다낭난소증후군 진단시 복식 초음파의 유용성에 관한 연구

정경아,이운정,정혜원,Jeong, Kyung-Ah,Lee, Woon-Jeong,Chung, Hye-Won 대한생식의학회 2009 Clinical and Experimental Reproductive Medicine Vol.36 No.4

목 적: 한국 가임기 여성의 다낭난소증후군 진단시에 복식 초음파를 이용하는 방법의 유용성과 정확도를 분석하여 국내 다낭난소증후군의 진단 기준 마련에 도움이 되고자 하였다. 연구방법: 이화여자대학교 목동병원에서 선별설문조사를 받은 15~44세 여성 8,793명에서 복식 초음파를 시행한 총 701명 중, 정상 월경을 하면서 안드로겐 과다 및 초음파의 다낭난소 소견이 없는 정상 대조군에서 복식 초음파를 시행한 185명과 초음파 검사 소견을 제외하고 NIH 진단 기준으로 다낭난소증후군을 진단 받은 248명의 환자에서 복식 초음파를 시행한 소견을 ROC (receiver operating characteristic) 곡선 분석하였다. 결 과: 정상 대조군의 평균 연령은 $23.64{\pm}4.26$세로 복식 초음파로 측정된 평균 난소 부피는 $6.03{\pm}1.89\;cm^3$, 평균 난포 개수는 $6.49{\pm}1.93$개였다. 복식 초음파를 진단에 사용할 경우 난소 부피를 이용하면 AURC (area under the ROC curve)가 0.761로 난소 부피>$9\;cm^3$ 기준일 때, 민감도 51.0%, 특이도 91.4%였다. 난포 개수에 대한 AURC는 0.733으로 ${\geq}9$개 기준일 때, 민감도 54.9%, 특이도 87.0%였으며, 난포 개수 ${\geq}10$개 기준일 때, 민감도 53.2%, 특이도 90.4%였다. 복식 초음파로 난소 부피와 난포 개수를 검사하여 다낭난소증후군의 선별 진단에 이용하기에는 부적합하였다. 결 론: 복식 초음파를 이용하여 다낭난소증후군을 진단하는 방법은 유용성과 정확도에서 신뢰할만하지 못하다. Objective: The objective of the study was to determine the diagnostic performance of transabdominal ultrasound by receiver operating characteristic (ROC) curve analysis, in order to evaluate the usefulness in establishing the diagnosis of polycystic ovary syndrome (PCOS). Methods: Questionnaires were given to 8,793 reproductive women reviewed at Ewha Womans University Mokdong hospital. Ultrasound examinations were performed in 701 women with a transabdominal transducer. Transabdominal ultrasounds were performed in 185 normal control women (normal menstruation without hyperandrogenism or PCO morphology) and 248 PCOS patients according to National Institutes of Health (NIH) PCOS diagnosis criteria. ROC curves were calculated for ovarian volume and follicle number. Results: In normal control group, the mean age were $23.64{\pm}4.26$ years old and the mean ovarian volume and follicle number were $6.03{\pm}1.89\;cm^3$ and $6.49{\pm}1.93$, respectively. The ovarian volume showed an area under the ROC curve (AURC) of 0.761. A ovarian volume decision threshold >$9\;cm^3$ had a sensitivity of 51.0% and a specificity of 91.4% for the diagnosis of PCOS. The follicle number showed an AURC of 0.733. A follicle number decision threshold ${\geq}9$ had a sensitivity of 54.9% and a specificity of 87.0% for the diagnosis of PCOS. A follicle number decision threshold ${\geq}10$ had a sensitivity of 53.2% and a specificity of 90.4%. A follicle number and a ovarian volume did not have a high diagnostic power for screening for PCOS. Conclusion: Our results suggest that transabdominal ultrasound assessment is not effective for the detection of PCOS in young women of reproductive age.

