제 50 차 대한내과학회 추계학술대회 초록집 : 자가면역성 갑상선 질환 환자에서 혈청내 수용성 Fas 치의 변동

주원찬,신재규,박소영,한희정,채수홍,김현진,송민호,김영건,노홍규 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

비외상성 척추 압박골절환자에서 척추 골밀도의 변화

주원찬,신재규,한희정,송민호,노흥규 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

The measurement of bone mineral density(BMD) is important for diagnosis of osteoporosis and prediction of fracture risk in postmenopausal women. We measured bone mineral density in patients with osteoporotic spinal compression fracture group and control group. Here we described clinical changes of bone mineral densities and fracture threshold in postmenopausal women who had the nontraumatic spinal compression fracture. The measurement of BMD were performed by dual energy X-ray absortiometry in 36 postmenopausal patients who had the spinal compression fracture which were evident in simple spine X-ray. The control group (fourteen postmenopausal women) had no back pain and no evident in simple spine X-ray. The mean bone mineral densities from L2-L4 in the pateinets with spinal fracture (0.630±0.114g/㎠) were significantly lower than the control group (0.969±0.156 g/㎠) (p<0.0001). The bone mineral densities were positively correlated with age (n=36, r=36, p<0.05). The number of spine fracture were increased with in patents who showed low bone mineral densities, high T score, low body mass index and early menopause. The most frequent site of compression fracture were noted at L1, T12, L2 and L4, L3, The fracture threshold definded by Riggs was 0.793 g/㎠ in theses patients. In conclusion, the patients with nontraumatic spinal compression fracture showed signifcantly low bone mineral densitie and T score and the fracture threshold was 0.793 g/㎠.

분화 갑상선암에서 전이평가를 위한 방사성 옥소 전신스캔과 혈청 갑상선글로부린 측정의 의의

노흥규,주원찬,김윤,한희정,원진호,채수홍,김현진,김도희,송민호 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

We retrospectively evaluated serum thyroglobulin and ^131I whole body scan of welldifferentiated thyroid carcinoma patients after total thyroid ablation by surgery and ^131I therapy. Serum thyroglobulin levels are highest in diffuse lung uptake(n=2, 2909.50±360.0ng/ml), regional lymph node uptake(n=12, 208.15±351.0ng/ml), remnant thyroid uptake(n=13, 19.53±25. 70ng/ml) and lowest in no active radioiodine uptake(n=4, 2.55±1.82ng/ml). We concluded that serum thyroglobulin and ^131I whole body scan were useful methods for assessing metastases and necessary in follow up of well-differentiated thyroid carcinoma. In cases of low serum thyroglobulin level and abnormal radioiodine uptake in ^131I whole body scan, thyroglobulin mRNA RT-PCR should be measured to assessing residual thyroid tissue and recurrence of well differentiated thyroid carcinoma. Thallium, ^99mTc-tetrofosmin, and fluorodeoxyglucose proton emission scans were known to more sensitive than ^131I whole body scan to detecting recurrence of well differentiated thyroid carcinoma. Patients with high serum thyroglobulin level and negative ^131I whole body scan, should be performed sensitive scintigraphies to reduce over-treatment of well differentiated thyroid carcinoma with high dose ^131I therapy.

당뇨병에 동반된 고지혈증에 대한 연구

김영건,주원찬,원진호,한희정,채수흥,김현진,김윤 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Background. Diabetes mellitus is combined with other metabolic disfunction, especially dyslipidemia. Dyslipidemia is the risk factor of cardiovascular disease. So we studied about dyslipidemia associated DM. Method. A total 169 subjects were studied. This study was performed by review of medical records retrospectively. Results. The mean level of triglyceride and total cholesterol was 315.2mg/dI, 249.3mg/dl respectively. The most common type of dyslipidemia was pure hypertriglyceridemia. Whether obese, hypertensive, have cardiovascular disease or not the level of triglyceride and total cholesterol was not different from another. The triglyceride of patients with fatty liver was significantly higher(370.4mg/dl) than that(296.4mg/dl) of patients without fatty liver. The total cholesterol of patients with overt proteinuria(30mg/day<daily urinary protein<300mg/day) was significantly higher(276.3mg/dl) than that(239.9mg/dl) of patients without proteinuria.

