당뇨병 백서의 부신 Glomerulosa세포에서 Angiotensin Ⅱ자극후 인지질분해효소 활성의 변화

성연아 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.1

연구배경: 당뇨병에서 흔히 고칼륨혈증과 대사성 산혈증을 초래 하는 저aldosterone혈증의 원인은 확실히 밝혀져 있지 않으나 혈중의 renin농도와 ACTH, K^+ 자극에 대한aldosterone의 분비는 다양하였으나 angiotensin Ⅱ(A Ⅱ)자극에 대한 aldosterone의 분비는 공통적으로 감소 되어 있다고 보고되었다. 그러나 이러한 AⅡ 자극 aldosterone분비 감소의 기전은 확실히 밝혀져 있지 않다. 본 연구는 당뇨병을 유발시킨 백서에서 생체와 시험 관내 aldosterone분비의 변화양상을 관찰하고 AⅡ 자 극 aldosterone 분비의 감소가 세포막 신호전달계의 이 상에 의해 나타나는지 밝히기 위해 AⅡ 작용의 세포막 신호 전달계중 세포내칼슘증가와 PKC활성화에 중요한 PLC 및 PLD의 활성의 변화를 관찰하여 당뇨병에서 AⅡ 자극 aldosterone분비변화의 기전을 AⅡ의 신호 전달계중 인지질분해효소 활성화를 중심으로 밝히고 이러한 변호가 인슐린 치료에 의해 교정되는지 규명하고자 하였다. 방 법: Sprague-Dawley 백서를 정상대조군, streptozotocin으로 당뇨병을 유발시킨 군, 당뇨병 유발후 인슐린으로 혈당조절을 한 세군으로 분류하고 실험시작 2주후 회 생시켜 혈중 renin과 aldosterone을 측정하였다. 부신 glomerulosa세포를 분리한 후 시험관내에서 ACTH와 K^+ 자극 aldosterone 분비 반응의 변화 및 AⅡ 자극 aldosterone 분비 반응을 측정하였다. AⅡ 자극후 PLC 및 PLD의 활성을 반영하는 IP_3, PA,PEt, DAG를 측정하였다. 결 과: 1)당뇨병백서의 혈장 renin활성도와 aldsoterone 농도는 정상 대조군 및 인슐린으로 혈당을 조절한 군과 유 의한 차이가 없었다(p<0.05). 2)당뇨병백서의 부신 glomerulosa세포의 기저상태, K^+, ACTH자극 aldosterone 분비는 정상대조군과 차이가 없었으나(p>0.05), AⅡ자극 aldosterone의 분비가 정상대조군과 유의한 차이가 없었다.(p>0.05). 3) AⅡ자극에의한 IP_3와 PA, PET, DAG의 생성은 세균간에 유의한 차이가 없었다.(p>0.05). 결 론: 당뇨병백신에서 부신 glomerulosa세포의 AⅡ자극 aldosterone분비가 감소되며 이러한 AⅡ자극 알도스테론 분비 변화는 인슐린의 치료에 의해 교정되고 PLC와 PLD 활성화후 산물의 생성이 정상군과 차이가 없는 것으로 보아 phospholipase의 활성화이후의 신호 전달체계의 결함에 의할 것으로 생각되었다. Objectives : Diabetic patients develop hypoaldosteronism which frequently caused hyperkalemia and metabolic acidosis and diabetic hypoaldosteronism is associated with selective unresponsiveness of aldosterone to angiotensin Ⅱ(AⅡ), but mechanism of defect in AⅡ stimulated aldosterone response still remain unclear. To elucidate the mechanism of defect in AⅡ stimulated aldosterone response and whether the defect was corrected by insulin treatment. author evaluated the responses of aldosterone production to AⅡ, K^+ and ACTH. I also evaluated the products of phospholipase C(PLC) and phospholipase D(PLD) activation important for increase of intracellular calcium and protein kinase C activation after AⅡ activation in adrenal glomerulosa cells prepared from streptozotocin induced diabetic rats. Methods : Two weeks after induction of diabetes by streptozotocin, rats were sacrificed by decapitation. The aldosterone production to AⅡ, K^+ and ACTH was measured by RIA. Inositol triphosphate(IP_3) and diacylglycerol(DAG) generated by activation of PLC and phosphatidic acid(PA), phosphatidylethanol(PEt) and DAG generated by activation of PLD were measured by anion exchange column and thin layer chromatography. Results : 1) Plasma renin activity and aldosterone level were not different among control rats, untreated and insulin treated diabetic rats. 2) basal, ACTH and K^+-stimulated aldosterone production were similar in cells from the three groups(p>0.05), but AⅡ stimulated aldosterone production was significantly decreased in cells from untreated diabetic rats compared with control and insulin treated diabetic rats(p<0.05). 3) AⅡ-induced IP_3, PA, PEt and DAG generation was similar among the three groups(p>0.05). Conclusion : These results suggested that decreased AⅡ-stimulated aldosterone response was present in glomerulosa cells from strepzptocin induced diabetic rats and reversed by insulin treatments. The main defect of altered AⅡ response of zona glomerulosa might be located in the step distal to the activation of phospholipase.

