제 2 형 당뇨병 환자 및 당뇨병과 심혈관질환이 없는 성인을 대상으로 조사한 심혈관계질환의 위험인자와 혈청 high sensitivity C - reactive protein 사이의 관련성 비교

김형진(Hyeung Jin Kim),배상운(S. W. Pae),김대중(Dae Jung Kim),김수경(Soo Kyung Kim),김세화(Se Hwa Kim),이유미(Yu Mie Rhee),정상수(Sang Su Chung),안철우(Chul Woo Ahn),차봉수(Bong Soo Cha),송영득(Young Duk Song),임승길(Sung Kil Lim),김경 대한내과학회 2002 대한내과학회지 Vol.63 No.1

N/A Background: High sensitivity C-reactive protein (hsCRP) is more sensitive than standard CRP assay for evaluation of risk of coronary heart diseases and other atherosclerotic events. But, there were no data of association of serum hsCRP with risk factors of cardiovascular diseases and nonalcoholic fatty liver in Korean type 2 diabetic and nondiabetic subjects. Methods: A hundred type 2 diabetic subjects (51 men and 49 women) from Severance Hospital and 200 nondiabetic subjects participating medical checkup in Health Promotion Center (105 men and 95 women) were recruited and subjects with acute illnesses and chronic inflammatory diseases such as upper respiratory infection, rheumatoid arthritis, osteoarthritis, or viral hepatitis were excluded. A standardized interview was conducted by trained personnel; detailed information was collected on medical history, dietary habits and lifestyle characteristics, including smoking, alcohol and physical activity. Body mass index (BMI) was computed and biochemical study were undergone using fasting blood. All subjects were done abdominal ultrasonography for evaluation of fatty liver. Serum hsCRP concentration was measured by Nephelometer AnalyzerⅡ (Behring Co.) and a lower detection limit of test was 0.18 mg/L. Results: There was no difference in sex, BMI, presence of fatty liver, concentration of total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and uric acid between diabetic and nondiabetic subjects. Age, total colesterol/HDL-C ratio, fasting blood glucose and incidence of hypertension were higher in diabetic than nondiabetic subjects, but a rate of smoking was higher in nondiabetic than diabetic subjects. The mean concentration of serum hsCRP was remarkably increased in type 2 diabetic subjects than nondiabetic subjects (1.34±1.87 vs 0.71±0.80 mg/L, p<0.05). After adjustment of different variables between both groups, there was significantly difference of the concentration of serum hsCRP (p<0.05). In nondiabetic subjects, by univariate analysis, there was a positive correlation between hsCRP and age (r=0.26, p<0.05), BMI (r=0.34, p<0.05), systolic blood pressure (r=0.21, p<0.05), diastolic blood pressure (r=0.16, p<0.05), triglyceride (r=0.27, p<0.05), total cholesterol/HDL-C ratio (r=0.22, p<0.05), uric acid (r=0.15, p<0.05) and a negative correlation between serum hsCRP and HDL-C (r=-0.16, p<0.05). Interestingly, subjects with fatty liver had shown increased serum hsCRP concentration than subjects without fatty liver (0.99±0.96 vs 0.58±0.69 mg/L, p<0.05). But there were no correlation of serum hsCRP with the history of smoking, sex, physical activity, fasting plasma glucose and presence of hypertension. After multiple regression analysis, only BMI and age were associated with serum hsCRP. In diabetic subjects, there were significant correlation of serum hsCRP with HDL-C and fasting plasma glucose, but other risk factors of cardiovascular diseases and fatty liver were not. When we compared serum hsCRP according to numbers of risk factors of cardiovascular diseases in nondiabetic subjects, group without risk factors had 0.41±0.55 mg/L, group with one risk factor had 0.48±0.40 mg/L, group with two risk factors had 0.75±0.88 mg/L, group with three risk factors had 1.08±0.87 mg/L and group with four risk factors had 1.55±1.21 mg/L. There was significant difference of serum hsCRP according to numbers of risk factors of cardiovascular diseases (p<0.05). Conclusion: Serum hsCRP is correlated with risk factors of cardiovascular diseases and may be useful tool for prediction of accelerated, atherosclerotic process in nondiabetic subjects. Although there is association of serum hsCRP with few risk factors of cardiovascular diseases, serum hsCRP is elevated in diabetic subjects. Therefore it is necessary to evaluate usefulness of serum hsCRP using carefully selected diabetic subjects. In addition, our study had show

