쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

제 2형 콜라겐에 의해 경구관용 유도된 DBA/1 mice에서의 세포면역반응

양형인 ( Hyung In Yang ),김완욱 ( Wan Uk Kim ),민도준 ( Do Jun Min ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),이상헌 ( Sang Heon Lee ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.4

Objective: To investigate the dosage of bovine type II collagen (BnCII) for the induction of oral tolerance in CIA animals, and to verify the changes of immune response and TGF-β production of mesenteric lymph node cells in tolerized CIA animals. Methods: Oral tolerance was induced by feeding of variable doses (5㎍, 10㎍, 20㎍ and 40㎍) of BnCII to DBA/1 mice 4 times per week during 2 weeks, and control mice were given ovalbumin (1000㎍), before immunization. We examed clinical assessment; incidence of arthritis, severity of arthritis, arthritic limb by visual analysis. IgG antibodies to BnCII were measured by ELISA, T cell responses to BnCII and PHA were quantified by antigen (CII)-induced 3H-thymidine incorporation into lymphocytes of mesenteric lymph node, draining lymph node, and spleen. TGF-β in supernatants obtained from lymph node culture medium was measured by ELISA. Results: Arthritis limbs were observed in 100% of control at 5 weeks after subcutaneous BnCII injection. The incidences of CIA in all tolerized group were significantly lower than that in control 5 weeks after immunization (control 100% vs. 5㎍ feeding group: 50%, 10㎍ feeding group: 50%, 20㎍ feeding group: 50%, 40㎍ feeding group: 55.5%, P<0.01). In comparison to control, mean articular indices were lower in all tolerized groups (control 5.13: 5㎍ feeding group 3.50, 10㎍ feeding group 2.75, 20㎍ feeding group 2.87, 40㎍ feeding group 2.63, P<0.05). Arthritic limbs were also significantly lower in tolerized groups (control 58.3: 5㎍ feeding group 20.8, 10㎍ feeding group 16.7, 20㎍ feeding group 20.8, 40㎍ feeding group 20.8, P<0.05). The titers of IgG antibody to CII were lower in tolerized group than that in control [tolerized group; median 10 (min. 0, max. 48), control; median 33 (min. 8.6, max. 101), P<0.05]. The proliferative responses to BnCII were significantly suppressed in tolerized (control 8010±2319cpm, tolerized group 4500±2060cpm, P<0.01). High TGF-β production was noted in tolerized group (control; 28pg/ml, BnCII feeding group; 73pg/ml). Conclusion: Oral tolerance in DBA/1 mice was successfully induced from low doses of BnCII (5㎍) and suppressed T and B cell function in conjunction with increased TGF-β production may play an important role for the induction of CII induced oral tolerance in DBA/1 mice.

유제놀에 의한 즉시형 알레르기 반응의 억제

김상현,신태용,김형룡,이영미,이은희,신보경,김윤철,안년형,김형민 우석대학교 의약품개발연구소 1996 藥學硏究誌 Vol.1 No.-

The current study evaluates the capacity of eugenol to regulate immediate allergic reaction by control of histamine release. Administrations of eugenol (1 M/kg. i.p.) at 60 min before and 5.10 min after the compound 48/80 treatment (8 mg/kg.i.p.) were shown the mortality rates as 0.44.4. and 77.8%. respectively. A 60 min before administered group revealed a singificant inhibition of serum his-tamine release compared with those of 5 and 10 min after the compound 48/80 injection. Eugenol (6-48mM) was also showed a dose-dependent activity on the compound 48/80-induced histamine release from the highly purified population of Alcian Blue-positive peritoneal mast cells. These results indicate that in vitro treatment with exogenous eugenol inhibited the active response of mast cell populations and modulated its characteristics.

다발성 말초신경병증의 조기진단 : 적외선 체열촬영검사와 전류지각역치검사의 조합진단 Combination Diagnosis Using by Digital Infrared Thermogram and Current Perception Threshold

이삼규,김재형,최인성,이소영,한재영,조성렬,김재휴,노성만,정민영,정동진,김현성 全南大醫大 2001 전남의대학술지 Vol.37 No.3

원인 불명의 실신 환자의 진단에 있어서 Head - up tilt Test 의 유용성과 혈관미주신경성 실신 환자의 임상적 특징

윤호중(Ho Joong Youn),정욱성(Wook Sung Chung),백상홍(Sang Hong Baek),김철민(Chul Min Kim),박인수(In Soo Park),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1994 대한내과학회지 Vol.47 No.2

N/A Background: Syncope, defined as a transient loss of consciousness, is a frequently encountered symptom, but despite thorough clinical and invasive diagnostic investigation, the cause of syncope remains unexplained. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. We studied to define the usefulness of various diagnostic test in the evaluation of patients with recurrent syncope, to assess the usefulness of head-up tilt test in the working of syncope of unknown origin and to evaluate the clinical characteristics of subgroups of patients with syncope induced by head-up tilt test. Methods: Between June, 1991 and November, 1992 at St. Mary`s hospital, 21 patients with history of syncope and 24 control subjects without history of syncope underwent 60° head-up tild test for 60 min. Results: 1) The definite cause for recurrent syncope were diagnosed in 10 of patients (47,6%) after clinical and invasive tests. 2) During head-up tilt test, vasovagal responses were provoked in 5 of 21 patients (23.8%) with recurrent syncope and 1 of 24 patients (4.2%) without syncope (p<0,05). 3) The head-up tilt test induced symptomatic bradycardia or hypotension in 3 of 10 patients (30%.) with negative electrophysiologic results. 4) During tilt induced vasovagal response, a) mean heart rate decreased to 42±24 beat/min from supine control of 70±12 beat/min (p<0. 05), b) mean systolic blood pressure decreased to 95±12 mmHg from supine control of 120±S mmHg (p<0,05), c) mean diastolic blood pressure decreased to 60±21mmHg from supine control of 72±13 mmHg (p<0.05), d) the time interval to onset of vasovagal response was 22±12 min. Conclusions: 1) In a large proportion of patients with recurrent syncope, the diagnosis remains unexplained despite a neurologic and cardiologic investigation including an electrophysiologic study. 2) Vasovagal responses are frequent cause in patients with recurrent unexplained syncope. 3) The head-up tilt test may be a simple, safe and highly yielding provocative test in the investigation of syncope of unknown origin.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

