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Case of hyperosmolar hyperglycemic state by a sodium-glucose cotransporter 2 inhibitor
노인영,박석오,김해성,강남규,이명원,김수경 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.3
Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) are proposed as a novel approach for the management of type 2 diabetes mellitus. SGLT2 cotransporters are responsible for reabsorption of 90 % of the glucose filtered by the kidney. The glucuretic effect resulting from SGLT2 inhibition contributes to reduce hyperglycaemia and also assists weight loss and blood pressure reduction. In this study, we presented the case of a 59-year-old male who developed hyperosmolar hyperglycemic state (HHS), possibly caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents. This case highlights that HHS can develop in patients with diabetes treated with SGLT2 inhibitors.
혈중 아디포넥틴 및 레지스틴 농도와 대사성 위험인자와의 상관관계
유성태,박석오,김세화 대한내분비학회 2005 Endocrinology and metabolism Vol.20 No.5
연구배경: 아디포넥틴은 비만 및 인슐린저항성과 연관이 있으며, 혈당강하, 항염증, 항죽상경화작용 등의 긍정적인 효과를 보이는 것으로 알려져 있다. 이에반해 사람에서 레지스틴의 생리적 역할에 대해서는 아직까지 규명되지 않은 상태이다. 이에 본 연구에서는 정상인과 제2형 당뇨병환자에서 아디포넥틴 및 레지스틴과 인슐린 저항성, adiposity, 대사성 위험인자 등과의 관련성에 대해 알아보고자 하였다. 방법: 본원 내분비내과와 검진센터를 방문한 83명의 2형 당뇨병환자와 139명의 정상인을 대상으로 단면적 연구를 시행하였다. 대상인들의 키, 체중, 체지방량을 측정하였고, 총 콜레스테롤, 중성지방, 고밀도 지단백 콜레스테롤 농도, 아디포넥틴 및 레지스틴을 측정하였다. 인슐린 저항성은 공복 인슐린과 혈당을 측정하여 HOMA-IR법으로 계산하였다. 또한 복부단층촬영을 하여 복부피하지방면적과 내장지방면적을 구하였다. 결과: 아디포넥틴은 당뇨군에서 가장 낮고 대조군에서 가장 높았으며, 각 군에서 의미있는 차이를 보였다. 이에 반해 레지스틴은 각 군에서 비슷한 수치를 나타냈다. 로그 아디포넥틴은 나이, 성별, 당뇨유무를 보정한 후 수축기혈압 (r=-0.169, P<0.05), 체질량지수(r=-0.224, P<0.05), 복부내장지방면적(r=-0.413, P<0.001), 공복혈당(r=-0.285, P<0.05), HOMA-IR(r=-0.273, P<0.05), 중성지방(r=-0.352, P<0.001), 저밀도 콜레스테롤(r=-0.184, P<0.05)과 음의 상관관계를 보였고, 고밀도 콜레스테롤(r=0.324, P<0.001)과는 양의 상관관계를 보였다. 다중회귀분석상 당뇨군에서는 공복혈당, HOMA-IR 및 고밀도 콜레스테롤이, 비당뇨군에서는 성별, 체질량지수, 복부내장지방면적, HOMA-IR 및 고밀도 콜레스테롤이 독립적으로 혈중 아디포텍틴 농도에 영향을 미치는 것으로 나타났다. 이에반해 로그 레지스틴은 고밀도 콜레스테롤(r=-0.193, P<0.05)과 음의 상관관계를 보였으며 체질량지수, HOMA-IR등과는 상관관계를 보이지 않았다. 결론: 혈중 아디포넥틴은 당뇨유무와 상관없이 인슐린저항성의 지표인 HOMA-IR과 높은 상관성을 나타냈으나, 레지스틴은 인슐린저항성 및 비만지표와 상관관계를 나타내지 않았다. Background: Adiponectin is a fat cell-secreted cytokine, which has been reported to improve insulin sensitivity and have antiatherogenic properties. However, it is still unclear whether resistin plays a significant role in the development of insulin resistance in humans. The aim of this study was to investigate the relationship of the adiponectin and resistin concentrations with insulin resistance, metabolic markers and adiposity in healthy and type 2 diabetic subjects. Methods: Eighty-three type 2 diabetic and 139 healthy subjects were studied. Blood samples were drawn after fasting to determine the fasting plasma glucose, insulin, resistin, adiponectin, total cholesterol, triglyceride and HDL-cholesterol levels. The subcutaneous and visceral fat areas were measured at the umbilical level using computed tomography. Results: The serum adiponectin concentrations were significantly lower in the diabetic(6.7±2.3μg/mL) than in the obese(8.2±2.4μg/mL, P<0.01) and non-obese subjects(9.9±4.5μg/mL, P<0.01). The serum resistin concentrations were Similar between the non-obese, obese and type 2 diabetic subjects. From a multiple regression analysis, the fasting glucose, HDL-cholesterol and HOMA-IR were found to be independent determinants of the log of the adiponectin level in the diabetes group. In healthy subjects, the gender, BMI, HOMA-IR, visceral fat area and HDL-cholesterol were associated with the log of the adiponectin level. However, the log of the resistin level was not associated with the markers of insulin resistance and obesity.Conclusion: This study showed that the serum adiponectin concentration was closely related to the insulin resistance marker in both healthy and type 2 diabetic subjects. However, the resistin concentration was not associated with the markers of insulin resistance and/or obesity
