안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 전신 염증인자, 산화 스트레스와의 관련성

함현석 ( Hyun Seok Ham ),이해영 ( Hae Young Lee ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Young Jung ),김호철 ( Ho Cheol Kim ),함종렬 ( Jong Ryeal Hahm ),박찬후 ( Chan Hoo Park ),이종덕 ( Jong Deok Lee ),손현준 ( 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.4

연구배경: 만성폐쇄성폐질환은 기도염증으로 인한 기도폐쇄를 특징으로 하는 질환이지만, 질병의 경과 중에 체중감소나 근위축 같은 전신증상을 동반하게 된다. 만성 염증과 산화 스트레스가 만성폐쇄성폐질환의 병인에 중요한 역할을 하므로 신체질량지수의 감소와 관련이 있을 것으로 추측할 수 있다. 연구자 등은 안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 관련된 인자를 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 안정된 만성폐쇄성폐질환 환자 53명(남: 여 =49:4, 평균나이 =68.25±6.32)과 정상 대조군 33명을 대상으로 폐기능 검사를 실시하고 전신염증인자로 혈청 IL-6, TNF-α를 측정하고 산화 스트레스 인자로 혈청 8-iso-prostaglandin F2α와 carbonyl protein을 측정하여 비교하였다. 또한 만성폐쇄성폐질환 환자를 신체질량지수에 따라 다시 3군(<18.5, 18.5-25,>25)으로 나누어 각각의 수치들을 비교하였고 만성폐쇄성 폐질환의 중증도에 따라 신체질량지수를 비교하였다. 결과: 만성폐쇄성폐질환 환자와 정상 대조군의 혈청에서 IL-6, TNF-α, carbonyl protein은 유의한 차이가 없었으며 8-iso-prostaglandin F2α은 각각 456.08±574.12 pg/㎖, 264.74±143.15 pg/㎖로 만성폐쇄성폐질환 환자에서 유의하게 높았다(p<0.05). 만성폐쇄성폐질환에서 신체질량지수의 차이에 따라 혈청IL-6, TNF-α, carbonyl protein 과 8-iso-prostaglan-din F2α 은 유의한 차이를 보이지 않았다. 신체질량지수에 따른 환자의 FEV1은 각각 0.93±0.25ℓ, 1.34±0.52ℓ, 1.72±0.41ℓ로 신체질량지수가 낮을수록 FEV1 값도 감소하는 경향을 보였고 (p=0.002, r=0.42), 최중증 만성폐쇄성폐질환 환자의 신체질량지수는 19.8±2.57로 중등증의 환자의 22.6±3.14에 비해 유의하게 낮았다(p<0.05). 결론: 본 연구에서 안정된 만성폐쇄성폐질환 환자의 신체질량지수는 전신염증인자와 산화 스트레스의 정도와는 관련을 보이지 않았으나 기도폐쇄의 정도와는 관련이 있을 것으로 사료된다. 만성폐쇄성폐질환 환자에서 신체질량지수의 감소와 관련된 인자에 대해서는 추가적인 연구가 필요할 것으로 사료된다. Background: The main factors associated with weight loss in patients with COPD are not well known. Since chronic inflammation and oxidative stress play a major pathogenic role in COPD, these factors may be responsible for the patients` weight loss. Therefore, this study measured the body mass index (BMI) in COPD patients and evaluated the variables, such as systemic inflammatory marker, oxidative stress and lung function, that correlate with the BMI. Method: The stable COPD patients (M:F=49:4, mean age=68.25±6.32) were divided into the lower (<18.5), normal (18.5-25) and higher (>25) BMI group. The severity of the airway obstruction was evaluated by measuring the FEV1. The serum IL-6 and TNF-α levels were measured to determine the degree of systemic inflammation, and the carbonyl protein and 8-iso-prostaglandin F2α level was measured to determine the level of oxidative stress. Each value in the COPD patients and normal control was compared with the BMI. Results: 1) Serum 8-iso-prostaglandin F2α in COPD patients was significantly higher (456.08±574.12 pg/㎖) than that in normal control (264.74±143.15 pg/㎖) (p<0.05). However, there were no significant differences in the serum IL-6, TNF-α, carbonyl protein between the COPD patients and normal controls. 2). In the COPD patients, the FEV1 of the lower BMI group was significantly lower (0.93±0.25ℓ) than that of the normal BMI (1.34±0.52ℓ) and higher BMI groups (1.72±0.41ℓ) (p<0.05). The lower FEV1 was significantly associated with a lower BMI in COPD patients (p=0.002, r=0.42). The BMI of very severe COPD patients was significantly lower (19.8±2.57) than that of the patients with moderate COPD (22.6±3.14) (p<0.05). 3). There were no significant differences in the serum IL-6, TNF-α, carbonyl protein and 8-iso-prostaglandin F2α according to the BMI in the COPD patients. Conclusion: The severity of the airway obstruction, not the systemic inflammatory markers and oxidative stress, might be associated with the BMI in stable COPD patients. Further study will be needed to determine the factors associated with the decrease in the BMI of COPD patients. (Tuberc Respir Dis 2006 61: 330-338)

