항정신병약물 사용 중인 정신분열병 환자에서 올란자판으로의 교체 방법에 관한 연구(II) : Comparison of Safety 안전성 비교

안용민,권용실,권준수,민성호,박두병,양문정,소형석,송종호,신윤식,우행원,유범희,이홍석,정한용,한창환,김용식 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.5

연구목적: 이 다기관 공동임상연구는 사용 중인 항정신병약물을 ’직접 교체 방법’또는 ’시작-감량 교체 방법’중 한 가지 방법으로 올란자핀으로 교체한 후, 안정성 측면에서 두 교체 방법 간의 비교와 교체후의 변화를 관찰하기 위한 것이다. 방법: 국내 13개 병원의 입원 및 외래에 내원한 환자들 중 ICD-10 지단기준으로 정신분열병에 해당되며, 임상적으로 항정신병약물 교체가 필요한 환자를 대상으로 하였다. 두 가지 교체 방법 중 한 가지를 무작위로 피험자에 적용하였으며, ’직접 교체 방법’에 배정된 경우에는 사용중인 항정신병약물을 일시에 중단하고 10㎎의 올란자핀을 바로 투여하였고, ’시작-감량 교체 방법’에 배정된 경우는 10㎎의 올란자핀 투여하고 2주에 걸쳐서 기존 약물을 감량하여 중단하였다. 올란자핀 사용기간은 총 6주이며, 용량은 5∼20㎎ 범위로 제한하였다. 한정성 평가를 위해서 체중, 생명징후, 자발적인 이상반응 복, 실험실 검사 그리고 Simpson-Angus Scale(SAS), Barnes akathisia rating scale(BARS), Abnormal involuntary movement scale(AIMS). Liverpool University neuroleptic side effect rating scale(LUNSERS)등을 이용하였다. 결과: 총 103명의 정신분열병 환자를 대상으로 하였다. 사용한 올란자핀의 용량, 벤조디아제핀의 병용률, 탈락률과 탈락 사유, 자발적인 이상반응 보고, 생명징후, 실험실 검사 그리고 대부분의 부작용 척도 상에서 임상적으로 의미 있는 차이를 두 교체 방법간에 발견하지 못하였다. 다만 AIMS의 감소는 ’직접 교체 방법’군에서 보다 적었고, 항콜린제의 병용률은 ’시작-감량 교체 방법’군에서 보다 많았다. 기저 상태에서 전체 피험자의 SAS와 BARS 점수는 각각 3.5점과 1.8점이었으며 70% 이상의 피험자가 고프로락틴 혈증을 보였다. 올란자핀으로 교체한 후, SAS, BARS, AIMS 점수의 유의한 감소가 있었으며 고프로락틴 혈증을 보인 피험자 분율도 약 30%이하로 감소하였다. 그러나 교체 방법과 상관없이 올란자핀 교체 후 유의한 체중 증가가 있었다. 결론: 이 연구를 통해 교체 방법에 관계없이 비교적 안전하고 용이하게 올란자핀으로 교체 할 수 있음을 알 수 있었다. 그리고 기존 항정신병약물을 올란자핀으로 교체함으로써 일부 부작용들을 줄일 수 있음을 간접적으로 관찰할 수 있었다. 하지만 이 연구는 여러 제한점과 문제점을 지니고 있기 때문에 보다 체계적인 연구를 통해 검정이 필요하리라 생각된다. Objectives: This multicenter clinical trial involving 13 hospital sites compared the safely of switching to olanzapine between ’direct switching method’ and ’start-tapering switching method’. Method: This study included both inpatients and outpatients who fulfilled the criteria for schizophrenia as defined in the ICD-10, and were in need to be appropriate for switching antipsychotics. Subjects were randomly assigned to one of the two switching methods. For ’direct switching method’group, previous antipsychotics were abruptly discontinued and 10㎎ of olanzapine was administered, and previous antipsychotics was gradually tapered for 2 weeks. Olanzapine was used for 6 weeks and the dose was adjusted within the range of 5-20㎎. The safety of switching to olanzapine was measured with vital sings including body weight, adverse events reported spontaneously, laboratory tests, and various scales such as Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS). Abnormal Involuntary Movement Scale(AIMS), and Liverpool University Neuroleptic Side Effect Rating Scale(LUNSERS). Results: 103 patients were switched to olanzapine in this study. The comparison between two switching methods did not show any significant difference in the dosage of olanzapine used, the concomitant use of benzodiazepine, the rate and reasons of drop-out, the adverse events, vital signs, laboratory tests, and most scales for measuring side-effects. However, the decrease in AIMS scores was significantly lower in ’direct switching method’ group, and the concomitant use of anticholinergics was comparatively greater in ’start-tapering switching method’ group. At baseline, SAS and BARS scores were 3.5 and 1.8 points respectively, and more than 70% of the subjects showed hyperprolactinemia. After switching to olanzapine, SAS, BARS, and AIMS scores were significantly decreased and the proportion of the patients with hyperprolactinemia was also decreased to less than 30%. However significant weight gain after the treatment of olanzapine was observed regardless of switching method. Conclusion: This study may suggest that switching to olanzapine can be done with relatively high safety regardless of switching methods and olanzapine can significantly decrease some side-effects induced by other antipsychotics.