김현진,박석오,고승현,이상열,허규연,김난희,문민경,이병완,김진화,최경묵 대한당뇨병학회 2017 Diabetes and Metabolism Journal Vol.41 No.6
The glucagon-like peptide-1 receptor agonists (GLP-1RAs) were recommended as a monotherapy or combination therapy with oral hypoglycemic agents or basal insulin in the position statement of the Korean Diabetes Association 2017 for pharmacological therapy. Many randomized clinical trials and systematic reviews report that GLP-1RAs have considerable glucose-lowering effect and lead to weight reduction and low risk of hypoglycemia when used as a monotherapy or combination therapy. The cardiovascular safety of GLP-1RAs has been assessed in several randomized clinical trials and systematic reviews. The results of cardiovascular outcome trials of long-acting GLP-1RAs (liraglutide, semaglutide) demonstrated cardiovascular benefits in subjects with type 2 diabetes mellitus and a high risk of cardiovascular disease. The GLP-1RA may be a choice of therapy when weight control and avoidance of hypoglycemia are important, and patients with high risk of cardiovascular disease might also favor choosing GLP-1RA.
이병철,민경업,박석오,최대섭,장석일,안재곤,문제웅,조병섭,천대철 대한알레르기학회 1996 천식 및 알레르기 Vol.16 No.1
Systemic allergic reaction by ant sting is relatively rare but is potentially lethal. We experienced two cases with systemic allergic reaction by ant(Brachyponera chinensis, Emery) sting in mother and daughter. Mother had a previous history of food allergy, and daughter had a history of at,opy and allergic rhinitis. They had generalized allergic reactions in skin and respiratory system after ant sting at home. They showed strong positive skin reactions to whole body extract of causative ant. We determined that their reactions were caused by ant venom in mother and daughter. The causative ant was confirmed by skin test.
Combination Therapy of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus
문민경,허규연,고승현,박석오,이병완,김진화,이상열,김현진,최경묵,김난희 대한당뇨병학회 2017 Diabetes and Metabolism Journal Vol.41 No.5
The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed from those of the 2015 KDA guidelines. The Committee on Clinical Practice Guidelines of the KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or third agent as a metformin and sulfonylurea add-on therapy should be based on the patient’s clinical characteristics and the efficacy, side effects, mechanism of action, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity. In this review, we address the results of meta-analyses and systematic reviews, comparing the effectiveness and safety among OHAs. It will help to choose the appropriate drug for an individual patient with T2DM.
우측폐의 형성 부전과 " Scimitar Sign " 을 보이나 좌심방으로 유입되는 우측 폐정맥을 보인 Scimitar Syndrome 1 예
김정한,이병철,김택수,추길연,박석오,천대철,조병섭,문제웅,안제곤,최대섭,권용화 대한내과학회 1995 대한내과학회지 Vol.48 No.2
The scimitar syndrome is a rare, complex, variable and congenital malformation of the right lung. These anomalies consist of anomalus pulmonary venous drainage of the right lung to the IVC, hypoplasia of the right lung, hypoplastic right pulmonary artery and anomalies of the right hemidiaphragm. But we recently experienced a case of typical scimitar syndrome except pulmonary venous drainage of the right lung to the IVC. This case shows drainage not to the IVC, but to the left atrium. We present this case with the review of literature.
위선암과 우측 쇄골상 림프절의 호지킨씨 림프종이 병발한 이중 원발성 암 1 예
김호정,김규태,최대섭,김택수,천대철,문제웅,변정원,박석오,이병철,조병섭,안재곤 대한내과학회 1996 대한내과학회지 Vol.50 No.6
Double primary cancer is defined as the case of primary malignant tumors, which must be arise in different sites and have a different histologic appearances. This article is a case report of synchronous double primary cancers. We have experienced with double primary malignant tumors of different site of origin such as stomach adenocarcinoma and Hodgkin's lymphoma of right supraclavicular lymph node, which were diagnosed by biopsies with gastrofibroscopy and fine needle aspiration of right supraclavicular lymph node. For its great rarity, we report this case with review of literatures.