원저 및 증례 : 조기에 발견된 횡문근융해를 동반한 전격성 제1형 당뇨병 1예

백종하 ( Jong Ha Baek ),이경주 ( Kyeong Ju Lee ),함종렬 ( Jong Ryeal Hahm ),정정화 ( Jung Hwa Jung ),김수경 ( Soo Kyoung Kim ),정순일 ( Soon Il Chung ),정태식 ( Tae Sik Jung ) 대한당뇨병학회 2010 임상당뇨병 Vol.11 No.1

Fulminant type 1 diabetes is characterized by an abrupt onset, severe diabetic ketoacidosis at diagnosis and a relatively low HbA1c. Rhabdomyolysis is not uncommonly combined with diabetic ketoacidosis or hyperglycemic hyperosmolar coma. Rhabdomyolysis increases the development of acute renal failure and mortality of the patients with hyperglycemic diabetic emergency. A 34-year-old man presented with 2-days duration of oliguria, vomiting and lethargy. Formerly, he developed polyuria and flu-like symptoms such as generalized myalgia and headache for 7 days. Initial investigation showed metabolic acidosis (arterial pH 7.093, bicarbonate 5.1 mmol/L), severe hyperglycemia (glucose 1,576 mg/dL), a relatively low HbA1c (7.1%) and acute renal failure (blood urea nitrogen 77 mg/dL and creatinine 4.4 mg/dL). Both serum and 24-hour urine C-peptide levels were checked at very low range and islet autoantibody tests were all negative. Serum creatinine kinase was elevated to 2,397 U/L and urine myoglobin test was positive. The patient recovered from acute renal failure and rhabdomyolysis after fluid and insulin therapy. He discharged on admission 17th days and controlled diabetes by self injection of basal and bolus insulin. (Korean Clinical Diabetes J 11:79-85, 2010)

저칼륨혈증과 횡문근융해증으로 발현한 원발성 알도스테론증 1예

박기홍,김수경,조은빈,정희정,최낙천,권오영,임병훈,함종렬,박기종,Park, Kee Hong,Kim, Soo-Kyung,Cho, Eun Bin,Jeong, Heejeong,Choi, Nack-Cheon,Kwon, Oh-Young,Lim, Byeong Hoon,Hahm, Jong Ryeal,Park, Ki-Jong 대한임상신경생리학회 2016 Annals of Clinical Neurophysiology Vol.18 No.1

Primary aldosteronism is one of the most common cause of secondary hypertension and can be accompanied with hypokalemia. Rhabdomyolysis with hypokalemia in primary aldosteronism has been rarely reported. We describe a patient of primary aldosteronism who presented with limb-girdle type weakness.

제 2형 당뇨병 환자의 피로와 영향요인

서영미(Seo, Yeong-Mi),최원희(Choi, Won-Hee),함종렬(Hahm, Jong-Ryeal) 한국산학기술학회 2014 한국산학기술학회논문지 Vol.15 No.9