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.

우심방을 침범한 거대 비호지킨씨 림프종 1예

강상범,진승원,이은경,박용현,최용호,김용주,박준철,김재형,홍순조,최규보,권종범,원용순,박건,이은희 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

선삭가공에서 절삭조건에 따른 절삭력과 표면거칠기에 관한 연구

홍철기,이호용 동국대학교 산업기술연구원 1995 산업기술논문집 Vol.6 No.-

STS410 스텐레스 강과 STC3 탄소공구강을 피복초경합금공구를 이용하여 절삭속도, 이송량, 절삭깊이 등의 절삭조건을 바꾸며 선삭가공하여 주분력, 배분력, 이송분력의 절삭력의 변화와 표면거칠기의 변화를 측정하였다. 날끝반경 0.8mm의 공구보다 0.4mm의 공구를 사용하였을 때 절삭력이 작게 나타났으며 표면거칠기는 0.8mm의 공구를 사용할 때가 양호하였다. 절삭력만을 고려할 때의 적절한 절삭조건은 절삭속도 223m/min, 절삭깊이 0.15mm, 이송량 0.06mm/rev이다. 또한 절삭속도 111.6m/min, 절삭깊이 0.55mm, 이송량 0.015mm/rev에서 양호한 표면거칠기가 얻어졌다. Turning experiments are conducted to investigate the relationship between cutting conditions and cutting forces and surface roughness. The cutting conditions consists of the cutting speed, depth, and feed. The STC3 carbon tool steel and STS410 stainless steel are used as working materials, and the KT250 coated sintered carbide tools with nose radius of 0.4mm and 0.8mm are used as the machining tools. It was observed from experiments that cutting with nose radius of 0.4R results in low cutting forces and that of 0.8R results in better surface roughness. Proper cutting conditions are obtained when we use the combinations of the cutting speed of 223m/min, depth of 0.15mm, and feed of 0.06mm/rev to minimize cutting force. Cutting speed of 111.6m/min, depth of 0.55mm, and feed of 0.105mm/rev are recommended for good surface roughness.

중증 만성정신질환자 수의 추산 : Through Two Community Surveys 두 지역사회 조사를 중심으로

홍진표,김윤,배재남,정유진,강영호,양병국,김용익,김병후,이철,조맹제 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

