제2형 당뇨병 환자의 치료에서 복약순응도가 혈당 조절에 미치는 영향

김경선,김민정,박소현,박영주,허정순,이은경,김선영,이수형,김상수,강양호,손석만,김인주,김용기 한국병원약사회 2009 병원약사회지 Vol.26 No.2

Abstract: As known in clinical trial like DCCT, UKPDS, tight glycemic control is essential to prevent complications from diabetes mellitus(DM). In type 2 diabetes taking multiple medication, nonadherence to medications is common problem. The aim of our study is to investigate adher-ence rate of patients with type 2 DM and to evaluate association between many factors including adherence rate and HbA_(1C). 441 patients with type 2 DM who visited Busan National University Hospital endocrine internal department from Aug 13 to Sep 2, 2008(3weeks) were enrolled. We conducted a man-to-man questionnaire survey about general knowledge about diabetes mellitus, medicine and adherence, and measured HbA_(1C). Among them, 305 patients taking oral hypo-glycemic agent(OHA) were analyzed to investigate correlation between adherence rate and glycemic control. We studied 305 patients(male 126, female 179, average age 61.2±9.8 years, DM duration 8.6±6.4 years, average adherence 88.8±16.2%, average HbA_(1C) 7.03± 1.18%). HbA_(1C) showed significant relation with DM duration(r=0.137, p=0.017), number of aHA in regimen (r=0.135, p=0.018), dosage frequency(r=0.132, p=0.026), Medication Refill Adherence(MRA)(r=-0.124, p=0.030) and adherence(r=-0.168, p=0.003). Adherence had significant relation with MRA(r=0.148, p=0.010) but didn't have statical corelationship with DM duration, number of aHA and dosage frequency. Patients that their adherence rate exceed 90% took fewer OHA(p=0.011) and went on a better dietary treatment(p=0.007). In patients controlling diabetes mellitus with aHA, when adherence rate and MRA was higher, HbA_(1C) was lower. As a result, to improve adher-ence rate, it is necessary to enhance patient education, do careful consideration about prescrip-tion medicine number and dosage frequency

임상 가검물에서 분리된 균(대장균과 황색 포도균)의 약제 내성

김중명,김재식,김경선,김재룡,전동석,최성만,서상철,김인자,김재숭,이건일,김경숙 慶北大學校 醫科大學 1982 慶北醫大誌 Vol.23 No.2

1981년 1월에서 12월말까지 임상 제료에서 분리한 Escherichia coli (E. coli)와 Staphylococcus aureus (S. aureus) 중에서 무작위로 각 50주 씩 선택하여 원판 확산법과 평판 희섭법으로 그 내성주를 조사하여 다음과 같은 성적을 얻었다. 전체적으로 볼 때에 Teteracyclin (TET), Chloramphenicol (CM) 및 Ampicillin (AMP)에 대한 내성주가 가장 많았고, Amikacin (AMK)에 대한 내성주는 가장 적어다. 이것을 균종별로 보면 E. coli에 있어서는 TET, AMP 및 CM는 원판 확산법으로서 74∼76%, 평판 희석법으로서는 78∼94%가 내성주임을 나타내었고, 또 Cephalothin(CEP)은 원판 확산법에서는 8%가 내성주로 나타났으나, 평판 의석법에서는 52%가 내성주로 나타났다. S. aureus에 있어서는 TET는 원판 확산법으로 82%, 평판 희석법으로서는 78%가 내성주로 나왔고 Penicillin (P)은 원판 확산법에서는 56% 평판 희석법으로는 22%의 내성주가 나왔으며, GM과 CM은 원판확산법에서는 18∼44%, 평판 희석법에서는 56∼58%가 내성주로 나왔다. Each 50 strains of Escherichia coli and Staphylococcus aureus were selected at random out of the stock cultures which were isolated from the clinical materials in the bacteriological laboratory of the department of clinical pathology. Kyungpook National University Hospital from the first of January to the end of December in 1982, and their resistance against eight antibiotics were as follows; Escherichia coli and Staphylococcus aureus had the most resistant pattern against tetracyclin, chloramphenicol, and ampicillin, while they had the most sensitive pattern against amikacin in general. Escherichia coli revealed resistant pattern to tetracyclin, ampicillin, and chloramphenicol 74-76% by the disk diffusion method and 78-94% by the plate dilution method, and revealed resistant pattern to cephalothin 8% by the disk diffusion and 52% by the plate dilution. Staphylococcs aureus disclosed resistant pattern to tetracyclin 82% by the disk diffusion and 78% by the plate dilution, and disclosed resistant pattern to penicillin 56% by the disk diffusion and 22% by the plate dilution, and to gentamicin and-chloramphenicol 18-44% by the disk diffusion and 56-58% by the plate dilution.