본 연구는 제 2형 당뇨병 환자의 피로정도와 피로에 영향을 미치는 요인을 확인하기 위하여 시도된 서술적 조사연구 이다. 연구는 117명의 제 2형 당뇨환자를 대상으로 하였으며 자료는 2013년 5월1일에서 6월 30일까지 J시에 위치한 일대학병 원에서 면대면 설문지법으로 수집하였다. 수집된 자료는 SPSS WIN 15.0 program을 이용하여 기술통계, t-test, one way ANOVA, Pearson Correlation, 다중회귀분석 등으로 분석하였다. 연구 결과, 대상자의 피로는 2.80점이었다. 피로에 영향을 미치는 요인들은 우울, 나이, 질병이환기간으로 확인되었고 이들 변수는 피로에 대해 40%의 설명력을 보였다. 따라서 건강전 문가들은 제 2형 당뇨환자의 건강관리를 위하여 피로감소 간호중재개발이 필요하며 이러한 간호중재의 보다 나은 효과를 위하여 나이, 질병이환기간을 고려하고 대상자의 우울 감소프로그램을 제공할 필요가 있다. This descriptive study was performed to identify the factors that influence fatigue in patients with type 2 diabetes mellitus. A total of 117 subjects were recruited from a university hospital in J city. For data collection, a questionnaire survey was performed between May 1 and June 28 2013. Data were analyzed by descriptive statistics, t-test, one way ANOVA, Pearson Correlation, and multiple regression analysis using the SPSS WIN 15.0 package. The mean fatigue scores of the subjects was 2.80. Depression, age, and time since the diagnosis were the variables influencing fatigue. The total explanatory power of these factors on fatigue was 40%. In conclusion, it is essential to develop a fatigue control nursing program considering depression, age and time since the diagnosis for patients with type 2 Diabetes mellitus.

한국인의 비만과 인슐린비의존성당뇨병에서 베타-2 아드레날린 수용체 유전자 다형성

김병준(Byoung Joon Kim),안규정(Kyu Jeong Ahn),김영설,최영길,이문규,김성훈(Sung Hoon Kim),김동준(Dong Jun Kim),함종렬(Jong Ryeal Hahm),정재훈(Jae Hoon Chung),민용기(Yong Ki Min),이명식(Myung Shik Lee),김광원(Kwang Won Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A Objective: Catecholamine play a central role in the regulation of energy expenditure, in part by stimulating lipid mobilization through lipolysis in fat cells. The beta-2 adrenergic receptor(BAR-2) is a major lipolytic receptor in human fat cells. A recent study has shown that common polymorphisms occuring at codon 16 and 27 of the BAR-2 gene are significantly associated with obesity and lypolytic BAR-2 function in adipose tissue. We investigated whether the previously described human BAR-2 gene polymorphisms are associated with obesiy and NIDDM in Koreans. Methods : All subjests were divided into two groups, non-obese and obese group, according to their body mass index. And their clinical characteristics were evaluated. The BAR-2 gene polymorphisms were analyzed by PCR-RFLP in 89 nondiabetics and 106 patients with NIDDM. Results : When the allele frequency of BAR-2 gene polymorphisms was compared with that of western people, there was a significant difference. In our study, there was no significant difference in the allele frequency of BAR-2 gene polymorphisms at codons 16 and 27 between nonobese and obese group both nondiabetics and NIDDM subjects. The frequency of Glu27 homozygotes was very rare(1.1%). Body mass index(BMI), waist-hip ratio(WHR), and serum glucose and insulin secretion of the nondiabetics with polymorphism of codon 16 or codon 27 did not differ from those of the subjects without the polymorphisms. In NIDDM group, the Gly16 homozygotes had a lower BMI than Arg16 homozygotes without any difference in WHR and the other laboratory parameters. Neither clinical or laboratory parameters of the diabetics with the polymorphism at codon 27 differ from those of subjectes without the polymorphism. Conclusion : These findings suggest that the genetic variability in the human BAR-2 gene is not a major determinant for the development of obesity and NIDDM in Koreans.

증례 : 성인기에 Prader-Willi 증후군으로 진단된 제2형 당뇨병 여자

김동욱 ( Dong Wook Kim ),정정화 ( Jung Hwa Jung ),안진숙 ( Jin Sook Ahn ),김현주 ( Hyon Joo Kim ),정태식 ( Tae Sik Jung ),정순일 ( Soon Il Chung ),함종렬 ( Jong Ryeal Hahm ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1S

증례 : 순환기 ; 심부전 환자에서 발생한 반복적인 자발성 저혈당과 의식저하 1예

김계환 ( Kye Hwan Kim ),김완철 ( Wan Chul Kim ),이은주 ( Eun Ju Lee ),고진신 ( Jin Sin Koh ),박정랑 ( Jeong Rang Park ),함종렬 ( Jong Ryeal Hahm ),황진용 ( Jin Yong Hwang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2

