운용 및 환경적인 요소가 전차 명중률에 미치는 영향 분석

김건국 광운대학교 대학원 2015 국내석사

비만하지 않은 비알코올성 지방간 의 경과 : 종적 관찰 연구

문지미 고려대학교 의학대학원 2009 국내석사

The course of Non Alcoholic Fatty Liver Disease (NAFLD) in Non- Obese Subjects; A longitudinal observation study Ji Mi Moon, M.D. Major in Internal Medicine, Department of Medical Science, Graduate School, Korea University, Seoul, Korea (Director: Prof. Sin Gon Kim, M.D.) Background: Non alcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with obesity, and loss of weight has been the standard treatment of NAFLD. NAFLD is not rare in non-obese subjects, and recently, it was reported that NAFLD is associated with metabolic disorder in non-obese subjects. However the course of NAFLD in non-obese subjects is not well known. This study was performed to evaluate the cross-sectional characteristics of NAFLD in obese and non-obese subjects. And through the longitudinal observational study, the natural course of NAFLD in non-obese subjects was also evaluated. Methods: We analyzed total 2308 subjects (mean age 52.4±10.8) who had baseline and follow up medical check ups in Korea university Anam Hospital from January, 2001 to January, 2007. All the subjects had negative serologic markers for hepatitis B or C viruses and had an alcohol intake less than 20g/day. NAFLD was defined by abdominal ultrasonography and other metabolic parameters were measured. Mean follow up period was 28 months(28.7 ± 13.2, mean ± SD). Results: Among 1505 non-obese (Body mass index < 25kg/m²) and 806 obese subjects (BMI ≥ 25kg/m²), NAFLD at baseline was observed in 341(22.7%) and 495(61.4%) cases. During follow up period, incidence of NAFLD was higher in obese subjects than non-obese subjects (47.6% vs 17.3%, respectively) and overall rate of regression of NAFLD was higher in non-obese subjects than obese subjects.(24% vs 12.2%, respectively) The mean weight change was -1.25±2.41 kg(non-obese) and -3.60±3.43 kg(obese) (p value<0.01). The mean weight change was the only independent predictor of development and regression of NAFLD in non-obese men and women. On the other hand, the metabolic syndrome is a independent predictor of NAFLD in non-obese subjects only in regression of NAFLD in women. Conclusion: Rate of spontaneous regression of NAFLD in non-obese subjects was higher and the mean weight change for the regression was relatively smaller in the non-obese subjects compared with obese subjects. Development and regression of NAFLD were more influenced by the mean weight change than the baseline metabolic parameters in non-obese subjects. 연구 목적: 비알코올성 지방간(Non alcoholic fatty liver disease, NAFLD)은 음주 등 간 내 지방 침착을 일으키는 원인 없이 간 내 지방 침착 및 염증을 일으키는 만성 간질환으로, 비만과 관련되어 있으며 현재 체중조절을 하는 것이 치료법으로 되어 있다. 또한 인슐린저항성은 대사증후군의 원인으로 알려져 있으며 대사증후군과 비알코올성 지방간의 연관성에 대해서 활발한 연구가 진행되고 있다. 이러한 비알코올성 지방간은 비만한 사람에게 많이 발생하나 체질량지수가 정상인 비만하지 않은 사람에서도 관찰되고 있어 비만하지 않으면서 비알코올성 지방간이 있는 사람들의 임상적 특징과 임상 경과에 대한 연구가 필요할 것으로 생각되어 연구를 진행하였다. 연구대상 및 방법: 본 연구는 2001년 1월부터 2007년 1월까지 고려대학교 안암병원 건강검진센터에 내원하여 기저 검사 및 추적 검사를 시행한 대상 중 하루 20g이상의 알코올 기왕력이 있는 자와 검사상 B형, C형 간염의 혈청학적 표지자가 양성으로 나온 자를 제외한 2308명을 대상으로 하였다. 비만하지 않으나(체질량지수 < 25kg/m²) 비알코올성 지방간이 있는 군과 비만한(체질량지수 ≥ 25kg/m²) 비알코올성 지방간 군의 임상적 특징을 단면 분석을 통해 확인하였으며, 종적 관찰 연구를 통해 비만하지 않은 비알코올성 지방간의 경과에 영향을 미치는 인자를 함께 분석하였다. 평균 추적 기간은 28개월이었다. (28.7 ± 13.2, mean ± SD) 결과: 1502명의 비만하지 않은 군과 806명의 비만한 군에서 비알코올성 지방간은 341(22.7%)명과 495(61.4%)명으로 관찰되었으며 추적 검사 후 각각 17.3%(201/1161)와 47.6%(148/311)의 비알코올성 지방간이 발생하였다. 비만하지 않은 군에서 관찰기간 동안 비알코올성 지방간의 호전율은 24.0%(81/338)로 확인되었으며, 비만한 군에서는 12.2%(60/492)만 호전되었다. 체중의 변화는 각각 -1.25±2.41 kg(비만하지 않은 군)와 -3.60±3.43 kg(비만한 군)이었다(p value<0.01). 기저 검사에서 대사증후군의 유무는 여자에서만 비알코올성 지방간의 호전에 관계된 것으로 확인되었으며, 남녀 모두에서 공통적으로 체중 변화만이 비알코올성 지방간의 경과에 영향을 미치는 독립적인 인자로 확인되었다. 결론 : 비만하지 않은 군에서 자발적인 비알코올성 지방간의 호전율은 높았으며, 이러한 호전된 대상들의 경우 비만한 군에서 비알코올성 지방간의 호전을 보였던 군보다 체중감소가 적었던 것으로 관찰되었다. 기저 검사상에서 대사증후군의 동반 여부 및 대사 위험 요인들보다 체중 변화가 비알코올성 지방간의 발생 및 호전에 가장 중요한 독립적인 인자로 확인되었다.

