쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

허혈 유사 조건이 심방근의 활동전위 특성에 미치는 영향

김재하,주정민,조용범,신동호,안병희,주신배,김상형 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.11

반자동 영상 캐릭터 설계 시스템

안재민,유헌우,장동식 한국경영과학회 2002 한국경영과학회 학술대회논문집 Vol.- No.1(1)

In this paper, a new semi-automated cyber character generating method is presented. Local edge detection tools extract face contour from graphic image files. Some graphic manipulation process detailed touch to obtain neat face contour. This method shortens the making process dramatically while maintaining the good quality similar to real face image. Some of the processed images are illustrated for clear explanation.

항혈청으로 처치된 질트리코모나스(Trichomonas vaginalis) 미세구조의 변화

민득영,류재숙,안명희,박승정,조휘율 한양대학교 의과대학 1994 한양의대 학술지 Vol.14 No.2

Trichomonas vaginalis is a parasitic flagellate found in the urogenital tract of humans. The present study was performed to evaluate the effect of antiserum from rat and rabbit on fine structure of T. vaginalis. Trophozoites were subcultured in TPS-1 medium(Diamond, 1968) at 37℃, CO₂incubator. T. vaginalis were inoculated in mixed medium containing of antiserum for 10 and 30 minutes, then observed with transmission and scanning electron microscope. The results are as follows: 1. T. vaginalis was ellipsoidal or ovoidal in shape with 4 flagella, an undulating membrane and an axostyle. The plasma membrane of body surface was smooth and furrowed. Pseudopodia(filopods) were often observed by SEM. Ultrastructure of trophozoites consisted of an elliptical shaped nucleus, RERs and Golgi complex around the nucleus, hydrogenosomes, glycogen granules, polysomes and vacuoles in cytoplasm. As the organelles for supporting and movement, an axostyle, kinetosomes, flagella, undulating membrane, costa and parabasal filaments were observed. 2. T. vaginalis treated with antiserum, its surface appeared destruction of plasma membrane, alteration and/or disappearance of axostyle, flagella and undulating membrane under the SEM and showed fine structural changes such as the nucleus surrounded by many vacuoles, decreased ribosomes, which attached to nuclear membrane and RER, vesiculated RER and Golgi complex. The area of filamentous cell coat and a number of coated vesicles were increased on plasma membrane with partial damage. According to going by the incubation time, the progressive destructions of cytoplasmic organelles, nuclear membrane, hydrogenosomal membrane, kinetosome and rootlet fiber were noted. With above results, it is presumed that specific antiserum induced the disturbance of protein systhesis and the damage of cytoplasm resulting lysis of T. vaginalis.

연령의 증가에 따른 남성의 골밀도와 골교체율의 생화학적 표지자의 변화

민용기,안규정,정재훈,고은미,이명식,이문규,김광원,이종헌 대한골대사학회 1995 대한골대사학회지 Vol.2 No.2

廢 EPS 再生 잉고트의 輕量 굵은骨材 活用方案에 관한 實驗的 硏究

안재철,안진봉,정민수,강병희 동아대학교 건설기술연구소 2000 硏究報告 Vol.24 No.1

This study is to investigate the possibility of using recycled EPS ingot as coarse aggregate and to set basic data of the efficient mixing design for making lightweight concrete. The condition of the most efficient mix design for making lightweight concrete is that under the replacement ratio of over 60%, if cement content is 400㎏/㎥ W/C ratio is 55%, if cement content is 450㎏/㎥ W/C ratio is 50% and 55%. From the result of the experiment under conditions, we could make the concrete whose qualities are slump value of over 18.0㎝, unit weight of less 1.99t/㎥, and compressive strength of over 216.39㎏f/㎠ when the cure duration is 28 days.

