한국인에서 담석증과 인슐린 및 인슐린 저항성과의 관계

김정미 ( Jung Mi Kim ),이항락 ( Hang Lak Lee ),문원 ( Won Moon ),고동희 ( Dong Hee Koh ),이오영 ( Oh Young Lee ),윤병철 ( Byoeng Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( Joon Soo Hahm ),이민호 ( Min Ho Lee ),이동후 ( Dong Hoo 대한소화기학회 2007 대한소화기학회지 Vol.50 No.3

고인슐린혈증과 인슐린 저항성은 허혈 심질환이나, 대장암과 같은 여러 병의 중요한 원인인자로 알려졌으나, 담석증과의 관계는 불확실하다. 이전의 많은 연구에서 이미 당뇨 환자에서는 당뇨 자체가 담석 발생의 위험인자이며, 고인슐린혈증과 담석증이 관련이 있다고 밝혀졌으나, 당뇨가 없는 환자에서 담석증에 대한 연구는 아직 미미하며 국내에서는 아직 없다. 이에 한국인에서 당뇨의 과거력이 없으며, 금식 후 혈장 혈당이 126 mg/dL 미만인 환자를 대상으로 담석증과 인슐린 또는 인슐린 저항성과의 연관성을 알아보고자 하였다. 대상 및 방법: 당뇨 과거력이 있거나, 금식 후 혈장 혈당이 126 mg/dL 이상인 환자는 제외한 118명의 환자를 대상으로 29명의 담석증이 있는 환자군과 89명의 담석증이 없는 정상 대조군을 나누어 비교하였다. 키, 체중, 허리와 엉덩이둘레, 체지방률, 체질량지수[체중(kg)/키의 제곱(m2)], 공복 혈청 인슐린, 혈당, 콜레스테롤, 중성지방, 저밀도 콜레스테롤을 측정하였다. 담석증 여부는 복부 초음파 검사를 통해 결정하였으며, 인슐린 저항성의 지표로는 homeostasis model assessment of insulin resistance (HOMA-IR)을 사용하였다. 결과: 담석증을 가진 환자군이 정상 대조군보다 혈중 인슐린, HOMA-IR 지수, 중성지방, 체질량지수, 체지방률이 더 높게 나왔으나, 두 군 간에 유의한 차이를 보인 것은 혈중 인슐린(p=0.037), HOMA-IR 지수(p=0.024), 체질량 지수(p=0.024)이며, 중성지방은 p=0.076으로 경계값에 있었다. 유의하게 나타난 인자로 로지스틱 회귀분석을 사용하여 분석한 결과, 혈중 인슐린(p=0.014, odds ratio=1.376)과 HOMA-IR 지수(p=0.013, odds ratio=2.006)가 담석증의 위험을 증가시키는 것으로 나타났다. 결론: 한국인에서 당뇨가 없으며, 정상 혈당을 가진 사람에서도 혈중 인슐린 수치가 높거나, 인슐린 저항성이 있으면 담석증 빈도가 높으며, 담석증 발생 위험이 증가한다. Background/Aims: Diabetes is one of the risk factors of gallstone diseases. Many studies found a positive association between insulin and gallstones in individuals with diabetes. However, this association is unclear in non-diabetes. So we conducted a case-control study for the evaluation of the association between gallstone diseases and fasting serum insulin level, insulin resistance in non-diabetic Korean general population. Methods: This study was a prospective case-control study on 118 Korean subjects which included clinical examination, abdominal ultrasound, and blood chemistries. Serum fasting insulin level were determined by radioimmunoassay and concentrations of cholesterol, glucose, and triglycerides by standard enzymatic colorimetric methods. Insulin resistance was determined by the homeostasis model assessment (HOMA-IR). Body mass index (BMI), percentage of body fat, and waist hip ratio were also measured. Results: We studied 118 subjects with no clinical evidence of diabetes mellitus and serum glucose <126 mg/dL. Compared with controls (n=89), cases (n=29) had higher levels of serum insulin, glucose, triglyceride levels, and BMI. In t-test and chi-square test for variables, the association between gallstone disease and serum insulin, HOMA-IR index, and BMI were statistically significant (p<0.05). In multiple logistic regression analysis, gallstone disease risk increased with the level of serum insulin (p=0.024, odds ratio=1.376) and HOMA-IR index (p=0.013, odds ratio=2.006). Conclusions: We suggest that hyper-insulinemia and insulin resistance could be associated with gallstone formation in individuals without clinical diagnosis of diabetes mellitus and with normal serum glucose level. (Korean J Gastroenterol 2007;50:183-187)