A pooled analysis of 29 patients with fulminant type 1 diabetes in korea : A comparison with a nationwide survey in japan

김남훈 고려대학교 대학원 2009 국내석사

Background/Aims: To describe the clinical characteristics of fulminant type 1 diabetic patients in Korea, and to compare the results with Japanese data. Methods: We performed a retrospective pooled analysis of 29 patients who had been diagnosed with fulminant type 1 diabetes in Korea and compared the results with the data of 161 patients from a nationwide survey in Japan. Results: The mean age, duration of symptoms, association with pregnancy, presence of autoantibodies and other laboratory data such as level of HbA1c, plasma glucose, serum c-peptide, arterial pH showed typical findings with previous studies and were not significantly different from the Japanese data. The mean BMI and the presence of a family history of diabetes tended to make differences between two countries, but there was no statistical significance. Only the frequencies of several symptoms, such as fever, sore throat, and disturbance of consciousness were significantly lower in the Korean patients than in the Japanese patients (P < 0.005). Conclusions: Fulminant type 1 diabetic patients in Korea have a very similar phenotype compared with Japanese patients. A worldwide study is needed to identify the characteristics and ethnic differences of fulminant type 1 diabetes.

Prevalence rates of obesity, central obesity, normal weight obesity and the associated factors in a north korean refugee population in south korea

권예지 고려대학교 의학전문대학원 2013 국내석사

Background & aims: Obesity is an undesirable outcome of poor life-style habits and behaviors.. Despite the increasing number of NK refugees in South Korea, there is very limited documented information on their health condition, especially in relation to prevalence rate of lifestyle diseases as they accommodating to westernized life style of South Korea. This study was aimed to determine the prevalence rate of obesity, central obesity, normal weight obesity and the associated factors in NK refugees. The relationship among body fat distribution and selected biomarkers are determined to analyze how normal weight obese can be a potential risk for development of the metabolic syndrome Methods and results: Anthropometric measurement of 340 NK refugees was analyzed. For the comparison, 2008 KNHNES and the clinical examination of 680 adults at the KUMC-Anam were used. The overall prevalence of obesity and central obesity were 24.4% and 21.8%. For the corresponding South Koreans, they were 30.2% and 25.8% respectively. All the subjects were divided with sex-specific tertiles of BF%. Among the normal BMI (18.5-22.9 kg/m2) subjects, the highest tertile of BF was labeled as NWO. The overall prevalence of NK NWO was 4.1% and they showed statistically significant metabolic abnormalities (P=0.013). Conclusions: NK refugees are in a transition state to developing obesity as they assimilating into South Korean society. The prevalence of NWO in NK refugees was higher compared with SK, and this indicated the increasing risk of cardiometabolic dysregulation among high %BF NK individuals.