호흡곤란 증후군 미숙아에서 혈중 L-arginine 농도와 Oxygenation Index 및 폐동맥압과의 관계

정경아,이순주,성인경,전정식,Jeong, Kyong Ah,Lee, Soon Ju,Sung, In Kyung,Chun, Chung Sik 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.12

Purpose : This study was performed to observe the relationship of plasma L-arginine level and the severity of disease and pulmonary artery pressure in respiratory distress syndrome of premature infants. Methods : Peripheral blood samples were obtained at 1st, 3rd and 7th day from 21 premature infants with respiratory distress syndrome to analyze the L-arginine concentration. Oxygenation index (OI), an indicator of the severity of the disease, was calculated at the same time of the blood sampling. And pulmonary artery pressure was measured by Doppler echocardiography at each period. Plasma L-arginine level, OI and right ventricular systolic time interval(RVSTI) were analyzed. Results : Plasma L-arginine concentration of the 1st day was lower than 3rd and 7th day. OI and RVSTI were significantly correlated with each other(r=0.772, P<0.01). Plasma L- arginine level was correlated with oxygenation index(r=-0.346, P<0.01) and RVSTI(r=-0.416, P<0.01). Conclusion : Plasma L-arginine level was lowest in the 1st day during the study period. Plasma L-arginine concentration correlated significantly with the severity of respiratory distress syndrome and pulmonary artery pressure in premature infants. 목 적 : RDS가 있는 미숙아에서 질병의 심한 정도와 폐동맥압 및 혈중 L-arginine 농도와는 어떤 연관이 있는지 알아보고자 하였다. 방 법 : RDS로 인공 환기요법을 시행 받은 재태기간 37주 미만 미숙아 21명을 대상으로 하여 제 1병일, 제 3병일, 제 7병일에 혈액을 채취하여 혈중 L-arginine 농도를 측정하였다. 혈액채취와 동일한 시기에 호흡곤란 증후군의 중등도를 나타내는 지수로서 OI를 산출하였고, 도플러 심초음파를 이용하여 RVSTI를 측정하여 폐동맥압의 지표로 삼았다. OI와 혈중 L-arginine 농도 및 RVSTI 간의 상관관계를 알아보았다. 결 과 : 1) OI가 클수록 RDS 미숙아의 혈중 L-arginine 농도는 낮았다(r=-0.346, P<0.01). 2) OI가 클수록 RVSTI도 증가되었다(r=0.772, P<0.01). 3) RVSTI가 커지면 RDS 증후군 미숙아의 혈중 L-arginine 농도는 낮았다(r=-0.416, P<0.01). 결 론 : RDS가 있는 미숙아에서 질병이 심할수록 혈중 L-arginine 농도는 낮고, 폐동맥압은 높았으며, 폐동맥압이 높을수록 혈중 L-arginine 농도는 낮은 관계를 보였다.

자궁외임신의 보존적 치료제로 Methotrexate의 치료에 관한 임상 지침

정경아 ( Kyung Ah Jeong ),한유정 ( You Jung Han ),이소현 ( So Hyun Lee ),신은경 ( Eun Kyoung Shin ),유은희 ( Eun Hee Yoo ),전선희 ( Shun Hee Chun ),김종일 ( Chong Il Kim ),나중열 ( Joong Yol Na ),강재성 ( Jae Seong Kang ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.11

최신임상강좌 : 월경전증후군: 진단 및 치료에 관한 임상적 접근

정경아 ( Kyung Ah Jeong ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.3

The large number and variety of premenstrual symptoms reported have made premenstrual disorders difficult to characterize. Premenstrual disorders can have a significant negative impact on a woman`s quality of life and work productivity. But women diagnosed as premenstrual syndrome (PMS) seldom seek a medical advice and commonly use non prescribing medicines. The pathophysiology of the wide range of PMS/premenstrual dysphoric disorder (PMDD) symptoms may be explained by multiple mechanisms. Clinicians need to recognize the diagnostic criteria for PMS/PMDD. The many and varied treatments used for premenstrual disorders can be a source of confusion. These practical treatment algorithms in women with PMS/PMDD would be helpful. It is important for clinicians practicing in women``s health to be familiar with the various approaches to treating premenstrual disorders and their relative efficacy.

