제2형 당뇨병 외래 환자의 비만도에 따른 미세혈관합병증

이성규,조남한,김현만,이관우,정윤석,채봉남,김윤정,이미덕,노혜림,홍은경,조현경 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.1

Background: Korean type 2 diabetic patients who are frequently non-obese, may be genetically different from Western type 2 diabetics who are frequently obese. Therefore, the diabetic complications of type 2 diabetes mellitus in Korea may be also different from those of Western countries. Until now, most studies reported in Korea did not analyse the microvascular complications of type 2 diabetes mellitus according to obesity, and also the criteria in the diagnosis of microvascular complications were different in each study. We investigated the microvascular complications and its relationship with obesity, in type 2 diabetic patients visiting an outpatient clinic. Methods: The study subjects were type 2 diabetic patients visiting an outpatient clinic of Ajou University Hospital. We selected patients participating in a 75 g oral glucose tolerance test, retrospectively. Type 2 diabetes was diagnosed according to the WHO/NDDG classification of diabetes. Biochemical studies including lipid profile, plasma insulin and C-peptide levels were done. Anthropometric measurements were performed. Based on BMI (㎏/㎡), the patients were divided into the following groups: the lean group, when the BMI was less than 20 ㎏/㎡ the ideal body weight (IBW) group, if the BMI was between 20 ㎏/㎡ and 25 ㎏/㎡ in women and 20 ㎏/㎡ and 27 ㎏/㎡ in men; and the obese group, when the BMI was $gt;25 ㎏/㎡ in women and $gt;27 ㎏/㎡ in men. Results: 1. Neuropathy (45.2%) was the most frequent among the microvascular complications, and the frequency of retinopathy was 15.1%, and that of nephropathy was 4.9%. Within 5 years of diabetes duration, the frequency of neuropathy, retinopathy, and nephropathy was 43.2%, 11.8%, and 2.9%, respectively. 2. Glycosylated hemoglobin (HbA_(1c)) and fasting blood glucose levels were not different among the three groups. Beta cell function{Δ (insulin 30min - insulin Omin)/Δ(glucose 30min - glucose 0min)} was the highest in the obese group. However, beta cell function(ΔI/ΔG) divided by the basal insulin level, considered insulin resistance, was not different among the three groups. 3. Within 5 years of diabetes duration, retinopathy tended to be the most frequent in the lean group, whereas neuropathy tended to be the most frequent in the obese group, and body mass index influenced the retinopathy and neuropathy, statistically significantly. Conclusion: Diabetic neuropathy was the most frequent among microvascular complications of type 2 diabetes mellitus in our study subjects. At the time of presentation within 5 years of diabetes duration, the lean group of type 2 diabetics had a tendency of the more frequent retinopathy, the obese group had a tendency of the more frequent neuropathy. These results suggest that type 2 diabetes mellitus in Korea is also not a single disease entity, as in Western countries and is a heterogenous group of disorders with a diversity of microvascular complications. However, the more studies about this will be required.

제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

건진센터 수검자 자료를 이용한 비만지표에 대한 연구

김상만,최희정,이득주,김광민,윤수진 대한비만학회 1997 The Korean journal of obesity Vol.6 No.2

We have examined l5145 persons(7468 men 7677 women) to determine the role of Obesity Index(body mass index, WHR, body fat percent) on the risk of various chronic disease. All the subjects were pooled from Health Examination Center who took the annual health examination from June, 1994 through Jan, 1997, BMI(Body mass index, kg/㎡), WHR(Waist hip ratio) were measured and correlated with the frequency of chronic disease. In order to evaluated the BMI, WHR, Body Fat as an independent factors on rnorbidity, analysis of covariance was applied adjusted for age. The risk of variows chronic diseases were also analyzed with obesity, defined by BMI above 26kg/㎡ (men), 25kg/㎡ (women), by logistic regression adjusted age and sex. Risk of hypertension was 2.6 with 95% eonfidence interval of 1.9-2.8 in obese group. Risk of diabetes mel1itus, hypercholesterolemia, hypertriglyceridemia, gall stone, fatty liver were 3.2(2.3-4.4), 1.2(0.9-1.4), 2.1(1.7-2.8), 1.4(1.1-2.6) and 1.3(0.8-2.3) respectiveiy. The risk of various chronic diseases were also analyzed with obesity, WHR above 0.9(men), 0.81(women), by logistic regression adjusted age and sex. Risk of hypertension was 1.7 with 95% confidence interval of 1.4 -2.1 in obese group. Risk of diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, gall stone, fatty liver were 3.1(2.3-4.0), 1.2(0.9-l.4), 1.4(1.1-2.6), 2.4(l.8-4.8) and 2.1(1.2-4.1) respectively. The BMI, WHR were independent risk factors for various chronic diseases.

