관해유도 항암요법을 받는 백혈병 환자에서 진균 감염증의 예방 : 무작위 배정법과 이중 눈가림법에 의한 Fluconazole과 Nystain의 효과에 관한 다기관 공동연구 A Randomized, Double-blind, Multicenter Trial to Compare Fluconazole with Nystatin

최강원,오명돈,배현주,백경란,박선양,김병국,신완식,강문원,진종률,박종원,김춘추,김동집,한지숙,민유홍,이선주,고윤웅 대한화학요법학회 1993 대한화학요법학회지 Vol.11 No.2

Fluconazole의 진균 감염증 예방 효과와 안전성에 관하여 3개 대학병원에서 관해유도화학요법을 받는 급성 백혈병환자를 대상으로 무작위 배정법과 너도나도 누가림법에 의하여 연구하였다. 모두 62명의 환자에게 fluconazole(100㎎ bid) 또는 nystatin(1,000,000IU/day)을 무작위로 투여하였다. 투약은 관해유도화학요법과 같은 날짜에 시작하여 호중구수가 1,000㎣이상으로 회복되거나 진균 감염증이 확인되거나 의심되어 Amphotericin-B를 시작하거나, 약과 관련된 부작용이 나타날 때까지 계속하였다. 진균 colonization은 fluconazole군에서 감소하였으나 nystqatin군에서는 증가하였다, 표재성 진균감염증으로 nystatin군에서 C. albicans 진균혈증 1례와 C.parasilosis 진균혈중 1례가 발생하였다. 경험적 항진균요법으로 Amphotericin-B를 투여한 경우는 fluconazolerns 34명중 7례(21%), nystatinrns 28명중 10례(36%)였다(p<0.05). Fluconazole군과 nystatin군 사이에 부작용이나 사망률에 차이는 없었다. 결론적으로, fluconazole은 관해유도화학요법을 받는 급성 백혈병환자에서 진균의 colonization을 줄이는데 효과적이고 안전한 항진균제이다. We made a randomized, double-blind, multicenter trial to compare the efficacy and safety of fluconazole with nystatin for prevention of fungal infections in patients with acute leukemia. Sixty-two adult undergoing remission induction chemotherapy for cute leukemia were enrolled. Patients were randomly assigned to receive either fluconazole (100㎎ bid) or nystatin(1,000,000IU×6/day) with corresponding placebo. The study drug was started in initiation of chemotherapy and continued until recovery of neutrophil counts(>1,000/㎣), development of proven or suspected invasive fungal infection, or the occurrence of drug-related toxicity. Fungal colonization decreased in fluconazole(F) group, however increased in nystain(n) group. Superficial fungal infection occurred in 1 of 34 F group, whereas invasive fungal infection developed in 3 of 28 N group. Empirical amphotericin-B therapy was given in 7 of 34(21%) F group and 10 of 28(36%) N group(p>0.05). The incidence of drug-related side effects and overall moratlity were similar in both study groups.

일부 산모에서 산모혈, 제대혈, 모유 및 태반에서의 환경 에스토레겐성 화합물(PCBs) : Environmental estromgen compounds(PCBs) in Maternal Blood, Cord Blood, Human Milk and Placenta of Korea women

이강숙,임현우,노영만,구정완,조재천,박정일,김진홍 가톨릭대학산업의학센타 산업의학연구소 2003 韓國의 産業醫學 Vol.42 No.2

The production and intensive use of organochlorine chemicals, both in agriculture and industry, have led to wide spread contamination of the environment. There may be biological effects of organochlorine contaminated breast milk even when levels are below those concentrations that are currently regarded as tolerable. To evaluate the exposure of to fetus PCBs, we measured the sum of 13 congeners of PCBs in maternal blood, cord blood, breast milk and placenta of 30 Korean women by gas chromatograpy/electron capture detector. The concentration of total PCBs of maternal blood, cord blood and breast milk were 7.16±4.29 ㎍/ℓ, 5.16±3.12 ㎍/ℓ, 1.77±2.87 ㎍/ℓ respectively and they have no significant correlation. PCBs in placenta was not defected. However there were no significant differences of PCBs according to age, education, body mass index, parity, breastfeeding, smoking and drinking.

