성인 당뇨병환자에서 GAD 자가항체 유무와 만성 합병증과의 관계

정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2

연구배경: 제2형 당뇨병환자의 대부분은 비면역학적 기전에 의해 발생하지만 초기에 제2형 당뇨병으로 진단되었던 일부 환자에서는 GAD에 대한 항체를 지니고 있다. 이러한 환자에서는 베타세포 기능 감소가 더 현저하며 마른 체형 및 고혈당의 빈도가 더 높다고 보고된다. 따라서 이러한 점들은 만성 미세혈관 합병증이나 대혈관 합병증의 발생에 있어서 인슐린저항성을 특징으로 하는 전형적인 제2형 당뇨병과는 다른 양상을 보일 수 있을 것으로 생각된다. 본 연구는 성인 당뇨병환자에서 GAD 자가항체 유무와 당뇨병성 만성미세혈관 합병증 및 대혈관 합병증 발생과의 관련성을 알아 보고자 하였다. 방법: 35세 이후에 임상적으로 제2형 당뇨병으로 진단된 환자들 중 GAD 자가항체 측정과 당뇨병성 합병증에 대한 평가가 이루어진 환자들을 대상으로 단면적 분석을 실시하였다. 신장, 체중, 체질량지수 및 허리둘레를 측정하였고, 혈장 혈당, C-펩티드, GAD 자가항체, 인슐린 농도, 당화혈색소, 총 콜레스테롤, 중성 지방, 고밀도지단백 콜레스테롤, 저밀도지단백 콜레스테롤, 유리지방산을 측정하였다. GAD 자가항체는 0.9 U/mL를 초과하는 경우 GAD 자가항체 양성으로 정의하였다. 당뇨병성 미세혈관합병증에 대한 평가를 위해서 안저촬영, 진동감각 역치 검사, 신경전도 검사 및 미세알부민뇨검사를 실시하였다. 대혈관 합병증의 유무를 확인하기 위해 관상동맥질환, 허혈성 뇌혈관질환 및 말초동맥혈관질환을 평가하였다. 결과: 총 427명의 환자 중 GAD 자가항체 양성인 환자는 26명이었으며 GAD 자가항체 음성인 환자는 401명이었다. GAD 자가항체 양성 환자에서 수축기 혈압이 낮았으며 고밀도지단백 콜레스테롤은 높았다(P<0.05). 또한 GAD 자가항체 양성 환자에서 공복 C-펩티드와 식후 C-펩티드 모두 유의하게 낮았다(P<0.001). 당뇨병성 미세혈관합병증의 유병률을 비교하였을 때 당뇨병성 망막병증은 GAD 자가항체 양성 환자가 19.2%, GAD 자가항체 음성 환자가 47.9%로 GAD 자가항체 양성 환자에서 유의하게 낮았다(P<0.05). 그 외 신증, 말초신경병증 및 심혈관계 자율신경병증은 두 군 사이에 유의한 차이를 보이지 않았다. 대혈관 합병증의 유병률을 비교하였을 때 관상동맥질환의 유병률은 GAD 자가항체 양성 환자에서 7.7%, GAD 자가항체 음성환자에서 11.2%로 두 군 사이에 유의한 차이는 없었다(P=0.755). 또한 허혈성 뇌혈관질환 및 말초동맥혈관질환의 유병률을 비교했을 때 두 군 사이에 유의한 차이는 관찰되지 않았다. 결론: GAD 자가항체 양성인 환자에서 자가항체 음성 환자에 비해 당뇨병성 망막병증의 유병률이 더 낮았으나 그 외 미세혈관 합병증과 대혈관 합병증의 유병률의 차이는 없었다. 따라서 GAD 자가항체 양성 환자에서 자가항체 음성환자에 비해 망막병증이 더 낮게 발생하는 요인에 대해서 더 많은 환자 군을 대상으로 한 전향적 연구가 필요할 것으로 사료된다. Background: Although the majority of diabetes mellitus (DM) patients diagnosed as adults have non-autoimmune forms of the disease, islet autoimmunity is encountered in some patients initially thought to have type 2 DM. The phenotype of DM patients with glutamic acid decarboxylase (GAD) antibodies is different from that of patients with GAD antibody-negative type 2 DM, with features such as relative leanness and hyperglycemia which may influence the development of complications. We sought to compare the prevalence of chronic complications in patients with and without the GAD antibody. Methods: We recruited 427 patients (M: 218, F: 209) that were clinically diagnosed with type 2 DM after the age of 35 years. We measured GAD antibody and assessed the factors associated with chronic microvascular and macrovascular complications. Results: Of these patients, 26 were GAD antibody-positive. The patients with GAD antibody had lower systolic blood pressure, higher high-density lipoprotein cholesterol value, and lower level of fasting and stimulated C-peptide than patients without GAD antibody (P<0.05). Also, the patients with GAD antibody had lower prevalence of retinopathy compared with the patients without GAD antibody (19.2 vs. 47.9%; P<0.05). The prevalence of nephropathy, peripheral neuropathy and cardiovascular autonomic neuropathy did not differ between the groups. In addition, the prevalence of coronary heart disease, cerebrovascular disease and peripheral arterial disease did not differ between the two groups. Conclusion: This study suggests that diabetic patients with GAD antibody have a lower risk for the development of retinopathy compared with patients without GAD antibody. (Korean Diabetes J 33:124-133, 2009)

