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한국인에서 다양한 진단기준에 따른 대사증후군의 유병률과 인슐린 저항성 반영의 차이
지재환 ( Jae Hwan Jee ),성지동 ( Ji Dong Sung ),최윤호 ( Yoon Ho Choi ),정재훈 ( Jae Hoon Chung ),민용기 ( Yong Ki Min ),이명식 ( Myung Shik Lee ),김광원 ( Kwang Won Kim ),이문규 ( Moon Kyu Lee ) 한국지질동맥경화학회(구 한국지질학회) 2006 韓國脂質學會誌 Vol.16 No.2
Objective: NCEP ATP III criteria, recent IDF and AHA/NHLBI criteria of metabolic syndrome (MetS) are useful to diagnose briefly MetS clinically, but exclude concept of insulin resistance in definition of MetS unlikely WHO criteria. We compared prevalence of MetS using various diagnostic criteria and evaluated if recent definitions of MetS reflect insulin resistance better than earlier criteria. Methods: Among 1,708 subjects aged 23~85 years (1,088 men; 620 women) who underwent medical checkup at health promotion center, we evaluated components of MetS with the basis of modified ATP III criteria using BMI≥25 kg/m2 instead of waist circumference (WC), classic ATP III criteria, IDF criteria, modified IDF criteria of Korea (IDF-K) using WC≥85 cm for women and AHA/NHLBI criteria, and calculated HOMA-IR in 708 subjects. Results: The prevalence of MetS according to AHA criteria was 25.3%, significantly higher than the other criteria (P<0.05) and that in IDF-K was 16.8%, significantly lower than the others, especially in women (P<0.001). In all criteria, prevalence of MetS increased significantly with aging in women (P<0.001) but decreased in 8th decade in men. Diagnosis of MetS showed positive relationships with HOMA-IR, and risk of HOMA-IR was higher in modified ATP III (OR 2.54, 95% CI 2.04~3.17) and AHA criteria (2.52, 2.03~3.14) in men, then high in classic ATP III (2.51, 1.64~3.85) and IDF criteria (2.65, 1.70~4.11) but lowest in modified ATP III criteria (1.88, 1.31~2.69) in women. Conclusion: In Koreans, according to AHA/NHLBI criteria, prevalence of MetS was higher than to the other criteria, and diagnosis of MetS reflected insulin resistance better than other criteria only in men.
안정형 및 불안정형 협심증 환자에서 관동맥 조영술상 병변형태와 관동맥내 혈전에 대한 비교
이록윤(Rok Yun Lee),한윤창(Yun Chang Han),지재환(Jae Hwan Jee),조병동(Byung Dong Cho),채경수(Gyeoung Soo Chae),장명국(Myoung Kuk Jang),서유미(Yu Mi Seo),김재삼(Jai Sam Kim),경태영(Tae Young Kyong),임종윤(Chong Yun Rim),고영박(Young B 대한내과학회 1996 대한내과학회지 Vol.51 No.6
N/A Objectives: Unlike stable angina, unstable angina is a common syndrome associated with significant morbidity and frequent progression to acute myocardial infarction. Several investigators have suggested that corronary artery thrombus formation, most likely secondary to plaque rupture in complex morphology of stenotic coronary artery, may preci- pitate unstable angina. But the frequency of coronary artery thrombus by coronary angiography is diverse. Methods: In 108 patients with either stable(27 patients) or unstable angina(81 patients), the morphology of coronary artery lesions was qualitatively assessed by angiography. Each obstruction reducing the luminal diameter of the vessel by 50% or greater was categorized into one of Ambrose morphologic classification. Results: Type II eccentric lesion was more frequent in patients with unstable angina pectoris (38.9%) than in patients with stable angina pectoris (6.1%) (p<0.01). Frequency of intraluminal ulcer was 31.9% in unstable angina, and 8.6% in stable angina(p<0.05). Intraluminal thrombus was observed more frequently in unstable angina pectoris(18.6%) than in stable angina pectoris(6.1%)(p<0,05). Conclusions: The high prevalence of type II eccentric lesion morphology, ulcer, and intraluminal thrombus observed in patients with unstable angina emphasizes the important role of intimal disruption and of subsequent thrombogenesis in the pathogenesis of myocardial ischemic in those unstable syndromes of ischemic heart disease.
부신피질기능의 평가에 있어서 저용량과 고용량 ACTH 자극검사의 비교
김현규,박성우,유형준,유재명,최문기,임성희,김두만,지재환 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.4
Background: Pharmacological ACTH test provide information only about the ability of the adrenal gland to respond to unusual stimuli and may not reflect the daily cortisol secretion. There were some controversies in the diagnosis of mild adrenal insufficiency by using a pharmacological dose of ACTH. The purpose of the present study was to assess and compare the effect of low dose 1 pg ACTH and high dose 249 pg ACTH in the evaluation of adrenal function. The intravenous injection of a pharmacological dose(250 pg) of ACTH has been used as a standard test in the initial assessment of adrenal function. So we low dose ACTH to evaluate the adrenal function and compare the result of high dose ACTH. Method: Basal serum cortisol sampling was done at 2:00 p.m.. And after 1 pg ACTH iv bolus injection, cortisol sampling was done at 20, 30, 45 and 60 min respectively. On the next day same procedure was repeated at same time, but 249 mg ACTH was given instead of the low dose. Normal adrenal function was diagnosed with the criteria of stimulated serum cortisol concentration over 20 mg/dL. Total 65 patients took part in this study. Three hypopituitarism patients and one Addisons disease were included. Sixty-one patients had the history of glucocorticoid ingestion or had physical findings of cushingoid features with symptoms suggest the adrenal insufficiency. Results: Sixteen patients showed normal response to both low dose and high dose ACTH. Thirty-six patients were not stimulated to both low dose and high dose ACTH. The remaining thirteen patients revealed normal response to high dose ACTH, but not to low dose ACTH. Conclusion: It appears that low dose ACTH stimulation test is more sensitive and specific than high dose ACTH and is capable of revealing mild adrenal insufficiency (J Kor Soc Endocrinol 13:580-589, 1998).