비비만인에서 발견되는 비알콜성 지방간의 대사적 의미

이광은 ( Kwang Eun Lee ),김유미 ( Yoo Mee Kim ),강은석 ( Eun Seok Kang ),김혜진 ( Hae Jin Kim ),정혜원 ( Hae Won Chung ),이시훈 ( Sh Hoon Lee ),김형진 ( Hyeung Jin Kim ),김대중 ( Dae Jung Kim ),김수경 ( Soo Kyung Kim ),안철우 ( Ch 대한내과학회 2002 대한내과학회지 Vol.63 No.5

N/A Background : It is well known that non-alcoholic fatty liver disease is associated with metabolic syndrome such as obesity, type II diabetes mellitus, dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-obese adults, but the meaning of it is unknown. So we studied the association of non-alcoholic fatty liver disease in non-obese adults and metabolic abnormalities. Methods : We examined 779 Korean adults above 30 years old (274 men, 505 women) participating in medical check-up in Health Promotion Center. Hepatitis B and C serologies were negative, and average weekly alcohol intake was .2 drinks. A standard interview, physical examination and biochemical study was conducted. An experienced operator carried out ultrasound liver studies. Results : 370 subjects had non-alcoholic fatty liver disease (47.3%). The frequency in men was higher than that in women (57.3 vs 42.2%, p<0.05). The frequency in non-obese (BMI<25 kg/m2, n=431) group was lower than that in obese (BMI.25 kg/m2, n=348) group (65.5 vs 32.3%, p<0.05). Compared with obese group, waist circumference, waist hip ratio, body fat, impaired fasting serum glucose, total cholesterol, HDL-cholesterol, total cholesterol to HDL-cholesterol ratio, fasting insulin, proinsulin, HOMA-IR and HOMA-beta were significantly different in non-obese, non-alcoholic fatty liver group. After multiple regression analysis, waist circumference was associated with non-alcoholic fatty liver disease in non-obese individuals. Odd ratios of insulin resistance in non-obese, non-alcoholic fatty liver group were 5.8 (CI: 3.1.10.9). Conclusion : The frequency of non-alcoholic fatty liver disease was very high in non-obese adults and well associated with central obesity and insulin resistance.(Korean J Med 63:488-495, 2002) Key Words : Non - alcoholic fatty liver disease, Body mass index, Metabolic syndrome, Central obesity

다중 하중조건에서의 2 층열차 차체의 최적설계

이진민(Jin Min Lee),정재준(Jae Jun Jung),이태희(Tae Hee Lee),황원주(Won Ju Hwang),김형진(Hyeung Jin Kim) 대한기계학회 2005 대한기계학회 춘추학술대회 Vol.2005 No.11

Double-deck train has been attracted growing attention as next generation transportation around metropolis because of high passenger carrying capacity. In order to develop high-speed double-deck train with low operational costs, the carbody must be designed as light as possible. In addition, the carbody must be strong enough to ensure the safety of passengers. For these purposes, weight minimization that determines thickness of aluminum extruded panels(AEP) of the carbody can be performed. First, we perform the screening process that select sensitive or/and important design variables through design exploration because the design variables of carbody are too many to treat all of them in the design optimization. Then, weight minimization is accomplished under multi-loading condition such as vertical, compressive and torsional load, while satisfying user specified strength constraints. Finally, the result of design optimization is discussed by comparison with it of initial design.

언더프레임 두께 최적화에 따른 2층열차의 구조강도비교

황원주(Hwang Won-Ju),김형진(Kim Hyeung-Jin) 한국철도학회 2004 한국철도학회 학술발표대회논문집 Vol.- No.-

Aluminum alloy is very useful material for high speed transportations due to its high strength and light weight characteristics. Especially because of a weight reduction, a large extrusion of aluminum alloy carbody has been manufactured. This aluminum extruded panel is a hollow extruded panel. This shape and thickness is various by designer"s sense and experience and VAW"s profiles. So it is important to find an optimized shape and thinckness of AEP. In this study we get the AEF"s thickness to minimize a weight by applying an optimization algorithm. The results of the study can be used as basic guidelines in designing double-deck trains in the future.

