미세단백뇨를 동반한 인슐린비의존형 당뇨병 환자에서 신장 병리 소견의 다양성

정윤이(Yun Ey Chung),이기업(Ki Up Lee),박중열(Joong Yeol Park),홍성관(Sung Kwan Hong),강재영(Jae Young Kang),이종수(Jong Soo Lee),오영하(Young Ha Oh),정재걸(Jae Gul Chung),유은실(Eun Sil Yu),박정식(Jung Sik Park) 대한내과학회 1998 대한내과학회지 Vol.55 No.5

N/A Objective: It was suggested that the cause of microalbuminuria is heterogeneous in NIDDM. However, only a few studies are available that investigated the renal pathology in NIDDM patients with microalbuminuria. This study was undertaken to evaluate renal pathology in Korean NIDDM patients with microalbuminuria. Methods: Fifty NIDDM patients with microalbuminuria and without retinopathy were undertaken renal biopsy. Renal pathologic findings were classified as follows' group A, near normal finding; group B, typical diabetic nephropathology; group C, atypical patterns of renal injury (mild glomerular change with disproportionally severe tubulointerstitial lesion, arteriolar hyalinosis or global glomerular sclerosis); group D, non-diabetic renal lesion. Results: Seventeen patients were classified into group A, 19 into group B and 8 into group C. Six patients had non-diabetic renal lesions and they were all confirmed to be IgA nephropathy, Fasting blood sugar and GFR were significantly higher in group B than in group A and group C respectively, and systolic blood pressure was higher in group C than in group A. Conclusion: Renal pathology in microalbuminuric NIDDM patients without retinopathy was heterogeneous. This may explain heterogeneous clinical meaning of microalbuminuria in NIDDM.

쿠싱 중후군 환자에서 미세단백뇨의 빈도 및 수술의 효과

고정민(Jung Min Koh),정윤이(Yun Ey Chung),박중열(Joong Yeol Park),송영기(Yung Kee Shong),홍성관(Sung Kwan Hong),이기업(Ki Up Lee),김기수(Ghi Su Kim) 대한내과학회 1998 대한내과학회지 Vol.55 No.2

N/A Objectives: Microalbuminuria predicts cardiovascular mortality in patients with non-insulin-dependent diabetses mellitus (NIDDM). Microalbuminuria is frequently associated with high blood pressure, dyslipidemia, insulin resistance and central obesity, and has been suggested to be a feature of metabolic syndrome (syndrome X). Metabolic syndrome is also present in Cushings syndrome, which is characterized by primary hypercortisolism as well as profound visceral obesity. Considering common features of Cushings syndrome and metabolic syndrome, microalbuminuria could be a feature of Cushings syndrome. Methods ' We studied urinary albumin excretion (UAE) in 13 patients with Cushings syndrome, UAE was reexamined after the correction of hypencortisolemia in the patients with microalbuminuria or overt proteinuria. Kidney biopsy was performed in 3 patients with microalbuminuria. Hesults: Eight out of 13 patients (61.5 %) had microalbuminuria. Kidney biopsy revealed apparently normal glomerular structures without evidence of diabetic or hypertensive nephropathy. Patients underwent successful removal of pituitary or adrenal tumors and were reevaluated 2 months after surgery. TJAE declined profoundly in all of the patients with initial microalbuminuria. . Conclusion - Our results demonstrate that more than 60% of patients with Cushings syndrome have microalbuminuria. This rate far exceeds the rate in NIDDM patients and hypertensive patients. Microalbuminuria nearly completely reversed after successful treatment of hypercortisolism.

트리요오드티로닌 자가항체가 동반된 하시모토 갑상선염 1예

정윤이,한정희,이성진,민원기,박기영,박건구,문대혁,안일민 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.2

Autoantibodies against thyroid hormones can be detected in the sera of patients with both thyroidal and non-thyroidal disorders. These antibodies interfere with the radioimmunoassay of serum total and free thyroid hormone concentrations, resulting in a discrepancy between the measured hormone levels and clinical features. This can in turn lead to an erroneous diagnosis and patients may receive unnecessary treatment from physicians who are unaware of the presence of the autoantibodies. We experienced a woman having Hashimotos' thyroiditis with a spurious elevation of total T_3 and free T_3 values according to one-step analog-tracer radioimmunoassay who was had been treated as Graves' disease in past. Through the use of a polyethylene glycol precipitation method, she was subsequently revealed to have anti-triiodothyronine autoantibodies. We report this case with a review of related literature