동아시아 국내 이주 여성의 정상 월경에 필요한 체질량 지수와 체지방율에 관한 연구

정경아 ( Kyung Ah Jeong ),김환지 ( Hwan Ji Kim ),김정명 ( Jung Myung Kim ),정혜원 ( Hye Won Chung ) 대한폐경학회 2009 대한폐경학회지 Vol.15 No.3

연구목적: 최근 급증하고 있는 동아시아 출신의 국내 이민 여성을 대상으로 코호트를 구축하고 정상 월경을 하기 위한 임계 체질량 지수, 임계 체지방율을 알아보고자 하였다. 연구재료 및 방법: 베트남과 캄보디아 등에서 국제 결혼을 통해 국내로 이주한 여성 1,710명을 대상으로 자국어로 작성한 설문지와 통역 가능한 조사원을 통해 월경 상태를 조사하였다. 체질량 지수, 허리-둔부 비율을 계산하였고 In body 230으로 체성분 검사를 시행하여 체지방율 값의 분포를 분석하였다. 결과: 평균 연령은 23.7±4.7세였으며, 정상 월경주기인 1,065 명의 체질량 지수는 평균 20.99±2.56 kg/m2로 5 백분위수 값, 17.35 kg/m2, 10 백분위수 17.99 kg/m2, 90 백분위수가 24.57 kg/m2, 95 백분위수 값이 25.94 kg/m2에 해당되었다. 허리-둔부 비율의 평균은 0.824±0.051로 5 백분위수 값이 0.744, 10 백분위수 0.759, 90 백분위수 0.892, 95 백분위수 값이 0.910까지의 범위에 분포하였다. 체지방율의 평균은 29.57±6.15%로 5 백분위수 값이 19.28%, 10 백분위수 21.75%, 90 백분위수 36.70%, 95 백분위수 값이 39.00%에 이르렀다. 결론: 점차 국내 주요 구성원으로 자리잡게 될 동아시아 이민자 여성에서 체질량 지수와 체지방율은 정상 월경을 유지하기 위한 중요한 요인으로 생각되며, 임계 체지방율 값은 낮았다. Objectives: The objective of the study was to evaluate the critical body mass index and critical percent body fat of East Asian immigrants with normal menstrual cycles. Methods: The subjects included 1,710 east Asian women (Vietnamese and Cambodians, etc.) who immigrated to Korea for marriage. Their menstrual status was examined by questionnaires and interviews. The age, body mass index and waist-hip ratio were calculated and the percentage of body fat was measured using In body 230. Results: The mean age was 23.7±4.7 years. In 1,065 east Asian immigrants with normal menstrual cycles, the mean body mass index was 20.99±2.56 kg/m2. The 5th, 10th, 90th and 95th percentiles of the body mass index were 17.35 kg/m2, 17.99 kg/m2, 24.57 kg/m2, and 25.94 kg/m2, respectively. The mean waist-hip ratio was 0.824±0.051. The 5th, 10th, 90th, and 95th percentile of the waist-hip ratio were 0.744, 0.759, 0.892, and 0.910. The mean percent body fat was 29.57±6.15%. The 5th, 10th, 90th and 95th percentiles of body fat were 19.28%, 21.75%, 36.70%, and 39.00%, respectively. Conclusion: Our results suggest that both body mass index and percent body fat were significantly associated with menstruation, but the critical percent body fat for normal menstruation was lower in the east Asian immigrants in Korea. (J Korean Soc Menopause 2009;15:193-199)

