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당뇨병성 족부궤양이 당뇨병환자의 재원기간 및 입원비용에 미치는 영향
김재문 ( Jae Moon Kim ),진홍용 ( Heung Yong Jin ),강선미 ( Sun Mi Kang ),김소영 ( So Young Kim ),박지현 ( Ji Hyun Park ),박태선 ( Tae Sun Park ),백홍선 ( Hong Sun Baek ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.2
연구배경: 우리나라에서 아직까지 당뇨성 족부궤양이 재원기간 및 재원 비용에 대해 미치는 영향에 대해 잘 알려져 있지 않다. 비록 당뇨성 족부궤양에 의한 재원기간 및 비용들을 정확히 측정하기는 힘들지만 이러한 시도가 향후 경제학적인 측면 및 사회적 짐이 될 수 있는 측면에서 볼 때 효과적인 의료비 절감을 할 수 있는 방안에 영향을 줄 수 있겠다. 방법: 본 자료는 2005년 1월부터 12월까지 전북대 병원 내분비 내과 및 당뇨성 족부궤양 및 당뇨를 주소로 입원한 환자에 기초하여 조사 및 비교하였다. 이중 49명의 당뇨병성 족부궤양 환자 와 나이 및 성별이 비슷한 족부 궤양이 없는 당뇨병 환자 49명을 재원비용, 협진건수, 수술여부, Lab(TG, HDL, LDL, Cr, HbA1c, Insulin, C-peptide)등을 비교하였다. 결과: 당뇨성 족부궤양이 없는 환자보다 당뇨성 족부궤양이 있는 환자는 있어서 평균 재원기간 및 입원비용이 더 높았다. (46.5 ± 36.2 vs 23.0 ± 21.4 일, P<0.05), (9,114,079 ± 7,341,282 vs 5,770,949 ± 5,387,066 원 P<0.05). 또한 당뇨병성 족부궤양 환자중 수술환자는 23명이었으며 이중 8염이 Major operation을 받았으며 15명이 Minor operation을 받았다. 결론: 위와 같은 결과를 보았을 때 당뇨병성 족부궤양의 예방은 향후 당뇨환자에게 있어서 경제적 짐으로부터 벗어날 수 있게 함을 알 수 있다. 따라서 당뇨병환자를 관리할 때, 당뇨병성 족부궤양에 대한 예방 및 교육, 치료에 좀 더 많은 관심을 가져야 하겠고 이는 요즘 증가하고 있는 사회적 측면에서의 의료비 절감효과에도 영향을 미칠 수 있으리라 사료된다. Background: Few data has been reported about the impact of diabetic foot ulcer on the length of hospitalization and costs in hospital care in Korea. Although it is difficult to estimate precisely, this trial is necessary for efficient medical policy in the respect of social budget and health economy. Methods: From Jan. 2005 to Dec. 2005, diabetic patients who have been admitted in Chonbuk National University Hospital were reviewed according to the presence of foot ulcer. After that, admission days, costs, and treatment modality were compared with diabetic patients without foot ulcer. Results: The mean value of admission days and the direct costs of diabetic patients with foot ulcer were higher than those of diabetic patients without foot ulcer (46.5 ± 36.2 vs 23.0 ± 21.4 days, P<0.05), (9,114,079 ± 7,341,282 vs 5,770,949 ± 5,387,066 won P<0.05). Among diabetic patients with foot ulcer, 23 patients had been operated including of amputation and local debridement in operating room. Conclusion: From this data, we suggest that the prevention of diabetic ulcer has a significant economic benefit in the Korea healthcare budget. Therefore, specific foot care of diabetic patients may be more beneficial in the management of diabetic patients and multidisciplinary team approach with specialized foot clinics, if possible, should be performed in the future.
결핵 및 비결핵성 뇌막염 환자에서 Lysozyme 활성도
박태선(Tae Sun Park),김정권(Jeong Kwon Kim),이충섭(Chung Seob Lee),이용철(Yong Chul Lee),이양근(Yang Keun Rhee) 대한내과학회 1989 대한내과학회지 Vol.37 No.3
N/A Lysozyme activities were measured in sera and cerebrospinal fluid (CSF) of 8 patients with tuberculous meningitis and 12 patients with non-tuberculous meningitis to differentiate tuberculous meningitis from non-tuberculous meningitis patients admitted to Chonbuk National University Hospital from March 1986 to August 1987. Sera and CSF were analysed for their lysozyme activities by the Freehool method in the Worthington Enzyme Manual. The results obtained were as follows: 1) Serum and CSF lysozyme activities in the control group were 66.8±10.3㎍/min/ml and 0.7±0.9㎍/min/ ml respectively. 2) Serum lysozyme activities in patients with tuberculous meningitis and viral meningitis were 114.46±16.5 ㎍/min/ml and 79.9±18.5 ㎍/min/ml respectively. 3) CSF lysozyme activities in patients with tuberculous meningitis and viral meningitis were 132.5 ㎍/min/ ml and 35.8±12.2 ㎍/min/ml respectively and there was a significant difference between the two groups (p<0.001). 4) Serum lysozyme activities in patients with pulmonary tuberculosis with meningitis and pulmonary tuberculosis without meningitis were 114.76±16.5 ㎍/min/ml and 133.38±55.3 ㎍/min/ml respectively. There was no significant difference between the two groups (p<0.05). CSF lysozyme activities in patients with tuberculous meningitis and tuberculosis without meningitis were 131.5±58.5㎍/min/ml and 3.29±5.8 ㎍/min/ml respectively and this was statistically significant (p<0.001). 5) Lysozyme activities in patients with tuberculous meningitis treated with glucocorticoid returned to the control level in CSF, but not in serum. The above results suggest that determination of CSF lysozyme activities is useful in differential diagnosis between tuberculous meningitis and non-tuberculous meningitis, except for pyogenic meningitis, and is useful in monitoring the clinical course of tuberculous meningitis.