대청댐과 역조정지의 수질특성 비교

임봉수 ( Bong Su Lim ),김형진 ( Hyeung Jin Kim ),김도영 ( Do Young Kim ),권충진 ( Chung Jin Kwon ) 한국물환경학회 2007 한국물환경학회·대한상하수도학회 공동 춘계학술발표회 Vol.2007 No.-

임신성 당뇨 과거력의 여성에서 제2형 당뇨병 발생과 LEP 및 LEPR 유전자의 연관성 분석

박영준 ( Young Joon Park ),김세련 ( Se Ryun Kim ),김종욱 ( Jong Wook Kim ),김민형 ( Min Hyeung Kim ),양재혁 ( Jae Hyug Yang ),김형진 ( Hyeong Jin Kim ),조율희 ( Youl Hee Cho ),정성노 ( Sung Ro Jung ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.2

목적: 임신성 당뇨 과거력의 여성이 산후 약 반수에서 제2형 당뇨병으로 발병하는 것으로 알려져 있다. 몇 가지 임상적 위험 인자가 제2형 당뇨병 발생에 관여하는 것으로 알려져 있으나 유전자와의 관련성에 대한 보고는 아직 없다. 본 연구는 leptin 및 leptin receptor 유전자가 임신성 당뇨의 과거력을 가진 여성에서 향후 제2형 당뇨병으로의 발병에 관여하는지 알아보고자 하는데 있다. 연구방법: 1992년 1월 1일부터 2002년 12월 31일까지 산부인과에 내원하여 임신성 당뇨로 진단된 여성을 대상으로 하였다. 연구 시점에서 제2형 당뇨병으로 확인된 경우를 제2형 당뇨병 양성군, 확인이 안 된 경우를 제2형 당뇨병 음성군으로 정의하였다. 임신성 당뇨 진단시와 연구 시점에서의 임상적 자료를 분석하였다. 관련이 있는 유전자를 알아보기 위해 leptin 및 leptin receptor 유전자와 8개의 SNP (LEP-632G>A, +4950G>A, +4998A>C, and LEPR-141013T>C, -186A>G, +5193G>A, +7187A>C, +27265A>G)를 선별하였다. 두 군 간에 유전적 위험도를 분석하고 두 군간에 통계적으로 차이를 보이는 SNP가 있는지 조사하였다. 결과: 임신성 당뇨 과거력을 가지고 있는 54명이 참여하였고, 제2형 당뇨병 양성군이 20명, 음성군이 34명으로 확인되었다. 임신성 당뇨 진단시 제2형 당뇨병 양성군과 음성군 간에 HbA1c와 50g 및 100g 당부하검사, 인슐린 농도 등이 통계적으로 유의하였다 (P<.05). 연구 시점에서 두 군간에 산과력 (P<.001) 외에는 통계적으로 유의한 차이가 없었다. 임신성 당뇨 진단 후 제2형 당뇨병 발생으로의 유전적 위험도 분석에서 두 군간에 유의한 차이를 보이는 SNP는 없었다. 결론: 임신성 당뇨의 과거력을 가진 여성에서 향후 제2형 당뇨병으로 발생하는데 관여하는 유전자는 본 연구에서는 없었다. 향후 더 많은 유전자와 더 많은 대상을 가지고 연구한다면 임신성 당뇨에서 제2형 당뇨병으로의 발생에 관여하는 유전자를 찾아낼 수 있을 것으로 판단된다. Objective: The history of gestational diabetes (GDM) is a high risk for the development of type 2 diabetes mellitus (T2DM). The purpose of this study is to investigate the genetic association of LEP and LEPR gene polymorphisms and the development of T2DM in Korean women of history of GDM. Methods: Women diagnosed as GDM during pregnancy from January 1992 to December 2002 were recruited. Those women with a T2DM at the time of study were classified as T2DM positive group, and without T2DM, as T2DM negative group. 2 genes (LEP and LEPR genes) and 8 SNPs (LEP-632G>A, +4950G>A, +4998A>C, and LEPR-141013T>C, -186A>G, +5193G>A, +7187A>C, +27265A>G) were selected. The TaqMan assay for genotyping and the statistical analysis for phenotypic and genetic factors between 2 groups were analyzed. Results: A total of 54 women, T2DM positive (n=20) and T2DM negative (n=34) were enrolled. At the time of diagnosis of GDM, HbA1c, 50g and 100g oral glucose tolerance test, and insulin level were significantly associated between T2DM positive and negative groups (P<.05). In analysis of genetic risk to T2DM, the significant association related with any SNPs was not shown between T2DM positive and negative groups. Conclusion: In Korean women having past history of GDM, there was no relationship between 2 genes and the development to T2DM. To clarify a effect of candidate genes related with development of T2DM, there will need more samples and genes.

