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).

초등학생의 사회적 지원과 운동참여 동기 및 주관적 가치가 운동참여에 미치는 영향에 관한 인과분석

민경훈(Kyung Hoon Min),박영기(Young Gee Park) 한국체육교육학회 2010 한국체육교육학회지 Vol.15 No.4

이 연구는 경기도내 거주하고 있는 초등학교 아동 530명(남: 282, 여 : 248)을 대상으로 친구와 부모의 사회적 지원, 운동참여동기, 주관적 운동가치와 운동참여 간에 어떤 인과관계가 있는가를 밝히는 것이었다. 이를 위해 친구와 부모의 사회적 지원을 외생변인으로 하고 동기, 주관적 운동참여가치와 운동참여를 내생변인으로 한 이론모델을 설정하고 이를 검증하였다. 그 결과 GFI, TLI, CFI 지수 및 χ2/df 값이 양호한 것으로 나타나 이 연구에서 설정된 이론모델은 양호한 모델로 나타났다. 세부적 지수를 분석한 결과 친구의 사회적 지원 → 동기, 주관적 가치, 부모의 사회적 지원영향 → 운동참여, 동기, 주관적 가치, 동기→ 운동참여 경로가 유의한 것으로 나타나 아동의 운동참여에 부모의 사회적 지원과 유능성 동기가 영향을 미치는 것으로 나타났다. This study examined the structure equation model. This theoretical model were exogenous variables which were constructed parental and best friends` social support, endogenous variables sport motivation of physical activity, subjective values of physical activity, and athletic participation. The subjects were 530 elementary school children(boys: 282, girls: 242) who have live in Kyung-kee province. This study used Fredricks & Eccles(2005)` social support scale, Williams, Ryan, & Deci(2004)`s perceptions of sport motivation, Eccles & Wigfield(1995)` subjective value of physical activity scale, and Sabiston & Crocker(2008)` athletic participation scale. The results were as follows; The suggest model was a good fit to data(χ2/df= 2.795, GFI=.923, TLI= .905, CFI=.908, RMSEA=.062(.041~.071)), therefore this structural model was testified significant as a theoretical model. In analysis each path significant, the path of friend`s support → sport motivation, values of physical activity, parent`s social support → athletic participation, sport motivation, and values of physical activity, and sport motivation → athletic participation, values of physical activity → athletic participation.

기계적 자극을 이용한 인체 중간엽줄기세포로부터 유사-섬유모세포로의 분화 유도

최경민 ( Kyung Min Choi ),서영권 ( Young Kwon Seo ),윤희훈 ( Hee Hoon Yoon ),권순용 ( Soon Yong Kwon ),이화성 ( Hwa Sung Lee ),박용순 ( Yong Soon Park ),손영숙 ( Young Sook Son ),송계용 ( Kye Yong Song ),김영진 ( Young Jin Kim 한국조직공학과 재생의학회 2006 조직공학과 재생의학 Vol.3 No.4

Recently, in vitro reconstruction of anterior cruciate ligament(ACL) has been tried using tissue engineering technique, especially mesenchymal stem cell(MSC) is considered as a good cell source. In this study, we tried to find the effect of mechanical stimulus on the differentiation of bone marrow-derived MSC into ACL fibroblastlike cell using a cell training bioreactor imposing cyclic mechanical tension whose parameters were 120 min/day, 1 Hz, and 5% strain. After 2 weeks of culture, MSCs under cyclic tension showed more regularly oriented alignment and lower expression of CD73 and CD105 than control by microscopy and FACS analysis. In transcriptional level, type I collagen, type II collagen, fibronectin, elastin, α-smooth muscle actin mRNA expressions of MSCs under cyclic tension were higher than control and similar to native ACL. In conclusion, it is thought that mechanical cyclic tension induced the loss of stemness of MSC, therefore improved the differentiation into ACL fibroblast-like cell.

