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ECG Gated Cardiac Blood Pool Scan에서 좌심실기능 분석에 관한 연구
조보연,이명철,고창순,한만청,정준기,김광원,이정균,이용우 대한핵의학회 1980 핵의학 분자영상 Vol.14 No.1
심질환 환자에서 임상적으로 중요한 좌심실의 기능을 측정하기 위해서 종전에는 심도자법과 심장영화조영술, 초음파심음향도등이 사용되어 왔으나 시술의 복잡성, 위험성, 부정확성 등의 제한점이 있어 왔다. ECG gated cardiac blood pool scan 방법은 간단하고 안전하면서도 정확하여 널리 쓰이고 있고, computer에 연결시켜 정량적인 분석도 하고 있다. 저자들은 ECG gated cardiac blood pool scan으로 좌심실의 기능을 측정하기 위하여 1979년 4월부터 1980년 3월까지 서울대학교병원에 입원한 각종 심질환환자 165명과 정상대조군 26명에서 blood pool scan을 시행하고 분석하였다. 1) 20명에서 blood pool scan에서 구한 심박출계수를 X-ray의 심장영화조영술에서 구한 심박출계수와 비교하여 보았다. 상관계수가 0.885로 높은 정확도를 보이고 있었다. 2) 심박출계수를 New York Heart Association의 functional class에 따라 분류하여 보았다. 정상대조군에서는 66.7±6.1%, class Ⅰ에서 62.1±9.0%, Ⅱ에서 53.4±9.1%, Ⅲ에서 42.2±12.3%, Ⅳ에서 31.0±8.8%로 심질환의 정도를 잘 반영하여 주고 있었다. 3) 각종 심질환에서의 심박출계수를 구해 보았다. 허혈성심질환에서 34.4±16.7%, 심근병증에서 20.1±4.8%로 다른 심질환에 비해 심하게 감소되어 있었다. 심장경색증에서 경색의 범위가 넓을수록 심박출계수가 떨어져 있었다. 4) 확장기말과 수축기말에서 심장윤곽을 중첩시켜 좌심실의 벽운동을 분석하여 보았다. 심장병증 환자에서는 전반적인 hypokinesia가 있었고, 심장경색증 환자에서는 심전도소견과 상응하는 부위에서 akinesia를 관찰할 수 있었다. 이와같이 ECG gated cardiac blood scan은 비관혈적으로 간편하게 좌심실의 기능을 관찰할 수 있고 또 성적이 종래의 방법과 비교하여 매우 정확하였다. 또한 내과학적인 치료나 수술후의 경과를 쉽게 관찰할 수 있고 그 예후도 미리 예측할 수 있어 임상적으로 크게 유용하다. Most of clinical morbidity in cardiology are associated with abnormalities of the left ventricle. Several methods have been developed to measure the left ventricular function, including cardiac catheterization with cineangiography, echocardiography, and systolic time interval. But these methods have many limitations. ECG gated cardiac blood pool scan provides a safe, noninvasive, repeatable method for determining the left ventricular function. Utilizing the cardiac blood pool scan, we measured the left ventricular function in 165 cardiac patients, and in 26 normal subject. 1) Left ventricular ejection fractions were measured by cardiac blood pool scan, and compared in 20 patients with that measured by x-ray cineangiography. Correlation coefficient was 0.855. 2) Ejection fractions were classified by funtional class made in New York Heart Association. Ejection fractions well represented the functional status. 3) Ejection fractions decleased in cardiomyopathy (20.1±4.8%) and ischemic heart disease (34.4±16.7%)Impaired ejection fractions in myocardial infarction were associated with the extent of infarction. 4) Regional left ventricular wall motion was evaluated from the end-diastolic and end-systolic images. In cardiomyopathy diffuse hypokinesia was noted and in myocardial infarction akinesia was noted on the infarcted areas.
