당뇨병성 합병증을 가진 환자에서 혈중 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 朝鮮大學校 附設 醫學硏究所 1998 The Medical Journal of Chosun University Vol.23 No.1

연구 배경 : 고혈당성에 의한 산화환원반응 이상(가저산소증)이 조절 되지않는 당뇨병의 특징으로 혈관과 신경 기능에 대한 진성 저산소증의 효과와 유사하며, 당뇨 합병증의 병태생리에 중요한 역할을 한다. 고혈당이 있는 인슐린 비의존형 당뇨병 환자에서 인슐린 수준이 정상이듯이, 빈혈이 있는 당뇨병 환자에서 EPO의 농도는 실제 혈색소 농도의 감소비율과 차이가 있을 것이라 추측된다. Friedman 등은 당뇨병성 합병증 원인 인자로 가저산소증(pseudohypoxia) 또는 저산소증(hypoxia)을 제기하였고 이런 인자들이 EPO의 상대적 또는 절대적 결핍에 의한 것임을 보고하였다. 방법 : EPO-Trac^(TM 125)I RIA kit을 이용하여 방사면역측정법으로 EPO 수준을 검사하였다. 전혈 3㎖을 5-10㎖ 시험관에 정맥 채혈하였으며, 용혈과 장기간의 보존을 위하여 원심분리를 즉시 시행하여 혈청을 영하 200C에서 냉동 보관 후 일괄적으로 검사 결과를 얻었다. 결과 : 1996년 9월부터 1997년 2월까지 조선대학교 부속병원 내과에 입원한 2형 당뇨병 환자 63례를 대상으로 하여 다음과 같은 결과를 얻었다. 1) 당뇨병성 합병증이 없는 군과 있는 군간의 혈색소, 혈중 EPO농도의 차이는 유의한 차이가 있었으며 혈색소의 감소율보다 혈중 EPO의 감소율이 더 높았다. 2) 당뇨병성 망막증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으나 혈중 EPO농도는 유의한 차이가 있었다. 증식성군에서만 혈중 EPO의 감소비율이 혈색소에 비해 높았다. 3) 당뇨병성 신증의 유무에 따른 혈색소, 혈중 EPO농도는 유의한 차이가 있었고 혈색소 감소율에 비해 EPO농도의 감소율이 높았다. 신증의 중증도에 따른 혈색소, EPO의 차이는 미세알부민뇨군을 제외하고는 유의한 차이를 보였고 혈색소 감소율에 비해 EPO의 감소율이 더높았다. 4) 당뇨병성 신경병증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으며 EPO농도는 유의한 차이를 보였다. 혈색소와 EPO의 감소비율은 비슷하였다. 신경병증의 중등도에 따른 혈색소와 EPO농도의 변화는 유의한 차이가 없었으나 stage 3에서는 혈색소감소율보다 EPO감소율이 더높았다. 결론 : 당뇨병성 합병증을 가진 환자에서 빈혈의 정도는 대부분 혈청 EPO치의 절대적 감소에 의함을 간접적으로 밝혀낼 수 있었으며 차후 더 많은 대상으로 비교 분석이 필요하리라 사료된다. Background: Hyperglycemic-induced redox(pseudohypoxia) imbalance is a characteristic feature of poorly controlled diabetes that mimics the effects of true hypoxia on vascular and neural functions and plays an important role on the pathogenesis of diabetic complications. As is true for apparently "normal" insulin levels typically found in NIDDM even in the presence of hyperglycemia, a "normal" erythropoietin level in an anemic diabetic subject may be disproportionally low for the actual red cell mass. Therefore, Friedman et al suggested that pseudohypoxia or hypoxia as an etiological factor of diabetic complications are due to absolute or relative erythropoietin deficiency Method: EPO-TracTM 125I RIA kit was used for the quantitative determination of erythropoietin(EPO) in serum by radioimmunoassay. An adequate sample of blood (3ml whole blood) was collected aseptically by venipuncture in a 5~10ml glass tube to yield a minimum of 400 L of serum per assay. The serum was promptly removed from the clot by centrifugation in order to avoid hemolysis. Then to increase its storage time it was frozen at -200C in a nonself defrosting freezer. Finally, tests were undertaken simultaneously Results We studied 63 cases with diabetes mellitus, who were admitted to Chosun University Hospital from September, 1996 to February, 1997 at the Department of Internal Medicine. We defined the control group, as diabetic patients who did not have anemia(<13mg/dl), diabetic complications(retinopathy, nephropathy, neuropathy) and the remainders were defined as the experimental group(we excluded anemic patients, who had secondary causes of anemia and diabetic patients with end stage renal disease)Data were as follow 1) The relationship of Hb and the 24hr urine protein between diabetic patients with and without complications significantly differed(p=0.02, < 0.001 respectively), but the Hb level was poorly related between diabetic patients with and without retinopathy(except in preproliferative, proliferative subgroups) and neuropathy. 2) Subgroups of patients with diabetic complications had higher 24hr urine protein than patients without diabetic complications, except stage I diabetic neuropathy 3) The EPO level was significantly different between diabetic patients with and without complications. 4) The correlation between EPO and Hb was significantly different, especially in diabetic patients with retinopathy and nephropathy according to severity of diabetic complications, compared with patients who did not have diabetic complications such as retinopathy and nephropathy. Conclusion: We know that anemia induced by diabetic complications is due to relative EPO deficiency than absolute EPO deficiency, and further evaluation and studies are needed on many cases in the future