간동맥 화학색전술 치료를 받은 간세포암 환자의 예후와 혈청 α1 - Antitrypsin 과의 관계

손정일(Chong Il Sohn),황선호(Seon Ho Hwang),박문승(Mun Seung Park),이오영(O . Young Lee),윤병철(Byoeng Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),서흥석(Heung Suk Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

N/A Objectives: Hepatocellular carcinoma(HCC) has a poor prognosis, and only by early detection, cure can be expected by surgery. With development of chemoembolization therapy, we may expect better survival even in the advanced HCC, There many reports about prognostic factors for HCC treated with TAE. We examined relationship between survivals and prognostic factors especially serum a 1-antitrypsin levels in patients with HCC treated with TAE. Methods: 42 patients who had been diagnosed as HCC by ultrasonography and hepatic angiography from 1987 to 1994 were examined for prognostic factors and their survival. Results: Patient's survival who had a single mass was longer (average 21 months) than that of patients who had diffuse tumor(average 4 months, p=0.005). Patient's survival without portal vein thrombosis was longer (average 16 months) than that of patients with portal vein thrombosis (average 4 months, p<0.001). Serologically, patients with low α-fetoprotein level(AFP<40ng/ml) survived longer (average 14 months) than patients with high AFP level(AFP>400ng/ml, average 4 months, p<0.001). Patients with low αl-antitrypsin level (AAT<300 mg/dl) survived longer (average 14 months) than patients with high AAT level (AAT>300mg/dl, average 4 months, p<0.001). Especially, in HCC with low AFP level (AFP<400ng/ml), patients with low AAT level (AAT<300mg/dl) survived longer(average 21 months) than patients with high AAT level (AAT>300mg/dl, average 14 months, p=0.001). Patients with Child's classification A and B showed no signigicant differences in their survival. Conclusion: Serum AAT level may be an important prognostic index in patients with HCC and especially it may be more valuable in patients who had low serum AFP level.

한국인 위암 환자의 p53 Codon 72 및 16-bp 중복 다형성 분석

김정미 ( Jung Mi Kim ),이오영 ( Oh Young Lee ),이춘근 ( Chun Geun Lee ),권성준 ( Sung Joon Kwon ),김경숙 ( Kyung Suk Kim ),문원 ( Won Moon ),고동희 ( Dong Hee Koh ),이항락 ( Hang Lak Lee ),윤병철 ( Byoeng Chul Yoon ),최호순 ( Ho 대한소화기학회 2007 대한소화기학회지 Vol.50 No.5