근로자 건강증진전략을 위한 행동변화에 대한 요구도 평가

이강숙,임현우,구정완,홍현숙,이정민,이원철,박정일,맹광호,M, O'Donnel 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : In order to evaluate the stage of behavior change for health promotion strategy in workplace Methods : Questionnaire survey was carried out for 309 workers who employed in H Electronics company in Kyong-in area from September to October 1998. Results : According to need assessment of four step such as precontemplation stage, contemplation stage, action stage, maintenance stage which were to change of behavior for health promotion, the percent for quitting smoking were observed 48.8%, 43.1%, 8.1%, 0%, and for the restriction of drinking were 29.8%, 10.6%, 9.3%, 5.3%; for fitness 11.1%, 31.0%, 37.3%, 20.6% in male 26.6%, 27.8%, 26.6%, 19.0% in female, for regular diet 26.1%, 19.8%, 38.7%, 15.3% in male, 27.8%, 22.2%, 40.0%, 10.0% in female and for stress management 5.8%, 10.6%, 8.7%, 75.0% in male, 13.6%, 22.7%, 19.7%, 44.0% in female. In heavy smoker(p=0.017) and heavy drinker,(p=0.021) the percent of precontemplation stage was significantly higher than in lower drinker and light smoker. Conclusions : This study suggested that company support for health promotion in workplace was and workers of high risk group for smoking and drinking were in precontemplation stage. So before conducting the health promotion program, health risk appraisal and need assessment for stage of behavior change should be taken for the efficient health promotion strategy.

골수이식 후 골밀도 및 골대사의 변화 : 2년 추적관찰 2-Year Prospective Study

이원영,강무일,오은숙,오기원,한제호,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘추 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

동종골수이식 후 혈당 및 혈중 지질농도의 변화양상 및 관련인자

이원영,강무일,오은숙,오기원,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘주 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:골수이식은 비교적 젊은 연령의 환자들을 대상으로 하며 면역억제제의 사용기간이 비교적 짧으므로, 주로 고령의 만성 질환 환자에서 시행되는 고형장기이식에서와는 달리 당대사 및 지단백 대사에 있어서 많은 차이점이 있을 것으로 추측된다. 저자들은 전향적 연구를 통하여 골수이식 후 시기별로 혈당 및 혈중지단백 변화 양상을 알아보고 이와 관련된 임상인자들을 규명하고자 하였다. 방법:1998년 10월부터 1999년 8월까지 가톨릭대학교 성모병원에서 동종골수이식을 시행한 환자들 중 43명을 대상으로 이식 전 및 이식 후 1, 2, 3, 4주와 3개월, 6개월에 공복 혈당, 혈중 총 콜레스테롤, 중성지방, 고밀도지단백을 측정하여 골수이식 후 시기별 변화를 관찰하고 여러 임상인자들에 따른 차이를 알아보았다. 결과:1. 공복혈당은 골수이식 수 첫4주 동안 상승하였고 이후 감소하였으나 이식 6개월 시점의 평균 공복혈당은 이식 전보다 유의하게 높게 관찰되었다. 혈중 총 콜레스테롤은 이식 후 1주에 최고치를 형성하였고 이후 기저수준으로 회복되었다가 이식 수 3,6개월에 다시 증가하여 기저치에 비해 유의하게 높았다. 혈중 중성지방은 이식 후 1개월까지 유의하게 증가하였고 이후 감소하여, 3,6개월에는 기저치와 유의한 차이가 관찰되지 않았다. 혈중 고밀도지단백은 이식 후 2,3주에 이식 전보다 유의하게 감소하였고 이후 이식 전 수준으로 회복되었다. 혈중 저밀도지단백은 총 콜레스테롤의 변화와 매우 유사하였다. 2. 골수이식 후 6개월 시점에서 공복 혈당이 126㎎/dL이상인 환자는 7명(16%)이었다. 이들 환자들과 공복혈당 126㎎/dL 미만의 환자 36명을 비교한 결과, 공복혈당이 126㎎/dL 이상인 환자군에서 스테로이드 평균 투여량이 많았고 고밀도지단백이 유의하게 낮았다. 3. 이식편대숙주질환이 발생한 환자는 그렇지 않은 환자보다 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤이 더 낮았고, 3개월의 공복혈당이 더 높았다. 혈연골수이식 환자군은 비혈연골수이식 환자에 비해 투여된 스테로이드 용량이 더 적음에도 불구하고 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤 수치가 더 높았다. 스테로이드 고용량 투여군(하루 평균 7.5㎎기준)은 저용량군보다 이식 후 3개월 시점의 공복혈당이 더 높았으나 나머지 시점의 혈당, 혈중 지질농도에 있어서는 유의한 차이가 관찰되지 않았다. 결론:골수이식 후 초기시기에 주로 당 대사 및 지질대사이상이 관찰되며 이는 면역억제제 투여와 관련이 있음을 알 수 있었다. 면역억제제가 고용량 투여되는 합병증 발생 시 이들 대사이상에 관심을 기울여 대처해야 할 것이다. Background: In bone marrow transplantation(BMT), recipients are usually younger and immunosuppressants are open used in shorter period than in solid organ transplantation. Therefore, there might be a difference in glucose and lipid metabolism between BMT and solid organ transplantation. However, the serial changes of metabolic parameters following BMT have not been studied. Therefore, the aim of this study is to investigate the serial changes of blood glucose, lipids and the putative factors that are related with these changes after BMT. Methods: We have prospectively investigated 43 patients who underwent allogeneic BMT. Fasting plasma glucose(FPG), total cholesterol, triglyceride and high-density lipoprotein(HDL) were measured before BMT, and at 1, 2, 3, 4, 12 weeks and 6 months after BMT. The serial changes of these metabolic parameters according to clinical factors including type of BMT, mean daily steroid dosage, and occurrence of graft versus host disease (GVHD) were examined. Results: 1. Mean FPG level increased during 4 weeks after BMT and remained above basal value at post-transplant 6 months. Total Cholesterol level was increased during initial 4 weeks after BMT and was above basal value at post-BMT of 3 and 6 months. Triglyceride level was progressively increased during initial 4 weeks after BMT, but returned to basal value there after. HDL-cholesterol level was significantly decreased during initial 4 weeks after BMT, but returned to basal value there after. 2. Patients with FPG above 126 mg/dL and the other patients, the former received larger amounts of daily steroid and had lower HDL-cholesterol level. 3. The changes of metabolic parameters were different according to type of BMT, steroid dose, and occurrence of GVHD. Conclusion: Although there was increase of FPG, TC, TG and decrease of HDL-C during initial 4 weeks after BMT, these metabolic changes recovered slowly thereafter. Immunosuppressants are thought to be associated with these changes. Further observation will be needed for the long-term effect of BMT on metabolic changes(J Kor Diabetes Asso 24:689~698, 2000).

