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종설 : 스타틴 치료 후에도 남아있는 심혈관계 질환의 위험성: HDL-C의 중요성
박예민 ( Yae Min Park ),고광곤 ( Kwang Kon Koh ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
Lowering low-density lipoprotein-cholesterol (LDL-C) is the primary target to prevent cardiovascular events in patients with dyslipidemia at high risk for cardiovascular disease. Many patients on statin therapy have initial or recurrent coronary heart disease events despite reductions in LDL-C. Indeed, 2/3 of patients on statin therapy suffer from residual risk. Low high-density lipoprotein- cholesterol (HDL-C) and high triglycerides levels are modifiable and important factors to resolve a residual risk. Especially, low serum levels of HDL-C (< 40 mg/dL for men, < 50 mg/dL for women) are highly prevalent and are recognized as an independent risk factor for cardiovascular morbidity (myocardial infarction, stroke, peripheral arterial disease, and restenosis after coronary stenting) and mortality. Thus, therapy focusing on raising HDL-C may be an important paradigm for treating and slowing progression of atherosclerosis, coronary heart disease, and co-morbid metabolic disorders. In this review, we discuss the importance of HDL-C based on experimental and large scaled clinical trials. (Korean J Med 2011;80:397-401)
현민수(Min Su Hyon),강덕현(Duk Hyun Kang),고광곤(Kwang Kon Koh),손대원(Dae Won Sohn),오병희(Byung Hee Oh),이명묵(Myoung Mook Lee),박영배(Young Bae Park),최윤식(Yun Sik Choi),서정돈(Jung Don Seo),이영우(Young Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.5
N/A We reviewed the patients who were diagnosed as infective endocarditis from January 1984 to September 1988, The total number of patients was one hundred and sixteen. Seventy-six were male and forty were female. The mean age was 37.5 years. Rheumatic heart disease was the most common predisposing heart disease with fifty-five cases l47.4%), followed by congenitai heart disease with eighteen cases (15.5%), prosthetic valve endocarditis with sixteen (18.8%) and cardiac pacemaker with one case. Culture was positive in sixty-eight cases (58.6%). Alpha hemolytic streptococci were the most commonly isolated micrroorganisms (51.5%), followed by S. aureus (16.2%). Fungus was also isolated (1case). Vegetations were found in seventy-nine cases an echocardiographic examination (68.1%). These were found more frequently on the aortic valve (48.1%) than on the mitral valve (32.9%). Fifty-nine cases (50.8%) developed congestive heart failure and twenty-seven cases (23.3%) had embolic complications. Out of 116 patients, 27 died and the overall mortality was 23.3%. Main causes of death were congestive heart failure and embolic complications. Surgical traeatment was performed in thirty-nine patients (33.6%). Operation was indicated more frequently in patients with prosthetic valve endocarditis ar in patients with vegetation.
관상동맥 경련이 의심되는 한국인에서 0.4㎎ Ergonovine Maleate 단일괴 사용법에 의한 유발 검사
고광곤,윤진,이기형,우재순,김치열,김영범,조철호,조상균,김삼수 대한내과학회 1992 대한내과학회지 Vol.42 No.2
관상동맥 경련은 허혈성 심질환의 다양한 임상상에 역할을 한다. 관상동맥조영검사가 경련을 진단 내리는데 유일한 직접적인 검사 방법이다. 경련을 유발시키기 위해서 여러 검사 방법들이 사용되었지만, ergometrine이 경련을 유발시키는데 가장 효과적 약물이라고 발표되었다. 여러 사람들이 다양한 용량과 다양한 방법으로 ergonovine을 사용해왔다. 하지만 ergonovine의 dose-response curve는 누적용량(0.1+0.2+0.3+0.4㎎)이 0.4㎎의 단일 용량과 똑같은 효과를 보였고, 용량 중강 방법이 시간 소비적이am로 0.4㎎ ergometrine 단일괴를 사용하여 검사한 결과, 위험성이 용량 중강 방법과 차이가 없다고 발표되었다. 방법 : 비전형적 흉통을 주소로 하는 6명과 급성 심근경색증 1명 모두 7명을 A군, 임상적으로 이형협심증이 강력히 의심되는 환자 6명을 B군으로 나누어 13명 환자들에게 단일괴 0.4㎎ ergonovine을 정주하여 검사하였다. 결과 : A군 환자들에게 관상동백조영검사상 30% 이하의 미만성 혈관수축을 관찰하였고, 흉통이나 심전도 변화는 없었다. B군 환자들에게 관상동맥조영검사상 2명에서 우측 관상동맥이 각각 100%, 95% 협착, 1명에서 좌전하행지 완전 협착, 1명에서 좌측 회선지 완전 협착, 2명에서 50에서 75%에 이르는 미만성 삼혈관상동맥 협착 소견을 관찰하였다. 6명 모두 전형적 협심증을 호소하였고, 6명중 2명에서 ST-T분절 변화 소견을 보였다. 저자들은 이형협심증이 의심되는 한국인에서 단일괴 0.4㎎ ergonovine 검사 방법을 치명적인 부정맥이나 심경색증, 사망 등의 합병증 없이 좋은 결과를 얻고 시행하였다. 결론 : 0.4㎎ 단일괴 ergonovine 유발 검사는 관상동맥 환자들은 진단내리는 데 예민하고 특이적이고 임상적으로 유용한 방법이며, 대상과 금기 사항을 잘 가기고 주의사항을 잘 알고 이행하며, 한국인에서도 안전하고 정확하게 시행될 수 있는 방법이라고 생각된다. Background. Many tests have been proposed for the provocation of coronary arterial spasm. But, ergonovine maleate has been known to be most effective for the provocation. Although ergonovine testing is usually safe, a number of complications have been described. Therefore, several investigators recommend the use of incremental doses starting with an intravenous injecion of 0.05~0.1㎎ followed by small incremdents of 0.1~0.15㎎ at 2~5 min intervals up to a maximum of 0.4㎎. By a dose-response curre of ergonovine, the cumulative doses (0.1+0.2+0.3+0.4㎎) have the same effects that a single dose of 0.4㎎ Methods. Because the technique with incremental doses is time-consuming, we performed using a single bolus of 0.4㎎ ergonovine intravenously without any increments in 13 patients who were divided clinically into 2 groups: group A: 7 patients with atypical chest pain (6) and acute myocardial infarction (1). group B: 6 patients with strongly suspected variant angina. Results. In group A patients coronary angiography demonstrated less than 30% diffuse vasoconstriction not accompanied by chest pain or electrocardiographic changes. In group B patients coronary angiography demonstrated right coronary artery 100%, 95% stenosis in 2 patient, total occlusion of left circumflex coronary artery in 1 patients and more than 50% to 75% stenosis of diffuse three vessel coronary in 2 patients. All six patients complained of typical angina and 2 of 6 patients showed ST-T segment changes. We performed using a single bolus of 0.4㎎ ergonovine to provoke coronary arterial spasm in Korean patients without major arrhythmia, myocardial infarction or sudden death. Conclusion. Provocative testing with a single bolus of 0.4㎎ ergonovine maleate in Korean is safe, time-saving and radiation exposure-reducing if precautions and contraindications are used.