그레이브스병 여성의 산후 갑상선 중독증 감별진단에서 항갑성선 수용체 측정의 임상적 의의

원종철,정윤이,문대혁,류진숙,안일민,김암,한정희,김하영,이성진 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.1

Background: It is known that pregnancy markedly influences the clinical course of autoimmune thyroid diseases. In the postpartum period, various kinds of autoimmune thyroid dysfunctions can be observed. Thyroid dysfunction is found in 5.57. L /r of postpartum women in the general population. Among those who show thyroid dysfunction after delivery, some will develop Graves disease and others will develop postpartum thyroiditis. It is also known that patients with Graves disease may manifest thyrotoxicosis in the postpartum period because of postpartum thyroiditis or relapse of the Graves disease itself. We evaluated the clinical features of postpartum thyrotoxicosis in Graves disease patients to find diagnostic indices that could be used in differentiating between postpartum thyroiditis and relapse of Graves' disease. Method: We reviewed the cases with postpartum thyrotoxicosis in patients that had a history of Graves disease between 1995 and 2000. The diagnosis of postpartum thyroiditis had been made by means of a 99m Tc thyroid scan or by the observation of a typical triphasic thyroid function change, in cases where a ' 99m Tc thyroid scan was not possible because of breast feeding. We measured the serum TSH, free T4, free T3, TSH binding inhibiting immunoglobulin (TBII), anti-thyroid peroxidase (TPO) antibody, and anti- thyroglobulin (Tg) antibody serially from the time of the diagnosis of Graves' disease to the time of postpartum thyroid dysfunction. Results: Eleven patients, 5 patients in the postpartum thyroiditis (PPT group) and 6 patients with relapse of the Graves' disease (GD group), were identified. The mean values of TBII of two groups at the time of diagnosis of Graves disease were 40.9?4.8 IU/mL (PPT group), 58.9+23.5 ?IU/mL (GD group) respectively, which were insignificant. The mean values of TBII of the two groups at early pregnancy were 3.2+1.9 ~pIU/mL (PPT group), 41.6+22.6 ~pIU/mL (GD group) and this difference was statistically significant (p=0.009). The mean values of TBIJ of the two groups the time of postpartum thyrotoxicosis were 1.9?1.6?IU/mL(PPT group), 51.5?23.2?IU/mL(GD group) which were also statistically significant (p0.003). The mean values of anti-TPO antibody, anti-Tg antibody, disease duration, and treatment duration between the two groups were not significantly different. The onsets of thyroid dysfunction after delivery in the two groups were 2.6?2.0 (PPT group), 4.0?3.9 (GD group) months which were statistically insignificant. Conclusion: These data suggest that the measurement of TBII at the time of the postpartum thyrotoxic period, could help to differentiate postpartum thyroiditis from a relapse of Graves disease in those patients that have a history of Graves disease especially when thyroid scan is not possible because of breast feeding (J Kor Soc Endocrinol l6:75-84, 2001).