남한 거주 북한 이주민의 갑상선 질환 : 남한 주민과의 비교를 중심으로

박솔아 고려대학교 의학전문대학원 2013 국내석사

Background and Objectives: Thyroid dysfunction is one of the most common endocrine disorders and its prevalence and pattern depend on ethnic and environmental factors including iodine intake. In Korea, as the prevalence of thyroid disorders increases annually especially in young women, thyroid disease has become a major health concern. North Korean refugees are the best subjects to identify the influence of environmental factors in disease outcome because they have the same genetic background with South Koreans, but at the same time they have been exposed to different environments for a long time. This study is aimed to examine and compare the prevalence patterns of thyroid disorders between North Korean refugees(NKR) in South Korea and South Koreans(SK). In addition, we will provide several hypotheses for thyroid disorders expressed differently between NKR and SK. Materials and methods: The analysis included the North Korean cohort that was drawn from a population-based study of 442 refugees at the Korea University Medical Center, Department of Endocrinology. 661 of South Korean were also selected for a comparison group who visited Korean University Medical Center for health check-up. Data from each population were analyzed age and sex-specifically using SPSS statistics. Results: The prevalence of hyperthyroidism was 3.2% in NKR males and 1.2% in NKR females(p=0.168), whereas it was 0.6% in SK males and 1.8% in SK females(p=0.267). Hypothyroidism was detected in 2.1% in NKR males and 9.0% in NKR females(p=0.024), while it was identified in 9.0% in SK males and 8.5% in SK females(p=0.492). The positive rate of anti-TPO Ab was not significantly lower in NRK(7.1%) than SK(10.2%)(p=0.077) but anti-Tg Ab positivity was significantly lower in NRK(8.8%) than SK(16.1%)(p<0.05). When measured among TSH >4.05uIU/mL groups, anti-TPO and anti-Tg Ab showed insignificantly higher positive rate in NKR with 21.2%, 27.3%, while it was 17.9%, 16.1% in SK, respectively. Screen-detected thyroid nodule patients were 192(44%) of 442 NKR and the sex ratio was 1 : 5.2. Nodules selected for fine needle aspiration(FNA) were 36 and 5 cases were confirmed as papillary thyroid carcinomas. The prevalence of malignancy cytology was similar between NKR and SK, 14% and 12%, respectively. Conclusions: The prevalence of hypothyroidism was higher than hyperthyroidism in both NKR and SK. However, they showed different sex ratios and disease patterns by age. Considering the same genetic background of the NKR and SK, different prevalence of thyroid disorders may result from their different life-style and environments. We suggest three hypotheses for different patterns of thyroid disorders between NKR and SR: iodine intake, stress, exposure period to estrogen.