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

Identification of a sensitive urinary biomarker, selenium-binding protein 1, for early detection of acute kidney injury

Kim, Kyeong Seok,Yang, Hun Yong,Song, Hosup,Kang, Ye Rim,Kwon, JiHoon,An, JiHye,Son, Ji Yeon,Kwack, Seung Jun,Kim, Young-Mi,Bae, Ok-Nam,Ahn, Mee-Young,Lee, Jaewon,Yoon, Sungpil,Lee, Byung μ,Kim, Hyung TAYLOR & FRANCIS 2017 Journal of Toxicology and Environmental Health Vol.80 No.9

<P>Acute kidney injury (AKI) is associated with increased mortality rate in patients but clinically available biomarkers for disease detection are currently not available. Recently, a new biomarker, selenium-binding protein 1 (SBP1), was identified for detection of nephrotoxicity using proteomic analysis. The aim of this study was to assess the sensitivity of urinary SBP1 levels as an early detection of AKI using animal models such as cisplatin or ischemia/reperfusion (I/R). Sprague-Dawley rats were injected with cisplatin (6 mg/kg, once i.p.) and sacrificed at 1, 3, or 5 days after treatment. Ischemia was achieved by bilaterally occluding both kidneys with a microvascular clamp for 45 min and verified visually by a change in tissue color. After post-reperfusion, urine samples were collected at 9, 24, and 48 hr intervals. Urinary excretion of protein-based biomarkers was measured by Western blot analysis. In cisplatin-treated rats, mild histopathologic alterations were noted at day 1 which became severe at day 3. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels were significantly increased at day 3. Levels of urinary excretion of SBP1, neutrophil gelatinase-associated lipocalin (NGAL), and a tissue inhibitor of metalloproteinase-1 (TIMP-1) were markedly elevated at day 3 and 5 following drug treatment. In the vehicle-treated I/R group, serum levels of BUN and SCr and AST activity were significantly increased compared to sham. Urinary excretion of SBP1 and NGAL rose markedly following I/R. The urinary levels of SBP1, NGAL, TIMP-1, and KIM-1 proteins excreted by AKI patients and normal subjects were compared. Among these proteins, a marked rise in SBP1 was observed in urine of patients with AKI compared to normal subjects. Based upon receiver-operator curves (ROC), SBP1 displayed a higher area under the curve (AUC) scores than levels of SCr, BUN, total protein, and glucose. In particular, SBP1 protein was readily detected in small amounts of urine without purification. Data thus indicate that urinary excretion of SBP1 may be useful as a reliable biomarker for early diagnosis of AKI in patients.</P>

C 의과대학에서 문제강의에 대한 학생들의 직접평가가 강의개선에 미친 영향

김석용, 이상진, 최재운, 김승렬, 김용대, 배성은, 김영규 충북대학교 의과대학 충북대학교 의학연구소 2012 忠北醫大學術誌 Vol.22 No.1