고지방식이가 백서 골격근 및 지방조직의 지방분해에 미치는 영향

김철희,정윤이,이성진,박중열,홍성관,김홍규,서교일,이기업 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:지방산화의 증가가 골격근에서 인슐린 저항성을 유발한다는 주장이 꾸준히 제기되어 나왔으나, 최근 제2형 당뇨병 환자나 인슐린저항성 상태에서 골격근의 지방산화능이 저하되어 있다는 보고도 있어 논란이 있는 상태이다. 본 연구에서는 고지방식이를 투여하여 인슐린저항성을 유발한 백서에서 microdialysis 기법을 이용하여 조직내의 지방분해 결과로 간질액내로 방출되는 글리세롤 농도를 골격근 및 지방조직에서 직접 측정하여 지방분해의 변화를 알아보고자 하였다. 방법:정상 Sprague­Dawley 백서를 두 군으로 나누어 4주간 고지방식이 및 저지방식이를 투여하였다. 4주간 기저상태 및 고인슐린 정상혈당 클램프 중의 골격근 및 지방조직에 microdialysis probe를 삽입하고 일정한 농도의 글리세롤을 포함하는 dialysate를 통과시켜 주입액과 유출액의 글리세롤 농도 차이로부터 조직 간질의 글리세롤 농도를 산출하엿다. 결과:기저상태에서 골격근 및 지방조직 간질의 글리세롤 농도는 저지방식이군에 비하여 고지방식이군에서 유의하게 낮았다. 고인슐린 정상혈당 클램프 중에는 골격근 및 지방조직 간질의 글리세롤 농도가 양군에서 모두 억제되었는데, 기저 상태와 마찬가지로 골격근 및 지방조직 모두에서 저지방식이군보다 고지방식이 군에서 더 낮았다. 기저 상태에 대한 고인슐린 클램프중의 글리세롤 방출 억제 정도는 저지방식이군에 비하여 고지방식이군에서 덜 억제되는 경향을 보였는데, 골격근조직에서만 통계적으로 유의하였다. 결론:본 연구 결과는 고지방식이에 의한 인슐린저항성 모델에서 골격근 및 지방조직내 지방분해가 억제되어 있음을 보여주며, 기존의 포도당­지방산 cycle 이론과는 달리 조직내 지방산화의 증가보다는 지방산화능의 감소에 따른 세포내 지방축척이 인슐린저항성과 관련될 가능성을 시사하였다. Background : It has been hypothesized that increased fat oxidation reduces glucose utilization in skeletal muscle, and is responsible for the insulin resistance associated with obesity or high-fat feeding. In contrast, there have been reports that fat oxidation capacity was decreased in skeletal muscles from insulin resistant subjects. This study was undertaken to examine whether insulin resistance in high-fat fed rats is associated with increased lipolysis in skeletal muscle and adipose tissue. Methods : Two groups of Sprague-Dawley rats were fed either high-fat or low-fat diets for 4 weeks. Lipolysis in skeletal muscle and adipose tissue was determined by measurement of interstitial 1 glycerol concentrations by a microdialysis method in basal and hyperinsuline mic-euglycemic clamp conditions. Results : In basal state, plasma glycerol levels and interstitial glycerol concentrations of skeletal muscle, and adipose tissue were lower in high-fat fed than in low-fat fed rats. The degree of suppression of glycerol release by the hyperinsuline mia was smaller in the high-fat diet than in the low-fat diet group. However, plasma and interstitial glycerol concentrations during the hyperinsuline mic euglycemic clamps were also lower in the high-fat diet group. Conclusion : Lipolysis was decreased in skeletal muscle and adipose tissue of insulin resistant, high-fat fed rats. These results support the idea that limited fat oxidation capacity resulting in lipid accumulation in tissues, rather than increased fat oxidation perse, is responsible for the insulin resistance associated with high-fat feeding (J Kor Diabetes Asso 24:641~651, 2000).

증식성 당뇨병성 망막병증을 가진 제2형 당뇨병 환자에서 혈청 Lipoprotein(a)농도의 증가

김은숙,정윤이,김상욱,이기업,홍성관,김철희,박형주,김진엽 대한당뇨병학회 1998 Diabetes and Metabolism Journal Vol.22 No.3

지방분해 억제제 투여에 의한 혈장 유리지방산의 감소가 스트렙토조토신 유발 당뇨 쥐에서 혈당 및 간 조직 내 글리코겐 함량에 미치는 영향

김은숙,정윤이,김상욱,이기업,박중열,홍성관,김진엽 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.1

지역주민에서 내당능에 따른 혈청 Leptin 농도 및 연관인자

김영일,김진엽,정윤이,김상욱,이기업,홍성관,이무송,박중열 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.4

제2형 당뇨병 환자에서 Voglibose와 Acarbose의 비교임상연구

정인경,정재훈,민용기,이명식,이문규,김광원,정윤이,박중열,홍성관,이기업 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.26 No.2