음향방출을 이용한 엔드밀의 마멸검출에 관한 연구

윤종학,여만구,김동성,이호영 서울産業大學校 1995 논문집 Vol.42 No.1

This study is focused on the prediction of an appropriate tool life by clarifying the correlation between progressive tool wear and signals, when cutting SM45C by end mill in machining center. First of all, end mill have a problem that position of sensor sticking because it is revolution tool, I think that it can be gained specific character according to sticking sensor in the vise. Consequently, the following results have obtained: 1. Each cutting speed of feed rate over 0.1mm had a tendency to increase linearly according to the RMS. 2. The level of AE signal at the same cutting area was more sensitive to depth of cut than the variation of feed rate. 3. In the range of cutting during about 75min at cutting speed 27m/min flank wear turns up about 0.21mm, about 0.29mm in the case of about 65min at 33m/min, hereby RMS increased rapidly at 0.2mm flank wear, also AE-HIT and CUM-CNTS.

무용전공 여대생의 전공 및 경력에 따른 성격특성 비교 분석

이종희,정윤영,이만균 경희대학교 체육대학 한국체육과학연구소 2003 體育學論文集 Vol.31 No.-

This study was designed to compare the characteristics of personality according to major and career in female college students majoring in modern dance, ballet, and Korean dance. The characteristics of personality was investigated utilizing survey in 120 female college students majoring in dance at K University. Among 120 survey results, 10 survey data were excluded due to statistical problem and 110 survey data were included for final data analysis. Subjects were well-distributed according to the major, i.e., 32 Korean dance, 40 ballet, and 38 modern dance. Their careers were divided into three categories, i.e., 1-3 years, 4-6 years, and 7-9 years for the statistical analysis. The sub-categories of personality in this study included activity-inactivity, emotional stability-instability, dominance-submission reflectiveness-impulsiveness, sociability, autonomy-heteronomy, achievement-nonachievement, neurosis, psychosis, and anti-social behaviors. The results obtained as a result of statistical analysis utilizing one-way ANOVA and Sheffe post-hoc test are summarized as follows: First, dominance of students in Korean dance was significantly higher than students in ballet, achievement and anti-social behavior of students in Korean dance and modern dance were significantly higher than students in ballet. Second, activity and sociality of high-career students were significantly higher than low-career students. reflectiveness in low-career students was significantly higher than high-career students. It was concluded that the characteristics of personality could be partly affected by major and career in female college student majoring in modern dance.

