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제2형 당뇨병 환자에서 장기간의 Sodium-glucose Cotransporter 2 억제제 치료가 신장기능에 미치는 효과
백종하 ( Jong Ha Baek ),오태정 ( Tae Jung Oh ),문주영 ( Ju-young Moon ),김태희 ( Taehee Kim ),고승현 ( Seung Hyun Ko ),문민경 ( Min Kyong Moon ),김현정 ( Hyun Jung Kim ),이동원 ( Dong Won Lee ),허규연 ( Kyu Yeon Hur ) 대한내과학회 2020 대한내과학회지 Vol.95 No.4
Chronic kidney disease is developed commonly in type 2 diabetes mellitus (T2DM) and is the most common cause of end-stage renal disease and related cardiovascular complications. Meanwhile, despite the current standard of care including optimized glucose control and the use of single-agent blockade of the renin-angiotensin-aldosterone system (RAAS), patients with T2DM remain at increased risk for death and complications from cardiorenal causes. The recent studies using sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown not only glucose lowering effect, but also a reduction in blood pressure, weight loss, and a lowering cardiovascular risk. Regarding renal outcomes, the use of SGLT2 inhibitor slows the progression of kidney disease compared to placebo when added to standard care. However, concern has been raised that currently available SGLT2 inhibitors in Korea may be also associated with improved renal outcomes with long-term treatment. As a result, we aimed to evaluate the effect of long-term SGLT2 inhibitor treatment on renal function in the patients with T2DM using meta-analysis. (Korean J Med 2020;95:236-243)
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)
임신성 당뇨병 환자에서 발생한 전격성 제1형 당뇨병 1예
백종하 ( Jong Ha Baek ),김경영 ( Kyong Young Kim ),김수경 ( Soo-kyoung Kim ),정정화 ( Jung Hwa Jung ),함종렬 ( Jong Ryeol Hahm ),정재훈 ( Jaehoon Jung ) 대한내과학회 2017 대한내과학회지 Vol.92 No.2
임신 후반기에 주로 발생할 수 있는 전격성 제1형 당뇨병은 드물지만 산모와 태아의 사망률이 높고, 임신성 당뇨병진단 하에 인슐린을 사용하고 있는 환자에서도 발생할 수 있으므로 주의와 함께 면밀한 경과 관찰이 필요하겠다. A 32-year-old pregnant woman (34 + 5 weeks) was admitted with dizziness, nausea, and vomiting. Previously, she was diag-nosed with gestational diabetes mellitus at 28 weeks with 100 g-OGTT and insulin therapy was started. Her average fasting glucose level was 97 mg/dL and postprandial 1-hour glucose level was 130 mg/dL with basal-bolus insulin therapy (to-tal dose of 28-30 IU/day). At 34 + 0 weeks of gestational age, polyuria and unexpected weight loss (2 kg/week) with hyperglycemia occurred, and total dose of daily insulin requirement was increased up to 50 IU/day. At admission, her serum glucose level was high (502 mg/dL), and urinalysis revealed ketonuria +3. Arterial blood gas analysis revealed pH of 6.83, pCO2 of 9 mmHg, and bicarbonate of 2 mmol/L with an anion gap of 23.5 mmol/L. The diagnosis of diabetic ketoacidosis was established and emergency caesarean sec-tion was conducted due to fetal distress. She was finally diagnosed with fulminant type 1 diabetes mellitus, and multiple daily in-sulin injection therapy was continued after delivery. (Korean J Med 2017;92:186-189)
결핵균과 비결핵성항산균 검출에 Real-time PCR의 유용성
윤은영 ( Eun Young Yun ),조수희 ( Su Hee Cho ),고세일 ( Se Il Go ),백종하 ( Jong Ha Baek ),김유은 ( You Eun Kim ),마정은 ( Jeong Eun Ma ),이기동 ( Gi Dong Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.4
Background: The purpose of this study was to evaluate recently developed real-time polymerase chain reaction (PCR) assay kit to detect Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM) in respiratory specimens. Methods: We assessed the positive rate of the real-time PCR assay to detect MTB and NTM in 87 culture-positive specimens (37 sputum, 50 bronchial washing), which were performed real-time PCR by using Real-QTM MTB&NTM Kit from January 2009 to June 2009, at Gyeongsang University Hospital. To compare the efficacy with the TB-PCR assay, we evaluated 63 culture-positive specimens (19 sputum, 44 bronchial washing) for MTB or NTM, which were performed TB-PCR by using ABSOLUTETM MTB II PCR Kit from March 2008 to August 2008. Results: Among 87 specimens tested using real-time PCR, MTB and NTM were cultured in 58 and 29, respectively. The positive rate of real-time PCR assay to detect MTB was 71% (22/31) and 92.6% (25/27) in AFB stain-negative and stain-positive specimens. For NTM, the positive rate of real-time PCR was 11.1% (2/18) and 72.7% (8/11) in AFB stain-negative and stain-positive specimens. Among 63 specimens performed using TB-PCR, MTB and NTM were cultured in 46 and 17, respectively. The positive rate of TB-PCR was 61.7% (21/34) and 100% (12/12) in AFB stain-negative and stain-positive specimens. TB-PCR was negative in all NTM-cultured 17 specimens. Conclusion: TB/NTM real-time PCR assay is useful to differentiate MTB and NTM in AFB stain-positive respiratory specimens and it is as effective in detecting MTB with TB-PCR.
김현정 ( Hyun-jung Kim ),김보라 ( Bo Ra Kim ),서영미 ( Yeong-mi Seo ),조윤영 ( Yoon Young Cho ),백종하 ( Jong-ha Baek ),김경영 ( Kyong Young Kim ),김수경 ( Soo-kyung Kim ),우승훈 ( Seung-hoon Woo ),정정화 ( Jung Hwa Jung ),정재훈 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Background: Chronic kidney disease is considered a risk factor for thyroid nodules as well as thyroid dys-function such as hypothyroidism. Among patients on hemodialysis, we assessed the size of thyroid nodule and goiter at baseline and 1 year later with ultrasonography. Methods: We prospectively selected 47 patients with hemodialysis at January 2012 and reviewed their medical records. We checked goiter and thyroid nodules at January 2012 and December 2012. Results: In the hemodialysis patients (n=47), 24 patients (51.1%) had thyroid nodules and 33 patients (70.2%) had goiter at baseline. Parathyroid hormone (PTH) was higher in patients with thyroid nodules (204.4±102.9 vs. 129.9±93.6 pg/mL, p=0.01). Thyroid ultrasonography was conducted in 29 patients after 1 year. The thick-ness of the thyroid isthmus increased (2.8±1.6 vs. 3.2±1.9 mm, p=0.003), but the number of nodules did not change (1.2±1.9 vs. 1.4±2.0, p=0.109). PTH was associated with the enlargement of thyroid nodules signi-ficantly through logistic regression analysis. Conclusion: Thyroid goiter and nodules in hemodialysis patients were more prevalent than in the general population. PTH influenced the production of thyroid nodules in hemodialysis patients. Regular examination with thyroid ultrasonography and thyroid function test should be considered in hemodialysis patients.