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김현,도용호,김재일,최현준,우재룡,박찬록,하태환,Kim, Hyeon,Do, Yong-Ho,Kim, Jae-Il,Choi, Hyeon-Jun,Woo, Jae-Ryong,Bak, Chan-Rok,Ha, Tae-Hwan 대한핵의학기술학회 2020 핵의학 기술 Vol.24 No.1
사구체 여과율은 신 기능의 평가와 신 질환의 경과 관찰에 중요한 지표다. 현재 임상에서 사구체 여과율을 측정하는 방법은 크게 혈청 크레아티닌 수치와 <sup>99m</sup>Tc-DTPA을 이용해서 계산하는 검사가 유용하게 이용되고 있다. Gates 공식이 발표된 이후, <sup>99m</sup>Tc-DTPA Renal Dynamic Scan 검사시 이를 적용해 GFR을 감마카메라 장비를 이용하여 측정하고 있다. 본 논문의 목적은 Gates 공식을 적용해 사구체 여과율을 측정할 때 동위원소의 용량 변화, Matrix Size 변경에 따른 사구체 여과율을 분석해 보고자 한다. 본원에서 <sup>99m</sup>Tc-DTPA Renal Dynamic Scan 검사를 받은 성인 환자 5명 (환자나이 = 62 ± 5, 남자 3명, 여자 2명)의 결과를 분석하였다. <sup>99m</sup>Tc-DTPA 15 mCi를 환자의 정맥에 순간 주사 후 21분간 동적 영상을 획득하였다. Activity, Matrix Size 변화에 따라 사구체 여과율을 평가하기 위해 2-3분 구간의 양쪽 신장과 조직에 관심 영역을 설정 후 총 계수를 측정하였다. Detector와 Table 간의 거리는 30cm로 유지하였고, 동위원소의 용량 변화 평가를 위해 Pre Syringe(PR)의 용량을 15, 20, 25, 30 mCi로 설정하였고, Post Syringe(PO)의 용량을 1, 5, 10, 15 mCi로 각각 설정하였다. 그리고 각각의 Matrix size를 32 × 32, 64 × 64, 128 × 128, 256 × 256, 512 × 512, 1024 × 1024로 변경하여 값을 비교 평가하였다. Matrix Size에서 동위원소의 용량이 증가할수록 사구체 여과율의 차이는 최대 52.95%에서 최소 16.67%로 점차 감소하였다. Matrix size 변화에 따른 사구체 여과율 값은 128에서 256, 256에서 512, 512에서 1024로 변경 시 2.4%, 0.2%, 0.2%로 유사하게 나타났으나, 32에서 64, 64에서 128로 변경 시 54.3 %, 39.43%로 GFR 값의 차이가 발생하였다. 마지막으로, 현재 사용 중인 256 Matrix, Pre syringe 15 mCi의 GFR 값을 기준으로 32 Matrix, Pre Syringe 15 mCi, Post Syringe 1 mCi 조건에서 82%로 가장 큰 차이가 발생하였고, 64 Matrix, Pre Syringe 30 mCi, Post Syringe 15 mCi의 조건에서 0.2%로 유사한 결과 값을 나타내었다. 본 논문을 통해 <sup>99m</sup>Tc-DTPA Renal Dynamic Scan에서 Gates 공식을 이용해 사구체 여과율을 측정할 때, 동위원소의 용량과 Matrix Size 변화에 따라 사구체 여과율 측정에 영향이 있음을 확인하였다. 그러므로 각 병원에서 이를 적용해 GFR을 측정할 때 적절한 Parameter를 적용해서 검사의 유용성을 높아야 한다고 생각한다. Purpose Glomerular Filtration Rate(GFR) is an important indicator for evaluating renal function and monitoring the progress of renal disease. Currently, the method of measuring GFR in clinical trials by using serum creatinine value and <sup>99m</sup>Tc-DTPA(diethylenetriamine pentaacetic acid) renal dynamic scan is still useful. After the Gates method of formula was announced, when <sup>99m</sup>Tc-DTPA Renal dynamic scan is taken, it is applied the GFR is measured using a gamma camera. The purpose of this paper is to measure the GFR by applying the Gates method of formula. It is according to effect activity and matrix size that is related in the GFR. Materials and Methods Data from 5 adult patients (patient age = 62 ± 5, 3 males, 2 females) who had been examined <sup>99m</sup>Tc-DTPA Renal dynamic scan were analyzed. A dynamic image was obtained for 21 minutes after instantaneous injection of <sup>99m</sup>Tc-DTPA 15 mCi into the patient's vein. To evaluate the glomerular filtration rate according to changes in activity and matrix size, total counts were measured after setting regions of interest in both kidneys and tissues in 2-3 minutes. The distance from detector to the table was maintained at 30cm, and the capacity of the pre-syringe (PR) was set to 15, 20, 25, 30 mCi, and each the capacity of post-syringe (PO) was 1, 5, 10, 15 mCi is set