연구배경:아카보스와 보글리보스는 ­glucosidase inhibitors로써 비록 약리학적 작용이나 부작용에 있어서 두 약물간에 차이가 있다는 것은 잘 알려져 있으나 당뇨병 환자를 대상으로 아직 이에 대한 두 약물간에 직접적인 비교에 대해 연구된 바는 없었다. 이에 저자등은 국내 2형 당뇨병 환자에 대해 유효성과 부작용 발현에 대해 두 약제를 비교하고자 무작위법에 의한 위약 대조군의 이중 맹검법 연구를 시행하였다. 방법:시험 약제 투여 4주간의 관찰기를 설정하여 공복혈당의 변화가 30㎎/dL 이하이고, 식후 혈당이 200㎎/dL 이상인 환자로 기타 제외 기준에 해당하지 않은 환자 53명을 대상으로 하여 보글리보스 군(24명)과 아카보스 군(29명)으로 무작위로 나누었다. 치료기간은 총 8주로 하였으며, 4주간 간격으로 혈청학적 검사와 부작용을 분석하여 치료 효과가 부작용을 평가하였다. 결과:1)혈당 변화:보글리보스군은 식후 1시간 혈당이 치료 후 4주, 8주째 의미 있게 감소하였도, 아카보스군은 식후 1시간과 2시간 혈당이 치료 후 4주, 8주째 의미있게 감소하였다. 또한 관찰기 혈당에 대한 치료 4주째 감소량은 아카보스군에서 더 큰 경향을 보였으나, 치료 8주째에는 두 군 간의 강하정도에 의미있는 차이가 없었다(p=0.569). 2)인슐린 치의 변화:보글리스 군은 식후 1시간 인슐린 치가 치료 전에 비해 치료 4주, 8주째 감소하는 경향을 보였고, 공복 인슐린이나 식후 2시간 인슐린치는 치료전 후에 의미 있는 차이가 없었다. 아카보스군에서는 치료 전후로 공복 인슐린, 식후 1시간과 2시간 인슐린치에 의미 있는 차이를 보이지 않았다. 두약제 간에 치료 전과 치료 8주사이의 식후 2시간 인슐린의 감소량이 보글리보스 군에서 의미있게 높았다(p=0.040). 3)당화혈색소:보글리보스 군은 치료 전에 비해 치료후 당화혈색소가 감소하는 경향을 보였고, 아카보스군은 치료 전에 비해 의미있게 감소하였다. 당화혈색소 변화량은 두 군간에 의미 있는 차이는 없었다(p=0.412). 4)지질대사의 변화:중성지방, 콜레스테롤, 고밀도 진단백 콜레스테롤에 대해 두 군간에 의미 있는 차이는 없었다. 5)부작용:소화기계 부작용의 빈도는 치료 4주째 보글리보스 군에서 의미 있게 낮았으나(p=0.028), 치료 8주째 부작용의 빈도는 두 군간에 의미 있는 차이가 없었다(p=0.215). 결론:2형 당뇨병 환자에서 보글리보스와 아카보스의 두 약제의 임상적 유효성과 부작용발현에 대해 비교한 결과 치료 후 8 주 후 혈당강화효과는 두 약제간에 유사한 효과를 보였으나 보글리보스군에서 4주째의 초기 위장관 부작용이 적었다. Background : Acarbose and voglibose are alpha-glucosidase inhibitors. Although different pharmacological effects and adverse abdominal events associated with the two drugs have been reported, no study directly compared acarbose and voglibose in diabetes has been undertaken. To compare the pharmacological effects and gastrointestinal adverse events between two drugs, a randomized, placebo-controlled, double-bind study was performed in type 2 diabetes patients. Methods : The period of study was 12 weeks(observation period: 4 weeks; treatment period: 8 weeks). Fifty-three patients were randomized into two groups(the acarbose group: 24 patients; the voglibose group: 29 patients). The serum glucose, insulin, fructosamine, HbA_1c, cholesterol, triglyceride and the incidence of adverse events were measured. Results : 1) The reduction of glucose from before treatment to 4 weeks after treatment was significantly higher in the acarbose group, but the change before treatment and 8 weeks after treatment in the two groups was similar(p=0.569). 2) The insulin significantly decreased after voglibose treatment(p=0.040). 3) HbAa_1c level tended to decrease in voglibose group, and there was a significant decrease after acarbose treatment. However, the change in HbA_1c level before and after treatment was similar between the two groups(p=0.412). 4) The two drugs did not cause any other changes in the total, HDL-cholesterol and triglyceride. 5) The number of patients with gastrointestinal adverse events was significantly low 4 weeks after voglibose treatment (p=0.049), but the incidence in the two groups was similar after 8 weeks(p=0.215). Conclusions : Acarbose and voglibose significantly improved postprandial hyperglycemia in diabetes. The incidence of gastrointestinal adverse events was low 4 weeks after voglibose treatment(J Kor Diabetes 26:134~145, 2002).

유리지방산이 배양된 혈관내피세포내 glutathione redox status에 미치는 영향

김영일,이재담,정윤이,이기업,박중열,홍성관,김철희,김홍규 대한당뇨병학회 1998 Diabetes and Metabolism Journal Vol.22 No.3