쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

A Comparative Experimental Study of the, In-vitro Efficiency of Hypertonic, Saline-Enhanced Hepatic Bipolar and, Monopolar Radiofrequency Ablation

Lee, Jeong Min,Han, Joon Koo,Kim, Se Hyung,Sohn, Kyu Li,Lee, Kyoung Ho,Ah, Su Kyung,Choi, Byung Ihn Korean Radiological Society 2003 Korean Journal of Radiology Vol.4 No.3

Optimization of Electric Field-assisted Ultrasonication for Disintegration of Waste Activated Sludge

( Kyung-won Jung ),( Tae-un Jeong ),( Min-jung Cha ),( Kyu-hong Ahn ) 한국폐기물자원순환학회(구 한국폐기물학회) 2014 한국폐기물자원순환학회 심포지움 Vol.2014 No.1

In the present study, an electric field is applied in order to disintegrate waste activated sludge (WAS). As a preliminary step, feasibility tests are investigated using different applied voltages of 10 to 100 V for 60 min. As the applied voltage increases, the disintegration degrees (DD) are gradually enhanced, thereby the soluble N, P, and carbohydrate concentrations increase simultaneously due to the protein decomposition. Subsequently, an optimization process is conducted using response surface methodology with a Box-Behnken design (BBD). The total solid concentration, applied voltage, and reaction time are selected as independent variables, while the DD is selected as the response variable. The overall results demonstrate that the BBD with an experimental design can be useed effectively in the optimization of the electric field treatment of WAS. In the confirmation test, a DD of 10.26±0.14% is recorded, which corresponds to 99.1% of the predicted response value under the statistically optimized conditions. Finally, the statistic optimization of the combined treatment (electric field + ultrasonication) showed that even though this is limited to highly disintegrated WAS when being applied individually, a high DD of 47.28±0.20% was recorded where the TS concentration was 6,780 mg/l, the strength of ultrasonication was 8.0 W, the applied voltage was 68.4 V, and the reaction time was 44 min. E-SEM images clearly revealed that the application of the electric field is a significant alternative method for the combined treatment of WAS, and this is first attempt to increase disintegration using electric field for combined treatment with ultrasonication.

부추 추출물에 의한 Escherichia coli 및 Staphylococcus aureus 의 생육 저해효과

이민경(Min Kyung Lee),이정아(Jeong-ah Lee),박인식(Inshik Park) 한국식품영양과학회 2001 한국식품영양과학회지 Vol.30 No.1

식품오염의 지표로 이용되는 Escherichia coli 와 식중독을 일으키는 Staphylococcus aureus에 대한 부추(Allium tuberosum) 추출물의 항미생물 활성을 검토하고, 그 활성의 열안정성 및 pH 안정성을 조사하였다. 부추 추출물은 미생물의 생육을 저해하였으며 특히 Staphylococcus aureus에서 생육 저해환의 면적이 크게 나타났다. 그리고 paper disc에 50 μL의 부추 추출물을 흡수시켰을 때는 Escherichia coli와 Staphylococcus aureus는 각각 440 ㎟, 609 ㎟의 저해면적을 나타내었으며 부추 추출물의 농도가 높을수록 생육 저해가 현저하였다. 또한 부추 추출물을 68℃에서 30분 또는 98℃ 20분간 열처리 후에도 부추 추출물에 의하여 미생물의 생육은 저해되었다. 그리고 부추 추출물을 pH 2.0에서 3시간 보관 후에도 항미생물활성은 비교적 안정하였다. 그러나 부추 추출물의 항미생물 활성은 투석에 의하여 완전히 활성이 없어졌으며, 따라서 부추 추출물에 존재하는 항미생물 활성은 저분자 물질인 것으로 사료된다. The growth retardation of Escherichia coli and Staphylococcus aureus by heat or acid treated leek (Allium tuberosum) extract was observed. Antimicrobial activity of the leek was the most effective when fresh leek extract was used, but it was stable after heat treatment at 68℃ for 30 min or 98℃ for 20 min. It was also relatively stable after incubated at pH 2.0 for 3 hrs. The antimicrobial activity in leek was not detected after dialysis with molecular weight cutoff of 12,000. Therefore it seems to be small molecule with molecular weight lower than 12,000.