흰쥐에서 JG - 381 의 단회경구독성시험

오우용(Woo Young Oh),이상호(Sang Ho Lee),김형진(Hyung Jin Kim),주상섭(Sang Sup Jew),박형근(Hyeung Geun Park),함광수(Kwang Su Ham),조장섭(Jang Sup Cho),이선미(Sun Mee Lee) 한국응용약물학회 2001 Biomolecules & Therapeutics(구 응용약물학회지) Vol.9 No.3

N/A The single oral toxicity of JG-381 was studied in Sprague-Dawley rats of both sexes. In this study, rats were administrated orally with dosages of 267, 400, 600, 900 and 1350 ㎎/㎏ of JG-381. We daily examined number of deaths, clinical signs, body weights and gross findings for 14 days after JG-381 administration. When we administered different doses of 267, 400, 600, 900 and 1350 ㎎/㎏, we found 1, 4, 4, 5 and 5 male rats died and 3, 5, 4, 5 and 5 female rats died within 1 day after administration, respectively. Some clinical signs (decrease locomotor activity, salivation, soft stool, prone position, lacrimation, crouching position, convulsion, ataxic gait, incontinence of urine) were also observed during the experimental period. Our findings suggest that oral LD_(50s) (95% confidence limit) for male and female rats are 327 ㎎/㎏ (270∼396 ㎎/㎏) and 250 ㎎/㎏ (236∼264 ㎎/㎏), respectively.

