폐경후 여성에서 호르몬 대치요법의 투여기간이 지질과 Lipoprotein ( a ) 에 대한 효과에 미치는 영향

김치정(Chee Jeong Kim),곽미향(Mi Hyang Kwak),김경만(Kyung Man Kim),이광제(Kwang Je Lee),정유석(Yoo Suk Chung),민용기(Young Ki Min),유왕성(Wang Seong Ryu),유언호(Un Ho Ryoo) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectievs: Hormone replacement therapy(HRT) in postmenopausal women decreases lipoprotein(a) [Lp(a)]. The influences of progesterone on Lp(a) and lipids, administered with estrogen, are controversial. However, previous studies had variable duration of therapy, and there was no report evaluating the effect of the duration of medication. Methods: A total 246 postmenopausal women were divided into 4 groups: group A; 0.625mg conjugated equine estrogen(CEE)(n=90), group B; 0.625mg CEE plus 5mg medroxyprogesterone acetate(MPA)(n=35), group C; 0.625mg CEE plus 10mg MPA(n=43), and group D; 2mg estradiol valerate(E2) plus 0.5mg norgestrel(N)(n=76). Lp(a) and lipids levels were measured before, 2, 6 and 12 months after HRT. Results: In total subjects, Lp(a) was decreased with medication for 2 months by 20.7%(p<0,0001). Compared with levels at 2 months after medication, levels at 6 and 12 months revealed further reduction(p<0.001) by 5.3% and 9.0% respectively. Medication for 2 months increased HDL-C in group A, not changed in group B and C, and decreased in group D. After 12 months, HDL-C levels were increased in Group A, B, and C, and not changed in group D, In total subjects, low density lipoprotein- cholesterol(LDL-C) was decreased by 12.2% after 2 months(p<0.001). Compared with levels at 2 months after medication, LDL-C level was decreased by 3.4% after 6 months(p<0.001) and there was no further reduction after 12 months. Conclusion: The effect of hormone replacement therapy on Lp(a) and lipids were dependent upon the duration of medication. Inconsistent results in previous studies can be partially explained by the difference in this parameter.

복잡성 심실성 부정맥과 좌심실 비후의 상관관계 및 예후에 관한 연구

이광제(Kwang Je Lee),정유석(Yoo Suk Chung),곽미향(Mi Hyang Kwak),김경만(Kyung Man Kim),김치정(Chee Jeong Kim),류왕성(Wang Seong Ryoo),유언호(Un Ho Yoo) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Objectives: Echocardiographically determined left ventricular hypertrophy is associated with increased risk for sudden cardiae death and for complex ventricular arrhythmias in 24-hour ambulatory electrocardiographic monitoring. In subjects with left ventricular hypertrophy, the presence of asymptomatic complex ventricular arrhythmias is associated with higher incidence of sudden cardiac death and higher cardiovascular mortality. However, their accurate relationship and prognostic significances have been remained to be established. The purpose of this study was to evaluate the relationship between complex ventricular arrhythmias, left ventricular hypertrophy, and sudden cardiac death in Korean patients. Methods: Twenty four hour ambulatory electrocardiographic monitoring, echocardiographic data and medical records were reviewed in 360 subjects from 1991 to 1994. We evaluated the relationship between complex ventricular arrhythmias and left ventricular mass index, and the prognostic values of them. Of the 360 subjects, 187 could be followed up for one to four years. The mean follow-up period was 2.8 years. Results: The incidence of complex ventricular arrhythmias was significantly correlated with left ventricular mass index and ejection fraction in all subjects. During the follow-up periods, seven of 187 subjects died from sudden cardiac death. Six of them had complex ventricular arrhythmias with left ventricular hypertrophy. Conclusion - The incidence of complex ventricular arrhythmias was significantly correlated with echocardiographically determined left ventricular hypertrophy and it is suggested that subjects with complex ventricular arrhythmias combined with left ventricular hypertrophy have higher risk for sudden cardiac death.