터너증후군과 동반된 그레이브스병 1예

정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3

It is becoming increasingly evident that adults with Turner`s syndrome are susceptible to endocrine autoimmunity. An increased prevalence of thyroid autoantibodies and hypothyroidism in patients with Turner`s syndrome has been reported, but the involvement of Graves` disease in these patients is relatively rare. We describe a case of Graves` disease associated with Turner`s syndrome. A 28-year-old woman was referred for diffuse anterior neck swelling and palpitation. She had been diagnosed with Turner`s syndrome with monosomy 45,X before the age of 9 years and she took estrogen together with progesterone. The physical examination revealed a firm, non-tender goiter. The T3 level was 632 ng/dL, the free T4 level was 5.68 ng/dL, the TSH level was 0.02 uIU/mL, the % of TSH-binding inhibiting immunoglobulin was 24% and the anti-thyroid autoantibodies were positive. The radioactive iodine uptake was increased. Therefore, she was diagnosed as having Graves` disease. (Korean J Med 74:325-329, 2008)

알도스테론 분비 부신샘종과 동측의 신장동맥혈관협착이 동반된

진준 ( Joon Jin ),임철환 ( Chur Hoan Lim ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ),최유덕 ( Yoo Duk Choi ) 대한내과학회 2015 대한내과학회지 Vol.89 No.1

The simultaneous occurrence of renovascular hypertension and an aldosterone-producing adrenal adenoma is a rare entity. Here, we report the case of a 52-year-old female who had a coexisting aldosterone-producing adrenal adenoma and ipsilateral renal artery stenosis. She was diagnosed with the aldosterone-producing adrenal adenoma and then underwent a laparoscopic left adrenalectomy. Her blood pressure was uncontrolled after the adrenalectomy. Selective renal angiography showed left renal artery stenosis; thus, she underwent balloon angioplasty at the same sitting. Subsequently, her blood pressure returned to normal after administration of a single antihypertensive drug. This case suggests that it is important to recognize the possible coexistence of renal artery stenosis in a patient with an aldosterone-producing adrenal adenoma. (Korean J Med 2015;89:97-101)

락툴로스 호기 검사 결과에 영향을 주는 요인에 관한 연구

김진원 ( Jin Won Kim ),박선영 ( Seon-young Park ),정진욱 ( Jin Ook Chung ),조현아 ( Hyun A Cho ),김동현 ( Dong-hyun Kim ),윤재현 ( Jae Hyun Yoon ),박창환 ( Chang Hwan Park ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 대한소화기학회 2020 대한소화기학회지 Vol.75 No.1

Background/Aims: This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS). Methods: The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed. Results: Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0-80.0 years) and 22.5 kg/m²(range, 14.4-34.3 kg/m²), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001). Conclusions: Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.

제2형 당뇨병 환자에서 알부민뇨와 말초동맥 질환과의 관계

박승환 ( Seong Hwan Park ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

Background/Aims: Albuminuria is an early indicator of renal damage in type 2 diabetes mellitus, and has been recognized as a risk factor for peripheral arterial disease (PAD). The aim of this study was to assess the association between albuminuria and PAD in Korean type 2 diabetes patients. Methods: Our retrospective study included 390 consecutive patients with type 2 diabetes mellitus. The ankle-brachial index (ABI) and toe-brachial index (TBI) were used to assess PAD. The urinary albumin-creatinine excretion ratio (UAE) was evaluated by determining the albumin/creatinine ratio (ACR) in the first voided morning urine sample. Results: Duration of diabetes, serum creatinine levels, and UAE were significantly higher in patients with low ABI scores (<0.9) than in those with normal ABI scores (≥0.9). Age, duration of diabetes, and UAE were significantly higher in patients with low TBI scores (<0.6) than in those with normal TBI scores (≥0.6). Albuminuria was independently associated with low ABI (OR=1.980,95% CI=1.001-3.918). It was also independently associated with low TBI and normal ABI (OR=3.149, 95% CI=1.260-7.871). Conclusions: The results of this study suggest that albuminuria may be associated with PAD, including in arteries distal to the ankle joint. (Korean J Med 2011;81:73-81)

비당뇨병 환자에서 인슐린 정주로 치료한 고중성지방혈증에 의한 급성 췌장염 1예

박선영 ( Seon Young Park ),정진욱 ( Jin Ook Chung ),조동근 ( Dong Keun Cho ),이완식 ( Wan Sik Lee ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ),정민영 ( Min Young Chung ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6