자연 유산의 염색체 이상과 질식 초음파검사 소견과의 관련성에 관한 연구

정경아(Kyung Ah Jeong),강태정(Tae Jung Kang),한지은(Jee Eun Han),이경순(Kyung Soon Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2

Objective : To investigate the importance of transvaginal ultrasonographic findings of spontaneous abortion and the relation of transvaginal ultrasonographic finding and the karyotype of abortus. Materials and Methods : Transvaginal sonography was undergone to 48 subjects with spontaneous abortion in their early pregnancies who had visited Ewha Womans University Mokdong Hospital, from March 1996 to June 1999. A chromosome analysis of their aborted products was done. Results : The frequency of chromosome abnormalities of abortus was 47.9%. Among the chromosomal abnormalities, trisomy was 31.2%(simple trisomy 27.0%, double trisomy 4.2%), monosomy X 8.4%, poliploidy 8.4%(tripoidy 4.2%, tetraploidy 4.2%). The average maternal age for trisomy was 30.2±4.9, and their past number of spontaneous abortions was 1.0±0.9, with trisomy 16 most frequent with 23.0%. In the case with trisomy 5, 22, and double trisomy, the average maternal age was increased with 38.0, 36.0±2.8, 35.5±5.0, respectively. However, no significant relevance could be found. The average maternal age for polyploidy was 30.5±3.7, and their past number of spontaneous abortions was 1.0±2.0. No significant relevance could be found compared with normal karyotypes. The average maternal age for monosomy X was 27.5±1.7, which is lower than the average maternal age for normal karyotypes, but not significantly so. The mean number of past abortions was no different with 1.0±0.8. No significant relevance could be found between ultrasonographic findings and chromosomal abnormalities. The measured/expected crown-rump length ratio of the aborted group was smaller than those of the control group. Conclusion : Serial ultrasonographic findings in early pregnancies help to diagnose spontaneous abortion, but not efficient to diagnose chromosomal abnormalities in the aborted group.

폐경 후 호르몬 대체요법 2년 후 총 경동맥의 혈관 내막 두께 변화로 동맥경화에 미치는 효과를 본 연구

정경아 ( Kyung Ah Jeong ),박기현 ( Ki Hyun Park ),안철우 ( Chul Woo Ahn ),배상욱 ( Sang Wook Bai ),이병석 ( Byung Seok Lee ),조동제 ( Dong Jae Cho ),송찬호 ( Chan Ho Song ) 대한폐경학회 2003 대한폐경학회지 Vol.9 No.1

