현암 김종희 회장의 생애와 경영이념 연구

김성수(Sung Soo Kim) 한국경영사학회 2009 經營史學 Vol.52 No.-

이 논문은 한국 화약산업의 개척자 한화그룹의 창업주 현암 김종희 회장의 생애와 경영활동 연구를 통한 경영이념 및 신 기업가정신(New Entrepreneurship)을 발굴하는 데 목적을 두었다. 현암 김종희 회장은 1922년 11월에 출생하여 1981년 7월(59세)에 영면 하였다. 비교적 짧은 생을 살았지만, 현암 김종희 회장은 1952년 30세 때에 화약산업의 불모지인 한국에서 한국화약㈜을 창업하였다. 그는 ‘다이너마이트’ 생산의 성공으로 혁신적인 화약류 국산화의 꿈을 실현한 훌륭한 기업가이다. 그는 한화그룹의 창업주로서 화약, 석유화학, 기계, 호텔, 건설, 무역 등 생전에 17개의 대기업집단을 이룬 창업 CEO이다. 그는 신의와 혁신, 도전과 개척 정신 그리고 변혁적 리더십 소유의 기업가로, 한국의 화약산업 개척자로서 화약산업사의 역사적 인물로 부각되며, 우리나라 화약산업의 기업 가사 연구의 중요한 경영사학적 사례를 제공한 기업인으로 평가된다. 그는 생애 경영활동을 통하여 사업보국 이념을 중심으로 ‘신용과 의리 그리고 봉사’로서 인류사회에 공헌하고자 하는 경영이념을 실현한 기업가이다. 특히 사업보국을 이념으로 발굴된 그의 신 기업가정신은 이 연구에 큰 의미를 준다. 즉, (1) 신의정신, (2) 도전과 개척정신, (3) 책임정신, (4) 근검절약정신, (5) 합리주의 정신, (6) 창의와 혁신정신, (7) 인재육성정신 등 7개의 기업가정신으로 나타나고 있다. 그리고 그의 혁신적 기업인 상은 (1) 인간성 중시의 변혁적 리더십을 소유한 기업인으로 대표되며, (2) 정도경 영을 실천한 기업인 (3) 경영이념(사업보국주의)을 통한 생산성 향상 정신을 실천한 기업인, (4) 혁신경영과 기술개발 노력을 실천한 기업인, (5) 위기극복과 문제점 해결능력을 갖춘 기업인 등으로 평가된다. 특히 (6) 국익증대의 선봉에 선 민간 외교관, (7) 스포츠 강국을 꽃피운 체육계의 거목이라는 경영인 상을 가진 기업가로도 높이 평가된다. The purpose of this study is to explore the chairman Chong-Hee Kim’s life and Managerial ideology, founder of Hanwha group. This research was to Highlight the entrepreneurship of chairman Chong-Hee Kim of Korea explosive founded (currently Hanwha Corp. Explosive Division), who carries the management principle which focuses on the devotion to business patriotism of social responsibility by providing best products and services with talent and technology. Also it aimed to revisit the life and the management principle of chairman Chong-Hee Kim who, with the business patriotism of righteousness and sense of mission, tried to found korea’s first gunpowder corporation. This research was mainly divided into two parts:literature-history research method and managerial history research method, and it analyzed the managerial accomplishment chronically according to the literature history documents, and managerial history method. This study took 12 months in which the document collecting process, writing process, and 6 party joint research processes were completed. The content of the research divided and categorized chairman Chong-Hee Kim’s life and managerial principle in the following order:(1) Social back ground at time of his birth (2) Elementary, middle and high school education in his teenage period (3) Business career begins (age 20-30) in his adolescent (4) 30s (age 31-40):president inauguration of the korea explosive founded, (currently Hanwha corp.explosive division), and his management his managerial growth process in his early adult life, in case, oct, 1952 korea explosive founded (gunpowder corp), oct, 1955 Incheon explosive plant acquired, jan,1959 all domestics industrial explosive suppled by korea explosives (5) 40s (age 41-50):his managerial revolution process in his middle the prime of the life, in case, Jan, 1964 Shinhan bearing industrial acquired, Nov, 1969 Kyungin energy established (6) 50s (age 51-59):genius management and establishment of the leading corporation in the Korean defense industrial and diversified management in his latter the prime of the life. In case, dec,1972, Hankook plastics industrial established, sept, 1974, union polymer established (currently Hanwha polydreamer), may 1975, Cheon-an Bukil foundation established, may 1976, sundo securities acquired (currently Hanwha securities). Next, the entrepreneurship through chairman Chong-Hee Kim’s managerial creed and ideology was examined. The 7 elements of Chong-Hee Kim’s new entrepreneurship of business patriotism that were examined are as follows : (1) Spirit of faithfulness (2) Spirit of challenge and pioneer (3) Responsibility for the fulfillment of obligation (4) Spirit of diligence and frugality (5) Spirit of rationalism for management (6) Spirit of creative and Innovation (7) Spirit of corporative social responsibility and service to society His entrepreneurship is based on the transformational leadership of rich humanity and management of righteousness, he is pioneer of schumpeter’s (J.A), and the creative entrepreneur who seeks for Innovation. The management philosophy of Hanwha (chong-hee, kim) is embedded in the Hanwha TRI circle ; the three circles Represent Trust, Respect and Innovation, respectively. They are the three pillars of how it’s conduct our business. Vision of Hanwha (chong-hee, kim) is just as committed being trustworthy, respected and Innovative as a responsible member of society as the Hanwha be to becoming dynamic global enterprise. As symbolized in the Hanwha TRI Circle, Trust, Respect and Innovation are core value as its interact with customer, serve our community and improve the everyday lives of people in general.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common 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 Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