폐경후 여성에서 에스트로겐, 이프리플라본, 칼시토닌 투여에 따른 골대사 표지자의 변화

노흥규,주원찬,한희정,채수흥,송민호 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

The measurements of metabolic bone markers are important for assesment of risks of osteoporotic fractures and efficacy of anti-osteoporotic treatment in postmenopausal women. We measured bone mineral densites, serum total alkaline phosphatases, and osteocalcin levels in estrogen replacement group(n=13), lpriflavone group(n=8), Calcitonin gruop(n=8) and untreated group(n=50). We used the dual energy X-ray absorptiometry for measurement of bone mineral densities in vertebra, used the p-nitrophenylphosphate and radioimmunoassay for serum alkaline phosphatase and serum osteocalcin, repectively. We compared the metablic hone markers, serum alkaline phosphatase, and osteocalcin between differrent treatment groups and analyzed the correlation between bone mineral densities with above metahlic bone markers. The treatment groups; estrogen, ipriflavone, and calcitonin groups showed significant low osteocalcin (p<0.05) levels but total alkaline phosphatase levels showed no significant difference compare to untreated group (p>0.05). There were no statistical significance of serum osteocalcin and alkaline phosphatase levels beween Ipriflavonc and untreated control group. Calcitonin group showed significant high alkaline phoshatase levels compare to untreated group(p<0.05) but osteocalcin levels showed no significant difference to untreated group. In conclusion, The biochemical bone markers such total alkaline phosphatase and serum osteocalcin are useful markers for the assesment of anti-osteoporotic treatment efficacy in postmenopausal women and reflect the high bone turnover in untreated postmenopausal women

폐경후 여성에서 치료 약제에 따른 부위별 골밀도의 변화

안봉수,신재규,주원찬,송민호,노흥규 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

Because of the prolongation of life span, the postmenopausal osteoporosis is a serious health problem, which needs active preventive and conservative measures. Recent evidence suggests that estrogen replacement therapy .(ERT), calcitonin, bisphosphonate and ipriflavone treatments are effective in preventing bone loss in postmenopausal women. In this study, we evaluated the effects of estrogen, ipriflavone, and combined therapy with estrogen and ipriflavone to BMD in various bone sites (lumbar spine, femoral neck and Ward's triangle). Forty-eight patients were devided into 3 groups by treatment modalities which are estrogen and ipriflavone group (n=12). After basal bone mineral desity (BMD) were determined by DEXA. (Dual energy X-ray absorptiometry. Lunar Radiation Corp. U. S. A. ), the patient were received medication according to each treatment protocol. The patients with estrogen treatment group were 2mg estradiol and 10mg of medroxy progesterone for 21 days a month. The patients of ipriflavone treatment group were received 600mg daily. The patients with combined therapy with estrogen and ipriflavone were received same dose of other two treatment groups. The BMD after treatment were compaired with basal BMD. The results were as follows. 1) The BMD in lumbar spine and femoral neck were significantly increased after estrogen treatment. 2) The BMD in lumar spine was significantly increased after ipriflavone treatment but the BMD in femoral neck and Ward's triangle were not increased with ipriflavone treatment. 3) After combined therapy with estrogen and ipriflavone, the BMD in each sites were increased and the BMD in Ward's triangle was more incresed than estrogen or ipriflavone treatment alone. In conclusion, estrogen prevented cortical bone and trabecular bone loss. ipriflavone prevented trabecular bone loss. The combination with estrogen and ipriflavone was increased effects of estrogen to prevent trabecular bone loss.