한국인 폐경후 여성에서 Tibolone과 활성형 비타민 D 병합요법이 골밀도에 미치는 영향

김세화,이유미,김수경,김대중,김형진,안철우,차봉수,송영득,김경래,이현철,허갑범,임성길 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: Tibolone은 조직 특이성을 나타내는 합성스테로이드로써, 골조직에서 에스트로겐, 자궁 내막에서 프로제스토젠 효과를 나타내어 자궁을 자극하지 않으면서 골소실을 예방하는 효과가 있음이 보고되고 있다. 본 연구에서는 폐경 후 여성에서 Tibolone과 활성형 비타민 D 사용후 골밀도 변화 및 새로운 척추 골절 발생에 미치는 영향에 대해서 알아보고자 하였다. 방법: 1997년부터 2000년까지 신촌 세브란스 병원에 방문한 폐경 후 여성을 대상으로 하여, 총 103명을 Tibolone 단독 사용군(40명), 활성형 비타민 D 단독 사용한 군(27명), Tibolone과 활성형 비타민 D 병합요법 군(36명)으로 분류하였고, 각 군에서 약제 투여 1년후 골밀도의 변화 및 새로운 척추 골절의 빈도를 살펴보았다. 결과: Tibolone 단독 사용군과 병합요법 군에서 약제 투여 1년 후에 요추부 및 대퇴부 모두에서 의미있는 골밀도의 증가를 보였으며, 활성형 비타민 D 단독 사용군에서는 모든 부위에서 의미있는 골밀도의 증가를 관찰할 수 없었다. 병합 요법군에서 골밀도의 증가는 다른 두 군에서보다 많은 경향을 보였으며, 요추부에서는 이를 연령, 체질량지수, 기저치 골밀도 등을 보정한 후에도 의미있는 차이를 나타냈다(p=0.038). 새로운 척추 골절은 활성형 비타민 D 단독 사용군에서 9명(33.3%), 병합요법 군에서 5명(13.9%)에서 발생하였으며, 병합요법 군에서 골절이 감소되는 경향을 보였으나, 의미있는 차이를 나타내지 않았다(Odds ratio 0.323, 95% Confidence interval 0.094∼1.112). 결론: 본 연구 결과로 Tibolone 및 Tibolone과 활성형 비타민 D 병합요법이 한국인 폐경 후 여성에서 골소실을 억제하며, 병합요법이 각각의 단독 치료보다 폐경 후 골다공증 치료에 효과적임을 알 수 있었다. Background: Tibolone is a novel synthetic compound with tissue-specific effects in bone, breast tissue and the endometrium. Tibolone, and active vitamin D, effectively prevent bone loss, and the maintain skeletal integrity of postmenopausal women. The aim of the present study was to examine the effect of tibolone, and active vitamin D (1-hydroxyvitamin D3), therapies given alone, or in combination, against bone loss in postmenopausal women. Methods: One hundred and three postmenopausal women were treated with tibolone 9n=40). alphacalcidol (n=27) or both drugs (n=36) for 12 months. All subjects took supplemental calcium carbonate (500㎎ daily). The bone mineral densities (BMD) of the lumbar spine and proximal femur were measured by dual-energy x=ray absorptiometry (DXA) at the baseline and after 12 months. Results: Tinolone therapy produced significant increase of 401 and 108% in the BMD at the lumbar spine (p<0.001) and femoral neck (p=0.009), respectively. The combination of tibolone and active vitamin D increased the BMD by 8.0 and 404% (p<.001) at the spine and femoral neck, respectively. The differences in the changed of BMD from the baseline at the lumbar spine was significant (p=0.038) in the combination treatment group compared that in the tibolone alone group. Conclusion: Tibolone alone, and in combination with active vitamin D, effectively increased the BMD at all skeletal sites in postmenopausal women. Combination treatment for osteoporosis is emerging as a promising modality in Korean postmenopausal women (J Kor Soc Endocrino 17:535∼543, 2002).

죽상동맥경화증의 위험인자로서 경동맥 내중막 두께에 대한 공복혈당장애의 역할

김수경,김대중,김세화,김형진,이유미,김하동,안철우,차봉수,임승길,김경래,이현철,허갑범 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.2