부산지역 무균성 뇌막염 원인 바이러스의 분리 및 동정 : 1998년을 중심으로

김영희,정영기,김기순,지영미,윤재득,김병준,구평태,민상기,정구영,김만수,조경순 동의대학교 기초과학연구소 2000 基礎科學硏究論文集 Vol.10 No.1

The incidence of aseptic meningitis infection is ensuing and threatening the health of children. Enteroviruses are the major agents of aseptic meningitis and identification of virus has been a clue to diagnosis and epidemiology. The outbreak of aseptic meningitis occurred in Pusan, 1998. Patients were concentrated from April through November. Children were more susceptible than adults. Among 306 cases of specimens from stool, throat swab tested, only 7.2% were positive on virus isolation, 12 cases from stool and 10 from throat, respectively. All isolated 7 serotypes of viruses represented cytopathic effect on cultured cells. Three types of echovirus 6, 25, 30 and coxsackievirus B2, B3, B4, B6 were identified by neutralizing anti body test. Isolated coxsackievirus and echovirus were observed by an electron microscope with negative staining.

Associations of serotonergic genes with poststroke emotional incontinence

Kim, Jae‐,Min,Stewart, Robert,Kang, Hee‐,Ju,Bae, Kyung‐,Yeol,Kim, Sung‐,Wan,Shin, Il‐,Seon,Kim, Joon‐,Tae,Park, Man‐,Seok,Cho, Ki‐,Hyun,Yoon, Jin‐ John Wiley Sons, Ltd 2012 INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Vol.27 No.8

<P><B>Objectives</B></P><P>Poststroke emotional incontinence (PSEI) has been associated with serotonergic dysfunction. Polymorphisms of serotonin transporter (5‐HTT) and serotonin 2a receptor (5‐HTR2a) genes may regulate serotonergic signaling at brain synapses, and this study was to investigate associations with PSEI in an East Asian population.</P><P><B>Methods</B></P><P>In 276 stroke cases, PSEI was diagnosed by Kim's criteria. Covariates included age, gender, education, history of depression or stroke, current depression, and stroke severity and location. Genotypes were ascertained for 5‐HTT gene‐linked promoter region (5‐HTTLPR), serotonin transporter intron 2 variable number tandem repeat, 5‐HTR2a 1438A/G, and 5‐HTR2a 102 T/C. Associations with PSEI were estimated by using logistic regression models, and gene–gene interactions were investigated by using the generalized multifactor dimensionality reduction method.</P><P><B>Results</B></P><P>PSEI was present in 37 (13.4%) patients. The 5‐HTT gene‐linked promoter region <I>s</I>/<I>s</I> genotype was independently associated with PSEI. No associations with STin2 VNTR and 5‐HTR2a genes were found, and no significant gene–gene interactions were identified.</P><P><B>Conclusions</B></P><P>Stroke patients with 5‐HTTLPR <I>s</I> allele had higher susceptibility to PSEI, which underlines the potential role of serotonergic pathways in its etiology. Copyright © 2011 John Wiley & Sons, Ltd.</P>