목적 : 본 연구는 폐경 후 호르몬 대체요법 후에 총 경동맥의 혈관 내막 두께를 추억 관찰하여 동맥경화에 미치는 효과를 알아보고자 하였다. 연구방법 : 102명의 폐경된 여성에서 호르몬 대체요법 전후에 초음파로 총 경동맥의 혈관 내막 두께를 측정하였다. 호르몬 치료는 평균 27.9±3.7개월동안 시행한 후에 추적 관찰하였다. 102명 중 36명은 sequential regimen(0.625㎎ conjugated equine estrogens : CEE/5㎎ MPA), 34명은 continuous regimen (0.625㎎ CEE/5㎎ MPA), 12명은 2.5㎎ tibolone, 10명은 oral estrogen regimen (0.625㎎ CEE), 10명은 transdermal estrogen regimen (50㎍ estradiol)을 투여받았다. 치료전후에 혈압 및 생화학적 검사로 총 콜레스테롤, 중성지방, 고밀도지단백, 저밀도지단백, lipoprotein (a), 공복시 혈당, 인슐린, fibrinogen과 plasminogen activator inhibitor-1을 각각 측정하여 비교하였다. 결과 : 폐경 후 호르몬 대체요법을 시행받은 후에 총 경동맥의 혈관 내막 두께는 통계학적으로 유의하게 감소하였다 (평균치 좌 0.69±0.18 vs 0.53±0.20 ㎜, p<0.001: 우 0.65±0.11 vs 0.48±0.17 ㎜, p<0.001, 최대치 좌 0.73±0.20 vs 0.63±0.23 ㎜, p=0.001; 우 0.68±0.12 vs 0.57±0.20 ㎜, p<0.001). 혈압은 변화가 없었고 총 콜레스테롤 (210.7±34.0 vs 202.8±30.9 ㎎/이,p=0.029), 저밀도지단백 (113.3±25.5 vs 80.5±24.7 ㎎/이, p=0.029), lipoprotein (a) (51.3±13.8 vs 39.7±13.2 ㎎/㎗, p=0.038)와 인슐린치 (6.8±2.6 vs 4.4±2.7 ??U/㎖, p=0.026)가 의미있게 감소되었으며 그 외 생화학적 검사 수치는 유의한 변화를 보이지 않았다. 총 경동맥의 혈관 내막 두께와 생화학적 검사 모두에서 호르몬 치료 방법에 따른 차이는 없었다. 결론 : 단기간의 폐경 후 호르몬 대체요법은 동맥경화의 진행에 있어서 예방적 효과가 있다. Objective : To assess the 2-year effects of postmenopausal hormone replacement therapy (HRT) on progression of atherosclerosis, measured as intima media thickness (IMT) in carotid arteries. Methods : This study included 102 postmenopausal women recruited from the general population. Blood pressure, biochemical charicteristics, and common carotid IMT with B mode ultrasonography were measured at baseline and 27.9±3.7 years-HRT : 36 patients; sequential regimen (0.625㎎ conjugated equine estrogens: CEE/5㎎ medroxyprogesterone acetate: MPA), 34 patients; continuous regimen (0.625㎎ CEE/2.5㎎ MPA), 12 patients; 2.5㎎ tibolone, 10 patients; oral estrogen regimen (0.625㎎ CEE), 10 patients; transdermal estrogen regimen (50㎍ estradiol). Results : After HRT, total cholesterol (210.7±34.0 vs 202.8±30.9 ㎎/㎗, p=0.029), LDL (l13.3±25.5 vs 80.5±24.7 ㎎/㎗, p=0.034), lipoprotein (a) (51.3±13.8 vs 39.7±13.2 ㎎/㎗, p=0.038), and fasting insulin (6.8±2.6 vs 4.4±2.7 ??U/㎖, p=0.026) were significantly decreased. Significant changes of the other biochemical characteristics and blood pressure could not be demonstrated. Common carotid IMT (average : Lt. 0.69±0.18 vs 0.53±0.20 ㎜, p<0.001, Rt. 0.65±0.11 vs 0.48±0.17 ㎜, p<0.001; maximum : Lt. 0.73±0.20 vs 0.68±0.23 ㎜, p=0.001, Rt. 0.68±0.12 vs 0.57±0.20 ㎜, p<0.001) was significantly decreased. There were no difference between the groups according to method of HRT. Conclusion : The findings of this study show that 2-year of HRT was effective in slowing progression of subclinical atherosclerosis in postmenopausal women.

폐경기 여성의 혈청 과산화지질 농도에 따른 항산화비타민의 영양상태

정경아(Jung Kyung-Ah),김상연(Kim Sang-Yeon),최윤정(Choi Yoon-Jung),우정익(Woo Jeong-Ik),장유경(Chang Yu-Kyung) 韓國營養學會 2001 Journal of Nutrition and Health Vol.34 No.3

터너 증후군 환자에서 총 경동맥의 혈관 내막 두께 측정을 통한 잠재성 동맥경화의 관계분석

정경아(Kyung Ah Jeong),박기현(Ki Hyun Park),김정연(Jeong Yeon Kim),송계영(Kye Young Song),안철우(Chul Woo Ahn),배상욱(Sang Wook Bai),이병석(Byung Seok Lee),조동제(Dong Jae Cho),송찬호(Chan Ho Song) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