식이섬유질원이 포함된 식이가 흰쥐의 장내 균총조성에 미치는 영향

이상선,이현아,김연희 漢陽大學校 韓國生活科學硏究所 1996 韓國 生活 科學 硏究 Vol.- No.14

This study was performed to investigate the influence of dietary fiber from the whole food on the composition of intestinal microflora in rats. The fiber sources of experimental diets were prepared by drying and milling of small water dropwort(WD), mugwort(MW), butterbur(BB) and apple(AP). Each fiber sources was mixed at the 15% level of the diet. The level of dietary fiber in WD, MW, BB diets was simillar but that in AP diet was slightly low. Male rats of Sprague-Dawley strain were blocked into 5 groups: WD, MW, BB, AP, FF(fiber free), The animal was fed ad libitum each of experimental diets for 37 days. Total viable counts and the numbers of Lactobacillus, Bifidobacterium, Bacteroidaceae, Eubacterium, Peptococcaceae, Streptococcus, Clostridium, Staphylococcus, E. coli were determined by nonselective and various selective media. Food intake of AP and FF groups were lower than the other groups, FF group was lower than the other groups in flood efficiency ratio. Total viable counts were the highest in FF group. The number of Bacteroides, Eubacterium were higher in AP group compared with other groups and that of streptococcus was lower in MW, BB, AP groups than others. The number of Lactobacillus was higher in WD, MW, BB groups than the other groups and that of Bifidobacterium was higher in BB, AP groups. A decrease in the intestinal population of Clostridium was shown in MW, BB groups. These findings suggests that the samll water dorpwort, mugwort butterbur are effective in improving intestinal flora of rats.

단클론항체를 이용한 타액 내 Streptococcus mutans 수준의 측정

김추성,김재곤,양연미,백병주,이경열,김미아,임수민 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.2

Streptococcus mutans는 구강 내에 상존하는 치아우식증의 주요 원인균으로서 치면의 피막에 부착 후 glucan을 형성하여 세균의 군락을 이루며, 외부로부터 공급된 자당대사를 통하여 유기산을 생성함으로써 법랑질을 탈회시킨다. 치아우식 활성도의 평가를 위한 단클론항체를 이용한 방법은 진료실에서 빠른 시간 내에 간편하게 타액에 존재하는 Streptococcus mutans의 정량분석이 가능한 방법이다. 이 연구는 3세에서 6세 사이의 어린이 15명을 대상으로 자극성 타액을 채취하여 시판 중인 단클론항체를 이용한 Salivacheck Mutans, strip을 이용한 Dentocult-SM 그리고 MSB배지 배양법으로서 타액 내 Streptococcus mutans를 측정한 후 그 값을 우식경험치아수와 비교하여 상관관계를 알아보았다. Saliva-check Mutans를 이용한 방법은 Dentocult-SM과 MSB배지법과 통계학적으로 유의한 상관관계를 보였으나 (p<0.05), MSB배지법은 어린이의 우식경험치아수와 통계학적으로 유의한 결과를 나타내지 않았다 (p=0.34). Streptococcus mutans, one of the major causal agents of dental caries, is component of the dental plaque. It produces various organic acids such as lactic acid which is the end-product of glycolysis, and this leads to dental caries. A new system using species-specific monoclonal antibodies was developed to detect Streptococcus mutans in saliva. The system quickly detects salivary Streptococcus mutans in 30min and classifies the result into two levels. The purpose of this study was to investigate correlation between monoclonal antibody-based detecting system and selective medium-based detecting methods. Children's deft indices were also compared with Streptococcus mutans counts in MSB agar plate. Subjects consisted of 15 children in the age of 3 to 6 years. They were assigned to three groups: Group Ⅰ (deft index = 3), Group Ⅱ (deft index ≤ 3), Group Ⅲ (deft index ≥ 4). The results are as follows : 1. The rate of children with positive response was 13.3% and with negative response was 86.7% in the result of Saliva-check Mutans test kit. 2. There was a positive correlation between monoclonal antibody-based detecting system and selective medium-based detecting methods (p<0.05). 3. Streptococcus mutans counts in MSB agar plate were irrelevant to deft of children(p=0.34).