Heparin and/or insulin stimulate lipoprotein lipase and are known to decrease serum triglyceride level. However, their efficacy in hypertriglyceridemia-induced acute pancreatitis in nondiabetic patients is not well documented. We report a case of hypertriglyceridemia-induced pancreatitis in 43-year-old nondiabetic woman in whom treatment with insulin was accompanied by reduction in serum triglyceride level and the resolution of pancreatitis. She presented to the emergency department with abdominal pain and biochemical evidence of acute pancreatitis. Her medical history was unremarkable. There was no history of alcohol consumption, and biliary imaging was not remarkable. Subsequent laboratory investigation revealed marked hypertriglyceridemia (1,951 mg/dL), impaired fasting glucose, and normal HbAlc level. The Ranson`s score and APATCH II score were 1 and 4. Abdominal CT showed diffuse enlargement of pancreas, peripancreatic fat infiltration, and multiple fluid collections around the pancreas. We treated the patient with the infusion of 5% dextrose and 1.5 unit/hr regular insulin to reduce serum triglyceride level. The level of serum triglyceride was decreased to 305 mg/dL on day 5. During the remainder of hospitalization, her clinical symptoms and laboratory values gradually improved. (Korean J Gastroenterol 2010;55:399-403)

재발된 그레이브스병 환자에서 항갑상샘약제 재투여 후 발생한 무과립구증 1예

정귀홍 ( Gwi Hong Jeong ),김성균 ( Seong Kyun Kim ),명대성 ( Dae Seong Myung ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2008 대한내과학회지 Vol.75 No.3

Antithyroid drugs are the most common treatment modality for Graves` disease and are used for the treatment of relapsed Graves` disease in Korea. Agranulocytosis is a rare and severe complication of antithyroid drug therapy, and most cases occur within 3 month after drug treatment. Agranulocytosis can develop in patients who have relapsed Graves` disease and undergo a second course of antithyroid drugs with a prior uneventful course of drug therapy. We report a case of antithyroid drug-induced agranulocytosis in a relapsed Graves` disease patient who had undergone prior uneventful antithyroid drug therapy. We also present a review of the relevant literature. (Korean J Med 75:362-366, 2008)

유두 - 여포 혼합형 갑상선암에서 동반된 말단비대증 환자 1 예

이창훈(Chang Hun Lee),천남일(Nam Il Cheon),홍세인(Se In Hong),정진욱(Jin Ook Chung),윤인석(In Seok Yoon),강호철(Ho Cheol Kang),정동진(Dong Jin Chung),정민영(Min Young Chung),조동혁(Dong Hyeok Cho) 대한내과학회 2002 대한내과학회지 Vol.62 No.3

Patients with acromegaly have high incidence of benign or malignant neoplasia than general population and many investigators suggest the stimulatory effect of GH and IGF-1 on mesenchymal cells. Both normal thyroid tissue and thyroid cancer cells express IGF-1 receptor and thyroid cancer cells have more than 3 times. We present a case of acromegaly in patient with mixed papillary-follicular thyroid carcinoma, suggesting the possible carcinogenic role of GH and IGF-1. (Korean J Med 62:307-312, 2002)

제2형 당뇨병 환자에서 초음파 측정 내장지방 지표와 심혈관계 위험인자와의 관계

정귀홍 ( Gwi Hong Jeong ),김성균 ( Sung Kyun Kim ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2007 대한내과학회지 Vol.73 No.6

Background: Visceral obesity is known as an independent risk factor of cardiovascular disease and metabolic syndrome. The objective of this study was to evaluate the association of ultrasonographic-determined visceral fat thickness and other parameters of obesity, metabolic syndrome, and risk factors of cardiovascular disease in type 2 diabetes. Methods: A total of 191 type 2 diabetic patients (101 men and 90 women) participated in this study. Anthropometric, clinical, and laboratory data including the body mass index, waist circumference, blood pressure and lipid profiles were measured. Insulin resistance was calculated by using the homeostasis model assessment-insulin resistance (HOMA-IR). The visceral fat thickness was measured by abdominal ultrasonography at 1 cm above the umbilicus. Results: The visceral fat thickness was positively correlated with the body mass index (p<0.001), waist circumference (p<0.001), fat mass (p<0.001), fat distribution (p<0.001), and HOMA-IR (p<0.05), whereas it was negatively correlated with the HDL-cholesterol level (p<0.05). The visceral fat thickness was better correlated with the presence of metabolic syndrome than with the subcutaneous fat thickness. The highest tertile of visceral fat thickness had a higher odds ratio for hypertension (OR=4.02, 95% CI 1.08~14.98), dyslipidemia (OR=9.64, 95% CI 1.08~85.37), and metabolic syndrome (OR=11.35, 95% CI 1.34~96.00) than did those in the lowest tertile, after adjustment for age, sex, and body mass index. Conclusions: The results of our study show that the measurement of abdominal visceral fat thickness using abdominal ultrasonography can be used as a reliable method to identify the risk for metabolic syndrome and cardiovascular disease in type 2 diabetic patients. (Korean J Med 73:618-630, 2007)

외측 미칩 갑상선에서 발생하여 다발성 전이로 발현된 유두상 갑상선암 1예

천남일,이창훈,홍세인,정진욱,윤인석,조동혁,강호철,정동진,정민영 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4-5