Effects of Mechanical Stimulation on the Proliferation of Bone Marrow-derived Human Mesenchymal Stem Cells

Choi, Kyung-Min,Seo, Young-Kwon,Yoon, Hee-Hoon,Song, Kye-Yong,Kwon, Soon-Yong,Lee, Hwa-Sung,Park, Jung-Keug Korean Society for Biotechnology and Bioengineerin 2007 Biotechnology and Bioprocess Engineering Vol.12 No.6

To support and enhance the in vitro growth and activity of mesenchymal stem cells (MSCs), the cell culture medium may be supplemented with various proteins and factors to mimic the physiological environment in which the cells optimally proliferate and differentiate. In this study, the effects of mechanical factors on cellular metabolic responses were investigated experimentally using a bioreactor. The effects of various chemical factors, such as growth factors, cytokines, and hormones, were also investigated. Based on previous reports demonstrating the important roles of mechanical factors in the growth and activity of MSCs, we sought to evaluate the effects of mechanical stimuli on the proliferation of bone marrow-derived MSCs using a cell training bioreactor that imposed cyclic mechanical stretch, with parameters of 240 min/day, 0.03 Hz, and $5{\sim}15%$ strain. The application of cyclic stretch $(5{\sim}15%\;strain)$ to the MSCs enhanced their proliferation during the early stage(3 days), but not the late stage (14 days), of batch culture. Mechanical stretch did not increase the release of lactate dehydrogenase (LDH) from the MSCs during culture. Appropriate levels of mechanical stretch $(5{\sim}10%\;strain)$ increased collagen synthesis, but did not alter MSC stretch was able to serve as a potent positive modulator of MSC proliferation during the initial stages of culture.

Pharmacokinetics and Biodistribution of a pGT2-VEGF Plasmid DNA After Administration in Rats

Son, Mi-Kyung,Choi, Jae-Hoon,Lee, Dong-Sop,Kim, Chae-Young,Choi, Seul-Min,Kang, Kyung-Koo,Byun, Jonghoe,Kim, Duk-Kyung,Kim, Byong-Moon Lippincott Williams Wilkins, Inc. 2005 Journal of cardiovascular pharmacology Vol.46 No.5

Intramyocardial administration of gene therapy vectors expressing angiogenic factors have been attempted as an alternative to conventional surgical methods for the management of myocardial ischemia. In this study, we have developed the pGT2-VEGF, a plasmid DNA vector expressing human VEGF165, for the management of ischemic cardiovascular disease and investigated in vivo pharmacokinetics and tissue distribution of pGT2-VEGF after intramyocardial and intravenous administration in rats. A high concentration of pGT2-VEGF was observed in the heart after intramyocardial injection of 300 μg, which is in line with the assumption that direct intramyocardial delivery enables extended localization at the administration site. Leakage of the pGT2-VEGF to the blood circulation was observed after intramyocardial injection, with an area under the curve (AUC) of 3.8 μg min/mL, as compared with 37.3 μg min/mL after intravenous injection of the same dose. The pGT2-VEGF concentration in blood peaked at 5 minutes after intramyocardial administration and declined rapidly to undetectable levels by 2 hours post-administration. In tissue distribution studies, pGT2-VEGF peaked at 5 minutes post-administration in various organs but was undetectable at 2 hours in all organs except heart, lung, and liver. Taken together, the results suggest that intramyocardial-delivered pGT2-VEGF was degraded rapidly in vivo and mainly persisted in target tissues, the heart. In addition, intramyocardial-administered pGT2-VEGF was expressed for longer periods than the persistence of the pGT2-VEGF plasmid DNA in a target tissue. Therefore, a direct myocardial injection of pGT2-VEGF might be useful for local therapeutic angiogenesis.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

體力에 따른 兒動의 社會性 비교 硏究

민경훈 圓光大學校附設 生活體育硏究所 1994 生活體育硏究 Vol.5 No.-

The paper is to exemine to have influence physical fitness on childern's sociality. The subject is 336 elementary students(boys ; 192, girls : 144) in Kwangju city. This study use two scales. The one of scale that is made by Institute of Korea Behavior Research is that tearcher evaluate childern's sociality. The other is that Childern evaluate themselves sociality. The variables of sociality is devied into diligence, independency, cooperation, and competition. The results are as follows: 1. In analysis of gernal characters, girls show higher competition than bodys. Boys and girls are increased sociality to except cooperation and physical fitness. In analysis of sociality between lower physical fitness group and that of higher, the former is higher independence and cooperation than the latter, but those factors of sociality are not different between groups. There is not different any other factors of sociality between higher and lower fitness group in girls. 2. There are significantly(P<.05) reverse correlation between 100m runing and diligence and cooperation, between long distance runing and deligence, between throwing and competition, are significantly(P<.05) correlation between long distance runing and independence, and competition, between throwing and independence, between total fitness and diligence, independence, and cooperation in boys. There are significantly(P<.05) reverse correlation between 100m running and independence, between throwing and diligence, and competition, are significantly(P<.05) correlation between pull-up and diligence, between sit-up and competition in girls. In analysis of regression, fitness has influence on the boys' development of sociality and father's scholastic ability has influence on the girl's development of sociality.

