한국 여성에서 중증자궁내막증과 CYP1B1 유전자 다형성과의 관련성에 관한 연구

조연진,허성은,이지영,송인옥,궁미경,문혜성,정혜원,Cho, Yeon Jean,Hur, Sung-Eun,Lee, Ji Young,Song, In Ok,Koong, Mi Kyoung,Moon, Hye Sung,Chung, Hye-Won 대한생식의학회 2006 Clinical and Experimental Reproductive Medicine Vol.33 No.2

목 적: CYP1B1은 자궁내막증의 발생과 관련된 에스트로겐의 대사 및 dioxin의 대사 모두와 관련이 있는 유전자로 생각하여 자궁내막증의 발생위험과 CYP1B1의 codon 119G${\rightarrow}$T, 432G${\rightarrow}$C, 449T${\rightarrow}$C, 453A${\rightarrow}$G의 유전자 다형성과의 관계에 대해서 알아보고자 하였다. 연구방법: 병리조직학적으로 자궁내막증 III기와 IV기임을 확인한 여성 199명과 대조군으로 자궁내막증 환자군과 연령이 비슷한 여성에서 양성 난소 낭종으로 수술을 시행하여 자궁내막증이 없음을 육안으로 확인한 183명을 대상으로 PCR 및 RFLP를 시행하여 CYP1B1의 codon 119G${\rightarrow}$T, 432C${\rightarrow}$G, 449T${\rightarrow}$C, 453A${\rightarrow}$G의 다형성을 조사하였다. 결 과: CYP1B1에서 $Ala^{l19}Ser$, $Va1^{432}Leu$, $Asn^{449}(T^{449}{\rightarrow}C)$, $Asn^{453}Ser$ 각각의 유전자 다형성은 그 분포와 위험도에 있어서 자궁내막증 환자와 대조군 간에 통계적으로 유의한 차이는 없었다. CYP1B1에서 앞서 밝힌 4가지 codon의 다형성을 조합한 결과 GG/CC/CC/AA의 유전자형을 갖는 여성에 비해 GG/GC+GG/TC+TT/AA의 유전자형을 갖는 경우만이 자궁내막증의 위험도가 2.056 (95% CI: 1.003-4.216)으로 유의하게 높은 것을 알 수 있었다. 결 론: 이상으로 볼 때 한국인 여성에서 중증자궁내막증 발생은 CYP1B1의 유전적 다형성과 관련이 있는 것으로 보이며, 향후 자궁내막증의 발생 기전을 밝히는데 주요한 자료가 될 것으로 본다. Objective: To investigate whether polymorphisms of gene encoding CYP1B1 is associated with the risk of endometriosis in Korean women. Methods: We investigated 199 patients with histopathologically confirmed endometriosis rAFS stage III/IV and 183 control group women who were surgically proven to have no endometriosis. The genetic distribution of four different CYP1B1 polymorphisms at $G^{119}-T$, $G^{432}-C$, $T^{449}-C$, and $A^{453}-G$ were analyzed by polymerase chain reaction(PCR) and restriction fragment length polymorphism of PCR products. Results: We found no overall association between each individual CYP1B1 genotype and the risk of endometriosis. The odds ratio of genotype GG/GC+GG/TC+TT/AA compared to GG/CC/CC/AA(reference) was calculated as 2.06 with a 95% confidence interval of 1.003~4.216. Conclusion: This results suggest that CYP1B1 genetic polymorphism may be associated with development of endometriosis in Korean women.

Association of the MMP-2 and TIMP-2 gene polymorphisms with advanced-stage endometriosis (초)

조연진 ( Yeon Jean Cho ),( Kyung Ah Jeong ),( Mi La Kim ),( Hye Won Chung ) 대한산부인과학회 2010 대한산부인과학회 학술대회 Vol.96 No.-

자궁내막폴립의 악성화 빈도와 관련 인자

조연진 ( Yeon Jean Cho ),김미라 ( Mi La Kim ),김주명 ( Joo Myung Kim ),주관영 ( Kwan Young Joo ),이인국 ( In Kook Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.1