在美 韓國 老人의 健康 및 生活 實態에 關한 硏究

金應翊,朴祥華,韓允愚,徐敬萬 대한보건협회 1992 대한보건연구 Vol.18 No.1

This study was perfomed to figure out the health status and life style of aged population in Korean-Americans living in Los Angeles in the United States. The number of subjects in this study were 283 persons aged 65 and over (male 141. female 142) drawn from Los Angeles Country in U.S.A. The data were collected by trained interviewers from July to August. 1991. The questionaire consisted of 1) general characteristics, 2) health status and medical health services, 3) 24 questions of CMI, and 4) the level of adaptations and difficulties to immigrant society. The results of this study are as followings: 1. In age distribution, 33.2 percent of total subjects was 65-69 age group, and 33.1 percent was 70-75 age group. The average duration of immigration were 7.89 years in male and 10.18 years in female, and percent distribution by duration of migration were 33.3 percent in 1-4 years, 30.5 percent in 5-9 years, 23.7 percent in 10-14 years, and 13.5 percent in 15 years and over. Of total subjects. 84.7 percent had permanent residence and only 13.8 percent had citizenship. In the reason of immigration of the elderly, 76.4 percent of them responded as reason for helping and joining to family, and only 8.5 percent of subjects were economic reason. The educational level of the subjects were generally high. Only 9.0 percent of the subjects recevied no or little education in the modern day education system. Primary graduates were 35.7 percent, middle and high school graduates were 37.8 percent and university(college) and over graduates constituted 16.6 percent. The educational level of the male were generally higher than that of female. A large proportion of the subjects(94.3 percent) responded as having religion, and 67.8 percent were protestant, 16.7 percent were catholic and 7.4 percent were buddhist. In the family structure. 75.6 percent of the elderly lived alone and with their spouses and 22.1 percent live in a family with 2 generation living together. The marital status of male showed that 80.7 percent of them lived with their spouses, 14.3 percent of men were widowed, and only 26.3 percent of female lived with their spouses and 71.5 percent of female were widowed. 2. One out ten of the elderly was presently smoking. Of the smokers, there were 4 times as many male smokers as female smokers. In response to a question about their drinking habits, 82.0 percent of the aged replied that they did not consume alcohol. Those who consumed alcohol 'daily' constituted 3.6 percent, 'frequently' were 4.3 percent 'sometimes' were 7.9 percent and 'scarcely' constituted 2.2 percent. Among the exercises and sports which the elderly were doing for the fitness and preservation of health. A walking was the most popular at 32.1 percent of the population. More rigorous sports such as hiking, jogging, physical cardiovascular exercises and ball games were being enjoyed by only a very few. 37.2 percent of the elderly replied that they did not exercise regularly. In the major pastime of daily life activities. 40.9 percent of the subjects responded 'none', 14.7 percent of them were domestic duty for family, about 10 percent of them were hobby, religion activities, social work and participating in social education program respectively. In the problems and difficulties of immigration, 78.1 percent of them responded 'yes' in the early times of immigration and 30.4 percent in the present time of immigration. Six major problems were identified by respondent. They were, in the rank order of their language; homesickness: transportation; income and economic and custom. 3. Most of the respondents considered themselves healthy. The proportion of the question to their health at the time of study, 36.2 percent in male and 23.2 percent in female replied that they seemed to be 'excellent healthy', 34.7 percent in male and 32.4 percent in female be 'good', and 4.3 percent in male and 2.1 percent in female be 'Very poor'. In considering specific parts of their body as having problems, many of the ederly pointed out the disease of circulatory system(17.7 percent in male and 23.2 percent in female). Comparatively few of the elderly thought that they had something wrong with their musculoskeletal system(5.7 percent in male and 16.1 percent in female), digestive system(9.2 percent in male and 5.6 percent in female) and endocrine and metabolic disease(6.4 percent in made and 9.9 percent in female). Of those elderly who perceived of some problems with their circulatory and musculoskeletal systems, there were more elderly women compared to elderly men. The largest percentage of the elderly(20.7 percent in male and 26.5 percent in female) indicated palsy as the disease they fear most. Thereafter, the order of diseases feared by the elderly was diabets. hypertension, neuralgia, cancer, and dotage. A majority of the elderly, 54.6 percent of men and 44.4 percent of women, replied that they did not visit a medical institution or a pharmacy to treat their diseases during the one month prior to the survey. Of the total survey subjects who did visit a medical facilities, those complaining of circulatory system disease constituted 13.5 percent in male and 14.8 percent in female, and digestive system diseases were 7.8 percent in male and 8.5 percent in female. For the endocrine and metablic disease, disease of nervous and sens organs and musculoskeletal system were all each less than 7 percent of all the study subjects. Of the total elderly, 49.0 percent utilized medical facilities such as hospitals, herbal clincics, pharmacies and others to treat illness within one month prior to the time of survey; the utilization of clinicl and hospital were 86.0 percent, herb clinic were 8.4 percent and pharmacy were 4.2 percent. 34.8 percent of men and 11.3 percent of female did not take a medicine for treatment and promoting nutrition at the time of the survey. 55.4 percent of total elderly used the drug for treatment of diseases, and 16.6 percent for promoting nutrition. 4. Except for group of questions concerning urinary system more women than men generally complained of problems and discomforts in each groups. More elderly suffered from problems associated with musculoskeletal system than any others, and the decreasing order of the groups of problems with which most complaints were indicated are the problems associated with mental condition, urinary system, circulatory system, nervous system, visual and auditory organs, respiratory system and digestive system.