남한 인구와 비교를 통한 새터민 남성의 빈혈 유병률 분석

김정아 고려대학교 의학전문대학원 2013 국내석사

Prevalence and Characteristics of Anemia in North Korean refugee JUNGA KIM Major in Medicine, School of Medicine, Korea University, Seoul, Korea (Director: Prof. SIN-GON KIM M.D., Ph.D.) Objectives : Anemia continues to be a common disorder in the world and has multifactorial causes such as genetics, nutrition, and infectious diseases. This study assesses by comparing between North Korean refugees (NK) and South Korean (SK), since NK and SK have the same genetic background but have different environment. This study was aimed to determine the prevalence and clinical characteristics of anemia of NK and SK and then suggest the cause of different prevalence of anemia between the two groups. Materials and Methods : 439 NK subjects were selected from the NK cohort study in Korea University Medical Center, Department of Endocrinology. For the comparison, we randomly selected 661 of the SK who visited regular health check up to Korea University Medical Center, in 2007. SPSS was used to analyze the data. Results : The prevalence of anemia was 17.0% in NK male and 3.6% in SK males (p=0.00), Whereas it was 11.59% in NK females and 16.47% in SK female (p=0.03). Normocytic anemia was the most common type of anemia in all groups. There were no differences in waist-hip ration (WHR), total cholesterol, ferritin, CRP between NK, SK. The prevalence of metabolic syndrome was 27% in NK male and 17% in SK male. Conclusion : Our study showed that the prevalence of anemia was significantly higher in NK males. Simply low nutrient intake is not a factor of NK’s high anemia prevalence. We suggest that infections such as tuberculosis and other chronic diseases caused anemia. Also, this study suggests that we shall approach the diseases that NK have from the chronic lifestyle aspect. KEY WORDS : North Korean refugees, anemia, prevalence

Vitamin D status and associated metabolic factors in north korea refugees in south korea

김경진 고려대학교 대학원 2014 국내석사

Background: Vitamin D deficiency is widespread in immigrants and refugees as well as general population. We investigated the prevalence of vitamin D deficiency and associated metabolic risk factors in North Korean refugees living in South Korea. Methods: We examined 386 subjectss aged over 30 years from the North Korean refugee health in South Korea (NORNS) study. Vitamin D deficiency was defined as serum 25(OH)D level of below 20 ng/ml. Metabolic syndrome and its components were also assessed. Results: The prevalence of vitamin D deficiency was 87%, and there was no one who had sufficient vitamin D level (25(OH)D ≥ 30 ng/ml) among North Korean refugees. Underweight subjects (body mass index (BMI) < 20 kg/m2) had significantly lower 25(OH)D levels compared with individuals with normal BMI (≥ 20 and < 23 kg/m2). In the multivariate logistic regression analysis, those with the lowest 25(OH)D levels (< 10 ng/ml) was significantly associated with metabolic syndrome (OR, 7.65, 95% CI, 1.62 – 36.1), high triglyceride (OR, 6.18, 95% CI, 1.83 – 20.8), and low high-density lipoprotein (OR, 4.51, 95% CI, 1.41 – 14.4) compared with those with 25(OH)D levels ≥ 20 ng/ml even after adjusting for confounding variables including BMI. Conclusions: Vitamin D deficiency was very common among North Korean refugees in South Korea. In spite of low BMI, low vitamin D levels were associated with metabolic syndrome in this population. 서론: 현대 사회에서 비타민 D 결핍은 흔한 의학적 문제로 인식되고 있으며, 열악한 영양 상태와 낮은 사회 경제적 환경으로 인하여 비타민 D 결핍은 이민자들에서 더 흔히 발생하고 있다. 본 연구에서는 한국에 거주하는 북한 이주민들의 비타민 D 결핍 상태와 이와 관련된 대사적 인자들을 확인하고자 하였다. 방법: 본 연구는 NORNS (NOrth Korean Refugee health iN South Korea) 연구를 기반으로 이루어 졌다. NORNS 연구에 참여한 30세 이상의 386명의 남녀 북한 이주민들을 대상으로 혈청 25(OH)D 수치를 검사하였고, 대사증후군 여부 및 대사 증후군의 개별 인자들을 조사하였다. 비타민 D 결핍은 혈청 25(OH)D 수치가 20 ng/ml 이하인 경우로 정의하였다. 결과: 비타민 D 결핍의 유병율은 87%에 달하였으며, 적정 비타민 D 수치 (≥ 30 ng/ml)를 가진 북한 이주민은 없었다. 체질량 지수 20 kg/m2 이하의 저체중 참여자에서 나이, 성별, 계절을 보정한 비타민 D 수치가 정상 체질량 지수를 가진 참여자에 비해 유의하게 낮은 것을 확인하였다. 다변량 로지스틱 회귀분석을 시행하였을 때, 체질량지수를 포함한 혼란변수를 보정한 후에도 비타민 D 수치가 10 ng/ml 이하인 군이 20 ng/ml 이상인 군에 비해 유의하게 대사 증후군 (OR, 7.65, 95% CI, 1.62 – 36.1) 및 고중성지방혈증 (OR, 6.18, 95% CI, 1.83 – 20.8), 낮은 고밀도지단백 콜레스테롤 수치 (OR, 4.51, 95% CI, 1.41 – 14.4)와 유의하게 연관되어 있었다. 결론: 비타민 D 결핍은 한국에 거주하는 북한 이주민에게서 흔한 건강 문제이며, 낮은 체질량 지수에도 불구하고 대사증후군과 밀접하게 연관되어 있다.