연구목적: 팀티칭에 근거한 통합강의는 최근 대부분의 의과대학에서 시행되는 강의형태이다. 그러나 기 존에 사용되고 있는 온라인 강의평가 방식은 이러한 강의 특성에서 나타나는 문제점을 파악하기 힘든 점이 있다. 본 대학에서는 팀티칭에 의한 통합강의에서 문제강의를 직접적으로 파악하는 ‘문제강의 직 접평가지’를 개발하였다. 본 연구의 목적은 새로이 개발된 문제강의 직접평가지가 강의개선에 끼친 영 향력을 알아보고자 하는 것이었다. 연구방법: 2007년 2학기부터 2009년 2학기까지 충북대학교 의과대학 1, 2학년을 대상으로 문제강의 직접평가지에 의한 강의평가를 실시하였다. 평가지 질문 중에서 두 가지 객관식 질문에 대한 답변을 분 석대상으로 선택하였다. 질문은 첫째, ‘가장 유익하고 도움이 많이 되었던 강의들은 무엇입니까?’와 둘 째, ‘가장 어렵거나 이해하기 힘들었던 강의들은 무엇입니까?’였다. 강의평가를 실시한 강좌들 중에서 2 년 이상 연속적으로 강좌구조와 평가지의 객관식 질문 형식이 변하지 않은 14개의 강좌를 분석대상으로 하였다. 각각 연도의 평균 긍정비율을 다른 연도의 것과 카이제곱 검정 방법을 사용하여 비교하였다. 결과: 14개의 강좌 중에서 시작연도와 마침 연도 간에 긍정비율이 증가된 경우는 13개 강좌였다. 그 러나 통계적으로 의미가 있는 경우는 5개 강좌에서 나타났다. 결론: 문제강의 직접평가지에 의한 문제강의를 판별해 내는 방법은 단기간에 통합강좌의 개선에 효과 적이다.

아세클로페낙 연질캡슬(클란자 에스 연질캡슬)의 개발

용철순,이경희,최진석,박병주,정세현,김용일,박상만,배명수,김귀자,김영식,유창훈,강성룡,유봉규,이종달,최한곤 한국약제학회 2004 Journal of Pharmaceutical Investigation Vol.34 No.1

To develop and aceclofenac soft capsule, four preparations with various solubilizers were prepared and their dissolution test was carried out. Among four preparations tested, a preparation with ethanolamine was selected a formula of aceclofenac soft capsule (Clanza S^(™), since it showed the fastest dissolution rate. Bioequivalence of aceclofenac tablet, Airtal^(™)(Dae-Woong Pharmaceutical Co., Ltd.) and aceclofenac soft capsule, Clanza S^(™)(Korea United Pharmaceutical Co., Ltd.) was evaluated according to the guideline of KFDA. Fourteen normal male volunteers (age 20-25 years old) were divided into two groups and a randomized 2×2 cross-over study was employed. After oral administration of one tablet or capsule containing 100 ㎎ of aceclofenac, blood ws taken at predetermined time intervals and the concentration of aceclofenac in plasma wa determined with an HPLC method under UV detector. The pharmacokinetic parameters (C_(max), T_(max) and AUC_(t)) were calculated and ANOVA was utilized for the statistical analysis of parameters using logarithmically transformed AUC_(t), C_(max) and T_(max) between Airtal tablet and Clanza soft capsule were 2.89%, 0.18% and 43.0%, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log(0.8) to log(1.250(e.g.log(0.81) - log(1.23) and log(0.89) - log(1.14)) for AUC_(t) and C_(max), respectively. Thus, the criteria of the KDFA guidelines for the equivalence was satisfied, indicating that Clanza S^(™) soft capsule is bioequivalent to Airtal^(™) tablet.