판별분석법을 이용한 관상동맥질환 고위험군의 예측

김성률,김기현,정갑열,김정만,박경일,김준연,이상주,김원술 동아대학교 부설 산업의학연구소 1995 산업의학연구소 논총 Vol.- No.2

The objective of this study is to predict the high risk group of coronary artery disease from body mass index, blood pressure, fasting blood sugar and serum lipids level using the method of discriminant analysis. Variables with significant difference between coronary artery disease group and normal group were HDS-C, LDL-C/HDL-C, LDL-C, and TG. But the acuity did not exceed 70% in any single variable. As the results of discriminant analysis, statistically significant discriminant variables were HDL-C, T-chol, FBS and TG. The discriminant equation was(Y) = -0.06759(HDL-C) + 0.01498(T-chol),+0.01923(FBS) - 0.01421(TG) + 0.5187, and the overall discriminant power using the above 4 variables was 79.3%

약물사용 고위험군 선별척도의 표준화 연구(Ⅰ)

김만희(Man-Hee Kim),김경빈(Kyung-Bin Kim),전현민(Hyun-Min Jun) 한국중독정신의학회 1998 중독정신의학 Vol.2 No.1

One of the screening tests used for identifying the high risk group of adolescent drug users is High Risk Group of Adolescent Drug Users Screening Test (HIRIGADUST) developed by Kyung-Bin Kim (1977) that consist of six subscales and 70 items. The Purpose of this study was to examine the reliability and construct validity of HIRIGADUST. HIRIGADUST was administered to 370 third grade middle school students. In the reliability test, the Cronbach’s α coefficients were 0.70-0.89 in five subscales, but the Cronbach’s α coefficient was 0.53 in ‘Personal experience and general environment’ subscale. The resulting of testing the construct validity of five subscales of HIRIGADUST by factor analysis provided evidence for the validity of the each subscales. We used T score 65 as a cut-off point. The cutting scores were 12 for ‘Peer relationships and school performance’ subscale, 14 for ‘Personality and value system’ subscale, 14 for ‘Psychological problems and health concerns’ subscale, 8 for ‘Family history and characteristics of parents’ subscale, and 14 for ‘Conserns about parents’ drinking subscale.

제 1형 신경섬유종증 환자에서 발생한 위장관 간질종양 1예

원경준,이준,변유미,조민근,한경택,김원,홍란,임성철,김경종,김영대,박찬국,김만우 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm arising in the gastrointestinal tract, but this tumor is rarely seen in association with type l neurofibromatosis (NFl) Generally, the majority of GISTs are isolated neoplasm and they are sporadically found in the stomach, but the GISTs in NFl patients are usually multiple and usually found in the small intestine. We report a case of multiple GISTs in the jejunum of a 63-year-old woman diagnosed as NFl accompanied by complication of gastrointestinal bleeding, In this case, Patient had multiple cafe-au lait spots and neurofibroma on skin and had freckling on axilla and groin, and then, we made a diagnosis of NFl. Gastrointestinal bleeding is controlled by resection of multiple GISTs. Generally, only 3-5% of all gastrointestinal bleeding comes from the small bowel. Causes of small intestinal bleeding are angiodysplasia, neoplasm, NSAIDs induced ulcer etc. but, If patients have NFl accompanied by complication of gastrointestinal bleeding, GISTs on small bowel must be considered.