연구배경: 1997년 미국 당뇨병학회(ADA)에서는 공복혈당을 기준으로 내당능장애(IGT)에 상응하는 새로운 범주인 공복혈당 장애(IFG)를 제안하였다. 내당능장애(IGT)에서 향후 당뇨병이나 심혈관계 질환의 발생 위험이 높은 것은 잘 알려져 있다. 그러나 공복혈당장애의 경우 동맥경화증으로 대표되는 심혈관계 질환에 대한 위험도에 대해 많은 논란이 있어, 국내 환자에서의 공복혈당 장애와 관상동맥 및 전신 죽상 동맥경화증의 지표인 경동맥 내중막 두께와의 관계를 알아보고자 하였다. 대상 및 방법: 2001년 4월부터 6월까지 건강 검진 센터에서 검진을 받은 1239명중 항고혈합제 및 지질개선제를 복용하거나 과거력상 심혈관계 및 뇌혈관계 질환이 있는 환자를 제외한 944명(남자 505명, 여자 439명)을 대상으로 당뇨병에 대한 치료 병력과 공복혈당을 기준으로 정상(공복혈당 <6.1mmol/L), 공복혈당장애(6.1mmol/L ≤공복혈당 <7.0mmol/L) 및 당뇨병(공복혈당 ≥7.0mmol/L 또는 당뇨병으로 치료받는 경우)으로 구분하였으며, 모든 환자에서 체질량지수, 허리-엉덩이 둘레비, 평균 및 최대 경동맥 내중막두께, 혈압, 혈청 인슐린, 총콜레스테롤, 중성 지방, HDL-콜레스테롤, 및 LDL-콜레스테롤 농도 등을 측정하였다. 결과: 1) 세 군간의 임상 및 생화학적 특징을 살펴보면, 당뇨병군에서 나이(p<0.001), 허리-엉덩이 둘레비(p<0.001), 및 혈청 중성지방 농도(p<0.05)가 다른군에 비해 높았다. 2) 경동맥 내중막두께에 영향을 미칠 수 있는 임상적 특성을 보정한 후, 평균 경동맥 내중막두께의 경우 당뇨병군이 0.77±0.22mm로 정상군(0.66±0.16mm, p<0.001)과 공복혈당 장애군(0.68±0.20mm, p<0.05)에 비해 유의하게 높았다. 최대 경동맥 내중막두께의 경우 당뇨병군이 0.84±0.26mm로 정상군(0.71±0.20mm, p<0.001)에 비해 유의하게 증가되어 있었으나, 공복혈당 장애군(0.74±0.30mm)과는 유의한 차이가 없었다. 평균 및 최대 경동맥 내중막두께는 공복혈당 장애군과 정상군간에 유의한 차이를 발견할 수 없었다. 3) 공복혈당치의 정도와 경동맥 내중막두께의 상관성을 알아보기 위해, 당뇨병의 기왕력이 없는 908명을 대상으로 공복혈당을 기준으로 1군 4.72mmol/L 이하, Ⅱ군 4.72mmol/L 초과 및 5.5mmol/L 이하, Ⅲ군 5.5mmol/L 초과 및 6.1mmol/L 미만, Ⅳ군 6.1mmol/L 이상 및 7.0mmol/L 미만, Ⅴ군 7.0mmol/L 이상으로 나눠 비교한 결과 평균 경동맥 내중막두께의 경우 Ⅴ군에서 0.74±0.15mm로 가장 높았으며, Ⅰ군, Ⅱ군과 Ⅲ군에 비해 유의하게 증가되어 있었고(0.65±0.15mm, 0.67±0.16, and 0.68±0.15, p<0.05, respectively), 최대 경동맥 내중막두께의 경우 Ⅴ군에서 0.79±0.15mm로 Ⅰ군(0.69±0.17mm)과 Ⅲ군(0.73±0.17mm)에 비해 유의하게 증가되어 있었다(p<0.05). 그러나 공복혈당장애에 해당되는 Ⅳ군의 경우 다른 어떤 군과도 유의한 차이를 볼 수 없었다. 4) 위의 다섯 군에서 HOMA법에 의해 인슐린 저항성을 평가하였는데, Ⅴ군에서 4.23±2.38으로 Ⅰ군(1.84±1.05, p<0.001)과 Ⅱ군(2.48±1.60, p<0.001)에 비해 높았으며, Ⅲ군(3.42±2.60과 공복혈당 장애군에 해당되는 Ⅳ군(3.31±1.89)에서도 Ⅰ군과 Ⅱ군에 비해 유의하게 증가되어 있었다. 결론: 당뇨병군에서는 정상군에 비해 평균 및 최대 경동맥 내중막두께가 증가되어 있었으나, 공복혈당 장애군에서는 뚜렷한 차이를 관찰할 수 없었다. 또한 공복혈당치에 따라 5개 군으로 분류한 바, 당뇨병에 해당되는 Ⅴ군에서 경동맥 내중막두께가 가장 증가함을 알 수 있었고, 공복혈당장애에 해당되는 Ⅳ군에서는 다른 군과 유의한 차이가 없었다. 이상의 결과로 공복혈당 장애는 죽상 동맥경화증의 위험인자가 아님을 시사한다. 그러나 정상 공복혈당군에서도 혈당이 증가함에 따라 인슐린저항성이 증가하는 것으로 보아, 당뇨병 기준치이하의 혈당에서도 다른 죽상동맥경화증의 위험인자를 고려하여, 경구당부하검사 등을 통해 고위험군을 선별하여 적절한 관리를 할 필요가 있을 것으로 생각된다. Background: The Expert Committee of the American Diabetes Assocaition(ADA) proposed a new category, but that was similar to the impaired glucose tolerance(IGT), that being the impaired fasting glucose(IFG). It was confirmed that the IGT is a fatal risk factor associated with cardiovascular disease. However, it is not known whether the IFG is a risk factor for atherosclerosis, as is IGT. In this study, we investigated the role of the IFG on the carotid artery intima-media thickness(IMT) as a risk factor for atherosclerosis. Methods: The analyses were based on the data obtained from the medical checkups of 944 subjects. Subjects with a previous history of coronary heart disease or cerebral vascular disease, or who had been treated with antigypertensive of hypolipidemic agents, were excluded. For the analysis, the classifications of diabetes and IFG were based on the recent ADA recommendations. Diabetes was diagnosed on the basis of a fasting plasma glucose(FPG)≥7.0mmol/l, or current treatment with oralhypoglycemic agents or insulin. IFG was defined as a FPG≥6.1mmol/l but <7.0mmol/l, and a