환경농업조성지구내 용수원 및 채수시기별 수질비교

김찬용,김창배,김종수,서영진,윤재탁 한국환경농학회 2002 한국환경농학회지 Vol.21 No.3

A study was conducted to investigate the seasonal changes in water quality of watershed in the Agricultural Environment Promotion Zone. samples collected were 12 GW (ground water), 2 IW (irrigation water), 2 SW (stream water) in An-Doug City, 4 GW, 6 IW, 11 SW in Young-Yang Gun, and sampling was conducted separately during dry and rainy season. In the ground water, EC and ionic species, except pH, were higher than those in stream water, and especially NO_3-N concentration exceeded the limitation of drinking water. Concentration of ions decreased as the sampling depth was far from the soil surface. During a rainy season, the concentrations of NO_3-N and K In the stream water were slightly higher than those during season. COD was lower during dry season in Yong-Yang, while the trend was contrasted to An-Doug. These results suggest that ground water was polluted by fertilization and compost while streamwater was polluted by loss of soil and organic during the rainy season. Principal chemical components related with changing water quality were EC, NO_3^-, Ca, Mg, Na, CI^-, SO_4^- in ground water, whereas NH_4-N, K, Mg, CI^-, SO_4^- in stream water.

내시경역행성담췌관조영술 후 발생한 종격동기종, 피하공기증, 긴장성 기흉 1예

조용건,이현승,권균홍,김자영,김봉진,김지연,배용목,박선자 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

However, Endoscopic retrograde cholangiopancreatography (ERCP) is still helpful procedure for the diagonosis of the pancreatobiliary disease and treatment through endoscopic sphinterectomy (EST) is relatively safe, these have possiblity of complications such as hemorrhage, infection, panceatitis, and perforation. ERCP related perforation was rarely reported in 0.3 to 1.1% of previous study, but most serious complication. A report of Pneumomediastinum, Tension Pneumothorax complicating perforation after ERCP and EST is very uncommon. In our hospital, we experienced case of pneumomediastinum, subcutaneous emphysema, and tension pneumothorax after ERCP and EST, and the patient (a 58 years old female with suspicious common bile duct stone) was treated successfully with conservative treatment.

흰쥐 척수 및 등뿌리신경절에서 Tyrosine Hydroxylase 함유구조물의 분포

박매자,배용철,조희중,김지윤,김용주,김지윤 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

정상 흰쥐의 각 분절별 척수 및 등뿌리신경절에서 catecholamine 함유구조물의 분포를 알아보고자 tyrosine hydroxylase(TH)에 대한 항체를 이용하여 면역조직화학적 염색을 실시하였다. 그 결과 TH 함유신경세포는 목척수분절과 엉치척수분절에서 관찰되었다. 목척수분절의 TH 함유신경세포는 첫째와 둘째 목척수분절에서만 관찰되었으며 신경돌기가 잘 발달된 다각형의 세포인 것으로 보아 이들은 뇌줄기의 TH 함유신경세포군이 목척수분절로 연장된 것이라 생각된다. 그러나 엉치척수분절에서 관찰되는 대부분의 TH 함유신경세포는 세포돌기가 보이지 않고 세포체부분만 면역염색되어 관찰되는 것으로 보아 퇴화단계의 세포인 것으로 생각된다. TH 함유신경섬유는 척수의 모든 분절에서 관찰되었으며 이들 TH 함유신경섬유가 각 척수분절의 등뿔보다 배쪽뿔과 중간뿔에서 훨씬 높은 밀도로 관찰되는 것으로 보아 catecholamine은 척수에서 체성감각뿐만 아니라 자율신경계 및 운동신경계의 조절에 관여하리라 생각된다. 등뿌리신경절에서 관찰되는 TH 함유신경세포는 척수의 엉치분절에서 관찰되는 것과 마찬가지로 세포돌기가 거의 보이지 않고 세포체부분만 염색되어 보였다. 또한 등뿌리 신경절의 TH 함유신경섬유는 혈관의 벽을 나선형으로 감고 돌아가는 형태로 관찰되었으며 어느 것도 등뿌리신경절의 신경세포와 연관되어 관찰되지는 않았다. 이로 보아 정상 쥐의 등뿌리신경절에서 catecholamine은 신경세포 사이의 신경전달이나 졸절보다는 신경절 내의 혈류조절과 관계있을 것으로 생각된다. With the aim of gaining more insight into the catecholaminergic system in the nervous system of the rat, we have studied the precise distribution pattern of the tyrosine hydroxylase immunoreactive (TH-IR) fibers and soma in the spinal cord and dorsal root ganglion. In the dorsal root ganglion (DRG) TH-IR fibers were observed to run along the vessel wall, spirally and not found in the neural tissue itself. A few TH-IR fibers were found in the spinal nerve, not in the ventral root. Many TH-IR neurons were distributed in the L3, 4, 5, and 6 DRG but none of them were found in the other DRG segments. In the spinal cord, TH-IR fibers have shown sparse distribution all over spinal cord but relatively dense distribution in the ventral hom, intermediolateral column, lamina I of the dorsal horn of the cervical, lumbar, sacral, and coccygeal segment. TH-IR neurons were found in the interrmediolateral column, dorsal gray commissure, dorsal horn of the C1 and C2 segments and S1-4 segments. TH-IR neurons in the cervical segments were polygonal or spindle shaped with well developed processes. In contrast to this, TH-IR neurons in the sacral segments were oval or spindle shaped withe no processes. In conclusion, neurons in the DRG were not influenced by catecholaminergic nervous input. Intrinsic catecholaminergic nervous systems were found in both of spinal cord and DRG.