표층확대형 조기위암 1예

고성만,김기훈,서호종,서광섭,유광렬,채선애,임병욱,김홍자,김호정,김진승,허병원,김해경 중앙대학교 의과대학 의과학연구소 2001 中央醫大誌 Vol.26 No.3

The superficial spreading type of early gastric cancer has usually been defined as an early gastric cancer in which the product of the longest diameter and the diameter perpendicular to it was greater than 25㎠. Although the superficial spreading type of early gastric cancer is histologically aggressive compared with those without such histological aggressiveness, the 5 year survival rate is as good as a non-superficial spreading types of early gastric cancers if the wide surgical resection with extensive lymph node dissection is performed as a treatment. We experienced a case of superficial spreading early gastric cancer in a 59-year-old man. This case is reported with a brief review of related literature.

한국인 제2형 당뇨병 환자의 골격근에서 인슐린 신호전달체계의 결함

최준혁,이관우,김효정,이동훈,이종우,김정은,엄현채,김경미,최성이,정윤석,김현만 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 제2형 당뇨병에서 나타나는 인슐린 저항성은 간, 지방, 근육 같은 말초조직에서 인슐린의 작용이 떨어지는 것을 말한다. 제2형 당뇨병의 발생기전에 인슐린 저항성과 인슐린 분비능 저하가 같이 관여함은 잘 알려진 사실이다. 인슐린의 세포내에서의 저항성을 규명하기 위한 인슐린의 세포내 신호전달체계에 대한 연구가 활발히 진행되고 있으며 몇몇 연구에서 인슐린 저항성을 가진 골격근육에서 IRS와 관련된 PI3-kinase의 활성감소와 Akt kinase의 활성감소를 보고하고 있으나 아직까지 명확하게 그 기작이 설명되어지지 않고 있다. 본 연구에서는 정상성인, 제2형 당뇨병 환자를 대상으로 경구당부하검사 및 인슐린 클램프검사를 시행하고 인슐린 클램프 검사시 대상인의 근육을 채취하여 인슐린 신호전달 체계(IR-β, IRS, Akt(PKB, Rac) kinase, GSK-3)를 연구하였다. 방법: 연구대상자는 한국인으로서 경구당부하검사상 정상인 및 당뇨병 환자 각각 11명, 9명을 대상으로 하였으며, 정상인은 건강인으로 과거력상 당대사에 영향을 줄 질환이 없고, 현재 당대사에 영향을 줄 약물 복용 및 다른 소견이 없는 경구당부하검사상 정성 내당능을 보이는 대상자로 하였다. 당뇨병환자는 모두 제2형 당뇨병 환자로 이환기간이 만 5년 이내인 경우로 하고, 인슐린으로 치료하는 대상자는 제외하도록 하였다. 대상자의 연령, 체질량지수, 체지방량, 공복시 총콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤 및 HbA1c, 인슐린, C-peptide를 측정하였고, "HOMA model"을 이용하여 베타세포의 기능와 인슐린저항성 정도를 평가하였다. 정상혈당클램프 검사(euhlycemic hyperinsulinemic clamp test)를 시행하고 인슐린 투입 전과 인슐린 투입 30분후, 두차례에 걸쳐 대퇴부 근육생검을 실시한후 western 법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 측정하였다. 결과: 정상인 11명과 당뇨병 환자 9명을 대상으로 하였으며 대상자의 평균 연령, 평균 체질량지수, 체지방량, 허리/엉덩이 둘레의 비(waist hip ratio; WHR)는 두 군간에 차이가 없었다. 평균 공복혈당은 정상군 98.0±0.3㎎/dL, 당뇨병군 208.1±16.5㎎/dL(p<0.05), HbA1c는 정상군 5.4±0.5%, 당뇨병군 9.2±0.6%(p<0.05)였다. "HOMA model"을 이용한 베타세포의 기능과 인슐린저항성은 정상군 56.4±8.5%, 1.4±0.2, 당뇨병군 72.2±52.3%(p<0.01), 10.2±6.3(p<0.01)였으며 정상혈당클램프 검사상 포도당 이용률은 정상군 8.2±0.6㎎/㎏/min, 당뇨병군 3.7±1.1㎎/㎏/min(p<0.01)로 정상군과 당뇨병군간에 유의한 차이를 나타내었다. Western blot법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 인슐린 투입전과 인슐린 투입 30분후 측정하였을 때 IR-β에서는 정상군이 103.9±2.3에서 241.3±18.6, 당뇨군이 108.9±2.2에서 198.7±6.3으로 증가하였다(p=NS). 