Objective: To determine the incidence of benign, hyperplastic, and malignant endometrial polyps and whether particular clinical parameters are associated with malignancy in the polyps. Methods: Four hundred and forty nine patients who were suspected as endometrial polyps by hysteroscopy underwent hysteroscopic guided removal over 12 months period were retrieved. The medical records and histopathological findings were reviewed. Statistical analysis was performed. Results: Histologically, among 360 (80.1%) polypoid lesions, 353 polyps (75.1%) were benign; 16 polyps (3.5%) had simple or complex hyperplasia, only 1 polyp (0.2%) had hyperplasia with atypia (considered as premalignant lesions), and 6 polyps (1.3%) were cancerous. Non polypoid lesions were found in 89 (19.9%) cases. Older age, postmenopausal status were associated with pre-malignant or malignant changes significantly, but presence of abnormal uterine bleeding, multiplicity, larger sizes (>1.5cm) were not a predictor of malignancy in the polyp. Conclusions: Age and menopausal status may increase the risk of premalignant and malignant polyps. Although the risk of malignancy is low, we should pay attention to postmenopausal women with endometrial polyps regardless of the symptoms, and we prefer hysteroscopic resection for the exact diagnosis.

The impact of body mass index on the outcome of IVF/ICSI in patients with polycystic ovarian syndrome

조연진 ( Yeon Jean Cho ),( Min Ji Kim ),( Sun Wha Cha ),( Hye Ok Kim ),( Chan Woo Park ),( In Ok Song ),( Mi Kyoung Koong ),( In Soo Kang ),( Jin Yeong Kim ) 대한산부인과학회 2008 대한산부인과학회 학술대회 Vol.94 No.-

난소의 기능이 저하된 불임 환자에서 연령 및 기저 혈중 FSH 수치가 체외수정시술의 예후에 미치는 영향에 관한 연구

유영,김민지,조연진,연명진,안영선,차선화,김혜옥,박찬우,김진영,송인옥,궁미경,강인수,전종영,양광문,Yu, Young,Kim, Min-Ji,Cho, Yeon-Jean,Yeon, Myeong-Jin,Ahn, Young-Sun,Cha, Sun-Hwa,Kim, Hye-Ok,Park, Chan-Woo,Kim, Jin-Young,Song, In-Ok,Koong, Mi 대한생식의학회 2007 Clinical and Experimental Reproductive Medicine Vol.34 No.3

목 적: 본 연구의 목적은 난소기능이 저하된 불임 환자에서 체외수정시술 시 그 결과의 예측인자로서 환자의 연령과 혈중 FSH 수치의 중요성 및 그 임상적인 의미를 알아보고자 하였다. 연구방법: 2000년 1월부터 2004년 12월까지 본원 불임센터에서 체외수정시술을 시행받은 환자 중 이전 체외수정시술주기에서 획득된 난자 수가 5개 이하이며 FSH 농도가 15 mIU/ml 이상 25 mIU/ml 이하로 그 연령이 42세 이하인 난소기능이 저하된 불임 환자 85명의 85 체외수정시술 주기를 연구대상으로 하였다. 남성요인의 불임이나 착상 전 유전진단인 경우는 제외시켰다. 과배란유도의 방법은 단기요법 (flare-up protocol)을 사용한 경우로 제한하였다. 결 과: 대상군을 환자의 나이에 따라 분류하여 분석하였을 때 환자의 연령이 낮은 군 (age < 35, n=35)에서 고령환자 군 (age $\geq$ 35, n=50)에 비해 통계적으로 의미 있게 높은 착상률 (19.0% versus 4.0%, p<0.05)과 높은 지속임신율(100% versus 14.3%, p<0.05)을 보였으며, 연구대상 군을 기저 혈중 FSH농도에 의해 두 군으로 비교하였을 때 낮은 기저 혈중 FSH를 가진 군 (basal serum FSH < 20 mIU/ml, n=58)에서 기저혈중 FSH가 높았던 군 (basal serum FSH $geq$ 20 mIU/ml, n=27)에 비해 획득된 난자 숫자는 통계적으로 의미 있게 높은 반면 (4.6$\pm$0.7 versus 2.2$\pm$0.5, p<0.05)주기 취소율은 의미 있게 낮은 (19.0% versus 55.6%, p<0.05) 결과를 보였다. 결 론: 난소반응이 저하된 불임 환자의 체외수정시술 시 그 예후에 관련된 인자로서 환자의 연령은 해당 주기의 임신성공 및 임신 지속여부에 대한 예후를 예측할 수 있는 인자로서 의미가 있는 반면 기저 혈중 FSH농도는 해당 주기에서의 난소의 반응에 대한 예측인자로써 활용이 가능 할 것으로 사료된다. Objectives: The purpose of this study is to investigate the clinical significance of age and basal serum FSH in predicting the outcomes of in vitro fertilization (IVF) in patients with poor-ovarian response. Methods: From January 2000 to December 2004, 85 second IVF cycles of 85 poor-ovarian response patients under the age of 42 with a back-ground of the first IVF cycles at our infertility center and 5 or less oocytes were retrieved and their basal serum FSH levels of 15$\sim$25 mIU/ml were enrolled in this study. Exclusion criteria were patients with a male factor for the etiology of infertility and undergoing genetic diagnosis of embryo such as PGD. Flare-up protocol was used for ovarian stimulation in all cases. Results: When we stratified the study groups by patient's age, the younger age group (age<35, n=35) showed significantly higher implantation rate (19.0% versus 4.0%, p<0.05) and higher ongoing pregnancy rate (100% versus 14.3%, p<0.05) than the older age group (age$\geq$35, n=50). And then, when we stratified the study populations by basal serum FSH level, the lower FSH group (basal serum FSH<20 mIU/ml, n=58) showed significantly higher number of retrieved oocytes (4.6$\pm$0.7 versus 2.2$\pm$0.5, p<0.05) and lower cancellation rate (19.0% versus 55.6%, p<0.05) than higher FSH group (basal serum FSH$\geq$20 mIU/ml, n=27). Conclusions: In conclusion, it was suggested that the patient's age could predict the IVF outcomes in respect to its potency of pregnancy and ongoing pregnancy. Serum basal FSH levels could predict more accurately the ovarian response of cycle, but not clinical outcomes.