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일차성 갑상선기능 저하증 환자에서 사람 TSH 수용체 항체를 발현하는 Chinese Hamster Ovary ( CHO ) 세포를 이용한 갑상선 자극차단 항체 활성의 측정
조보연,김원배,박도준 대한내분비학회 1997 Endocrinology and metabolism Vol.12 No.1
Background: The Chinese hamster ovary cells transfected with human TSH receptor cDNA (hTSHR-CHO), expressing functional human TSH receptors, are known to be more sensitive in detection of thyroid stimulating antibodies than FRTL-5 cells. There has been no report on the usefulness of these cells to measure thyroid stimulation blocking antibody(TSBAb) activity which is frequently found in patients with primary myxedema, Methods: We established the optimal assay condition of measurement of TSBAb using hTSHR- CHO cells, and simultaneously measured TSBAb activities with FRTL-5 cells and with hTSHR- CHO cells in 49 patients with primary myxedema, compared them with their thyrotropin binding inhibitor immunoglobulin(TBII) activities. Results: 1) hTSHR-CHO cells specifically bound bTSH and were stimulated by bTSH in terms of cyclic AMP generation in a dose dependent manner. 2) Myxedema IgG suppressed TSH-stimulated cAMP production of hTSHR-CHO cells in a dose dependent manner reaching plateau at the concentration of I g/L. Normal pooled IgG has no suppressive action at the concentration of less than 1 g/L, but caused significant suppression at the concentration of greater than 1g/L. 3) TSBAb activities measured by hTSHR-CHO cells in 49 patients with primary myxedema were as follows: Four of 25 TBII-negative cases(16%) and 22 of 24 TBII-positive cases(92%) had TSBAb activities. Most of TSBAb positive patients(95%), especially in TBII positive cases, showed very high activities of more than 90%. 4) TSBAb activities measured by hTSHR-CHO cells and those by FRTL-5 cells were both positive in 24 patients(49%), both negative in 18 patients(37%), and were discrepant in 7 patients(14%). The TSBAb activities measured with hTSHR-CHO cells and those measured with FRTL-5 cells were significantly correlated(r=0.71, p$lt; 0.01). 5) Forty five percent of patients with primary myxedema had all of 3 kinds of activities(TBII, hTSHR-CHO cell TSBAb, FRTL-5 cell TSBAb), 37% of them had none of 3 activities and 18% of them had 1 or 2 kinds of activities only. Conclusion: The usefulness of hTSHR-CHO cells in measurements of TSBAb activities were confirmed. The TSBAb activities of most patients with primary myxedema measured by hTSHR- CHO cells were concordant with those measured by FRTL-5 cells. However, a small subset of patients(18%) had discrepant results in assays of TSH receptor antibodies according to the differences in TSH receptors(rat, human and porcine) used in assay. Such discrepancy may be explained by heterogeneity in epitopes for blocking TSH receptor antibodies. (J Kor Soc Endocrinol 12:18-32, 1997)
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무증상 갑상선기능저하증 환자에서 Thyroxine 치료에 따른 혈청 지질 및 아포지단백의 변화
조보연,신찬수,김원배,고창순,김성연,박혜영,박건상,이홍규,박형규,김숙경 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.1
Background: Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies(J Kor Soc Endocrinol 11:41-51, 1996).
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방사성동위원소정맥촬영술의 진단적 의의 : X-선정맥조영술과의 비교 연구 A Comparison with X-ray Contrast Venography
조보연,고창순,배상훈,박재형,한만청 대한핵의학회 1981 핵의학 분자영상 Vol.15 No.2
Radionuclide venographies were performed in 138 limbs of 58 patients and X-ray contrast venographies were performed in 23 patients of them. Positive radionuclide venography findings were area of decreased radioactivity flow corre-sponding to the region of thrombosis, abnormal collateral flows and radioactivity stasis below the lesion. The success rate of radionulide venography was 89% and the overall concordance between radionuclide venography and X-ray contrast venography was 91%. Radionuclide venography is simple and easy to perform and less invasive than X-ray contrast venography. These results indicate that radionuclide venography is the most ideal screening test for the detection of venous thrombosis in patient with signs & symptoms of deep vein thrombosis.
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