인체혈장 중 에탐부톨의 HPLC 분석법의 검증 및 단일용량 투여에 의한 약물동태 연구

곽혜선,박경호,최준식,송진아,성민경,장정옥,이화정 한국약제학회 2005 Journal of Pharmaceutical Investigation Vol.35 No.2

An HPLC method was employed for the determination of ethambutol in human plasma. After addition of internal standard (IS, octylamine, 2 μg/mL) and alkalinization of the plasma with 5 M sodium hydroxide, the drug and IS were extracted into the mixture of chloroform and diethyl ether (40:60, v/v). Following a 15-min vortex-mixing and a 10-min centrifugation, the organic phase was spiked with 100 pL of phenylethylisocyanate (2000 μg/mL) for chemical derivatization, mixed for 5 min and evaporated to dryness under a stream of nitrogen. The residue was reconstituted with 100 μL of mobile phase and 20 pL was injected into Cl8 column with a mobile phase consisting of methanol:water (70:30, v/v). The samples were detected utilizing an ultraviolet detector at 200 nm. The method was specific and validated with a limit of 0.15 μg/mL. Infra- and inter-day precision and accuracy were acceptable for all quality control samples including the lower limit of quantification. The applicability of this method was demonstrated by analysis of human plasma after oral administration of a single 1200-mg dose to 20 healthy subjects. From the plasma ethambutol concentration vs. time curves, the mean AUC was 9.61 ± 1.64 μg hr/mL. and Cmax of 2.68 μg/mL reached 2.73 hr after administration. The mean biological half-life of ethambutol was 3.46 ± 1.21 hr. Based on the results, this simple and validated assay could readily be used in any pharmacokinetic studies using humans.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

서울 지역 여자대학교 집단에서 월경전기 증후군 및 월경전 불쾌기분장애의 유병율

정범석,이철,이지현,서민경,한오수,김창윤 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 가임기 여성의 75%가 하나 이상의 월경전기 증상을 경험하며, 일상생활에 지장을 주는 경우도 3∼8%에 이르지만 한국 여성을 대상으로 한 월경전기 증후군(Premenstrual syndrome : PMS)및 월경전 불쾌기분장애((Premenstrual dysphoric disorder : PMDD)에 대한 역학 조사는 부족한 실정이다. 따라서 본 자들은 한국에서의 유병율, 증상의 양태 및 삶에 미치는 정도 등의 역학 조사를 통해 월경전 불쾌기분장애에 대한 올바른 정보를 제공하고 관련 임상 연구의 기초자료로 활용하고자 본 연구르 시행하였다. 방 법 : 6개의 서울 소재 4년제 여자대학교에서 무작위 군집표본 추출로 선택된 4개 학교의1∼3학년 학생 중 무작위 군집표본추출을 통해 선택된 1419명을 대상으로 하였다. DSM-IV진단기준을 근거로 저자들이 제작한 6점 척도의 설문지가 사용되었으며, 난포기에 비해 황체기에 75%이상 악화된 경우 증상이 있다고 판정할 경우의 월경전 불쾌기분장애의 유병율을 조사하였다. 월경전 불쾌기분장애 집단과 증상은 있으나 진단기준에 부합되지 않는 월경전기 증후군 집단으로 나누어 증상 양태, 식습관 변화, 생활에 미치는 영향 정도 등을 비교하였다. 결 과 : 부적절한 자료 198명(13.9%), 주요 신체 혹은 정신질환을 앓은 경우 등 선정 배제 기준에 속하는 경우 348명(24.5%)을 제외한 873명이 최종 분석되었다. 873명 중 월경전 불쾌기분장애의 유병율은 5.0%이었으며, 월경전기 증후군의 유병율은 83.3%이었다. 가장 흔한 증상은 월경전기 증후군 집단의 경우 신체증상(54.6%)이었고, 월경전 불쾌기분장애 집단의 경우 '지속적으로 짜증난다'(95.5%)이었다. 월경전 불쾌기분장애 집단의 88.6%에서 증상 때문에 한 달에 1∼2회 이상 일이나 공부에 지장이 초래되었다. 결 론 : 한국 여자대학생 집단이 경험하는 월경전 불쾌기분장애의 유병율과 증상 양상은 외국과 비슷하다. 아울러 월경전 불쾌기분장애 집단은 월경전기 증후군 집단에 비해 기분 증상이 더 흔하고 심하는 점에서 월경전 불쾌기분장애는 월경전기 증후권과 구별되는 하나의 질환 상태임을 시사한다. Objects : More than 75% of women have been reported to experience premenstrual symptoms and three to eight percent of them suffer from premenstrual dysphoric disorder(PMDD). But little is known about prevalence of premenstrual syndrome(PMS) and PMDD and PMS in Korean women who sttended universities at the time of survey. Methods : One thousand four hundred and nineteen subjects were randomly selected with cluster sampling methods among four women's university in Seoul. We measured the severity of premenstrual symptoms using six-point rating scale developed by the authors on the basis of the research criteria for PMDD in DSM-IV. Premenstrual worsening of symptoms was defined as increase in symptom scores of more than 75% from follicular to luteal phase score. And also, we compared characteristic symptoms, eating behaviors, and functional impairments between PMS and PMDD. Results : After excluding inadequate data according to our exclusion criteria, 873 of 1419 subjects(61.5%) were included in the estimation of the prevalence of PMS and PMDD. Each prevalence rate of PMS and PMDD was found to be 83.3% and 5.0% on the basis of 75% change method respectively. The most frequent symptom was physical symptoms such as headache or breast tenderness(56.4%) in PMS and 'felt irritable'(9.5%) in PMDD. Of the 44 subjects with PMDD, 39(88.6%) reported to have experienced the impairment in work or school at least once per month because of premenstrual symptoms. Conclusions : Our results indicate that prevalence and symptoms of PMDD in Korean university women are similar to those in western culture. The finding that mood symptoms were more frequent and severe in PMDD than in PMS implies that the former may be a disordered condition to be distinguished from the latter physiologic one.