목적: 종양억제 유전자인 p53 유전자는 DNA 결합 단백질을 부호화하여 세포주기정지와 세포자멸사에 관여하고 DNA 복구 과정을 조절하는 데 중요한 역할을 한다. 최근에는 p53 유전자의 돌연변이와 같은 유전 변화가 암에 대한 감수성에 영향을 끼쳐 위암 발생의 중요한 원인임이 밝혀지고 있다. 이번 연구는 위암 환자군과 정상 대조군에서 p53 유전자의 codon 72 (exon 4) 다형성 및 16-bp 중복(intron 3) 다형성을 분석하여 특정 유전자형 분포 및 빈도가 한국인 위암 발생에서 유전 감수성을 결정짓는 인자인지를 알아보고자 하였다. 또한 위암 환자의 연령과 흡연 여부, 조직학적인 분류 또는 병변 부위에 따라 유전자형의 분포를 분석하였다. 대상 및 방법: 조직학적으로 확인한 120명의 위암 환자군과 145명의 정상 대조군을 분석 대상으로 하였으며 말초혈액으로부터 DNA를 추출하여 조사하였다. p53 유전자의 codon 72 다형성은 중합효소연쇄반응-제한효소단편길이를 이용하였으며, 16-bp 중복 다형성은 중합효소연쇄반응 후 전기영동하여 분석하였다. 결과: 위암 환자군과 정상 대조군과의 p53 codon 72 다형성 유전자형의 빈도를 비교하였을 때 위암 환자군에서 Arg/Arg, Arg/Pro, Pro/Pro의 빈도는 각각 39.2%, 49.2%, 14%였고, 정상 대조군에서는 43.5%, 44.1%, 18%의 빈도를 보여 두 군 간에 통계적인 유의성은 없었으며(p=0.7125), p53 16-bp 중복 다형성 유전자형의 동형접합체(156/156), 이형접합체(156/172)의 빈도는 위암 환자군에서 각각 90%, 10%였고, 정상 대조군에서는 95.2%, 4.8%으로 두 군 간에 차이가 없었다(p=0.1659). 특정 유전자형의 분포 및 빈도가 위암의 이환율을 높이지는 않았다. 위암 환자군의 연령, 조직학적인 구분, 병변 부위에 따라 유전자형 분포는 유의한 차이가 없었다. 흡연력에서는 p53 codon 72 다형성 유전자형의 분포는 유의한 차이가 없었으나, p53 16-bp 중복 다형성 유전자형의 분포에서는 25갑년 이상의 고흡연군은 유전자형의 분포 및 빈도가 정상 대조군과 비교하여 유의한 차이를 보였다(p=0.0079). 결론: p53 유전자 codon 72 다형성과 16-bp 중복 다형성은 한국인 위암 발생의 유전 감수성과 연관 관계가 없거나 아주 낮을 것으로 생각된다. 다만 p53 유전자 16-bp 중복 다형성은 한국인에서 흡연과 관련된 위암 발생의 감수성에 영향을 끼쳐 앞으로 보다 명확한 연관관계 규명을 위해 타인종 및 더 많은 수의 환자군에 대한 추가 연구가 필요한 것으로 생각한다. Background/Aims: p53 gene plays an important role in cell cycle control in response to DNA damage which may increase the probability of mutations leading to carcinogenesis. The role of p53 gene polymorphisms [codon 72 (exon 4) and 16-bp duplication (intron 3)] as potential markers indicating cancer risk remains inconclusive, and the data on gastric cancer are very limited. The aim of this study was to assess the role of p53 gene polymorphisms in the risk of gastric cancer and in the determination of genetic susceptibility to gastric cancer in Koreans. Methods: We analysed p53 genotypes using a polymerase chain reaction-based restriction fragment length polymorphism assay in a population-based case-control study in 120 gastric cancer patients and 145 cancer-free controls in Koreans. Results: There was no specific genotype of p53 gene polymorphism in the gastric cancer patients compared to cancer-free controls. In p53 codon 72 and 16-bp duplication polymorphisms, the frequency and distribution of genotypes showed no statistical significance (p=0.7125 and p=0.1659). There was no difference in genotype by histologic subtypes, location of lesion, and age. However, the genotypic distribution in the patient subgroups with a history of heavy cigarette smoking of p53 16-bp duplication polymorphism were significantly different from those of cancer-free controls (p=0.0079). Conclusions: The p53 codon 72 and 16-bp duplication polymorphisms were not associated with the increased risk of gastric cancer and did not seem to contribute to gastric cancer susceptibility among Koreans. It is possible that p53 16-bp duplication polymorphism modulates the risk of smoking-induced gastric cancer development in Koreans. In order to clarify the associations between specific genotypes and gastric cancer risk, the evaluations of these polymorphisms in other ethnic backgrounds with larger number of patients would be needed. (Korean J Gastroenterol 2007;50:292-298)

만성 간 질환에서 경직장 Thallium-201 간 스캔의 임상적 의의 및 방사능 분포 양상

박경남,이민호,박근태,김진배,최호순,기춘석,함준수,윤병철,조석신,박문승 대한소화기학회 1998 대한소화기학회지 Vol.30 No.4

Background/Aims: Quantification of the portosystemic shunt is important for properly managing the patients, predicting prognosis and adjusting dosages of oral iirugs for chronic liver disease. In this study, we evaluate the clinical significance of thallium-201 liver scan for chronic liver diseases mainly in the aspects of radioactivity distribution. MethndIs: From February 1991 to April 1994, 54 patients with chronic liver disease(25 patients with chi anic active hepatitis, 22 Child A cirrhotics, and seven Child B cirrhotics) underwent the scan. The shunt index(H/L ratio) was determined and was classified into three groups according to the patterns of distributioo of radioactivity performed in them(Type I: normal, Type II: filling defect in the liver with or without extra hepatic radioactivity, Type III: extrahepatic radioactivity only) Results: The shunt index in cirrhotics was higher than chronic active hepatitis(0.56±0.38 vs 0.35±024 p$lt;0.05). In terms of patterns of distribution of radioactivity l3 patients among 14 patients with type I(93%) were patients with chronic active hepatitis, 14 patients among 25 patients with type II(56%) were cirrhotics and the remaining were patients with chronic active hepatitis. 14 patients among 15 patients with type Ill were cirrhotics. In terms of shunt indices according to the patterns of distribution of radioactivity the shunt index of type III was higher than that of type II and that of type II was higher than type I(0.79±0,40:0.39±0.29 p$lt;0.01, 0.39±0.29:0.21±0.14 p$lt;0.05). Conclusions: Determination of the shunt index using a per rectal thalliurn-201 liver scan wa:$gt; a useful method for quantifying the porto- systemic shunt noninvasively and it can differentiate chroruc active hepatitis from cirrhosis. Considering that the graver the chronic liver disease is, that moie frequent type III is, we assume that transformation from type I to type III indicates a progres. Ion of chronic active hepatitis to cirrhosis.

