$\beta_2$ 교감신경 수용체 다형성이 아토피 및 혈청 IgE에 미치는 영향

이신형,심재정,강용구,정혜철,김경규,권영환,김제형,이승룡,이소라,이상엽,조재연,인광호,유세화,강경호,Lee, Sin-Hyung,Shim, Jae-Jeong,Kang, Yong-Koo,Jeong, Hye-Cheol,Kim, Kyung-Kyu,Kwon, Young-Hwan,Kim, Je-Hyeong,Lee, Sung-Yong,Lee, So-Ra,Lee, San 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.6

연구배경 : $\beta_2$ 교감신경 수용체의 다형성이 기관지 천식의 표현형에 영향을 미친다고 알려져 있다. 이에 저자들은 먼저 기관지 천식 환자와 정상인에서의 $\beta_2$ 교감신경 수용체의 다형성의 빈도에 차이가 있는가를 알아보고, 또한 기관지 천식 환자에서 아토피의 유무 및 혈청 총 IgE의 증가 여부와 $\beta_2$ 교감신경 수용체의 다형성이 관계가 있는지 알아보고자 본 연구를 시행하였다. 방 법 : 기관지 천식 환자 109명과 정상인 42명에 대하여 혈청 총 IgE를 측정하고, 항원 특이 IgE 검사 및 피부 단자 검사를 실시하였고, mutated allele specific amplification 법으로 $\beta_2$ 교감신경 수용체와 다형성을 검색하였다. 결 과 : $\beta_2$ 교감신경 수용체의 다형성을 조사한 결과 16번 아미노산 위치에서는 Arg 야생형 및 Arg/Gly 이형접합체 변이형, Gly 동형 접합체 변이형이, 그리고 27번은 Gln 야생형, Gln/Glu 이형 접합체 변이형, Glu 동형 접합체 변이형이 관찰되었다. 34번 아미노산의 경우는 Val 야생형과 Val/Met 이형 접합체 변이형이, 164번은 Thr 야생형만 있었다. 1) 정상인과 기관지 천식 환자에서 $\beta_2$ 교감신경 수용체의 16, 27, 34번 아미노산 위치에 있어서 다형성의 빈도는 통계학적으로 차이가 없었다(p>0.05)(Table 3). 2) 기관지 천식환자에서 $\beta_2$ 교감신경 수용체 다형성의 빈도와 아토피의 존재 유무는 16, 27, 34 번 아미노산에서 모두 통계학적으로 관계가 없었다(p>0.05) (Table 4). 3) 기관지 천식 환자 중 혈청 총 IgE가 증가된 군과 정상 군에서 $\beta_2$ 교감신경 신경 수용체 다형성과 혈청 총 IgE의 증가 여부의 비교는 16, 27, 34번 아미노산 모두 통계학적인 관련이 없었다(p>0.05) (Table 5). 결 론 : 결론적으로 기관지 천식 환자와 정상인 사이의 $\beta_2$ 교감신경 수용체의 다형성은 16, 27, 34번 아미노산 위치에서 차이가 없었고, 기관지 천식환자에서 아토피의 유무 및 혈청 총 IgE의 증가 여부와 $\beta_2$ 교감신경 수용체의 다형성의 빈도는 통계적으로 유의한 관계가 없었다. Background : The $\beta_2$ adrenergic receptor ($\beta_2$ AR) polymorphisms occurring at amino acid position 16 (Arg to Gly), 27 (Gln to Glu), 34 (Val to Met), and 164 (Thr to Ile) are known to be functionally relevant and also disease-modifying in subjects with asthma. However the contribution of these polymorphisms to the development of the asthmatic phenotype or other markers for allergic disease remains to be established. Methods : 109 patients with bronchial asthma and 42 healthy person were included. Serum total IgE, allergen specific IgE, and skin prick test were performed to all of the subjects. $\beta_2$ AR polymorphisms were checked by mutated allele specific amplification (MASA) method. Results : The results were as follows. The frequencies of $\beta_2$ AR polymorphisms in asthmatic patients and healthy person were not statistically different(p>0.05). There was no association between $\beta_2$ AR polymorphisms of amino acid position 16, 27, 34 and the existence of atopy among asthmatic patients(p>0.05). Between asthmatic patients with or without elevated IgE level and $\beta_2$ AR polymorphisms of amino acid position 16, 27, 34, there was no statistically significant association(p>0.05). Conclusion : There was no difference in frequency of the $\beta_2$ AR polymorphism between asthmatic patients and healthy person. In the bronchial asthma, association of $\beta_2$ AR polymorphism and atopy/serum total IgE was not found.

주요 류머티스 질환의 보험의학적 이해

이신형,Lee, Sin-Hyung 한국생명보험의학회 2012 保險醫學會誌 Vol.31 No.1

Nowadays, Rheumatic diseases are increasing more and more. So, it's important knowing the pathophysiology and extra-risk of each rheumatic disease so as to do sound underwriting. Here is brief review and long-term prognosis of some rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, Sj$\ddot{o}$gren syndrome, antiphospholipid syndrome, systemic sclerosis, ankylosing spondylitis, Takayasu's arteritis, and Behcet syndrome.

보험의학회지 제27권 1호의 발간에 즈음하여...