Clinical, histologic, radiologic characteristics of patients with lung metastases in differentiated thyroid carcinoma presenting with negative iodine uptake

서지혜 고려대학교 대학원 2015 국내석사

Objective: When lung nodules are found in DTC patients, it is important to distinguish metastases of DTC from other malignancies such as primary lung cancers or benign nodules to select the most optimal treatment. This study aimed to determine whether there are distinct characteristics of DTC patients with lung metastases compared to non-metastatic nodules. Methods: We performed a retrospective review of 58 patients with differentiated thyroid carcinoma (DTC) who had undergone the histopathologic comfirmation of lung nodules through surgery or percutaneous needle biopsy (PCNB) in Korea University Medical center, between 2004 and 2014 were enrolled our study. We divided the patients into the group with lung metastases of DTC, as DTC metastases group (n=12) and patients other than DTC metastases, as non DTC metastases group (n=46, 26 cases of non small cell lung cancer, 2 cases of metastatic colorectal cancer,1 case of metastatic leiomyosarcoma, and 17 cases of benign nodules.) Hospital records of these patients were systematically reviewed. Results: The factors that significantly differentiated DTC metastasis from non-DTC metastasis were the tumor size ≥ 2cm, N stage (N1b), recurrence of cervical lymph node, off Tg ≥ 2 ng/ml measured before the first RAI therapy, and off Tg ≥ 1 ng/ml at the time of detection of lung nodule. The factors that showed more than 90% of specificity were tumor size≥3 cm, off Tg level measured before the first RAI ≥10 ng/ml, on Tg at the time of detection of lung nodule ≥1, ≥2 and ≥5 ng/ml. No radiologic features were noted in DTC metastasis group compared with non DTC metastases group, but when compared with primary lung cancer group the margin tend to be smoother in DTC metastasis nodules. Conclusion: Tumor size, N stage, recurrence of cervical lymph node, off Tg level measured before the first RAI, and the on Tg measured at the time of detection of lung nodule can be used as a predictive tools to differentiate DTC lung metastases from other lung nodules in DTC patients.

C-peptide response index as a predictor of long-term glycemic control in newly diagnosed type 2 diabetes

최주희 고려대학교 대학원 2016 국내석사

Background & aims: Measurement of serum C-peptide level helps to determine endogenous insulin secretion in patients with type 2 diabetes. C-peptide response after meal would be an accurate marker of beta cell functional capacity, however, its role in predicting long-term glycemic control has not been evaluated. Methods: In this retrospective study, 194 patients with newly diagnosed type 2 diabetes were followed over 2 years, from 2012 to 2015. At the time of diagnosis, fasting and postprandial C-peptide level, and their differences were measured. C-peptide response index (CPRI) was defined as the difference between serum fasting and 120 min postprandial C-peptide levels, and further adjusted for fasting plasma glucose level. Patients were classified into three groups by the tertile of CPRI. Serum HbA1c level was measured in each 3 months. Results: Correlation analyses of CPRI and HbA1c showed that CPRI was negatively correlated with initial HbA1c (r = -0.695, p < 0.001), mean HbA1c from 6 to 24 month (r = -0.466, p < 0.001) and HbA1c at 2 year (r = -0.288, p < 0.001). Patients with lower CPRI were younger, had higher HbA1c, and lower body mass index than those with higher CPRI. During 2 years of follow-up, patients with higher CPRI had more favorable results in terms of glycemic control; mean HbA1c during 2 years (7.44%, 6.98%, and 6.55%, in the 1st, 2nd, and 3rd tertile groups of CPRI, respectively, p for trend <0.001), and standard deviation (SD) of HbA1c (1.75, 1.01, and 0.50, in corresponding groups, p for trend < 0.001). In the multivariate logistic regression analyses, the highest tertile CPRI group had significantly higher OR of the proportion of HbA1c at 2 year < 7.0% (OR, 6.35 [2.36-17.05]) than the lowest tertile CPRI group after adjusting for possible confounders including age, BMI, education level, physical activity, oral anti-hyperglycemic medications. The association was prominent in in obese (BMI ≥ 25 kg/m2) patients. Conclusions: C-peptide response after meal could be a useful indicator predicting long-term glycemic control and glycemic variability in newly diagnosed type 2 diabetes.