이는 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 통계적인 차이가 없었다. IRS에서는 정상군이 111.6±7.3에서 295.6±17.2, 당뇨군이 114.5±6.1에서 222.0±23.2로 증가하였으며(p<0.05), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 24% 감소하였다. Akt kinase에서는 103.4±6.0에서 416.8±29.5로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 43% 감소하였다. GSK-3에서는 정상군이 107.7±6.7에서 595.7±28.1, 당뇨군이 104.3±4.8에서 443.3±12.9로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 25% 감소하였다. 결론: 제2형 당뇨병 환자에서 정상인과 비교하여 인슐린 자극후 IR-β는 인산화량의 증가정도가 큰 차이가 없었으나, IRS, Akt kinase, GSK-3에서는 인산화량의 증가 정도가 감소되는 것으로 보아 상위 인슐린 신호전단체계부터 결함이 있는 것으로 생각된다. Background: The glucose uptake rate is the limiting step in glucose utilization and storage. The failure of insulin to stimulate glucose uptake in muscle appears to be a primary defect of insulin resistance. This study was undertaken to examine the effect of physiological hyperinsulinemia on the phosphorylation of the insulin receptor (IR-β), insulin receptor substrate (IRS), Akt kinase and GSK-3 in isolated skeletal muscle, in people with type 2 diabetes(n=9) and control subjects(n=11). Methods: 75g OGTT and euglycemic hyperinsulinemic clamp test were done. And vastus lateralis muscle was obtained before and 30 min into the euglycemic clamp. Western blots were performed for tyrosine phosphroylation of insulin receptor substrate (IRS) and phosphorylation of the insulin receptor(IR-β), Akt and GSK-3. Result: There were no statistical differences in the mean age, BMI and body fat between the control subjects and diabetic patients. The fasting blood sugar and HbA_1c in controls and diabetic patients were 98.0±0.3 and 208.1±16.5ng/dl, and 5.4±0.5 and 9.2±0.6%, and 1.4±0.2 in the control subjects, and 72.2±52.3%(p<0.01) and 10.2±6.3(p<0.01) in the diabetic patients, respectively. The insulin resistance from the euglycemic hyperinsulinemic clamp test were 8.2±0.6㎎/㎏/min and 3.7±1.1ng/㎏/min in the control subjects and in the diabetic patients, respectively(p<0.01). Compared with the normal controls, insulin-stimulated IR phosphorylation was no different to that in the diabetic patients. However, insulin-stimulated IRS phosphorylation, insulin-stimulated Akt phosphorylation and insulin-stimulated GSK-3 phosphorylation were reduced in the diabetic patients compared with the normal controls by 24, 43 and 25%, respectively(p<0.05). Conclusion: In Korean type 2 diabetic patients, the insulin resistance may be due to the impairment of the upstream insulin signal molecular network. Further studies will focus on determining whether these signaling defects are the cause of the development of insulin resistance, or secondary to the altered metabolic state, associated with type 2 diabetes mellitus (J Kor Soc Endocrinol 17:685∼697, 2002).