담도 배액관 교체 후 발생한 혈담증

박경남,한동수,이민호,최호순,손주현,기춘석,함준수,윤병철,은창수,조윤주,전용철 대한소화기학회 1999 대한소화기학회지 Vol.32 No.6

Hemobilia is defined as hemorrhage into the biliary tract and occurs when injury or disease cause communication between the biliary tract and blood vessels. The causes of hemobilia are trauma (accidental, iatrogenic), inflammation, gallstone, neoplasm, and vascular lesions. Currently, the mos common cause of hemobilia is trauma. Specially, iatrogenic causes are considered as the mos important. Iatrogenic cause of hemobilia has increased now because invasive procedures such as liver biopsy, biliary drainage (PTBD, ERBD) were popular. We experienced 2 cases of iatrogenic hemo bilia developed after exchange of ERBD stent.

Minocycline Hydrochloride 1회 주입으로 치료된 거대 간낭종 1예

이준수,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수,김용수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Hepatic cysts are usually asymptomatic, and require no treatment, but occasionally they may become large enough to cause symptoms. Aspiration of cystic fluid, surgical intervention, or instillation of various sclerosing agents has been used. Recently, some reports have shown that treatment with minocycline hydrochloride instillation into the cyst produces good results. We experienced a successful treatment of a huge hepatic cyst by instillation of minocycline hydrochloride. After cystic fluid was aspirated, 600 mg of minocycline hydrochloride was instilled into the hepatic cyst, 15 cm in diameter, through the pigtail catheter under ultrasound guidancee. After 2 months, the cyst could not be detected by diagnostic imaging, and no recurrence was observed. We report a case of successful treatment of a huge hepatic cyst with instillation of minocycline hydrochloride.

궤양성 대장염과 유사한 양상을 보인 살모넬라 대장염 1예

손병관,한동수,은창수,박준용,이오영,전용철,손주현,윤병철,함준수 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

Salmonella species have recently been shown to involve the colon in a fashion resembling ulcerative colitis by radiographic and endoscopic appearance. The presentation of Salmonella colitis is usually similar to that of ulcerative colitis; and often leads to delayed or inappropriate management. Furthermore, Salmonella infection and inflammatory bowel disease (IBD) can coincide in the same patient. Salmonella colitis in the setting of undiagnosed underlying IBD can present a diagnostic dilemma for the clinician. We report a case of Salmonella colitis in which the radiographic and colonoscopic findings were similar to those of ulcerative colitis.

점막하 종양양상의 위 과오종 1예

박경남,한동수,이민호,박용욱,조윤주,장우영,최호순,이동후,이오영,기춘석,함준수,윤병철,은창수,전용철,고동희 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.3

Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3×2×1.5 cm and was characterized by cystic dilation of glandular structures, The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures.

만성췌장염과 유사한 췌장두부암 1예

박경남,한동수,이용욱,김진영,이민호,조윤주,최호순,손주현,기춘석,전용철,윤병철,함준수 대한소화기학회 1999 대한소화기학회지 Vol.32 No.5

It is important but difficult to differentiate pancreatic cancer without mass formation, chronic pancreatitis and pancreatic cancer coexisting with chronic pancreatitis. These diseases have similar clinical presentations and markedly overlapping findings in various imaging studies, but have extremely different prognosis and treatment modalities. We report a case of pancreatic head cancer without mass formation. Its clinical features are similar to chronic pancreatitis in the initial studies. However, it turned out to be malignant after 4 months.

유두괄약근 절개술 후에 발생된 유두부 재협착 1예

박경남,한동수,이민호,최호순,이동후,손주현,기춘석,함준수,손영우,전용철,윤병철,조윤주 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.