저소득계층 여성노인의 스트레스와 건강증진행위

정경순;이지민 김천과학대학 2009 김천과학대학 논문집 Vol.35 No.-

This study was to identify the degree of the stress and the health -promoting behaviors and to determine affecting factors in female elderly based on the health - promoting behaviors. The subjects were 253 of vulnerable female elderly adults aged over 60 in D city. Data were collected from November 1st to December 30th 2007 by questionnaire survey. The instruments used for this study were the HPI(Health Practice Index) developed by Breslow and the PSS(Perceived Stress Scale) developed by Goldberg. Analysis of data was done by use of frequency, percentage, Chi-square test and logistic regression with SPSS program. The results are summarized as the followings: 1) 50.2% of subjects were exposed to medium degree of stressed group. Factors that affected the stress were significantly different according to the type of family living together and medical insurance. 2) 77.0% of subjects were exposed to low level of the health-promoting behavior group. Factors that affected the health - promoting behavior were significantly different according to the type of family living together and medical insurance. 3) Subjects who were living with their spouse or another family member were more highly affected on the health-promoting behavior than alone. Subjects who were benefited from health insurance more highly affected on the health - promoting behavior than those who got medical care. Subjects who were exposed to the low degree of stress more highly affected on the health - promoting behavior than the medium degree of stress. These results suggest that stressful situation is an important variable in the health - promoting behavior. These findings may give useful information for developing health-promoting programs focused on stress in the vulnerable female elderly adults

68세 여자에서 발견된 Morgagni hernia 1예

정영일,정귀예,민영돈,김경종 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.3

Morgagni hernia is a herniation of abdominal viscera into the thoracic cavity through the sternocostal hiatus (foramen of Morgagni). It has the lowest occurrent rate of 3% among congenital diaphragmatic defects. Generally, the defect is present from the early embryonic period without apparent symptoms, but symptoms can occur with the defect growing in size in adult. We report a case of Morgagni hernia complaining of intermittent RUQ abdominal pain in 68-year-old women. In addition, we considered other related references with our case.

멀티미디어를 기반으로 하는 정보통신 분야 자격시험 학습 자료 개발

민경일,정기석,조용석,황재효 永同工科大學校 1996 硏究論叢 Vol.2 No.1

저작 도구를 사용하여 정보통신분야 1, 2급 멀티미디어 CD 타이틀을 제작하였다. 유제 문제는 STC 교과목 학습을 통하여 엄선하여 데이터 베이스화 하였다. 또한, 정보통신공학을 전공한 학생들이 CD 타이틀 제작에 참여하므로 멀티미디어 시스템 실무 능력을 배양하는 계기가 되었고, 전공에 대한 실질적인 학습 효과가 있었다. 학생들이 제작된 CD 타이틀을 이용하면 자기 학습과 반복 학습이 가능하므로 학습 능률이 극대화되어 기사 자격 시험을 준비하는 학습을 효과적으로 할 수 있을 것이다. A multimedia CD title has constructed for qualifying test of information and communication engineering. Similar problems have been selected during STC lectures and have been databased. Furthermore, the students majored in information and communication engineering participated in the process of constructing the CD title, and as the results, they could obtain practical abilities on the multimedia systems. Using the CD title, they can be able to study for the qualifying test efficiently.