여성 생식기에 발생한 샘모양 종양 (adenomatoid tumor)의 임상양상: 195예 분석

이지은 ( Ji Eun Lee ),조연진 ( Yeon Jean Cho ),김미라 ( Mi La Kim ),김주명 ( Joo Myoung Kim ),주관영 ( Kwan Young Joo ),전종영 ( Jong Young Jun ),한호원 ( Ho Won Han ),구유진 ( Yu Jin Koo ),김윤영 ( Yun Young Kim ),전이경 ( Yi Kye 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.8

Objective: Adenomatoid tumors of female genital tracts are benign lesions derived from mesothelium, occurring most commonly during the reproductive years. The aim of this study was to evaluate the overall incidence of adenomatoid tumors in Korean women and to analyze the clinical characteristics. Methods: One hundred and ninety five patients with adenomatoid tumors were found in a retrospective medical records review of pathologic reports for 44,984 benign uterine diseases at Cheil General Hospital, from January 1995 to April 2009. Results: The overall incidence rate was 0.42% of all benign uterine disease. Among them, 149 patients received hysterectomy, and 46 patients received uterine conservative surgery. Main symptoms of the patients were pain (25.1%), bleeding (30.2%), and palpable mass (18.5%). Most common associated pathologies were leiomyoma (46.6%), adenomyosis (25.1%) and endometriosis (13.1%). Most of the diagnosis was made postoperatively. Among 46 patients with conservative treatment, 13 patients showed successful pregnancy outcome. No recurrence occurred during the follow up period. Conclusion: Adenomatoid tumors are associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. The recurrence is rare even after conservative operation. Our data about this benign neoplasm may be helpful for counseling patients after operations.

자궁내막 폴립의 악성화 위험인자

이희숙 ( Hee Suk Lee ),조연진 ( Yeon Jean Cho ),김주명 ( Joo Myung Kim ) 대한폐경학회 2013 대한폐경학회지 Vol.19 No.2

Objectives: The objective of this study is to evaluate the prevalence of endometrial premalignant and malignant polyps in women who underwent hysteroscopic polypectomies, and to investigate whether clinical parameters predict histopathologic outcomes. Methods: A review was carried out on the medical records of patients who had undergone hysteroscopic endometrial polypectomy from January 2010 to December 2011. One thousand one hundred ninety-six women who ranged in age from 16 to 81 years were included in the study. Polyps were classified as benign (endometrial polyps and polyps with non-atypical simple hyperplasia and non-atypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), or malignant. A statistical analysis was then performed. Results: Histopathologically, 96.7% benign, 1.1% premalignant, and 2.2% malignant lesions were detected. Abnormal uterine bleeding and postmenopause were the only factors which were determined to be associated with a higher risk of malignancy, with an odds ratios of 5.07 (95% CI, 2.25-11.41) and 3.41 (95% CI, 1.14-10.24), respectively. Conclusion: The risk factors associated with premalignant and malignant endometrial polyps include abnormal uterine bleeding and menopause. (J Korean Soc Menopause 2013; 19:74-80)

소아 및 청소년기 난소종양의 임상병리학적 고찰

유지희 ( Ji Hee Yoo ),김주명 ( Joo Myung Kim ),조연진 ( Yeon Jean Cho ),육지형 ( Ji Hyoung Yook ),이희숙 ( Hee Suk Lee ),김미라 ( Mi La Kim ),주관영 ( Kwan Young Joo ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.6

