removal of all the parathyroid glands, In some instances, not all the tissues are removed, but the remainder undergoes vascular supply compromise secondary to the fibrotic changes in the neck after surgery, Previously, the surgery for hyperthyroidism was the most frequent cause of acquired hypoparathyroidism. Idiopathic hypoparathyroidism is a relatively rare disease that is characterized by hypocalcemia and hyperphosphatemia due to a parathyroid hormone deficiency of an unknown cause, It usually develops at a young age, and shows various clinical symptoms and signs accompanied with hypocalcemia. In addition, it is rarely associated with polyglandular autoimmune syndrome during the follow-up. Hypocalcemia and idiopathic hypoparathyroidism associated with labor and lactation are rarely reported condition previously. We here describe a case of a woman in whom the symptomatic severe hypocalcemia appeared after her delivery. We reviewed all the previously reported cases and suggest a possible physiological explanation for the association between pregnancy, lactation, and the appearance of symptomatic hypocalcemia.

Amitriptyline 과 Desipramine, Paroxetine 은 백서의 Schwann 세포 일차배양에서 산화질소의 생성을 억제한다

김용철,이상철,김선희,임영진,함병문,김현정,정일영,박학수 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2

Background : Antidepressants are being used as supplemental therapy in neuropathic and inflammatroy pain. The mechanism of their inhibitory effect on experimental animal inflammation is not clear. Studies during the past few years clearly indicate an important role for nitric oxide (NO) in the inflammation and pain-processing system. We evaluated the effects of amitriptyline, desipramine and paroxetine on NO production in primary Schwann cell cultures. Methods : Primary cultures of the Schwann cell were prepared from dorsal root ganglia of 1-to 3-day old Spraque-Dawley rats. Schwann cells were cultured in the presence or absence of interferon-?? (500 ng/㎖) plus tumor necrosis factor-α (500 ng/㎖), amitriptyline, desipramine or paroxetine. Production of NO was determined in the supernatant of the culture media. Results : Amitriptyline (10 ㎍/㎖), desipramine (10 ㎍/㎖) and paroxetine (10 ㎍/㎖) inhibited NO release by 29.8%, 51.4%, and 66.8%, respectively. No drug had a toxic effect on cultured cells, which was determined by an LDH assay. Conclusions : Inhibition of NO production by Schwann cells may be a mechanism by which some antidepressant medications affect inflammatory and neuropathic pain. (Korean J Anesthesiol 2002; 42: 221~227)

정신분열병 환자의 가족부담 척도 개발에 대한 예비연구

김철권,조진석,서지민,김용관,김호찬,김현수,김상수,제영묘 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적 : 정신분열병 환자의 가족이 느끼는 부담을 측정하기 위한 가족부담 척도를 개발하기 위함이다. 방 법 : 200명의 정신분열병 환자 가족과의 비구조적 면담과 외국 부담척도 고찰을 통하여 94문항을 수집하였고 그 다음에 전문가들과 가족들이 문항 및 영역을 분류하고 통합하여 최종적으로 36문항을 선정하였다. 그리고 정신분열병 환자의 가족 135명, 불안장애 환자의 가족 22명, 기분부전장애 및 신체화 장애 환자의 가족 26명, 치매 환자의 가족 49명을 대상으로 신뢰도와 타당도를 검증하였다. 결 과 : 자료분석 결과 검사-재검사 신뢰도, 내적 일치도, 감별타당도 모두 높게 나타났으며, 요인분석을 통해 다섯 가지 구성요인이 추출되었다. 결 론 : 본 가족부담 척도는 정신분열병을 포함한 만성 정신질환을 앓고 있는 환자의 호전과 가족의 부담을 덜어주기 위한 다양한 프로그램의 효과를 검증하는데 유용하게 사용되어질 수 있을 것이다. Objectives : This preliminary study was carried out to develop the Family Burden Scale(FBS) of the schizophrenics. Methods : Ninety-four items were collected by interviewing in a free unstructured format with one relative of each 200 schizophrenic patients and reviewing foreign FBS's. Several professionals and relatives were asked to group and integrate them into several categories. Finally 36 burden items were chosen to constitute a FBS. The FBS was administered to the relatives of 135 schizophrenic, 22 anxiety disorder, 26 dysthymic disorder and somatization disorder, and 49 dementia patients for examining the reliability and validity. Results : The FBS showed high test-retest reliability, internal consistency, and discriminant validity. The results of the factor analysis revealed five-factor solution. Conclusion : The FBS can be used to evaluate the effectiveness of various programs intended not only to reduce decompensation among schizophrenics, but also to alleviate family burden.