갑상선 악성결절에 대한 미세침흡인검사와 침생검의 진단적 의의

노흥규,신재규,주원찬,한희정,송민호 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To evaluate the usefulness. of fine needle aspiration (FNA) cytology and biopsy for the detection of malignant thyroid nodules in nodular nontoxic goiter. We retropsectively analyzed 70 patients who had the nodular nontoxic goiter which is highly suspicious by the cytological and biopsy findings. The results were as follows: 1) Out of 70 patients who were thyroidectomized for malignant nodules, 63 (88.6%) patients were women and 7 (11.4%) men. 2) Sensitivity and specificity of FNA cytology for the detection of malignant thyroid nodule were 72% and 15.4% respectively. 3) Sensitivity and specificity of biopsy for the detection of malignant thyroid nodule were 97.4% and 33.3%, respectively. 4) Sensitivity and specificity of combination of FNA cytology and biopsy for detection of malignant thyroid nodule were 95% and 100%m respectively. 5) Malignant thyroid nodules were almost (93.4%) cold nodules in ^99m-Tc thyroid scan single nodule (72.7%) was more common than multiple nodules, location of lesion was 1.99 times more common in right lobe than in left lobe in malignant thyroid nodule. 6) Regional lymph node and distant metastasis were identified in 43%, 3.7% of malignant thyroid nodules, respectively. We concluded that preoperative biopsy may increased detection rate of malignant thyroid nodule with benign findings in FAN cytology.

급·만성 간질환 환자에서 혈청 25-하이드록시 비타민 D_3 농도의 변화에 대한 연구

신재규,한희정,주원찬,송민호,이헌영,노흥규 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The liver plays a central role in the vitamin D metabolism; it determines the overall efficiency of vitamin D₃utilization through the 25-hydroxylation of vitamin D. The abnormalities of vitamin D metabolism in acute and chronic liver diseases result from multiple causes such as defects in synthesis of vitamin D binding protein and decreased metabolic activities in 25-hydroxylation of vitamin D. Presumably the severity of liver disease may be related to the low level of vitamin D₃,especially 25-hydroxylated vitamin D₃. We measured the serum 25-hydroxyvitamin D₃in the patients with acute and chronic liver diseases and analyzed their levels according to the severity of liver disease. The patients with acute hepatitis(n=9, M/F;7/2, age 32.3±16.2) and with liver cirrhosis (n=30, M/F;22/8, 55.8±10.5) were subjected to measure serum concentrations of 25-hydroxylated or 1,25-dihydroxylated forms of vitamin D3. Simultaneously we measured serum albumin, serum calcium, parathyroid hormone (PTH) to assess calcium metabolism and the severity of liver disease in those patients. 1) The level of serum 25-hydroxyvitamin D, concentrations in the patients with liver disease (acute hepatitis 12.4±6.4 ng/ml and liver cirrhosis 8.5±4.7 ng/ml, p<0.05) showed significant lower levels compared to normal controls (21.6±9.3 ng/ml) but there was no significant differences in the groups between acute hepatitis and liver cirrhosis. 2) The serum calcium concentrations were not significantly changed in the patients with acute hepatitis (9.06±0.33 mg/dl, p>0.05) but in the patients with liver cirrhosis showed significant decrease in serum calcium levels (8.22±0.57 mg/dl, p<0.05) than those of normal controls (8.76±0.5 mg/dl). 3) The level of serum 1,25-dihydroxyvitamin D₃ concentrations in the patients with liver, cirrhosis showed significant decrease (12.1±10.3 pg/ml, p<0.05) than those of normal controls (35.1±16.2 pg/ml). 4) We could observe the significant positive correlations between serum 25hydroxyvitamin D₃concentrations and serum albumin concentrations in both groups of acute hepatitis (r=0.757, p<0.05, n=9) and liver cirrhosis (r=0.431, p<0.05, n=30). We could observe low serum 25-hydroxyvitamin D, concentrations in patients with acute and chronic liver diseases. This finding suggest that the 25-hydroxylation of vitamin D showed a defect in the early course of liver disease and this is progressively deranged during the course of chronic liver disease. This finding support the causal relationship between liver disease and its metatolic derangement.