국내 중증 만성정신질환자 수를 추정하기 위하여 일 농촌 및 대도시 지역의 지역의료보험 및 의료보호 대상자 중 1993년 1년간 의료기관에서 정신증 상병(ICD-9 code 상 290-299) 및 알콜 남용/중독, 성격장애 및 정신박약 진단하에 치료를 받은 적이 있는 사람에 대해 설문조사를 실시하였다. 연구자들이 개발한 진단도구를 이용하여 진단을 평가하고, Strauss-Carpenter scale 등을 이용하여 기능 장애를 평가하고 유병기간 등을 조사하였다. 결과를 요약하면 다음과 같다. 1) 진단평가상 정신분열병군(61.1%)이 가장 많았으며, 정동장애군(23.7%), 알콜장애군(11.2%), 기질성 정신장애군(4.0%)의 순서이었다. 2) 직업활동정도는 진단군별로 차이가 많았다. 지난 1년간 직업활동이 6개월 미만이거나 전혀 없는 환자 비율이 정신분열병군은 67.2%, 알콜장애군 52.0%, 정동장애20.8%의 순으로 정신분열병군이 가장 불량하였다. 3) 사회활동도 진단군별로 차이가 많아서 지난 1년간 의도적, 사회활동이 없는 비율이 정신분열병군이 가장 높았고(72.3%), 알콜장애군(32.0%), 정동장애군(20.7%)의 순이었다. 4) 국내 의료보험 및 사회복지시설 이용 자료 등을 토대로 본 조사 결과를 적용한 결과 국내중증 만성 정신질환자의 수는 약 8만 7천명으로 추산되었다. Objectives: The purpose of this study was to estimate the number of serious and persistent mentally ill patients in Korea. Methods : Study populations were recruited from medical insurance data of two district areas ; one rural and the other urban areas. Subject were all mentally ill who had ever visited any hospital in 1993 and were diagnosed as having psychosis, personality disorder and drug abuse. We conducted a home visiting survey applying semi-structured diagnostic interview, assessing the level of social adjustment with Strauss-Carpenter Scale, and past psychiatric history by the trained researchers, in October and November,1994. Results : According to diagnostic assessment schizophrenic patients constituted the major portion(61.1%) of study subjects. The distribution of occupational functions and social contacts was variable according to diagnosis. Most schizophrenic patients were unemployed or worked less than 6 months in the previous year(67.2%), and showed poor social contact(72.3%). But affective disorder patients were relatively independent in job maintenance and social relationship. Alcoholic patients lay between those of schizophrenic and affective disorder groups. It was estimated that about 87,000 adult Koreans were suffering from chronic mental disorders which seriously interfere with their daily life. Conclusions : Serious and persistent mentally ill patients were common in Korea. Community support program should be provided for them.

고속의 실시간 MPEG-2/H.264 transcoding 구조 제안

홍용택,이경호,김진상,조원경 경희-다반 ASIC 설계교육센터 2006 경희-다반 ASIC센터 논문집 Vol.7 No.-

H.264 비디오 코딩 표준은 기존 비디오 코딩 표준에 비해 뛰어난 압축부호화 효율로 인해 차세대 비디오 표준으로 각광받고 있으며 H.264가 가진 잠재적인 영향력 때문에 오늘날 디지털 비디오 시스템의 주를 이루고 있는 MPEG-2 시스템을 대체할 것으로 보여진다. 현재 MPEG-2 시스템이 광범위하게 자리 잡고 있기 때문에 H.264 시스템으로의 완전한 이동은 다소 시간이 걸릴 것으로 예상되고, 따라서 트랜스코딩 기술이 중요하게 대두되고 있다. 트렌스코더는 디코더와 인코더를 포함한 구조이기 때문에 매우 많은 연산량이 요구되며 그 복잡도를 줄이는 것이 중요하다. 본 논문에서는 디코딩 과정에서 추출된 정보를 인코딩 과정에 재사용함으로써 복잡도를 줄이도록 하였고, 또한 H.264에서 연산량이 많은 부분들을 여러 가지 알고리즘을 통해 복잡도를 줄임으로써 보다 빠른 속도로 동작이 가능한 트랜스코더 구조를 제안하였다.

Genome-wide investigation of a Korean synthetic breed, Woori-Heukdon using the Illumina PorcineSNP60K BeadChip

Yong‑Min Kim,Ha‑Seung Seong,Jung‑Jae Lee,Da‑Hye Son,Jin‑Su Kim,Soo‑Jin Sa,Young‑Sin Kim,Tae‑Jeong Choi,Kyu‑Ho Cho,Joon‑Ki Hong,Jung‑Woo Choi,Eun‑Seok Cho 한국유전학회 2020 Genes & Genomics Vol.42 No.12

Background: Woori-Heukdon (KWH) is a Korean synthetic pig breed generated using Chookjin-Duroc (KCD), Chookjin-Chamdon (KCC), and their crossbreds. Currently, there is a severe lack of studies investigating the Korean breed populations including wild boars (KWB) throughout the genome. Objective: This study was performed to investigate the genetic characteristics of Korean pig populations at the genome-wide level. Methods: Using the SNP dataset derived from genotyped and downloaded datasets using the Illumina PorcineSNP60K BeadChip, we compared the genomes of 532 individuals derived from 23 pig breeds to assess the genetic diversity, inbreeding coefficient, genetic differentiation, and population structure. Results: KWB showed the lowest average expected heterozygosity (HE = 0.1904), while KWH showed the highest genetic diversity (HE = 0.02859) among Korean populations. We verified that the genetic composition of KWH, showing USD of 74.8% and KCC of 25.2% in ADMIXTURE analysis. In population structure analyses, KCC was consistently shown to be separated from other pig populations. In addition, we observed gene flow from Western pigs to a part of Chinese populations. Conclusion: This study showed that Korean native pigs, KCC have genetic differences in comparison with Chinese and Western pigs; despite some historical records and recent genetic studies, we could not find any clear evidence that KCC was significantly influenced by Chinese or Western breeds in this study. We also verified the theoretical genomic composition of KWH at the molecular level in structure analyses. To our knowledge, this is the first genomic study to investigate the genomic characteristics of KWH and KCC.

