체외수정시술시 유전자 재조합 난포자극호르몬제의 효용성

한국선,이홍복,송인옥,박용석,변혜경,전진현,궁미경,Han, Kuk-Sun,Lee, Hong-Bok,Song, In-Ok,Park, Yong-Seog,Byun, Hye-Kyung,Jun, Jin-Hyun,Koong, Mi-Kyoung 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.1

Objectives: Recently, recombinant FSH (rFSH) has been manufactured using a Chinese hamster ovary cell line transfected with the gene encoding human FSH. Both rFSH and urinary gonadotropin (uFSH) could be used for controlled ovarian hyperstimulation (COH). However, uFSH implies a number of disadvantages, such as batch-to-batch inconsistency, no absolute source control, dependence on large amounts of urine, low specific activity, and low purity. The purpose of this study was to evaluate the efficacy of rFSH in human IVF-ET program. Materials and Methods: A total of 508 infertile women was enrolled in this study. They are classified into rFSH group (n=177) or uFSH group (n=331), and all of them were matched by age and cause of infertility in same period. The $Puregon^{(R)}$ (Organon, Holland) was used as rFSH, and the Metrodin-$HP^{(R)}$ (Serono, Switzeland) and $Humegon^{(R)}$ (Organon, Holland) was used as uFSH. We subdivided the patients into three age groups. The outcomes of IVF-ET program were analyzed using the statistical package for social sciences (SPSS). Results: There was no significant differences in the level of estradiol on hCG injection day, the numbers of retrieved oocytes, matured oocytes, fertilized oocytes, transferred embryos, frozen embryos between the two groups. The total dose (IU) of gonadotropin for COH was significantly lower in the rFSH group compared to uFSH group ($1339{\pm}5491.1$ vs $2527.8{\pm}1075.2$ IU, p<0.001). Clinical pregnancy rate per embryo transfer in the rFSH group showed increasing tendency, compared to the uFSH group, but there was no statistical significance (35.2% vs 29.3%). Our results demonstrated that the relative efficiency of rFSH compared with uFSH is higher in older patients. Conclusions: The ovarian stimulatory effect and clinical outcome of recombinant FSH was similar to that of the urinary gonadotropin. The IVF-ET cycles with significantly lower dose of gonadotropin in rFSH group showed comparable results. Therefore, we suggest that recombinant FSH is more potent and effective than urinary gonadotropin.

월경 주기 이상을 보이는 10 대 및 20 대 초반 여성에서 혈중 Leptin 농도의 임상적 중요성

한국선(Kuk Sun Han),윤병구(Byung Koo Yoon),이제호(Je Ho Lee),최두석(Doo Seok Choi) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.6

N/A Objective : Leptin is known as an endocrinologic mediator which acts on the hypothalamic- pituitary-ovarian axis. This study was undertaken to evaluate whether the serum leptin level affects the menstrual cycles of adolescents and to analyze the clinical features of adolescents with abnormal serum leptin levels. Methods : Seventeen normal controls and 118 patients with menstrual abnormalities were included in this study. The ages of patients ranged from 15 to 25 years. Patients with menstrual abnormality were divided into five subgroups according to the etiologies: group I; premature ovarian failure(n=8), group II; primary amenorrhea without congenital structural abnormality(n=14), group Ⅲ; oligomenorrhea(n=12), group IV; secondary amenorrhea(n=53), group V; dysfunctional uterine bleeding(n=31). After collection of blood samples, the serum leptin levels were measured with a radioimmunoassay kit. The serum leptin level and the corrected leptin level(leptin/body mass index(BMI)) were compared and the clinical features of those with abnormal leptin concentration (>mean+standard deviation, <mean-standard deviation) were analyzed. Results : The serum leptin level was closely correlated with BMI in both the control and the patient group(r=0.730, 0.737 p<0.01). There were no significant differences in the serum leptin level, BMI and leptin/BMI among the control group and the patient group and the subgroups. The most common clinical manifestation in those with abnormal leptin level was secondary amenorrhea. In particular, most of the secondary amenorrhea patients had a history of sudden weight loss of more than 5㎏ within a 3 month period. Conclusion : From our results, seeing as there were wide variantion of individual serum leptin levels(mean±SD: 9.59±6.07), and as minor change of serum leptin level did not seem to affect the menstrual cycle, but sudden change or extreme value of serum leptin levels might cause menstrual abnormalities. Therefore serum leptin may play a permissive role rather than a regulatory role in the adolescent menstrual cycle.