확장성심근중 환자에서 Enalapril 치료가 좌심실내경의 순간변화율에 미치는 영향

김철우(Cheol Woo Kim),정유석(Yoo Suk Jung),이광제(Kwang Je Lee),곽미향(Mi Hyang Kwak),김경만(Kyung Man Kim),김태호(Tae Ho Kim),김치정(Chee Jeong Kim),류왕성(Wang Seong Ryu),유언호(Un Ho Ryoo) 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective: Angiotensin-converting enzyme inhibitors have been shown to improve survival in patients with congestive heart failure. To evaluate the efficacy of enalapril in patients with dilated cardiomyopathy during concurrent treatment with digoxin and diuretics, the peak rates of left ventricular movement were assessed after 6 months of follow-up by digitized echocardiography. Methods: Using a high quality digitizer, continuous measurement of left ventricular dimension and its rate of change (dD/dt) were obtained throughout the cardiac cycle. Normalized rates of wall movement (dD/dt/D) were used for comparison. Results: 1) Compared with control subjects, patients with dilated cardiomyopathy showed much lower Peak(-) dD/dt and Peak(-) dD/dt/D. 2) Peak(+) dD/dt and Peak(+) dD/dt/D were also depressed in patients. 3) Peak dD/dt improved significantly (p<0.05) in the enalapril group (n=16), but did not change in the conventional treatment group (n=20) after 6 months. Peak dD/dt/D improved approximately (p<0.005) in the enalapril group. 5) There were no deaths in 2 treatment groups during initial 6 months, but 3 patients in the conventional treatment group died suddenly during 1 year of follow-up. Conclusion: The present study has shown that left ventrieular Peak dD/dt and Peak dD/dt/D are significantly depressed in patients with dilated cardiomyopathy. Enalapril appears to provide well-tolerated and effective long-term therapy by improving peak rates of left ventricular movement in patients with dilated cardiomyopathy.

관동맥 확장술 후 추적 운동부하 검사에서 관찰되는 QT 분산의 변화

이왕수(Wang Soo Lee),김상욱(Sang Wook Kim),안지현(Ji Hyun Ahn),이상엽(Sang Yub Lee),송영빈(Young Bien Song),김상민(Sang Min Kim),조성원(Sung Weon Jo),이광제(Kwang Je Lee),곽미향(Mi Hyang Kwak),김태호(Tae Ho Kim),김치정(Chee Jeong Kim 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: QT 분산은 불균등한 심실 재분극을 나타내는 지표로 증가된 QT 분산은 허혈성 심질환과 돌연사 등과 연관성이 있다고 알려져 있는데, 관동맥 확장술이 심실 재분극의 불균등성이 양호하게 회복시켜서 성공적인 관동맥 확장술 후에는 QT 분산이 유의하게 감소된다고 알려져 있다. 운동부하 검사는 관동맥 확장술 후 추적검사로 흔히 사용되고 있으나, 관동맥 확장술 후 운동부하 검사에서 QT 분산의 변화에 대한 보고는 많지 않다. 저자들은 스텐트시술 후 추적검사로 운동부하검사시 관찰되는 QT 분산의 변화와 임상적 의미를 알아보고자 하였다. 방법: 허혈성 심질환으로 입원하여 관동맥 조영술을 시행하여 유의한 관상동맥 협착을 보였던 환자들 중, 운동부하 검사를 시행하고 약물치료를 시행하였던 46명과 스텐트시술을 시행한 후 6개월에 운동부하 검사를 시행하였던 41명을 대상으로 두 군에서 QT 분산과 교정 QT 분산을 스텐트시술 전 심전도에서 측정하였고, 6개월 후 추적 운동부하 검사에서 운동부하 전, 최대 운동부하시, 회복기 2분에 digitizer를 이용하여 측정 후 비교 관찰하였다. 결과: 내원시 치료 전 심전도에서 측정한 QT 분산과 교정 QT 분산은 스텐트 시술군 에서 시술 전에 각각 51.2±15.6, 58.4±14.1 msec였고, 약물치료군에서는 내원시 50.9±13.8, 56.7±16.3 msec로 두 군 간에 유의한 차이는 없었다(p>0.05, 그림 1). 6개월 후 추적 운동부하 검사에서 최대 운동부하시 QT 분산 및 교정 QT 분산은 스텐트시술군에서 각각 28.2±11.9, 39.3±16.2 msec였고, 약물치료만 받은 군에서 40.4±20.5, 57.8±30.0 msec로 스텐트시술군에서 유의하게 감소하였으며, 운동부하 검사 시작 전과 회복기 2분에도 스텐트시술군에서 약물치료군보다 유의하게 짧았다(p<0.05, 표 3, 그림 1). 하지만 병변 위치와 병변 혈관 수에 따른 QT 분산과 교정 QT 분산의 변화는 관찰되지 않았다. 결론: 본 연구에서는 허혈성 심질환 환자에서 스텐트시술 후 6개월에 추적 운동부하검사를 시행한 결과 QT 분산과 교정 QT 분산이 유의하게 감소되어 스텐트시술이 심근허혈의 완화와 심실재분극상태의 향상에 효과적이고 운동부하검사시 교정 QT 분산의 측정이 유용한 지표가 될 수 있음을 알 수 있었다. 향후 관동맥 확장술 후 추적 운동부하 검사에서 QT 분산의 의미에 대해서는 체계적인 연구가 필요하다고 사료된다. Background: QT dispersion (QTd) represents inhomogeneous ventricular repolarization. Increased QTd has been reported to be associated with ischemic heart disease and sudden cardiac death. Successful percutaneous coronary angioplasty (PTCA) produces a favorable recovery of inhomogenous repolarization and reduces QTd. Although treadmill exercise test is commonly used for follow-up test after PTCA, limited data are available about QTd during treadmill test. The purpose of this study was to evaluate the change in QTd and determine its clinical role in follow-up treadmill exercise test after coronary stenting. Methods: 41 patients with significant coronary artery disease underwent successful coronary stenting, while 46 patients were medically treated. Treadmill exercise test was performed to compare QTd between two groups as a follow-up test at 6 months after coronary stenting and medical therapy. Treadmill exercise test was recorded in pre-test, peak exercise, and recovery 2 minutes phase. QTd and corrected QT dispersion (QTcd) were measured in these ECGs using a digitizer. Results: Coronary stenting significantly reduced QTd and QTcd at 6 months after coronary stenting. QTd and QTcd did not show significant difference between coronary stenting and medical therapy group at initial EKG before treatment. After coronary stenting, QTd and QTcd were significantly reduced than those of medical therapy group. And the changes in QTd and QTcd were more marked at peak exercise (28.2±11.9 and 39.3±16.2 msec in coronary stenting group vs 40.4±20.5 and 57.8±30.0 msec in medical therapy group). Lesion location and diseased vessel number were not associated with changes in QTd and QTcd. Conclusion: Coronary stenting reduced QTd and QTcd significantly in follow-up treadmill exercise test. Coronary stenting appears to be more effective to relieve myocardial ischemia and to improve inhomogenous ventricular repolarization than medical therapy. The measurement of QTcd during treadmill exercise test may be a useful index to evaluate myocardial ischemia after coronary stenting. Clinical relevance of these finding will require further study. (Korean J Med 63:186-194, 2002)