영지버섯 리큐르주의 침출시간에 따른 성분변화

金紅出,李相元,金哲鎬,趙鏞雲 진주산업대학교 2000 산업과학기술연구소보 Vol.- No.7

The physicochemical factors such as organic acid composition, pH, sugar content, acidity and color according to extraction time of Ganodema licidum liquor changed as followings; 1. The major general components of Ganodema licidum were analyzed to be crude fiber(47.5%), carbohydrate (29,4%), crude protein (14.8%), crude fat (6.5%) and crude ash (1.8%) in dry basis. 2. pH and sugar content in Ganodema licidum liquor slightly decreased, whereas acidity increased with extraction time. 3. The luminosity of color (L) showed no remarkable change. 4. The tone of color (a) decreased, whereas the chroma (b) increased as time goes by. 5. The concentration of total organic acid in Ganodema licidum liquor was 2.453%, and nine kinds of organic acids such as oxalic, citric, tartaric, succinic, lactic, formic, acetic, propionic and isobutyric acid were detected. Among them, the concentration of lactic acid was highest acetic and isobutyric acid were medium level, and that of citric, formic, succinc and tartaric acid was very low.

精神症狀에 대한 韓國人의 態度調査

元鎬澤,洪元植,張煥日,陳聖太,金光日,李基南,嚴龍燮,金明正 大韓神經精神醫學會 1973 신경정신의학 Vol.12 No.1

Korean psychiatrists are more apt to take the abnormal drinking behavior lightly and regard the psychosomatic symptoms as more serious, comparing with American psychiatrists. On the other hand, physicians as well as adults from the population in Korea are less concerned about the neurotic and psychosomatic symptoms and alcoholic behavior as psychiatric problems. It is the authors' concern to understand such differences in opinion about abnormal behaviors from the cultural and social psychiatric view point. The authors used Dohrenwend's questionaire form of 45 mental symptoms and three additional items i. e., homosexual behavior, symptom of senile psychosis and delusion of jealousy following the authors' interests. Each item was rated by three point cale (psychiatrically very serious=2 points, somewhat serious=1, not serious at all=0) and evaluated with critical ratio. As a preliminary study, the reliability of this questionaire was confirmed by the test-retest method; Spearman's rho was 0,93. The subjects in this study consist of 50 psychiatrists, 49 physicians, 54 herb practitioners and 154 adults from the normal population(60 urban samples and 94 rural samples). The collection was carried out by individual interviews for the physicians and normal samples, by letters for the psychiatrists and the herb practitioners. And the data of American psychiatrists compared in this study were quoted from Dohrenwend's report(27). This study has two parts: one is the cross-cultural comparison between American psychiatrists and Korean ones, the other is intracultural comparison among psychiatrists, physicians, herb practitioners and normal population samples. Inspite of the general notion that Korean psychiatry has been much oriented to American psychiatry for over twenty years, there are definite differences in opinion about the severity of abnormal behaviors between American and Korean psychiatrist, especially about alcoholic behavior and psychosomatic symptoms. Such differences are possibly interpreted as arising from the cultural differences. The American psychiatrists seem to be more concerned about alcoholic behavior probably due to the strict attitude of people and/or the fact that the United States reveals the highest incidence of alcoholism throughout the world. The Korea psychiatrists, however, have much tolerable attitude toward alcoholic behavior according to the cultural tradition. Solitary drinking is hardly found in Korea; drinking in Korea is a suitable way of interpersonal contact. They drink slowly and are not so intensively dependent upon alcohol itself. Dependency need to alcohol can be diffused to the other persons. And they take alcohol with many kinds of