정신과 입원환자의 서비스 만족척도의 개발

김철권,이지연,송영선,김규호,김경률,김제원,이동기,최병무 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.3

목적 본 연구의 목적은 국내 정신의료기관(정신병원, 종합병원 정신과)에서 간편하게 사용할 수 있는 신뢰도와 타당도가 검증된 입원환자의 서비스 만족척도를 개발하기 위한 것이다. 방법 여러 단계를 거쳐 국내 실정에 맞는 문항을 개발하였고,정신병원, 종합병원, 대학병원 정신과 병동에서 퇴원하는 348명의 환자들을 대상으로 신뢰도와 타당도를 조사하였다. 요인분석 결과 5개의 요인이 추출되었으며 전체 변량의 63.04%를 설명하였다. 내적 일관성에 대한 신뢰도 계수 (Crohnbach's α)는 0.95로 상당히 높은 수준이었고, 수정된 개별문항-총점 상관계수는 0.50부터 0.72까지의 범위에 속하였다. 요인분석을 통해 추출된 서비스 만족척도의 각 하위척도 점수와 서비스 만족척도에 첨부된 각 영역에 대해 전반적인 만족도를 묻는 세 개의 문항 점수 간의 상관성 역시 유의하게 높았다. 결과 진단명에 따른 서비스 만족척도의 전체 점수에서는 불안/신체형/강박장애 환자군과 기분장애 환자군이 각각 정신분열병 및 기타 정신병 환자군과 알코올중독 장애 환자군에 비하여 유의하게 높은 점수를 보였으며, 입원형태에 있어서는 자발적 입원군이 강제 입원군에 비하여 전체 만족점수가 유의하게 높았다. 그러나 성별, 월수입, 학력, 직업, 종교, 결혼상태 등의 변수에서는 서비스 만족척도의 전체 점수에서 유의한 차이가 발견되지 않았으며, 마찬가지로 연령, 입원일수, 입원횟수, 첫 발병나이, 유병기간 등의 임상적 변수에서도 서비스 만족척도의 전체 점수와 유의한 관계를 보이지 않았다. 서비스 만족척도의 전체점수에서 대학병원 환자군이 정신병원 환자군과 종합병원 환자군에 비하여 각각 유의하게 높았다. 결론 결론적으로 국내 정신의료기관에 입원한 환자들의 서비스 만족을 평가하기 위한 목적으로 개발된 본 척도는 높은 수준의 신뢰도와 타당도를 보였으며, 또 국내 정신의료 환경에 맞는 요인구조를 보였다. 따라서 정신의료 서비스에 대한 정신과 환자의 만족도에 대한 연구가 거의 없는 실정에서 본 척도의 개발은 향후 국내 정신의료의 질과 치료결과를 높이는 도구로 활용될 수 있을 것으로 기대된다. Objectives : To develop and test the validity and reliability of a brief self-completed questionnaire (Service Satisfaction Scale : SSS) for routinely assessing the quality of service in psychiatric ward inpatients. Methods : A 30-item multidimensional questionnaire was developed by several steps of face validity and content validity. The questionnaire was administered to inpatients (n=348) discharged from psychiatric hospitals, general hospitals, and University hospitals. Construct validity was supported by performing principal component analysis. Reliability was estimated by calculating internal consistency of Cronbach's alpha. Results : Factor analysis yielded five factors comprising staff attitude, treatment quality, ward environment, access/cost, and ward rule, which account for 63.04% of the common variance. The internal consistency of the scale was high (Cronbach's alpha=0.95). The concurrent validity was supported by the significant correlation of each of five factors with item that measured overall satisfaction of SSS. Patients with neurosis (anxiety disorder, somatoform disorder, obsessive compulsive disorder) and mood disorders were significantly satisfied than those with psychosis and alcoholic disorders. Patients who admitted voluntarily were more significantly satisfied than those who admitted involuntarily. Sociodemographic variables such as age, gender, marital status, monthly income, education level, employment status and religion were not significantly different at the total scores of SSS. Similarly, clinical characteristics such as age of onset, duration of illness, lengths of hospital stay and number of previous hospitalization did not associate significantly with the total scores of SSS. Patients discharged from university hospitals were significantly more satisfied than those of the general and psychiatric hospitals. Conclusion : SSS performed well in the validity and reliability, indicating that it can be a useful tool for measuring Satisfaction of psychiatric inpatients in Korea.

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).

하지방사통을 동반한 성인 협부결손성 요추전방전위증의 후방요추간유합술 및 추경나사고정술후 추적결과

최철,김근수,최하영,김철진,김형일,이정청 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.4