normal glucose tolerance(NGT) as a FPG<6.1 mmol/l. The body mass index(BMI), waist-to-hip ratio(WHR), systolic and diastolic blood pressures(SBP and DBP), serum fasting glucose, insulin, total cholesterol, triglyceride and HDL-cholesterol were measured in all participants. High-resolution B-mode ultrasonography was performed to determine the mean and maximal carotid IMT. Results: 1) There were significant differences in the age, WHR and triglyceride between the NGT, IFG, and diabetic groups. 2) After adjustment for age, sex, smoking history(packs/year), BMI, WHR, SBP, DBP, serum triglyceride, and HDL-cholesterol, the mean carotid IMT was significantly increased in the diabetic group(0.77±0.20mm) compared to the NGT(0.66±0.16mm, p<0.001) and IFG(0.68±0.20mm, p<0.05) groups. The maximal carotid IMT was significantly increased in the diabetic group compared to NGT group(0.84±0.26mm vs. 0.71±0.20mm, p<0.001), but not the IFG group(0.74±0.30mm, p=0.07). However, there were no significant association between the IFG and NGT groups in terms of the mean or maximal carotid IMT. 3) We divided all the participants, with no history of diagnosis or treatment for diabetes, into five classes according to their fasting glucose levels(Class Ⅰ : ≤4.72mmol/l, class Ⅱ : >4.72mmol/l and ≤5.5 mmol/l, class Ⅲ: >5.5mmol/L and <6.1 mmol/L, class Ⅳ : ≥6.1 mmol/l and <7.0mmol/L, and class Ⅴ : ≥7.0mmol/l). After adjusting for age, sex, smoking history, BMI, WHR, SBP, DBP, triglyceride and HDL-cholesterol, the mean carotid IMT in class Ⅴ was significantly increased compared to those in classes Ⅰ, Ⅱ and Ⅲ(0.74±0.15mm vs. 0.65±0.15mm, 0.67±0.16mm and 0.68±0.15mm, p<0.05, respectively). The maximal carotid IMT for class Ⅴ was significantly increased compared to classes Ⅰ and Ⅲ(0.79±0.17mm vs. 0.69±0.17mm and 0.73±0.17mm, p<0.05, respectively). However there were no significant differences in both the mean and maximal carotid IMT in class Ⅳ compared to the IFG and the other classes. 4) In the five classes above, we assessed the insulin resistance using the HOMA method. The insulin resistance in class Ⅴ (4.23±2.38) was significantly increased compared to classes Ⅰ and class Ⅱ which were 1.84±1.05 and 2.48±1.60(p<0.001), respectively. In classes Ⅲ and Ⅳ, the insulin resistances were 3.42±2.60 and 3.31±1.89, respecitvely, which were higher than classes Ⅰ(p<0.001) and Ⅱ(p<0.001 and p<0.05, respectively). Conclusions: There were significant differences between the diabetic and NGT groups for the mean and maximal IMT. However, for the IFG group, there were no sihnificant differences with respect to the mean and maximal IMT compared to the NGT or diabetic groups. Therefore, IFG may not be a risk factor for atherosclerosis, but as the FPG level was increased, the insulin resistance also increased. Therefore subjects with normal fasting blood glucose levels, which have risk factor for atherosclerosis, need to be thoroughly screened by oral glucose tolerance tests to exclude the possibility of IGT, a risk factor of cardiovascular disease.

담낭천공에 의한 이소성 담석의 내시경적 치료 2예

김상현,김일두,장미화,배용목,서길동,임성엽,황영훈,김형진,김명준,김수형,조성락 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6

Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.