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.1

Korean life insurance medical association's public periodical, the Journal of Korean Life Insurance Medical association (J Kor Lif Ins Med Assoc, JKLIMA) is now published $27^{th}$ issue. From this issue there are some changes of the journal than before. It is because general requirements for medical journals from the Korean association of medical journals editors. It can be remedy for the development of JKLIMA, in terms of academicism. First, the style of the manuscripts, medical opinion of insurance administration is added. This style of manuscript needs not keep the format of original research article such as background, materials, results, and discussion. Secondly, It is emphasized that submitted manuscripts must be reviewed by peer reviewers. Thirdly, we will make an effort to globalization of our journal. Lastly the publication period has been changed from annual to biannual. The publication date will be at March 31st and September 30th every year.

진료과목 관련성을 중심으로 분석한 의학적클레임검토 유형론에 관한 연구

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.1

BACKGROUND : The medical claims review(MCR) is unique methodology of medical consultation in terms of insurance claim administration in Korean insurance market. The most important practical matter in the MCR is formatted question. In Korea, medical specialty is composed of 26 legally defined hospital departments. It is worth of studying to investigate type of MCR by hospital departments. METHODS : Fifty Cases of the MCR were selected randomly by statistical program SPSS among 1,032 cases which were performed between April 1, 2006 and March 31 2007. All of selected cases were evaluated one insurance doctor and made a score points from 0 to 10 in terms of hospital department. RESULTS : Multidimensional scaling was performed. The MCR types - diagnosis, malignancy and cause of death are located in the same 2-dimensional configuration area. It can be called as verification of benefit. Others are advice. - such as causality, interpretation, translation, independent medical examination, and so on. DISCUSSION : We can conclude the classification of MCR typology are two main subjects, verification and advice. Theses results are same as previous article which was based on experience.

내성결핵의 보험의학적 위험분석

이신형,Lee, Sin-Hyung 한국생명보험의학회 2009 保險醫學會誌 Vol.28 No.1

Background: Recent emergence of drug-resistant tuberculosis such as multidrug-resistant tuberculosis(MDR-TB) or extensively drug-resistant tuberculosis(XDR-TB) has become important health care problems. It has also became grave issues for insurance industries in determining medical risks. We have therefore strived to analyze the comparative mortality rates for drug-resistant tuberculosis through utilization of results from previous articles. Methods: Comparative mortality was calculated from source articles using mortality analysis methods. Results: Mortality ratio of MDR-TB was estimate to 1200%, and excess death rate was 110 per 1,000. Comparative mortality between MDR-TB and XDR-TB by Korean $study^{(1)}$ were 1750, 382, 405, 443, 1025, and 357%, for each 10 months study intervals, respectively. Total mortality ratio was 594% and total excess death rate was 60 per 1,000person. It was determined that the risk of XDR-TB was much greater than MDR-TB. Discussion; Pending the development of a novel anti-tuberculosis drug, it would be prudent to steer clear insuring XDR-TB during underwriting phase due to high medical cost that it creates.

주요 호흡기질환의 보험의학적 이해

이신형,Lee, Sin-Hyung 한국생명보험의학회 2011 保險醫學會誌 Vol.30 No.2

Lung diseases are common in general population and they are also important in insurance medicine. According to current textbook of insurance medicine, there are references of western research which performed at 1980s and early 2000. It's necessary to update the reference. In this article, several respiratory disorders such as Kartagener's syndrome, bronchial asthma, drug-resistant tuberculosis, etc are reviewed in terms of insurance medicine. Reference articles were used in Korean study, if possible. I hope this article being a role of helping many insurance doctors and underwriters in Korea.

보험의학적 악성도 판단

이신형,Lee, Sin-Hyung 한국생명보험의학회 2005 保險醫學會誌 Vol.24 No.-

Among medical claims review, decision of malignancy is very important. According to the pathologic report may be ordinary pathway. Some tumors are not completely studied especially malignancy. Wheather malignancy or benign is the important thing in medical claims review. We here disscuss on the debatable tumors such as carcinoid tumor, gastrointestinal stromal tumor (GIST), desmoid tumor, MALToma, and pseudomyxoma peritonei. Another controversial subject in the medical claims review is selection of pathologic report. If the result of the pathologic report is not same in one patient, We prefer the selsection of the report from more professional hospital. We have called this professional hospital l as "third hospital" or 'refferal hospital".

기스트와 말토마의 보험의학적 악성도 판단

이신형,Lee, Sin-Hyung 한국생명보험의학회 2008 保險醫學會誌 Vol.27 No.2

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

제한적인 출처논문을 활용한 사망률분석

이신형,Lee, Sin-Hyung 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.2

Medical risk selection or mortality analysis is very important in insurance medicine. Among many kind of source articles there have been several limitations. There are few long-term follow-up studies in rare disease, as Romeo's article. We can do mortality analysis of this type using cause of death within the article and assumption of expected mortality q'. In the case of article which is published in foreign country such as Tikkanen et al, we can use comparative group from the control group within source article. It is another way for mortality analysis of limited article. However Retrospective study even performed in Korea, is unusable for estimation of extra-mortality.

만성폐쇄성폐질환의 보험의학적 이해

이신형,Lee, Sin-Hyung 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.1

Global prevalence of chronic obstructive pulmonary disease(COPD) is known to 5.6 ~ 9.8%. Then life insurance applicants from persons with COPD are frequently encountered, and the underwriter and insurance medical doctors are called on with some regularity to render assessments of the mortality risk associated with COPD. According to previous article which contains long-term follow up of COPD, mortality ratio and excess death rate were 230% and 29 per 1000, respectively. Nowadays molecular genetic methodology such as GWAS has been developed. So it might be possible that molecular diagnostic methods may be one of useful underwriting tools in the life insurance risk selection of COPD applicants.