원발성 유방암에서 Sodium Iodide Symporter의 발현과 ^(99m)Tc-MIBI 유방스캔의 관계

석주원,김성장,곽희숙,이창훈,김인주,김용기,배영태,김동수 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.6

목적: hNIS는 갑상선 조직 외에 다른 조직들에서도 발현된다고 알려져 있다. 유방암 세포는 그런 조직들 중에 하나이며, 그에 의한 유방암의 방사성옥소치료의 가능성이 제시되고 있다. 본 연구에서는 유방암 조직에서 hNIS의 발현정도를 알아보고, ^99mTc-MIBI 유방스캔과 hNIS의 발현 정도와의 관계를 조사하여 보았다. 대상 및 방법: 본 연구에서는 유방암으로 수술을 시행했던 56명의 환자를 대상으로 하였다. hNIS의 발현은 면역조직화학염색에 의해서 평가되었으며, 그 결과를 ^99mTc-MIBI 유방스캔의 판정 결과와 비교하였다. 결과: 전체 56명의 환자에서 hNIS의 발현율은 41.1%였다. 병리학적 진단에 의해 침윤성관상피암종이었던 49명에서의 발현율은 42.9%, 관상피내암종이었던 7명에서의 발현율은 28.6%였다. ^99mTc-MIBI 유방스캔에서 국소섭취 소견이 관찰되었던 41명에서의 hNIS의 발현율은 31.7%였다. 비정상적인 섭취 소견이 관찰되지 않았던 15명의 환자에서의 hNIS의 발현율이 의미있게 높게 관찰되었다(66.7%, p>0.05). 결론: 유방암 환자에서의 hNIS의 발현율은 그다지 높지 않았다. ^99mTc-MIBI 유방스캔에서 섭취증가 소견이 없을 때 hNIS의 발현율이 더 높았다. Purpose: Human Na^+/I- symporter (hNIS) is known to be expressed in many tissues other than thyroid gland. The breast cancer cells are one of them and the possibility of radioiodine therapy in treatment of the breast cancer may be suggested. We investigated the expression rate of hNIS and the relationship between the expression of hNIS and the finding of 99mTc-MIBI scintimammography in the breast cancer. Materials and Methods: Surgically proved 56 patients with breast cancer were the subjects of this study. The expression of hNIS were evaluated by immunohistochemistry and the results were compared to the findings of 99mTc-MIBI scintimammography. Results: Overall expression rate of hNIS was 41.1% in 56 patients. According to the pathologic diagnosis, it was 42.9% in 49 patients with invasive ductal carcinoma and 28.6% in the 7 patients with ductal carcinoma in situ. The expression rate of hNIS in the 41 cases with a focal increased uptake at he breast lesion on 99mTc-MIBI scintimammogram was 31.7%. That in the 15 cases without any abnormal uptake on the scan was significantly higher(66.7%, p<0.05). Conclusion: The expression rate of hNIS in the patients with breast cancer was not so high. The rate was higher in the patients with no increased uptake at the breast lesion on 99mTc-MIBI scintimammography. (Korean J Nucl Med 2002;36;325-32)