경동맥 죽상반에서 Tumor Necrosis Factor Receptor Superfamily의 발현

곽미향,김미경,김세화,이원하,유언호,박정의 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.12

Alpha-subunit/TSH Molar Ratio 가 증가되지 않은 갑상선 자극호르몬 분비 뇌하수체 선종 1 예

곽미향,이광제,박수정,신순현,배현철,최성남,장무선 대한내과학회 1997 대한내과학회지 Vol.53 No.6

Thyrotropin(TSH)-secreting pituitary adenoma is a rare disorder causing hyperthyroidism, which is one of the syndrome of inappropriate secretion of TSH. It is characterized by high serum T₄, T₃ as well as elevated serum TSH. Generally serum free α-subunit concentration is also increased and α- subunit/TSH molar ratio is more than 1. This α- subunit/TSH molar ratio is a clue of diagnosis as well as a useful marker of therapeutic response. We experienced a case of 29-years old man with hyperthyroidism due to TSH-secreting pituitary adenoma. He was underwent 1.5cm sized pituitary tumor removal via transsphenoidal approach in our neurosurgery department. In immunohistochemical stain monotonous tumor cells showed strong positive reaction to antihuman TSH antibody and equivocal reaction to ACTH antibody. After operation, goiter size was progressively decreased and also serum T₄, T₃and TSH were decreased in nearly normal range. However, he showed elevated serum T₄, T₃and TSH after 1 month due to residual tumor. So he received radiation therapy thereafter. In this case the α -subunit and α-subunit/TSH molar ratio were not increased. So we report a case of TSH-secreting pituitary macroadenoma which had low α-subunit/TSH molar ratio with a literature review.

급성반응양 물질로서 Lipoprotein ( a )

김경만,김치정,유언호,곽미향,유왕성,박종택 한국지질학회 1996 韓國脂質學會誌 Vol.6 No.2

This study was conducted to evaluate the property of lipoprotein(a)[Lp(a)] as an acute phase reactant. Lp(a) consists of low density lipoprotein and apolipoprotein(a), specific glycoprotein. It is generally accepted that high concentration Lp(a) is an independent risk factor for cardiovascular disease. However, Lp(a) level cannot be lowered by nonpharmacologic and pharmacologic methods for hyperlipidemia. Although Lp(a) is thought to be an acute phase reactant, there is still controversy. A total 22 premenopausal women who underwent transabdominal hysterectomy with/without unilateral salphingoophorectomy were enrolled. Lp(a) and lipid profiles were measured before, at 1 week and at 1 month after operation. In contrast to other lipids, Lp(a) concentration was elevated by 96.7% from 18.1±2.6 ㎎/dL to 35.6±27.1 ㎎/dL at 1 week after operation. At 1 month, the concentration returned to basal level. Low density lipoprotein cholesterol was lowered only by 11.2%, and total cholesterol and high density lipoprotein cholesterol decreased after operation. In conclusion, Lp(a) is thought to be an acute phase reactant and this property might be involved in the pathogenesis of atherosclerosis.