환자복 디자인 개선에 관한 연구

안민영;서미아;박재옥;이연희 한양대학교 2004 韓國 生活 科學 硏究 Vol.- No.24

The purpose of this project was to find out design elements of patients' uniform which satisfied needs and wants of patients and nurses. Data were obtained via a self-administered questionnaire from 127 patients who were admitted and nurses who employed to Hanyang University Hospital. The questionnaires were composed of dissatisfaction of exiting patient's uniform, evaluation criteria, design preference, and demographic factors. For data analysis, Descriptive statistics, one-way ANOVA, and Duncan test were employed. The results of this study were as follows; 1. Patients and nurses considered important design elements of neckline, sleeve length, waistband of the pants, and number of pocket. 2. There were differences in dissatisfaction of exiting patient's uniform related to role types. Patients considered factors related to movement such as comfort, easy to dress more importantly, while nurses considered factors related to affairs such as convenient for medical treatment, classification of size, and colorfastness to the laundry more importantly. 3. There was a significant difference in evaluation criteria of patients' uniform related to role types. Nurses considered more important expressive and economic criteria, while patients considered more important functional criteria than others. 4. There was a difference in deign preference of patients' uniform related to role types. Patients preferred uniform design which composed of U-neckline, sleeve of three-quarter length, pants of ankle length, elastic-band with a drawstring, and colors of pink and light green, while nurses preferred design which composed of round neckline, long sleeve length, pants of floor length, and colors of light green and light blue.

면역시킨 마우스 흉선 및 비장세포에 대한 병원성 Naegleria의 세포병변 효과

안명희,류재숙,민득영 한양대학교 의과대학 1991 한양의대 학술지 Vol.11 No.1

Naegleria fowleri is a causative agent of primary amoebic meningoencephalitis (PAM) in man and experimental animal. We investigated the interaction of immunized mouse thymocyte and splenocyte with N. fowleri trophozoites in vitro. BALb/c mouse was immunized with 150∼200×10⁴/ml N. fowleri trophozoites, intraperitoneally, once a week, for two times. Thymus and spleen cells from immunized or normal mouse cocultured with N.fowleri in 10% FCS+MEM, 37℃, 55%-CO₂incubator and cell: amoeba ratio was 200∼400:1. Thymus or spleen cells and N. fowleri were observed at 24, 48, 72 hrs after incubation by inverted microscope. Spleen cells from immunized mice showed moderate lysis aftre 72 hrs with round amoeba, but other group cells were completely lysed at 48 hrs after incubation with N. fowleri. It may be secreted a certain cytolytic amterial from N. fowleri because of cell lysis occured abruptly after 24 hrs culture. And amoebae showed better condition i.e., pseudopodaand vacuoles, after phagocytosis of lytic cell material. On the other hand, nonadherent cells from immunized spleen were completely lysed at 48 hrs with N. fowleri conculture and immunized thymus cell with aditive activated mactophage showed prolonged cell survival. And so, cooperative reaction of immunized T-lympocyte and macrophage are important to supperss N. fowleri in vitro.

축소 플랜트를 이용한 PID 제어기 설계

안두수,임윤식,김민형,이재춘,이한석 成均館大學校 科學技術硏究所 1995 論文集 Vol.46 No.1

In this paper, a simple method is developed for desiging a single loop PID contriller using a computer oriented algebraic approach which is based on general polynomial. Specifically, the proposed PID controller can approximately achieve an arbitrarily specified closed-loop response, which satisfies time domain specifications such as rising time, overshoot and settling time. The design technique is straightforward, and the paramaters of the PID controller are determined by solving a set of linear equations using the least squares method. It does not involve any trial and error proceduer, hence the difficulty of the conventional approach can be avoided.

질편모충(Trichomonas vaginalis)의 시험관내에서의 용혈능

안명희,류재숙,홍택원,민득영 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.2

To evaluate the hemolytic activity of T. vagindlis from Korean women and fresh human RBC of A type were nsed for hemolytic assay. RBC(1×10 /ml) was added to RPMI-TPS media(RPMI 1840:TPS-1= 20 : 1) containing T. vaginalis(2×10 ) and incubated at 37℃, 5% CO₂incubator for 6hr and hemolysis was measured by spectrophotometer at 412m. We investigated the parasite to erythrocyte ratio and lemperature needed for hemotysis. Optimal erythrocyte lysis by T. vaginalis was achieved at ratio of 1 : 5 and optimol temperature 37℃. Minimal hemolytic activity was detected in lysates of T. vaginalis. No hemolysis occured when a membrane a 3㎛ pore size was nsed to prevent contact between parasites and erythrocytes. These data suggest a need for contact for trichomonol hemolysis. Hemolytic activity did not correlated with the production of subcutaneous abscess in mice.