Objective : This study was undertaken to determine whether women with Turner syndrome have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. Methods : 18 Women with Turner syndrome and 18 women as control group were measured the intima media thickness (IMT) of common carotid artery by B-mode ultrasound. We compared the IMT between cases and controls, and analyzed risk factors which affect the IMT. Results : There are no differences between the groups in age and body mass index (BMI). The height was shorter (147.8±7.9 vs 160.3±5.9, p<0.001) and the waist-hip ratio (WHR) was significantly increased in Turner syndrome (0.86±0.04 vs 0.78±0.04, p<0.001). Fasting blood sugar (FBS) (90.1±9.9 vs 79.4±4.4 ㎎/㎗, p<0.001), fasting insulin (9.5±3.0 vs 4.7±1.0 μIU/㎖, p=0.009), total cholesterol (187.1±21.3 vs 154.8 ±21.8 ㎎/㎗, p=0.014), and LDL (111.3±10.0 vs 82.8±16.4 ㎎/㎗, p=0.009) were significantly higher in Turner syndrome. Compare to control, the IMT was significantly increased in Turner syndrome (0.61±0.09 vs 0.49±0.02 ㎜, p=0.002). In the analysis of correlation between the IMT and clinical & biochemical characteristics, Turner syndrome status, WHR, FBS and fasting insulin were significantly affecting factors (Coefficients of correlation: 0.720, p<0.001; 0.671, P<0.001; 0.445, p=0.020; 0.904, p<0.001). Conclusion : These results suggested that women with Turner syndrome might have an increased risk of subclinical atherosclerosis and insulin resistance was most important risk factor.

다낭성 난포증후군 환자에서 총 경동맥의 혈관내막 두께 측정을 통한 인슐린 저항성과 잠재성 동맥경화의 관계분석

김정연(Jeong Yeon Kim),박기현(Ki Hyun Park),정경아(Kyung Ah Jeong),강경숙(Gyoung Sook Kang),안철우(Chul Woo Ahn),배상욱(Sang Wook Bai),조동제(Dong Jae Cho),송찬호(Chan Ho Song) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

Objectives: The purpose of this study was to determine whether women with PCOS have greater subclinical atherosclerosis and evaluate the relationship to risk factors for atherosclerosis. Methods: Women with PCOS(n=24) and age and body mass index(BMI)-matched cycling women(n=16) as control group underwent carotid scanning for the measurement of the IMT. We compared IMT and plaque between cases and controls, assessed some risk factors for atherosclerosis, and analyzed factors affecting IMT. Results: There was no difference between the groups in waist-hip ratio(WHR) and in the levels of total cholesterol, triglyceride(TG), LDL, Lp(a), fibrinogen, homocystein, plasminogen activator inhibitor 1. However, HDL was significantly lower, and systolic and diastolic blood pressure, fasting blood sugar or insulin concentration and IMT was significantly higher in PCOS group than control group (51.1±11.6 vs 60.4±10.0mg/dl, 119.4±12.5 vs 109.0±11.6mmHg, 79.1±11.1 vs 68.9±7.8mmHg, 93.6±11.1 vs 85.0±5.9 mg/dl, 8.9±5.2 vs 5.0±3.3pU/ml, 0.57±0.12 vs 0.49±0.11mm respectively, all p<0.05). In the analysis of correlation between the IMT and clinical characteristics, PCOS status, BMI, systolic and diastolic blood pressure, fasting blood sugar or insulin concentration, TG, HDL, fibrinogen were significantly independent variables (Coefficients of correlation were 0.358, 0.461, 0.452, 0.349, 0.405, 0.466, 0.478, -0.433, 0.349 respectively, all p<0.05). The factors affecting IMT by multivariate regression were PCOS status and fasting insulin concentration. Conclusions: We concluded that women with PCOS might have an increased risk of subclinical atherosclerosis and insulin resistance was assumed to be the main risk factor of atherosclerosis.