요로결석 환자의 체외충격파쇄석술 치료경과와 결석 특성과의 관련성

김성길,김기순,류소연,한미아,이선옥,노준 朝鮮大學校 附設 醫學硏究所 2009 The Medical Journal of Chosun University Vol.33 No.S

요로 결석에 대한 비 침습적 치료 방법인 체외충격파쇄석술에 의한 치료경과와 결석 특성과의 관련성을 파악키 위해 2002년 12월부터 2008년 3월까지 G시 H병원에서 요로 결석으로 진단되어 체외충격파쇄석술을 받은 33l례를 대상으로 의무기록 자료를 이용하여 분석한 결과는 다음과 같다. 1. 조사 대상자 331례중 남자는 68.6%, 여자는 31.4%이었으며 평균연령(표준편차)은 44.2 (13.9)세 이었고 84%가 G시내 거주자였다. 2. 조사 대상자에게 시행된 체외충격파쇄석술의 평균 시술횟수(표준편차)는 1.9(1.5)회 이었으며 평균 통증제거기간(표준편차)은 3.2(2.1)일 이었고 요로결석 진단 시로부터 치료가 완료되었다고 의사가 판정했을 때까지의 치료기간의 평균(표준편차)은 10.3(8.4)일 이었다. 3. 시술횟수에 통계적으로 유의하게(P<0.01) 관련된 요인은 결석크기, 결석의 방사선 투과성, 요관 폐색여부 이었으며 모형의 설명력은 13.5%이었다. 4. 통증제거기간에 통계적으로 유의하게(P<0.01) 관련된 요인은 결석의 방사선 투과성 이었으며 모형의 설명력은 7.4%이었다. 5. 치료기간에 통계적으로 유의하게(P<0.01) 관련된 요인은 결석크기와 결석의 방사선 투과성 이었으며 모형의 설명력은 13.5%이었다. 따라서 결석의 크기가 크거나 결석이 방사선에 비 투과성일 때, 요관이 폐색되어 있을 때 치료경과가 늦게 됨으로 이러한 사실을 참고 하여 추후 진료지침을 작성 시 보다 효과적이고 효율적인 치료법을 적용할 필요가 있다고 판단되며 보다 체계적인 평가와 연구가 필요할 것이다. Objectives & Methods: To find the treatment process by extracorporeal shock wave lithotripsy (ESWL) and its related stone characteristics in urinary tract stone patients, an analysis was done from medical records of 331 cases who were treated by ESWL from December 2002 to March 2008 at H hospital in G city. Results: Among 331 study subjects 68.6% were male and 31.4% were female. Their mean age (standard deviation, SD) was 44.2 (13.9) years old and 84.0% lived in G city. Average frequency of ESWL done toward study cases were 1.9±1.5 times. Mean duration of disappearance from pain was 3.2±2.1 days and total treatment period for a stone was 10.3±8.4 days. Statistically significant (p<0.01) stone and urinary tract characteristics related with frequency of ESWL were stone size, radio-opacity of the stone, and obstruction of urinary tract. The model composed of these 3 independent variables explained 13.5% of frequency of ESWL. Statistically significant (p<0.01) variable related with disappearance from pain was radio-opacity of the stone, and this model explained 7.4%. Statistically significant (p<0.01) variables related with treatment duration due to stone were stone size and radio-opacity of the stone. These two variables explained 13.5%. Conclusion: The bigger the size of stone are, the slower the treatment process will be. And when the stone is radio-opaque and urinary tract is obstructed, the treatment process will be slower than stone is radio-luscent and urinary tract is not obstructed. So to make effective and efficient treatment manual for ESWL, above fact must be considered and continuous systematic evaluation and research toward ESWL are necessary.