북한 어린이 설사증 현황분석 및 보건의료 지원방안 : 로타바이러스성 장염을 중심으로

박영혜 고려대학교 대학원 2021 국내석사

목적: 본 연구는 전염성 질환인 설사가 5세 미만 어린이의 주요 사망원인인 북한의 상황을 정확히 파악하고 보다 효율적인 보건의료지원 방법을 제시하고자 수행 되었다. 방법: 북한에서 발행된 보건의료관련 1차 자료와 국제기구 및 연구기관에서 발표된 북한관련 자료를 분석하여 북한 어린이 설사증 및 로타바이러스 감염으로 인한 어린이 사망과 질병부담 및 위험요인을 평가를 하고, 국제기구와 민간단체 및 남한 정부와 민간단체가 시행한 북한 어린이 대상 대북인도지원 중 어린이 설사증과 관련된 지원을 분석하였다. 결과: 2019년 현재 북한의 5세미만 어린이 사망률이 남한의 약 6배이며, 하기도감염과 설사성 질환 등 ‘예방 가능한 질환’이 큰 원인이며 이는 영아기에 특히 두드러지게 나타나 사망원인의 51%에 이른다. 2017년 설사성 질환으로 인한 북한 어린이의 질병 부담은 남한에 비해 약 12배 높았으며, 영양장애와 비타민 A 및 철분 부족 등의 영양적 요인과 오염된 물, 위생시설 불량 등의 생활 환경 관련 요인으로 인한 악순환이 반복되고있다 북한 의료학술지에서는 설사 질환을 앓는 7개월부터 1년 사이 영아에서 로타바이러스 검출률이 52.0%이며 신생아부터 6개월까지의 영아에서 41.7%의 검출률이 나타났음을 보고하여, 북한의 1세미만 영아에서 로타바이러스 감염이 치명적인 사망의 원인임을 보고한 국제 연구기관의 통계를 뒷받침 한다. 또한 로타바이러스 감염에 대한 진단장비의 부족과 및 급성 감염증에 대한 대처 부족 상황을 나타내고 있기도 하다. 남한 정부와 민간단체 및 국제기구와 민간단체들의 대북지원은 대부분 인도주의 필요와 우선순위에 따른 지원으로 보건, 영양 및 식수 및 위생에 집중되어 있고 로타바이러스 백신은 지원 항목에 포함되어 있지 않다. 로타바이러스 백신의 도입은 북한에서 연간 132명의 어린이의 생명을 구할 수 있을 것으로 예측되고 있다. 결론: 북한어린이 설사증 관리를 위한 장 단기 지원 전략 1단계로 로타바이러스 백신 및 신속검사키트 지원. 정맥 수액 공급을 위한 시설지원 및 의료인력의 역량강화를 위한 교육, 2단계로 어린이 설사 질환의 주요 원인인 영양부족 및 식수 오염, 불량한 위생 환경을 개선으로 원인을 차단하여 악순환을 끊을 수 있는 지속적인 지원을 제안한다. 주제어: 북한어린이 설사증, 로타바이러스성 장염, 로타바이러스 백신, 북한보건의료현황, 영유아 대상 대북인도적 지원사업.