저자들은 반복적인 저혈당에 의한 의식저하를 주소로 내원한 심부전 환자로 수술적 치료 이후 1년간 저혈당 및 심부전 악화 없이 외래 경과관찰 중인 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hypoglycemia in adults without diabetes can be caused by drugs, critical illness, hormone deficiency, and hyperinsulinism. Spontaneous hypoglycemia in congestive heart failure has been reported rarely in adults. We report a case of spontaneous hypoglycemia in congestive heart failure in a 73-year-old woman with mitral stenosis and atrial fibrillation who had been receiving treatment for 6 years. She had two episodes of low serum glucose with unconsciousness, but there was no evidence of diabetes. Heart failure with concomitant hepatic dysfunction was presumed to have caused the hypoglycemia. She underwent mitral valve replacement after being diagnosed with severe mitral stenosis. There was no episode of hypoglycemia during follow-up. (Korean J Med 2014;87:205-208)

폐 선양낭성암에 동반된 중추성 요붕증으로 발현한 뇌하수체 종양 1예

이강완,함종렬,정정화,강미연,이기동,김현진,정순일 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.3

저자들은 다음, 다뇨의 증상을 호소한 52세 여자환자에서 폐에 원발성으로 발생한 선양낭성암의 전이로 추정되는 뇌하수체 종양에 의한 중추성 요봉증을 경험하였기에 문헌 고찰과 함께 증례 보고하는 바이다. The metastatic tumor occurs in about 6% to 20% of all cases with central diabetes insipidus. Many kinds of cancers such as breast, lung, colon, prostate, leukemia, and lymphoma can metastasize to the pituitary and its stalk. Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease. It is histologically and ultrastructurally identical to salivary gland adenoid cystic tumor and is regarded as a slowly growing, low graded-malignancy. This is a case report of a 52-year-old woman with diabetes insipidus caused by a pituitary tumor that might have been associated with adenoid cystic carcinoma arising in the bronchus. The patient was diagnosed by water deprivation test, chest CT scan, bronchoscopic biopsy, and brain MRI scan. The water deprivation test showed the patient had central diabetes insipidus, while chest CT scan revealed a lung mass lesion with distal right intermediate bronchial obstruction. The primary malignancy was confirmed by bronchoscopic biopsy. Finally, we confirmed that the patient had a 7mm-sized in the posterior pituitary gland and a thickened stalk by brain MRI scan (J Kor Soc Endocrinol 18:311~317, 2003).

성인 여자에서 발견된 뇌하수체 전엽 무형성증 1예

정태식,함종렬,이강완,정정화,김수희,하종,조활석,정순일 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.2

Dear Author, You have used abbreviations that will need to be defined in the main paper, i.e. PIT1, PROP1 and MRI. This is just for your advice. Pituitary agenesis is an uncommon cause of panhypopituitarism. It has been proposed that breech delivery, or birth trauma, is a major factor causing pituitary agenesis. Recent studies have suggested that genetic defects in the PIT1 or PROP1 gene might be involved in the pathogenesis of pituitary agenesis. In this case we report on the diagnosis of a 33-years old female patient with- growth retardation and sexual infantilism. We diagnosed anterior pituitary hormones deficiencies, with the exception of adrenocorticotropic hormone, by a combined pituitary stimulation test. We observed pituitary agenesis using sella MRI. Involvement of the PIT1 or PROP1 genes in this case remains to be determined. Here we report a case of pituitary agenesis found in an adult woman together with a brief review about this disease entity

그레이브스 병에 병발한 막성 신병증 1예

김현정,백주은,하혜정,양중일,함종렬,장세호,전은실 대한내과학회 2003 대한내과학회지 Vol.64 No.1

저자들은 28세의 그레이브스 병으로 진단 받은 환자에서 그레이브스 병의 악화에 동반되어막성 신병증이 발생함을 경험하여 보고하조가 한다. 자가면역 갑상선 질환과 이에 동반되는 막성 신병증간의 연관관계는 아직 명확하지 않으나, 질환의 발병기전을 고려할 때 두 질환간의 관련성이 제시되고 있으므로 자가면역 갑상선 질환 환자에서 진단 혹은 치료를 하는 과정에서 요검사를 시행하여 혈뇨와 단백뇨의 유무를 관찰하는 것은 필요하다고 생각한다. Membranous nephropathy is one of the most common causes of the nephrotic syndrome in adults. Membranous nephropathy is known as a disease associated with many other disorders and the presumed etiology of the disease is a deposition of circulating immune complexes. But, it has rarely been reported in association with autoimmune thyroiditis. We report a case of membranous nephropathy associated with Graves' disease and review the literature regarding this disease entity. (Korean J Med 64:130-136, 2003)