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.

김재철 회장의 생애와 기업가정신 연구

김성수(Sung soo Kim) 한국경영사학회 2009 經營史學 Vol.50 No.-

이 논문의 목적은 “성실한 기업활동으로 사회정의 실현”과 “도전과 정도경영”에 바탕을 둔 동원그룹의 창업자 김재철 회장의 생애와 경영활동을 통한 기업가 정신(Entrepreneurship)을 발굴하는 데 있다. 김재철 회장은 1969년 34세때 동원산업(주)를 창업한 현재(2009년 4월)까지 40여년간 한국수산업계를 선도해온 창업자이면서 전문경영자(CEO)이며, 식품산업으로 시작하여 1차산업에서 2차산업으로 그리고 3차산업의 금융 및 서비스산업까지 사업다각화로 동원그룹을 세계적(Global)기업으로 발전시킨 창조적, 혁신주의 기업가이다. 이러한 동원그룹의 김재철 회장의 연구는 다음과 같은 네 가지의 중요성을 가지고 있다. 첫째, 동원그룹 창업자 김재철 회장의 생애와 경영이념을 고찰하여, 동원창업자의 Entrepreneurship을 발굴하여, 한국기업가사 연구의 체계적 정립을 마련하는 데 있다. 둘째, 동원 김재철 회장은 슘페터(J. A, Schumpeter)가 지적한 혁신적(Innovation) 경영활동을 적용해서 “동원경영학”의 정립을 체계화시키는 데 노력하고 있다는 점이다. 셋째, 대표적 수산업의 CEO 김재철 회장 경영활동을 통하여 “동원수산경영”의 발전과정을 경영사학계에 보급시키고자 하는 기초자료 제공에 있다. 넷째는 앞으로 해양수산업의 관리자 및 CEO가 되고자하는 청소년 및 대학생들에게 기업가 정신(Entrepreneurship)의 중요성을 인식케 하는 기초자료를 제공하는 데 있다. 본 논문은 경영사연구방법론을 채택하였다. 경영사의 개척자인 미국하버드 경영대학원(Harvard University, Graduate School of Business Administration=HBS) 경영사 교수인 그라스(Norman Scott Brien gras)와 챈들러(Alfred, D. Chandler)박사 등이 개발하고 활용하여 전 세계 학계에 보급한 ‘경영사연구방법론’을 도입하여 활용하였다. 이에 따라 동원의 김재철 회장이 추구하는 가치와 정신은 고객/주주 제일주의, 1등주의, 현금흐름주의 등이며, 21세기 그의 정신은 (1) 창조정신, (2) 열성정신, (3) 도전정신 등 ‘Candoism’으로 요약된다. 또한 그의 기본사상은 (1) from the basic(기본의 철저한 준수) (2) fact finding(현장주의 업무수행 자세) (3) global standard(국제수준의 업무품질) 등으로 나타났다. 그리고 성실한 기업 활동으로 사회정의 실현을 선도하는 가치는 (1)생활문화의 New Leader로서 위상을 향상시키는 사업가치 (2) 고객을 존중하고 만족시키며, 동원그룹을 창조기업으로 승화시키는 고객가치 (3) 1등주의 인재육성과 성과조직을 인적자원관리의 최우선으로 하는 인재가치 등을 확인할 수 있었다. This study was to highlight the entrepreneurship of chairman Jae-Chul Kim the founder of Dongwon Industries Co., Ltd, who carries the management principle which focuses on the devotion to under the realization of social justice, the function of the enterprise will be done in honesty and loyalty. Dongwon creates fresh and new experiences into the customers’ lives. it will be the prime company that leads the lifestyle culture in the 21st century. Also it aimed to revisit the life and the management principle of chairman Jae-Chul Kim who, with the new management, tried to found world’s first human corporation social responsibility. This study was mainly divided into two parts:literature-history research method and managerial history research method, and it analyzed the managerial accomplishment chronically according to the literature history documents, and managerial history method. this research took 8 months in which the document collecting process, writing process, and 7 party joint research processes were complete. The content of the research divided and categorized chairman Jae-Chul Kim’s life stages and managerial principles in the following order:(1) social back ground at the time of his birth (2) elementary, middle and high school education in his teenage period (3) university and establishment of oneself in life, one’s youth period is the time of adventure and daring (4) president inauguration and the foundation of the Dongwon Industries Co., Ltd and his management and his managerial growth process in his early adult life, (5) genius management and new experience creator-Dongwon group of the leading enterprise in the world in his latter adult life Next, the entrepreneurship through chairman Jae-Chul Kim’s managerial principle was examined. The 10 element of Jae-Chul Kim’s new the Entrepreneurship that were examined are as follows : (1) Spirit of a Sincerity and Credit (2) spirit of creativity and Innovation (3) spirit of earnestness (4) spirit of challenge and cultivation(development). (5) spirit of customer satisfaction (6) spirit of human respect (7) spirit of Justice (right) management (8) spirit of responsibility and autonomous(self-control) (9) spirit of stage management or artistic management (10) spirit of corporate social responsibilities. Dongwon corporation’s chairman Jae-Chul Kim carries the entrepreneurship principles such as (1) management that gives happiness to the customers (2) management that respects people (3) management that creates new value (4) living up to the fundamental principle (5) applying significance to even a small matter (6) challenging any new tasks, etc. His entrepreneurship is based on the righteous managerial spirit, known as “I need to be the challenge and innovation”, which aims to reflect the past and analyze today’s critical situation. especially his righteous managerial spirit is leading the Dongwon Group as the global corporation through Business ethics, humanity, innovation, etc. therefore, he is pioneer of Schumpeter’s(J.A), and the creative entrepreneur who seeks for innovation. He is reviewed as one of the greatest 21st century manager who carries these 6 characteristics:(1) artistic mind of stage management (2) positive mind (3) emphasis on self-changing (4) faith and trust (5) keeping endurance and rule (6) having courage not to be afraid of failure (7) emphasis on social contribution.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