폐경 후 여성에서 호르몬 대체요법이 체중 및 체지방 분포에 미치는 영향

윤병구(Byung Koo Yoon),한국선(Kuk Sun Han),안광화(Kwang Hwa Ahn),노정래(Cheong Rae Rho),신경자(Kyung Ja Shin),황종대(Jong Dae Hwang),최두석(Doo Seok Choi),이제호(Ja Ho Lee) 대한폐경학회 2000 대한폐경학회지 Vol.6 No.2

N/A Background and Objective; Obesity, especially central fat distribution, is closely related to cardiovascular risk. Body weight and waist to hip ratio (WHR) tend to increase during the decade following menopause. Hormone Replacement Therapy (HRT) is reported to reduced the risk of cardiovascular disease by half. One of major concerns in women considering HRT is whether it might cause weight gain. Therefore this study was designed to investigate the effect of HRT on body weight and WHR in postmenopausal women. Subjects and Methods; 214 healthy postmenopausal women (estrogen only: 44, combined estrogen-progestin therapy: 170) underwent HRT for alleviation of acute menopausal symptom and prevention of osteoporosis and cardiovascular disease. Body weight and WHR were measured at baseline, 3, 6 and 12 month of HRT. Expected body weight and WHR were calculated from healthy 1,330 control with multiple regression analysis, and corrected value was defined to be measured valued divided by expected one. Results; Formula for expected value was as follows: expected weight =-0.076xAge+2.000xBMI+15.280, expected WHR =0.002xAge+0.011xBMl+0.420. Corrected weight did not change, but corrected WHR decreased significantly at 12 month with HRT. Conclusion; HRT dose not increase body weight and decrease WHR, which would contribute to cardioprotection in postmenopausal women.

시험과 과제물 부정행위와 아동의 도덕성 관계

허정경 ( Jung Kyoung Huh ),한국선 ( Kuk Sun Han ) 대한가정학회 2010 Human Ecology Research(HER) Vol.48 No.7

The purpose of this study was to examine the relationships between children`s cheating behaviors and their self-reported orality. For this study, 883 children were selected from 7 elementary schools and from 7 middle schools in Seoul, Korea. The participating students included 4th, 6th and 8th graders. The research was performed through the administration of questionnaires designed to measure the students` cheating behaviors and morality. The results were as follows: 1. The children cheated on occasion. More cheating occurred during homework than while taking an examination. During an examination, there was more lone cheating than students helping other students to cheat. With regard to homework cheating, helping others to cheat was higher than students doing their own cheating. Cheating behavior increased in higher grades, but there was no difference between genders. 2. In relation to children`s morality, distinctions between 6th graders, 8th graders and 4th graders were different demonstrated. 3. In relation to cheating behavior and morality (4 factors), while PHIL (interests to others) factor decreased cheating behavior, EMP (understanding of emotion and feeling) factor increased cheating behavior.

유전질환 및 염색체 이상의 예방을 위한 착상전 유전진단의 결과

김진영,임천규,송인옥,유근재,양광문,한국선,허걸,송지홍,전진현,민동미,박소연,전종영,궁미경,강인수,Kim, Jin-Yeong,Lim, Chun-Kyu,Song, In-Ok,Yoo, Keun-Jai,Yang, Kwang-Moon,Han, Kuk-Sun,Hur, Kuol,Song, Ji-Hong,Jun, Jin-Hyun,Min, Dong-Mi,Park, So- 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.4

Objective s: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. Materials and Methods: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6$\sim$10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. Results: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced emb ryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). Conclusions: PGD by using FISH or PCR is useful to get n ormal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

습관성 유산환자의 향후임신에서 분석한 산과적 결과

허걸(Kuol Hur),양광문(Kwang Moon Yang),한정열(Jung Yeol Han),한국선(Kuk Sun Han),이홍복(Hong Bok Lee),김진영(Jin Young Kim),송인옥(In Ok Song),송지홍(Ji Hong Song),전종영(Jong Young Jun),궁미경(Mi Kyoung Koong),유근재(Keun Jai Yoo) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.3

N/A Objective: To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. Met hods: From 1 June 1998 to 30 June 2000,82 patients who attended infertility & recurrent miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. Results: The etiology of recurrent miscarriage was immunologic factor (36.6%),unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%)and chromosomal abnormality (5.6%).The rate of preterm delivery (11%)and incidence of pregnancy induced hypertention (8.5%)were significantly higher than those of control group (3.2%and 2.5%respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. Conclusion: The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.