side-dishes. These drinking manners seem to be cultural virtues for low incidence of alcoholism in Korea. Thus, Korean psychiatrists as well as adults from normal population have highly tolerable attitude toward alcoholic behavior. Even when some person reveals a destructive behavior after drinking, they grant it as a personal charm. Korea psychiatrists, therefore, are not so nervous about the alcoholic behavior. On the other hard, the psychosomatic problems seem to be serious in Korean mental patients. They are easily apt to express their emotional problems as somatic symptoms possibly due to the disease concept of oriental herb medicine that has a high tendency of projection of emotional conflicts unto the soma. So most of Korean people are not aware that psychosomatic symptoms are originated from the emotional problems, and quite contrary to it, the psychiatrists may be highly conscious of psychosomatic symptoms. Another significant difference is seen in suicidal idea and suspiciousness: American psychiatrists regard them as more serious, and reversely Korean psychiatrists regard them as less serious. Such a pattern may also be derived from the socio-cultural differences. When Koreans are either dissapointed or delighted, they say frequently "I want to die" or "It's funny to death" and so on. This idiomatic expression is far from the real death wish but rather an expression of magnification. And the suicidal idea itself is frequently seen in normal population even suicidal attempt is evaluated as abnormal in Korea. With such reasons, Korean psychiatrists may notice suicidal idea as less serious than American psychiatrists. And the suspiciousness may be a way of living for the people under the historical turmoil and vigorous aculturation, that it is perceived as not so abnormal. The next problem is the marked discrepancy of opinion about abnormal behaviors among psychiatrists, physicians, herb practitioners and normal population samples. The agreement of physicians, herb practitioners, urban samples and rural samples with the psychiatrists on the relative severity of symptoms revealed as Spearman's rho of 0.79, 0.59, 0.58 and 0.44 respectively. It is the main point of problem that physicians are less aware of neurotic symptoms which can appear in the somatic illness, and of psychosomatic symptoms as psychiatric problem. Possible reason is that Korean physician have been oriented to the somatic medicine without proper psychosomatic orientation. On the other hand, the herb practitioners are apt to ignore the severity of psychotic symptoms and on the other, regard the neurotic and psychosomatic symptoms as much as psychiatrists' opinion. And the samples of normal population regard the neurotic symptoms as more serious than the psychotic symptoms, and are not aware of the psychosomatic symptoms as psychiatric problems. Physicians, herb practitioners and samples from the normal population underestimate the alcoholic behavior more than psychiatrists do. The alcoholism according to physicians' opinion is rather somatic problem than psychological one. The herb practitioners and adults from normal population manifest the prominently tolerable attitude toward alcoholic behavior. In conclusion, two kinds of problems can be suggested. One is that the difference between Korean and American psychiatrists in the evaluation on the severity of abnormal behaviors, is possibly due to sociocultural differences. The other is the intracultural difference among psychiatrists, physicians, herb practitioners and adults from normal population. Such a difference suggests that there is a considerable cultural lag in the disease concept and attitude between the modern psychiatry and the cultural tradition. This discrepancy can result in the undesirable wandering of patients for seeking the treatment and some hardship in modern psychiatric practitioning in Korea.