최대 암에르고미터 운동 시 경험 유·무에 따른 척수 장애인의 환기역치 비교

김태수,김성수,윤성진,황부근,이동희,이강우 한국특수체육학회 2004 한국특수체육학회지 Vol.12 No.3

The purpose of this study was to determine the effect of state for training at the VT using other relative physical factors as like a VT-Sec, VT-VO2peak, VT/VO2peak%, VO2peak, VT-HRpeak, VT/HRpeak%, HRpeak, with individuals with spinal cord injuries. The participants were composed of 7 spinal cord injured wheelchair basketball athletes who are involved with regular activity, 5 spinal cord injured sedentaries who are not involved any regular activity. The statistical procedures used to the analysis were unpaired T-test. The results were as follows; First, the significant differences in VT-Sec, VO2peak were observed between 2 groups. Second, the validity of 44-72VT/V O2peak% and 56.78VT/HRpeak% is suggested as an alternative exercise intensity by individuals with all spinal cord injuries.

구강악안면 영역의 치성 감염 환자에 대한 세균학적 연구

김일규,윤승환,오성섭,최진호,오남식,김의성,이성호,배수환,강문수 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.4

Oral & maxillofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting, they may occasionally spread deeply into fascial spaces or planes far from the initial site of involvement. If early diagnosis and appropriate therapy is delayed, complications such as mediastinal extension, retropharyngeal spread and airway obstruction could happen to the patients. For the study of the microbiology, we have retrospectively analysed the oral & maxillofacial infected patients in the Dept. of Oral & Maxillofacial Surgery, In-Ha University Hospital from 1997 September to 2000 April. The results were as follows 1.The male patients were more common than female, with male 61.9% and female 38.1%. 2.Dental originated infections were most common cause with the incidence of 62%. 3.Most common fascial space involved was buccal space 42cases(37.2%) followed by submandibular space 13cases(11.5%), infraorbital space 13cases(11.5%), masseteric space 11cases(9.7%) , periapical abscess 11cases(9.7%) . 4.The causative organisms isolated from the pus culture were Gram Positive Bacterial species, which were 46cases(31.9%) of Streptococcus viridans, 16cases(8.6%) of α and β-hemolytic streptococcus, 4cases(3.1%) of Strep.-group D non enterococci, 7cases(5.1%) of Staphylococcus Coa. Neg., 5cases(3.9%) of Staphylococcus aureus, 3cases(2.3%) of Enterococcus faecalis, 1case(0.8%) of Bacillus species, 1case(0.8%) of Peptostreptococcus, 1case(0.8%) of Clostridium and Gram negative bacterial species, which were 4cases(3.1%) of Acinetobacter baumannii, 2cases(1.6%) of Pseudomonas aeruginosa, 2cases(1.6%) of Burkholderia cepacia, 1case(0.8%) of Neisseria species, 1case(0.8%) of Klebsiella pneumoniae, 1case(0.8%) of Klebsiella oxytoca, 1case(0.8%) of Escherichia coli. 5.In drug sensitivity test, high resistant tendency was found in Penicillin system(Penicillin G 83.3%, Ampicillin 60%) and Aminoglycosides (Gentamycin 50%, Tobramycin 45.5%), but tertiary Cephalosporin system(Cefoperazone 9.1%, Ceftazidime 18.2%), and glycopeptides system (Teicoplanin 0% , Vancomycin 0%) showed lower resistancy.