상호문화적 음악교육의 의미와 지도방법에 관한 연구 : 초등학교를 중심으로

민경훈 민족음악학회 2004 음악과 민족 Vol.28 No.-

It is very difficult to see international students in Korean classrooms and there are no music programs in Korean classrooms as well. Unlike the heterogeneous population of the U.S., Korea is the homogeneous society. Therefore, we can exactly apply the systems of both the multicultural music education in the U.S. and the intercultural Music education in Germany. In this regard, Korean multicultural music education should be different from both of these countries. Korean multicultural music education should start from Globalization which is broadly used as the meaning that the world is one. Now days, we live in the global world where all the nations cooperate and exchange their traditions for better existence. Therefore, we should respect and appreciate the differences and traits of the other culture's traditional music. I can dare to say that the intention of our multicultural music education should be based on bringing up better human beings to make this complicated world peaceful. This kind of attitude is gradually and naturally growing up by experiencing various multicultural activities from early ages. Consequently, our music education society should understand the necessity of multicultural music education and try to develope this in our music classrooms.

스포츠를 통한 非行靑少年 善導策

閔庚熏,吳容敎 서강정보대학 1988 論文集 Vol.7 No.-

음악교사를 위한 현대음악 지도방법 연구 : 쇤베르크의 「바르샤바의 생존자」를 본보기로 Im Beispiel vom Arnold Schoenbergs Werk 「A Survior from Warsaw」 (Op. 46)

민경훈 민족음악학회 2005 음악과 민족 Vol.29 No.-

Viele Musikpa¨dagogen argumentieren u¨ber die Mo¨glichkeiten der Einfu¨hrungen von Lerninhalten 'Neue Musik' in schulischen Musikunterricht, und damit u¨ber musikpa¨dagogische Anwendungen der Neuen Musik. In diesem Hintergrund versuche ich, didaktisch-methodische Ansa¨tze zum Unterricht der Neuen Musik fu¨r die Klassen 10 und 11 zu finden. Fu¨r die Entwicklung dieser didaktisch-methodischen Konzepte werden vor allem folgende Faktoren beru¨cksichtigt: a)Musikalische Begriffe b)Lernzielvorstellung und musikdidaktische Konzepte c)Lernvoraussetzungen beim Schu¨ler d)Pa¨dagogische Prinzipien e)Umgangsweisen mit musikdidaktischen Methoden f)Interdisziplina¨re Verflechtungen (Einfluβ auf Unterricht) g)Qualita¨t der Musiklehrer h) Institutionelle Einbindung. Es ist fu¨r die Befu¨rworter der Neuen Musik im Musikunterricht entscheidend, daβ die Musik unseres Jahrhunderts existiert, die zu einer Vera¨nderung der musikalischen Wirklichkeit und zur Neubestimmung von Tradition und Gegenwart beigetragen hat. Wirklich ist die Neue Musik einen Tell unserer gesellschaftlichen Realitat und vera¨ndert unser Denken u¨ber den Begriff 'Musik'. So in bezug auf musikalische Lerninhalten 'Neue Musik' sollte der Musiklehrer daran interessiert sein, seinen Musikunterricht mit neuen Ideen, umfassenden Informationen abwechslungsreich zu gestalten und damit das musikalische Interesse der Schu¨ler zu wecken. Dabei konnen sich die Schu¨ler zum fro¨hlichen, wohlhabenden und scho¨pferischen Leben fu¨hren, auch Forschungsgeist sowie Nachdenkensfa¨higkeit fo¨rdern. Eine entsprechende Sach- und Methodenkompetenz des Musiklehrers ist unbedingt notwendig fu¨r die Bereitschaft des Schu¨lers zur Auseinandersetzung mit dem Lerninhalt 'Neue Musik'. Aber die Musiklehrerausbildungssta¨tte war bisher eher ein Hort der Tradition, weniger jedoch des Neuen. Tatsa¨chlich sollte das musikpa¨dagogische Institut fu¨r zuku¨nftige Musiklehrer mehr qualifizierte Ausbildungsmo¨glichkeiten anbieten als bisher, z. B. durch das neue Bildungssystem und vielfa¨ltige Veranstaltungen.