자궁경부암 검진에서 인유두종 바이러스 검사의 임상적 의의

신경자(Kyung Ja Shin),황종대(Jong Dae Whang),유진경(Jin Kyung Yoo),한국선(Kuk Sun Han),오영륜(Young Lyun Oh),노정래(Cheong Rae Roh),박창수(Chang Soo Park),배덕수(Duk Soo Bae),이제호(Je Ho Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.2

목적 : 자궁경부 세포진 검사로 미확정 비정형성 편평세포변화(ASCUS) 혹은 그 이상으로 판독된 여성에서 인유두종 바이러스(HPV) DNA 검사를 시행하여 고등급 편평 상피내 병변(HSIL)과 편평 상피암의 진단에 대한 임상적 가치를 밝히고자 시행하였다. 연구 방법 : 1998년 12월부터 1999년 12월까지 삼성서울병원 건강의학센터에서 검진받은 총 자궁경부세포진 검사상 조직검사로 확인된 169명을 대상으로 중합효소연쇄반응법(PCR)을 이용한 고위험군 HPV DNA (아형 16, 18, 33)검사, 반복 세포진 검사 그리고 질확대경 조준하 조직 생검을 시행하여 임상적 의의를 분석하였다. 결과 : HPV DNA 양성유무는 비정상 세포진 검사와 조직검사 상 HSIL 및 편평상피암과 유의한 연관성을 보였다(P=0.034). 169명을 대상으로 조직검사로 확인된 38명의 HSIL과 편평상피암을 동정해내는 확률을 단계적 프로토콜로 비교 검토했을 때 세포진 검사와 HPV DNA 검사는 민감도 65.8%(25/38), 특이도 85.5%(112/131), 양성 예측도 56.8%(25/44) 그리고 음성 예측도 89.6%(112/125) 를 나타내었다. 결론 : PCR을 이용한 HPV DNA 검사는 비정상 세포진 소견을 가지고 있는 여성에게 치료가 필요한 HSIL 및 편평상피암을 향후 예측할 수 있는 유용한 검사법이라 할 수 있다. Objective : To determine the clinical value of human papillomavirus deoxyribonucleic acid(HPV DNA) testing by polymerase chain reaction(PCR), specifically to examine whether HPV testing could identify the women with Pap smears read as mostly atypical squamous cells of undetermined significance(ASCUS) or more. Methods : HPV DNA testing by PCR for 3 high-risk cancer associated genotypes(HPV 16, 18, 33), repeat Pap smears and colposcopically directed punch biopsies were performed concurrently on 169 women referred for cervical cancer screening test with a previous Pap smear read as ASCUS or more. Results : HPV DNA testing positivity was significantly associated with abnormal cytology and high-grade squamous intraepithelial lesion(HSIL) and squamous cell carcinoma(SCC) in histology(P=0.034). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) of Pap smear and HPV testing for identifying 38 cases of histologically confirmed HSIL and carcinoma by different triage protocols(HPV positive or HSIL or SCC) among 169 women were 65.8%(25/38), 85.5%(112/131), 56.8%(25/44) and 89.6%(112/125), respectively. Also sensitivity, specificity, PPV and NPV were varied by ages and more higher in older. Conclusion : HPV DNA testing by PCR appears to offer an effective means by which women whose cervical Pap smears have been read as ASCUS or more could be triaged for colposcopically directed biopsy. The sensitivity for HSIL could be maintained in high and specificity markedly improved by HPV genotypes 16, 18, 33.

임신 제 1삼분기에 자연유산 된 환자에서 질식초음파로 확인된 태아심장박동 유무에 따른 자연유산 수태물의 핵형 비교

양광문 ( Kwang Moon Yang ),송인옥 ( In Ok Song ),유근재 ( Keun Jae Yoo ),허걸 ( Kuon Hur ),한국선 ( Kuk Sun Han ),전진현 ( Jin Hyun Jun ),박소현 ( So Yeon Park ),김진영 ( Jin Young Kim ),전종영 ( Jong Young Jun ),강인수 ( Inn Soo 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12