지형학적 순간단위도 유도에 관한 연구

민병형,서진호,이상배 東亞大學校 海洋資源硏究所 1994 硏究論文集 Vol.7 No.2

The Instantaneous Unit Hydrograph Method are presented for representation of the effective rainfall-runoff hydrograph by using the Geomorphologic parameter of a basin. The channels in the network are numbered according to the Starahler scheme, and the mathematical formulation corresponding to the existing techniques adopted by Rodriguez-Iturbe and Valdes. The applicability of the Geomorphologic Instantaneous Unit Hydrograph(GIUH) to the real drainage basins is tested using the data observed in a few IHP basins by the Least square Method(LSM), the Synthetic Unit Hydrograph Method(SUHM) and Moment Method(MM). The results of simulation cases such as LSM, SUHM and MM for observed data were promising, and their efficiency error rates were 16%, 113% and 52%, respectively. LSM was approved to be used for prediction of the basins.

상악 구개측 중앙부에 매복된 과잉치

민성진,최형준,,김성오,이제호,곽지윤,최병재 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.4

과잉치는 치배 형성기에 정상 치판의 과도한 증식의 결과로 발생하며 산발적일 수도 있고 유전적일 수도 있다. 발생 빈도는 1~3%이며,2:1의 비율로 남아에게 호발한다. 주로 상악 전방부에서 많이 발견되며, 매복, 영구치의 위치 이상, 정중부 이개, 낭종, 비강으로의 맹출 등과 같은 다양한 합병증을 나타낼 수도 있다. 상악 전방부에서 발견되어지는 과잉치는 치축방향에 따라 위치가 결정되며 상악 전방부 과잉치의 1/3 정도는 역위 매복되어 맹출의 가능성이 없지만, 치낭의 치관 부위가 정상적인 관계로 존재하는 한 과잉치의 이동이 일어날 수 있다. 치아의 이동은 경구개, 소구치 부위, 비강까지도 일어날 수 있다. 또한 전상악 수직고경의 성장으로 시간이 지남에 라 외과적 접근이 어려워질 수 있다. 이에 본 두 증례에서는 역위 매복된 상악 전방부의 과잉치가 구개 측 중앙부까지 이동된 것을 발견하여 외과적으로 제거하였다. Supernumerary tooth develops as a result of abnormal proliferation of the dental lamina during the initiation stage of dental development. It could be a sporadic occurrence or a hereditary transmission. Supernumerary tooth occurs with a frequency of 1 to 3%, Generally, there is a 2:1 preference for boys. It is usually found in the anterior portion of the maxilla and may be associated with complications such as impaction, malposition of permanent teeth, formation of diastema, cysts and eruption into nasal cavity. The position of supernumerary tooth found in the anterior portion of the maxilla is determined by the axis of the tooth. One third of supernumerary tooth in the anterior portion of the maxilla has no possibility of eruption due to its invertedly impacted position. However, as long as the coronal part of the follicle remain intact, migration of supernumerary tooth is possible. The migration may occur into the palate, the premolar region, the sinus or the nasal cavity. Also, growth of vertical dimension of maxilla could make surgical approach difficult as time goes by. For this reason, we have found invertedly impacted mesiodens moved to the vault of the palate in the two cases, and extracted supernumerary tooth surgically.

쌍곡선형 완경사방정식을 이용한 비스듬한 입사파에 대한 연구

민병형,김인철,민일규,허상기 東亞大學校 海洋資源硏究所 1992 硏究論文集 Vol.5 No.1

Various kinds of calculation method for wave field have been proposed but some problems remain with regard to the accuracy of the shoaling coefficient(Tanimoto and kobune, 1975) or to the boundary conditions(Berkhoff, 1976). Thus, a hyperbolic mild slope equation was based on the flow rates and the wave surface elevation by Maruyama and Kijima(1985) but this model could not be calculated for waves moving obliquely into a wave field. In this study the fault of the hyperbolic mild slope equation is elliminated by treating lateral boundary condition as incident boundary condition. The result that the modified model is applied to a simple wave field agrees to the exact solutions.

하천 수변공간 개발에 관한 연구

민병형,김가현,이승휘,이정환,유상호 동아대학교 건설기술연구소 2001 硏究報告 Vol.25 No.1

The concern for a cleaner environment together with the need to conserve and reuse our resources has created a challenge for which sanitary engineers, working with environmentalist, will be called upon to find new solutions over the next few years. The result of the study of development of the River's waterfront run as follows. 1. The introduction of the water facilities (which is) utilized in the neighborhood by adjacent citizens and the development of the water site (which is) equipped with facilities for environment must be actually progressed. 2. The concerned authority's favorable complation of the budget must be made up to construct the facilities as the district. 3. Close investigation on the coast and arbores and so on, must be progressed to develop the river in a manner (which is) close to nature.