to evaluate the activity change. And then, each matrix size was changed to 32 × 32, 64 × 64, 128 × 128, 256 × 256, 512 × 512, and 1024 × 1024 to compare and to evaluate the values. Results As the activity increased in matrix size, the difference in GFR gradually decreased from 52.95% at the maximum to 16.67% at the minimum. The GFR value according to the change of matrix size was similar to 2.4%, 0.2%, 0.2% of difference when changing from 128 to 256, 256 to 512, and 512 to 1024, but 54.3% of difference when changing from 32 to 64 and 39.43% of difference when changing from 64 to 128. Finally, based on the presently used protocol, 256 × 256, PR 15 mCi and PO 1 mCi, the GFR value was the largest difference with 82% in PR 15 mCi and PO 1 mCi. conditions, and at the least difference is 0.2% in the conditions of PR 30 mCi and PO 15 mCi. Conclusion Through this paper, it was confirmed that when measuring the GFR using the gate method in the <sup>99m</sup>Tc-DTPA renal dynamic scan. The GFR was affected by activity and matrix size changes. Therefore, it is considered that when taking the <sup>99m</sup>Tc-DTPA renal dynamic scan, is should be careful by applying appropriate parameters when calculating GFR in the every hospital.
강화지역 성인남녀의 12년간 고혈압 발생률과 위험요인: 강화연구
김현창,지선하,이강희,김창수,남정모,서일,Kim, Hyeon-Chang,Jee, Sun-Ha,Lee, Kang-Hee,Kim, Chang-Soo,Nam, Chung-Mo,Suh, Il 대한예방의학회 1999 예방의학회지 Vol.32 No.4
Objectives: The purpose of this study was to examine the twelve-year incidence of hypertension, and to find risk factors for the incidence in adult population in Kangwha County, Korea. Methods: In 1986, 413 males(mean age 37 years) and 434 females(mean age 33 years) were examined in the Kangwha Study, Among 764 non-hypertensive participants, 164 males and 214 females were reexamined in 1998. Blood pressure(BP) was measured with standard mercury sphygmomanometers. Multiple logistic regression analysis was used to estimate the relative risk of risk factors on the incidence of hypertension. Results: During the 12-year period, 68 of 164 males and 53 of 2f4 females developed hypertension. In a multiple logistic model adjusted for age and pulse rate, baseline BP, baseline body mass index(BMI) and BMI change during the follow-up period were significantly related to the incidence of hyperiension. Adjusted relative risk(RR)s of baseline high-normal BP were 3.90(95% CI: 1.81-7.84) in males, and 12.72(95% CI: 3.70-30.73) in females. Compared with lower baseline BMI group, adjusted RRs of middle baseline BMI group were 2.66(95% CI: 1.19-5.70) in males, and 2.33(95% CI: 0.95-5.55) in females. Adjusted RRs of upper baseline BMI group were 3.52(95% CI: 1.53-7.67) in males and 3.63(95% CI: 1.50-8.43) in females. Increase of BMI was positively related to the incidence in males(adjusted RR=2.71, 95% CI: 1.00-6.71) and females(adjusted RR=3.05, 95% CI: 1.29-6.88). Conclusions: The twelve-year incidence of hypertension was 41.5% in males, and 25.8% in females. Baseline BP, baseline BMI, and BMI change were strongly related to the incidence of hypertension.