Objective: The purpose of this study was to describe the clinical presentation and histopathologic findings that help in decisions about management of ovarian mass in childhood and adolescence. Methods: We retrospectively analyzed the data on 307 patients with surgically treated ovarian mass under 20 years of age at the Cheil General Hospital, between January 1995 and December 2005. Results: Of the 307 cases, 40 cases (13%) were ovarian malignancy. The incidence of malignant ovarian tumor increased to 16.9% in 237 neoplastic tumors. Epithelial, germ cell, and sex-cord stromal malignancies accounted for 57.5%, 30% and 12.5%, respectively, of the 40 ovarian malignancies. The stage of the 35 cases (87.5%) with the ovarian malignancy was the FIGO stage I. The incidence of ovarian malignancies increased with larger size, higher CA125 level. Solid ovarian masses on ultrasound were more likely ovarian malignancy. But age and menarchal status was not correlated with ovarian malignancy. Mature cystic teratoma seen in 132 patients (55.7%), was the most common neoplasm of ovary in this age group, and the incidence of bilaterality was 12.1%. On follow up, 4.9% (13/267) of previously diagnosed benign ovarian tumor were reoperated due to recurred or newly developed ovarian tumor. After cystectomy, the recurrence rate of ipsilateral ovarian tumor was 2.8% (4/142). Conclusion: If there is no evidence of malignancy, conservative surgical treatment should be employed to preserve future endocrine function and fertility in this age group.

질식 자궁적출술이 질 전체 길이에 미치는 영향

김미라 ( Mi La Kim ),이원식 ( Won Sik Lee ),조연진 ( Joo Myung Kim ),김주명 ( Yeon Jean Cho ),주관영 ( Kwan Young Joo ),최규홍 ( Kyu Hong Choi ),이인국 ( In Kook Lee ),김재준 ( Jae Joon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11

Objective: The purpose of this study was to evaluate the impact of vaginal hysterectomy on total vaginal length (TVL). Methods: Retrospective analysis of 155 medical records of patients underwent vaginal hysterectomy by one surgeon with benign uterine pathology in the absence of prolapse between January 2004 and February 2007. After hysterectomy, uterosacral vaginal vault resuspension (anchoring to vaginal vault about 1.0~1.5 cm proximal at the ligament) was performed for prevention of vault prolapse. Patients` characteristics and TVL before and after surgery were evaluated. Results: Preoperative mean TVL was 7.32±0.84cm. At two months after the surgery, mean TVL was 7.42±0.77 cm. The change of vaginal length was statistical significance (P=0.045). Eighty-one patients were reevaluated at five to twelve months after surgery, mean TVL was longer than the preoperative results (7.3±0.82 cm vs 7.48±0.78 cm, P=0.011). We evaluated 30 patients who were followed at least 12 months after the surgery, the length was longer than the preoperative results, also (7.17±0.81 cm vs 7.46±0.66 cm, P=0.006). Conclusion: Although that appears to be statistically significant elongation of the total vaginal length after vaginal hysterectomy, the impact is unlikely to be clinically significant.

복강경하 자궁경부 자궁근종절제술: 단일 기관에서의 5년간의 경험

이수윤 ( Soo Yoon Lee ),이희숙 ( Hee Suk Lee ),조연진 ( Yeon Jean Cho ),주관영 ( Kwan Young Joo ),김주명 ( Joo Myung Kim ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.7

Objective: This retrospective case series evaluated the feasibility and safety of laparoscopic cervical myomectomy. Methods: Sixty-five patients with cervical myoma who underwent laparoscopic cervical myomectomy were included in this study. Results: The mean age of the patients was 39.2 ± 6.0 years. The marriage rate was 67.7%, and the mean parity was 1.09. The most common symptoms in the patients were increased myoma size (41.5%) and menorrhagia (13.8%), while 20% of patients were asymptomatic. The average diameter of the myomas treated was 72.68 ± 20.28 mm, and the mean number of myomas per patient was 1.41± 0.88. Laparoscopic cervical myomectomy required a mean time of 63.25 ± 20.34 minutes. The difference between preoperative and postoperative hemoglobin levels was 2.01± 0.73 g/dL, and no patient required transfusion or conversion to laparotomy. Conclusion: Sixty-five procedures of laparoscopic cervical myomectomy were performed safely. Operation time and complications were minimal. With correct understanding of pelvic anatomy, laparoscopic cervical myomectomy can be carried out safely and easily, and represents a minimally invasive treatment choice for symptomatic cervical myoma.