Ca Ionophore, A23187에 의한 30A-5세포의 지방세포 분화 억제

이권행,윤경하,한만덕 순천향대학교 1993 논문집 Vol.16 No.1

지방세포 분화 억제 과정에서 ??의 역할을 알아보기 위해, 30A-5 preadipocyte가 지방세포로 분화되는 과정에 ?? ionophore, A23187을 첨가하여, 30A-5세포의 지방세포 분화도와 acetyl-CoA carboxylase 활성을 검토하였다. 30A-5 preadipocyte는 insulin과 dexamethasone의 존재하에서 성숙된 지방세포로 분화되는데, 세포가 분화되는 과정에서 1 μM의 ?? ionophore, A23187을 가하면 30A-5 의 지방세포로의 분화가 거의 완전히 억제된다. 30A-5 세포가 지방세포로 분화되는 과정에서 비례적으로 증가하는 지방산 합성의 조절효소인 acetyl CoA carboxylase의 합성은 ?? ionophore, A23187처리에 의해 억제하는데, 30A-5 세포의 지방세포 분화억제는 acetyl-CoA carboxylase합성 저하에 따른 결과로 추측된다. ?? ionophore, A23187에 의한 acetyl-CoA carboxylase 의 합성저하는 비교적 장기간에 걸쳐 나타나는 효과로, 이 억제효과는 ??의 세포막이동의 경쟁적 저해제인 ??에 의해 부분적으로 극복된다. 따라서 A23187에 의한 acetyl-CoA carboxylase의 합성저하와 이에 따른 지방세포로의 분화를 억제하는 과정의 signal tranduction 과정에는 ??의 이동이 중요한 역할을 할 것으로 추정된다. To examine inhibitory effect of ?? ionophore, A23187 on adipocyte conversion of the 30A-5 preadipocytes, we checked the degree of differentiation and acetyl-CoA carboxylase activity of 30A-5 cells in the presence and absence of ?? ionophore, A23187. Inhibition of differentiation of 30A-5 preadipocytes into matured adipocytes was almost completely inhibited by ?? ionophore, A23187. Inhibition of differentiation of 30A-5 cells be resulting from decreased synthesis of acetyl-CoA carboxylase, which is regulatory enzyme in de novo fatty acid synthesis, by ?? ionophore, A23187. Decreased synthesis of acetyl-CoA carboxylase by ?? ionophore, A23187 might be one of the long term effect, and this inhibitory effect was partially recovered by ?? which is competitive inhibitor in membrane transport of ??. Therefore we assumed that ?? mobilization may play a important role on signal tranduction process in inhibitory action of 30A-5 preadipocytes into adipocytes.

아침형과 저녁형 사람에서 야간의 졸리움, 수행 및 체온의 비교

윤진상,국승희,신일선,신만식,최영,이무석,이형영 大韓睡眠-精神生理學會 1994 수면·정신생리 Vol.1 No.1

α-Alkyl N-Benzylaspartates의 합성

이채호,이만구,채규윤 圓光大學校 基礎自然科學硏究所 1986 基礎科學硏究誌 Vol.5 No.2

Synthesis of α-alkyl N-benzylates from maleic anhydride is described. Maleic anhydride was transformed into monoalkyl maleates which were treated which benzylamine to afford β-alkyl N-benzylaspartates(alkyl=methyl and benzyl). Base hydrolysis of these esters and subsequent treatment of the resulting carboxylic acid with HBr in AcOH produced N-benzylaspartic anhydride hydrobromide. Alcoholysis of this salts in methanol and benzyl alchol yielded α-methyl N-benzyl-aspartate and α-benzyl N-benzylaspartate, respectively.

인슐린의존형 당뇨병환자에서 임신중 병발한 당뇨병성 케톤산증 1예

이성근,신영구,이성규,정윤석,이관우,김현만,김행수 아주대학교 1997 아주의학 Vol.2 No.2

저자등은 인슐린의존형 당뇨병환자에서 임신중에 병발한 당뇨병성 케톤산증을 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. IDDM is an autoimmune disease resulted from beta cell destruction and insulin deficiency, and developed mostly in children and puberty. Ketoaddosis remains one of the most senous complications that can occur in the pregnant diabetic. A 26-year-old woman, gravida 1, para 0, was admitted at 32 weeks gestation because of fever lasted for 6 days. She had been treated with insulin pump during the pregnancy. Blood sugar was well controlled before admission, and the etiology of her ketoacidosis was urinary tract infection and no insulin-intake. DKA was treated with fluids and intravenous insulin. Urinary tract infection was treated with antibiotics, based on culture test. Healthy newbom was later delivered by cesarean section due to fetal distress. We experienced a case of DKA in pregnant woman and report it with a review on literature.