목적 : 수정란의 유전적 결함은 배아발달의 이상과 자연유산의 가장 흔한 원인이다. 일단 태아의 심장박동이 확인되면 향후 자연유산의 가능성은 5% 이내로 보고되고 있다. 임신초기 태아 심장박동 확인 후의 자연유산이 염색체 이상과 더 관계가 깊다고 보고되고 있으나 보고자들에 따라 의견이 분분하다. 이 연구의 목적은 임신 제 1 삼분기에서 질식초음파로 확인된 태아심장박동 유무와 자연 유산된 이상 핵형과의 관련성을 보기 위함이다. 대상 및 방법 : 2001년 Objective : Genetic defects of the zygote, such as chromosome aberration, are the most frequent cause of abnormal embryonic development and spontaneous abortion. Recent advances in ultrasonographic technology have allowed documentation of early embryonic

정상 임산부의 혈청 Alpha-fetoprotein치의 임상적 이용

김목진,한국선,안재홍,서정호,이영기,박윤기,이태형 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

1993년 1월부터 1996년 9월까지 영남대학교 의과대학 부속병원 산부인과에 내원한 임신 8주에서 41주까지의 정상 임산부 500명을 대상으로 혈청 AFP치를 측정하여 다음과 같은 결과를 얻었다. 1. 정상임산부 혈청 AFP치는 임신 8주에 가장 낮았으며, 임신 32주에서 최고치를 나타내었다. 2. 초산부와 경산부의 혈청 AFP평균치는 각각 166.4±12.1 ng/ml, 223.8±14.0ng/ml 이었으며, 경산부가 초산부보다 혈청 AFP치가 통계적으로 의의있게 높았다(p<0.01). 3. 정상남아와 정상여아를 분만한 임산부의 혈청 AFP 평균치는 각각 193.0±13.0ng/ml, 194.3±13.0ng/ml, 194.3±13.8ng/ml이었으며, 정상남아를 분만한 임산부는 정상 여아를 분만한 임산부와 비교시 혈청 AFP치가 통계적으로 유의한 차이가 없었다(p<0.05). 4. 각 주수에 따른 정상 산모의 혈청 AFP는 표 3과 같다. Alphafetoprotein(AFP) is a glycoprotein by the fetus early in gestation by the yolk sac and later by the gastrointestinal tract and liver. The concentration of AFP is fetal serum and amniotic fluid around 13th week, and 32nd week in maternal serum. Some conditions are associated with anormal maternal serum AFP concentration. For examples, neural tube defects, omphalocele, renal anomalies are associated with elevated maternal serum AFP and felta death, chromosomal trisomies are associated with low level of maternal serum AFP. So maternal serum AFP screening plays a significant role in assessing candidaties for prenatal diagnosis and prenatal counselling in pregnant women. This study evaluates the normal ranges of AFP using enzyme immunoassay in normal pregnant women. We studied 500 normal pregnant women who visited the Department of Obstetrics & Gynecology, Yeungnam Medical Center, Yeungnam University during the period through January, 1993 to September, 1996. The group of the study were selected randomly at various gestational ages from 8 to 41 weeks. The results were summarized as follows: 1. The lowest level of AFP in our study group was 2.1ng/ml at 8 weeks of gestation. Thereafter serum aplha-fetoprotein concentrations rose rapidly to reach a peak value at 32nd week. 2. The mean levels of AFP in the primipara and mulitipara were 166.37±12.06ng/ml, and 223.78±14.00ng/ml, respectively, showing stastiscally significant difference between these two groups(p<0.01). 3. The mean levels of AFP between mothers who delivered male female babies were 192.96±13.00ng/ml, and 194.29±13.84ng/ml, respectively, without statistically significant difference(p>0.05). 4. The normal ranges of maternal serum AFP according to each gestational week were evaulated.

체외수정 시술 후 발생된 병합임신 2례

이경아,곽양수,한국선,고민환,이태형 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

Combined intrauterine and ectopic (heterotopic) pregnancy occurs in appoximately 1 in 30,000 spontaneous gestations. Heterotopic gestations are increased in women who have had reconstructive pelvic surgery,pelvic inflammatory disease and artificail ovarian hyperstimulation. Patients who require assisted reproductive technologies, such as in vitro fertilization / embryo transfer and gamete intrafallopian trasfer, also have an increased risk of a heterotopic pregnacy. We experienced two cases of combined pregnancy following IVF-ET. Following is a report of these cases with a brief review of references.