노년기 여성의 식이 섭취 조사를 위한 반정량 식품섭취빈도조사지 개발에 관한 연구

김상연,정경아,장유경 漢陽大學校 韓國生活科學硏究所 2000 韓國 生活 科學 硏究 Vol.- No.18

A data based semiquantitative flood frequency questionnaire, which can be used in studies investigating relationship between diet and cardiovascular diseases in Korean elderly women, was developed. The questionnaire is a 30-minute, face-to-face administered instrument designed especially for assessing food and mixed dishes. Food items were selected from 3-day flood records. 140 food items were finally selected based on the frequency of consumption and the contribution of specific foods to the total population intake of the following 11 nutrients: energy, carbohydrate, protein, fat, cholesterol, SFA, MUFA, PUFA, β -carotene, vitamin C, and vitamin E. The percentage of total nutrient intake which each food provides is presented for the top 50 contributiors of each of the nutrients listed above, as well as the proportion of the population consuming them. Foods sometimes overlooked as important sources are found in some instances to be quantitatively important to population intake, such as carrot as an independent sources of carotenoids. Portion size of each food item was determined considering the mean and median values of the amounts consumed by subjects in the preliminary survey. Frequency of consumption was asked in nine categories ranging from more than 'three times a day' to 'almost never'. A nutrient database was compiled from many sources, but mostly from Korean nutrition society. This flood frequency questionnaire should be useful to epidemiologists with a substantive interest in dietary etiologies and it can reasonably estimate the usual dietary intakes among postmenopausal women for cardiovascular disease study, but shorter form of questionnaire and validation would be needed.

통합심리치료의 인지분화훈련이 정신분열병 환자의 기초 인지기능에 미치는 영향

이희상,현명호,조현상,이연희,김태용,장순아,노규식,정기립,이만홍,유계준 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

연구목적 : 정신분열별 환자들을 대상으로 통합심리치료의 소프로그램인 인지분화훈련을 실시하여 실행기능, 개념형성능력, 언어능력 및 추론력에 대한 훈련이 보다 더 하위단계의 인지기능인 주의력, 기억력, 반응시간 등을 호전시킬 수 있는 지를 알아보고자 하였다. 연구방법 : DSM-IV상 정신분열병으로 진단된 24명의 입원환자를 무작위로 양분하여 한 군은 인지분화훈련군으로 다른 한 군은 대조군으로 나누었다. 훈련군은 4주동안 1주일에 3회(매회 60분간)로 총 12회의 통합심리치료의 인지분화훈련을 받았으며 대조군은 동일한 시간동안 정신건강교육을 받았다. 훈련전후에 훈련군과 대조군을 대상으로 개정판 Wechsler 기억검사로 주의집중력, 장·단기 기억력을 측정하였고 Vienna test system중 결정반응시간검사로 반응시간, 반응결정시간, 반응운동시간을 평가하였다. 연구결과 : 1) 주의집중력에서는 훈련군과 대조군사이에 집단간 효과, 집단내 효과 및 상호작용 효과가 없었다. 2) 단기기억력에서는 훈련군과 대조군사이에 집단내 효과는 있었으나(F(1,24)=10.46. p〈.05). 집단간 효과, 상호작용 효과는 없었다. 3) 장기기억력에서는 훈련군과 대조군사이에 집단내 효과는 있었으나(F(1,24)=15.09. p〈.05). 집단간 효과, 상호작용 효과는 없었다. 4) 반응시간에서는 상호작용 효과(F(1,24)=5.18, p〈.05)가 있었다. 5) 반응운동시간에서는 집단간 효과, 집단내 효과 및 상호작용 효과가 없었다. 6) 반응결정시간에서는 상호작용 효과(F(1.24)=6.00, p〈.05)가 있었다. 결 론 : 통합심리치료의 인지분화훈련은 정신분열병 환자에서 하위단계의 인지기능 중 반응시간(특히 반응결정시간)을 단축시키는 효과가 있었다. Objectives : The purpose of this study was to investigate the effects of cognitive differentiation training of Integrated Psychological Therapy(a training program of executive function, concept formation, language, and abstraction) on micro-level cognitive function such as attention, memory and reaction time in patients time in patients with schizophrenia. Methods : Twenty-four inpatients diagnosed as schizophrenia using DSM-IV were randomly assigned to 2 groups. The training group went through a total of 12 sessions of cognitive differentiation training for 4 weeks. The control group received psychoeducation program during the same period. Wechsler Memory Scale-Revised and Decision-Reaction Timer of Vienna Test System were administered to all patients, both before and after the training program. Results : 1) In the attention and concentration scores of Wechsler Memory Scale-Revised, between group, within group and interaction effects of training were not significant. 2) In the short-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=10.46, p〈0.05), but the between group and interaction effects did not reach significance. 3) In the long-term memory scores of Wechsler Memory Scale-Revised, within group effect of training was significant(F(1,24)=15.09, p〈0.05), but the between group and interaction effects did not reach significance. 4) In the reaction time scores of Decision-Reaction Timer, interaction effect of training was significant(F(1,24)=5.18, p〈0.05). 5) In the motor time scores of Decision-Reaction Timer, between group, within group and interaction effects of training were not significant. 6) In the decision time scores of Decision-Reaction Timer, interaction effect of training was significant(F(1,24)=6.00, p〈0.05). Conclusion : Our findings suggest that cognitive differentiation training of Integrated Psycho-logical Therapy is partly effective on improving micro-level cognitive functions such as reaction time(especially, decision time) in patents with schizophrenia.