비알콜성 지방간과 대사성 질환들과의 연관성

김홍규,서찬종,윤효중,황용하,이기영,박혜영,김갑환,강문호 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 비알콜성 지방간은 일반적으로 비만, 제2형 당뇨병 및 고지혈증과 연관성이 있는 것으로 알려져 있으나, 인슐린 저항성과의 독립적인 연관성여부나, 대사 증후군과의 연관성에 관해서는 아직 연구가 많지 않다. 한편, 최근 건강검진센터를 중심으로, 초음파를 이용한 지방간의 진단이 흔하게 되었는데, 이런 대상에서의 지방간의 임상적인 의미에 대해서는 잘 알려져 있지 않았다. 따라서, 본 연구에서는 초음파로 진단된 비알콜성 지방간과 비만, 당대사이상, 이상지질혈증 및 인슐린 저항성과의 연관성을 알아보고, 대사성 증후군과 비알콜성 지방간의 동반정도를 알아보고자 하였다. 방법: 2000년도 4월부터 6월까지 종합건강진단을 위해 가천의대 길병원 건강증진센터에 내원한 262명 중 음주력과 바이러스성 간염, 심한 간기능 또는 신기능이상 및 현성 갑상선기능이상을 보인 147명을 제외한 115명을 대상으로 하였다. 지방간의 진단은 경험 있는 1명의 방사선과의사에 의해 복부 초음파로 진단하였다. 대사성 증후군의 정의는 당대사이상이 있으면서 비만, 이상지질혈증, 그리고 고혈압 중 두 가지 이상의 이상이 있는 경우로 하였다. 결과: 대상자 115명중 비알콜성 지방간이 있는 경우는 30명, 대조군은 85명이었다. 1) 수축기 및 이완기 혈압, 체중, 체질량지수, 체지방량 및 체지방률, 총콜레스테롤과 중성지방, 공복 혈중 인슐린 및 HOMA 인슐린저항성지표는 비알콜성 지방간군에서 의미 있기 높았다. 2) 나이, 성별, 체질량지수, 허리-둔부 둘레비, 체지방량, 체지방률, 공복혈당, 총콜레스테롤, 중성지방, HLD-콜레스테롤, 인슐린, HOMA 인슐린 저항성지표, 그리고 고혈압유무를 포함하여 로지스틱 회귀분석을 실시하였을 때, 체질량지수, 총 콜레스테롤 및 HOMA 인슐린저항성지표가 비알콜성 지방간과 독립적인 연관성이 있었다. 3) 비알콜성 지방간과 대사성 증후군의 연관성을 조사하였는데, 비알콜성 지방간을 가진 사람의 27%에서 대사성 증후군을 동반하였고, 대사성 증후군의 가진 사람의 53%에서 비알콜성 지방간을 동반하였다. 4) 대조군과 비알콜성 지방간군에서 대사성 증후군의 각 구성 인자인 당대사이상, 비만, 이상지질혈증 및 고혈압 중 2개 이상의 인자를 갖는 경우는 각각 28%와 73%로 비알콜성 지방간군에서 현저하게 높았다. 결론: 본 연구의 결과는 비알콜성 지방간이 인슐린 저항성과 독립적인 연관성을 가질 가능성을 시사하였고, 비알콜성 지방간이 있는 경우에 당대사이상, 비만, 이상지질혈증 및 고혈압 중 두 가지 이상의 대사성 질환을 가질 확률이 대조군에 비해 약 3배나 높음을 보여주었다. 따라서, 비알콜성 지방간으로 진단된 환자들에서 이러한 대사성 질환들에 대한 적절한 평가와 이를 호전시키기 위한 노력 및 주의 깊은 경과관찰이 필요할 것으로 생각되었다. Background: Non-alcoholic fatty lever disease (NAFLD) is known to be frequently associated with obesity, type 2 diabetes and dyslipidemia. Recently, the diagnosis of fatty lever disease, based on ultrasonographic findings, has increased. Therefore, we examined the association between NAFLD and various metabolic disease, such as obesity, glucose intolerance, dyslipidemia, and hypertension or metabolic syndrome, and tried to find out whether NAFLD was independently related to insulin resistance. Methods: From April to June 2000, 262 subjects, attending for routine physical check-ups, were screened. Of these, 115 one hundred fifteen subjects were studied, with the other 147 excluded due to significant alcohol consumption, evidence of viral or toxic hepatits, significant liver or renal dysfunction, and overt thyroid disease. Fatty lever was diagnosed if the subject had a 'bright' liver on ultrasonographic examination. All diagnoses were made by a singled experienced radiologist. Results: of the 115 subjects. 30(26%) showed NAFLD. 1. Systolic and diastolic blood pressures, body weight, serum total cholesterol, triglyceride, fasting insulin levels, and HOMA IR (homeostasis model assessment insulin resistance index) were higher in the subjects with NAFLD than in the controls. 2. Multiple logistic regression analysis, including age, sex, BMI, waist to hip ratio, fasting serum, glucose, lipids and insulin levels, HOMA IR, and hypertension showed that BMI, total cholesterol and HOMA IR were independently related with NAFLD. 3. 27% of the subjects with NAFLD showed metabolic syndrome, and 53% of subjects with metabolic syndrome had NAFLD. 4. The percentage of subjects who had more than two factors of metabolic syndrome was three times higher in the subjects with NAFLD compared to the controls. Conclusion: These results suggest that NAFLD may be independently related with insulin resistance. Metabolic diseases, such as glucose intolerance, obesity, dyslipidemia and hypertension, were more prevalent in the subjects with NAFLD than in the controls. Therefore, we should try to assess the status of the metabolic disease, and treat them in patients with NAFLD (J Kor Soc Endocrinol 17:526∼534, 2002).