폐기물 성상과 매립방식에 따른 침출수 특성

성낙창,김은호,문추연,김정권,장성호,김수생,박출재 동아대학교 환경문제연구소 1996 硏究報告 Vol.19 No.1

In this study, we can be obtained the following conclusions about the characteristics of leachate with waste compositions and landfill methods. pH shows a tendency to increase in E. landfill, because NH₃ is created by anaerobic degradation and dissolved in leachate. The concentrations of BOD and COD become different, In case of E. landfill, food of combustible is H. & S. landfill and then SS is high in concentration. According to passed time, T-N is high in concentration, but T-P shows a similar tendency. Heavy metals of leachate is lower than threshold concentrations. If leachate is treated biologically, microbes are not inibitory.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

병원획득 Klebsiella pneumoniae 균혈증 분석을 통해 본 Ciprofloxacin 내성과 Extended-Spectrum β-Lactamase생성 간의 연관성

김미영,추은주,곽이경,송문희,나성수,송태준,김성혜,전재범,최상호,정진용,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : K. pneumoniae는 ciprofloxacin내성 증가가 전세계적으로 문제가 되고있는 extended-spectrum beta-lactamase (ESBL)를 생성하는 대표적인 세균으로 최근 외국에서 ciprofloxacin 내성과 ESBL 생성사이에 관련이 있다는 2-3편의 보고들이 있었다. 본 연구에서는 병원획득 K. pneumoniae 패혈증이 있었던 환자들을 대상으로 ciprofloxacin 내성과 관련된 인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월 부터 2002년 12월 사이에 2200병상의 3차 의료기관인 한 대학병원에서 입원 후 72시간 이후에 나간 혈액배양에서 K. pneumoniae가 배양된 입원환자를 대상으로 의무기록과 전산기록을 분석하여 환자의 성별, 나이, 병동, 기저질환, 이전의 항생제 사용력, 패혈증 발생당시까지의 재원기간, 이전 입원력, 원인균의ESBL 생성유무 등을 파악하였고 이들 변수가 ciprofloxacin 내성과 관련이 있는지를 분석하였다. 재발성 패혈증의 경우는 첫 번째 경우만을 분석에 포함하였다. 결과 : 연구대상 환자는 총154명이었고 K. pneumoniae의 ciprofloxacin에 대한 내성률은 28.6% (44/154)였다. Ciprofloxacin 내성균주 중 ESBL 생성균주의 비율은 95.5% (42/44)였고 ciprofloxacin 감수성균주에서 ESBL 생성균주의 비율은 24.5% (27/110)였다(P<0.001). ESBL생성외에 단변량 분석에서 유의한 관련을 보인 변수로는 남자, 나이가 많은 경우, 패혈증 당시 중환자실 재원, 기저질환이 고형암, 혈액암, 담도계 질환인 경우, 패혈증 발생이전 1달 이내의 항생제 사용력, 3세대 cephalosporin, metronidazole, fluroquinolone, carbapenem 투여력이 있었다. 다변량 로지스틱 분석을 시행 하였을 때는 나이가 많은 경우(Adjusted odds ratio[A0R]; 1.04, 95%confidence interval[CI]; 1.01-1.06)와 ESBL 생성(AOR; 81.35, 95% CI; 17.76-372.53)이 유의하게 ciprofloxacin 내성과 관련이 있었다. 결론 : 패혈증을 일으킨 병원획득 K. pneumonias에서의 ciprofloxacin 내성은 ESBL 생성과 유의한 관련을 보였고 향후 이에 관련된 원인이나 기전을 분석하기위한 분자역학적·분자생물학적 연구가 필요하겠다. Background : Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. Materials and Methods : Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. Results : The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3^(rd)-generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). Conclusion : The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.