폐경 후 여성의 심혈관질환 예방을 위한 식사중재에 대한 준수도(adherence) 평가

정경아,김상연,우정익,장유경 漢陽大學校 韓國生活科學硏究所 2001 韓國 生活 科學 硏究 Vol.- No.19

The purpose of this study is to assess the adherence to dietary intervention for prevention of coronary heart disease (CHD) in postmenopausal women by observing changes of antioxidant vitamins and fatty acid composition in dietary intake and seam level. The subjects with hypercholesterolemia (TC≥240mg/dl) were treated with one of hormone replacement therapy (HRT group), dietary intervention (DIET group) or combination of hormone replacement therapy and dietary intervention (HRT+DIET group) for 12 weeks. The results were as followed. Mean daily nutrient intakes were not significantly changed in the HRT group, but were significantly changed in the DIET group and the HRT+DIET group. Especially, dietary vitamin A and E intakes were increased from less than 75% to more than 90% of RDA for Korean in the two groups. With changes of dietary intakes, serum vitamin A and E levels were also significantly increased in the DIET group and tended to increase in the HRT+DIET group. Dietary fatty acid composition was also not significantly changed in the HRT group, but was significantly chanced in the DIET group and the HRT+DIET group. With changes of dietary fatty acid composition, serum phospholipid fatty acid composition was significantly changed in the DIET group and the HRT+DIET group although there was tendency of returning to initial value after 12 weeks. Judging from changes in serum phospholipid fatty acid composition, subjects' adherence to dietary intervention tended to decrease after 12 weeks. However, the changes of antioxidant vitamins and fatty acid composition in dietary intake were compatible with the changes of those in serum level, and we can conclude that dietary intervention was adhered quite well by subjects.