만성 신부전증에서 혈청 1,25-디하이드록시 비타민 D농도와 부갑상선 호르몬, 혈청 칼슘과 25-하이드록시 비타민 D치의 상관관계

노흥규,신재규,주원찬,송민호 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Objectives : Low production of 1,25-dihydroxyvitamin D_3 due to decreased 1-hydroxylation in patients with chronic renal failure causes reduction of gastrointestinal calcium absorption, secondary hyperparathyroidism and development of renal osteodystrophy. The measurement of serum 1,25-dihydroxyvitamin D_3 concentration is important as a marker of renal osteodystrophy. We measured the serum 1,25-dihydroxyvitamin D_3 and evaluated the inerrelationship between 25-hydroxyvitamin D_3, PTH and calcium level in the patients with chronic renal failure. Methods : 23 patients with chronic renal failure were measured the serum level of 25-hydroxyvitamin D_3, and 1,25-dihydroxyvitamin D_3 with radioreceptorassay. We also measured the parathyroid hormone and calcium level simultaneously in same patients and analyzed the relationship of those hormones in the patients with chronic renal failure. Results : The mean level of 25-hydroxyvitamin D_3 and 1,25-dihydroxyvitamin D_3 in the patients with chronic renal failure were lower (11.8±8.3ng/ml, 6.3±8.3pg/ml,repectively)than those of normal control (20.7±9.1ng/ml, 38.8±18.7pg.ml, p<.0001,repectively). The mean level of parathyroid hormone in the patients with chronic renal failure (135.3±160.8pg/ml) was higher than that of normal control (33.9±35.9pg/ml, p<0.01). The mean PTH concentraion in the CRF patient who showed the normocalcemia was lower than hypocalcemic (Ca <8.5mg/dl) CRF patients (44.8±49.1 vs 160.5±172.7 pg/ml, p<0.05 repectively). Old aged (above 60yrs) CRF patients showed significantly less 1,25-dihydroxyvitamin D_3 level than younger patients (4.05±3.53 vs 8.83±11.5, repectively p>0.05). we could not find any statistically significant correlations between 1,25-dihydroxyvitamin D_3, 25-hydroxyvitamin D_3, parathyroid hormone levels in both groups of chronic renal failure and normal control Conclusion : We could confirm the low 1.25-dihydroxyvitamin D_3 level in patients with chronic renal failure, this decreased 1-alpha hydroxylation were causing secondary hyperparathyroidism and aggravation of renal osteodystrophy. In near future, the therapeutic correction of low 1,25-dihydroxyvitamin D_3 level might be helpful for the prevention of metabolic bone abnormalities associated with chronic renal failure.

당뇨병성 족부병변의 임상적 특성

김영건,한희정,원진호,김윤,주원찬,신재규,박소영,송민호 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

Diabetic foot lesions are one of the major cause of morbidity, mortality, disability in patients with diabetes. Diabetic patients have a 15fold higher risk of lower extremity amputation than nondiabetic individuals. Its etiology includes diabetic neuropathy, macrovascular disease and hyperglycemia. The aim of the present study was to establish clinical characteristics of diabetic foot lesions. We studied 35 cases with diabetic foot lesions from January, 1995 to December, 1997 at Chungnam National University Hospital. The incidence of diabetic foot lesions was 3.46% and there was a tendency to be increased in annual incidence. The diabetic foot lesions were most frequently found under the toes. One or more of diabetic complication were found in 91.4% of diabetic patients with foot lesions and neuropathy was the most common. Most common organism was S.aureus in foot infection. In 53.1% of foot lesions were treated with conservative treatment but 42.9% were treated with amputations and skin grafts.