고콜레스테롤혈증을 지닌 폐경 후 여성의 영양소 섭취 평가

김상연,정경아,장유경 漢陽大學校 韓國生活科學硏究所 2003 韓國 生活 科學 硏究 Vol.- No.21

Women have a greater incidence of coronary heart disease(CHD) after menopause. It relates to hormone imbalance-induced changes in known CHD risk factors, especially hyperlipidemia. Accordingly, once women are diagnosed, the rate of morbidity and mortality is greater than for men. Thus, preventive strategies are critical to improve the quality of life in the later years for women. The purpose of this study was to explore the difference of nutrient intakes and diet quality based on nutrient intake between normocholesterolemia and hypercholesterolemia. The subjects were classified as normocholesterolemia and hypercholesterolemia based on The Guideline for Korean Hyperlipidemia. The semiquantitative food frequency questionnaire was used to measure dietary intakes of the subjects. The results obtained are summarized as follows. Intakes of nutrients such as energy, carbohydrate, protein, fat, minerals and antioxidant vitamins were not significantly different between normocholesterolemia group and hypercholesterolemia group. However, antioxidant vitamins and folate intakes in hypercholesterolemia group tended to be lower than those in normocholesterolmia group. Intakes of vitamin A, vitamin E, and Ca in normocholesterolemia and hypercholesterolemia groups were below RDA. In particular, RDA for those nutrients in hypercholesterolemia was much less than RDA for those nutrients in normocholesterolemia. MAR and INQ in hypercholesterolemia group tended to be lower than those in normocholesterolemia. In particular, INQ of vitamin A was significantly(p<0.05) lower in hypercholesterolemia group than in normocholesterolemia group. These results indicate that it is important to use various diet quality index based on nutrient intake such as % RDA, NAR, MAR, and INQ to explore the relationship between blood cholesterol and nutrient intake. Key words : postmenopausal women, hypercholesterolemia,, % RDA, NAR, MAR, INQ

Chlorhexidine과 fluoride 성분의 varnish가 타액 내 mutans streptococci 수에 미치는 효과

서정아,김재곤,백병주,양연미,이용희,김상훈 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.4

본 연구의 목적은 chlorhexidine(Cervitec)과 fluoride(Fluor-protector) 성분을 각각 포함한 varnish를 치아에 적용하였을 때 타액내의 mutans streptococci의 수의 감소에 미치는 효과를 알아보기 위한 것이다. 전북대학교 치과대학생 40명을 대상으로 하여 mutans streptococci 균종 수를 평가하였으며, 이들을 무작위로 네 군으로 나누어 다음과 같이 varnish를 적용하였다; A) varnish를 적용하지 않은 군(n=10), B) chlorhexidine varnish 적용군(n=10), C) fluoride varnish 적용군(n=10), D) chlorhexidine과 fluoride varnish를 모두 적용한 군(n=10), Mutans streptococci 수 측정에는 Orion diagnostica 사의 Dentocult SM을 사용하였다. Varnish를 적용하지 않은 상태에서 1차로 Mutans streptococci 수를 측정한 후 각각의 varnish를 적용하였으며, varnish 적용 12주 후 다시 측정하여 기록하였다. 모든 실험군(group B, C, D)에서 12주 후에 측정한 Mutans streptococci 수가 감소한 개체가 증가한 개체보다 많았으나 통계적으로 유의한 차이는 보이지 않았다(p>0.05). 실험에 사용된 어떠한 varnish도 적용 12주 후에 타액 내 mutans streptococci 수에 통계적으로 유의할 만한 변화를 주지는 못하는 것으로 나타났다(p>0.05). The objective of the present prospective trial was to compare the efficacy of chlorhexidine(Cervitec), Fluoride(Fluorprotector) and combination of chlorhexdine and fluoride varnishes in decreasing the level of salivary mutans streptococci. Forty healthy students of school of dentistry, Chonbuk national university were investigated to evaluate mutans streptococci(MS) counts and randomized into four groups to treat with the experimental varnishes: A) untreated group(n=10), B) chlorhexidine group(n=10), C) fluoride group(n=10), D) chlorhexidine and fluoride group(n=10). Dentocult SM^(�)(Orion Diagnostica) strip method was used for measurement of the level of mutans streptococci in saliva. Stimulated saliva were collected at baseline for mutans streptococci counts evaluation(ms1), 12 weeks later the completion of each varnish treatment, mutans streptococci counts were re-evaluated. In varnish group with chlorhexidine, fluoride and combination of chlorhexidine and fluoride, the level of mutans streptococci was lower after 12 weeks than at baseline, but there were no significant differences in saliva(p>0.05), when compared with baseline. After 12 weeks, a remarkable reduction was still found in the subjects with high level of mutans streptococci at baseline, but not different in the low and moderate level of mutans streptococci(p>0.05).

Inoue Balloon을 이용한 PMV의 장·단기 결과 분석

진은선,이연아,전숙,김현숙,정승묵,박상선,최락경,임달수,홍석근,황흥곤 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.11