서울시 대기오염과 호흡기 질환 환자와의 관련성에 대한 시계열적 연구

최병철,구정완,박성균,임현우,이강숙,이원철,박정일 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.1

목적 : 서울시의 대기오염 수준이 호흡기 질환 외래 환자수에 미치는 단기 영향을 파악하고자 하였다. 방법 : 1997년 7월부터 1998년 6월까지 서울시의 대기오염자료와 호흡기 질환에 대한 의료보험자료를 분석하였다. 추세변동과 기상요인, 요일 및 주별 효과등의 교란요인을 제어하고 관련성을 평가하기 위하여 generalized additive model(GAM)을 이용하였다. 결과 : 교란요인을 제어한 기본모델에 각 대기오염 물질을 포함시켜 분석한 결과, CO는 모든 연령층에서 일정하게 당일 농도가 가장 유의한 영향을 미치는 것으로 나타났고(RR=1.041∼1.051), NO₂역시 3일전의 농도가 모든 연령층에서 가장 유의한 영향을 미쳤다(RR=1.024∼1.050). O₃와 SO₂는 4일전 농도부터 당일 농도까지 지연시간이 길게 나타나는 특징을 보였으며, 15세 이하에서는 3일전 농도가(O₃RR=1.047, 95 % Cl=1.045∼1.049, SO₂RR=1.018, 95 % Cl=1.017∼1.020), 15-64fll (O₃RR=1.035, 95 % Cl=1.032∼1.037, SO₂RR=1.037, 95 % Cl=1.035∼1.039)와 65세 이상 (O₃RR=1.042, 95 % Cl=1.033∼1.051, SO₂RR=1,029, 95 % Cl=1.022∼1.036)에서는 당일 농도가 가장 유의한 결과를 나타냈다. PM□은 유의성이 낮게 나타났는데 15세 이하는 하루 전 농도(RR=1.011, 95 % 71=1.010∼1.013), 15∼64771(RR=1.021, 95 % Cl=1.019∼1.023)와 65세 이상(RR=1.025, 95 % Cl=1.018∼1.032)은 당일 농도가 유의하게 나타났다. 두 포염물질씩을 기본모델에 포함시켜 분석한 결과 CO, NO₂, O₃는 상대위험비가 '단일 오염물질모델'의 값과 거의 일정하게 통계적 유의성을 유지하였으나 SO₂는 15세 이하에서 NO₂와 같이 포함된 모델에서 통계적 유의성을 상실하였다. PM□은 모든 연령층에서 CO와 같이 포함된 모델에서 통계적 유의성을 상실하여 '단일 오염물질모델'에서 나타난 유의성이 CO에 의한 교란작용의 결과임을 알 수 있었다. 또한 15세 이하에서 NO₂, 15∼64세와 65세 이상에서 502와 같이 포함된 모델에서 역시 유의성을 상실하여 본 연구에서 살펴본 호흡기 질환에 미치는 PM□의 영향은 크지 않은 것으로 나타났다. 결론 : 본 연구의 결과는 서울시의 일상적인 대기오염이 여러 호흡기질환의 발생을 증가시킬 수 있음을 보여주었다. 따라서 대기오염의 효율적 규제에 대해 보다 적극적인 대책이 마련되어야 할 것이다. Objectives : This study was conducted to investigate whether air pollution levels in Seoul have short term effects on respiratory disease outpatients. Methods : We analyzed five air pollutants (CO, NO₂, O₃, SO₂, PM□) and daily counts of outpatient for respiratory disease divided by age group ((15yrs, 15-64yrs, 654yrs)during the period of July 1997-June 1998 using Generalized Additive Model (GAM) . Results : After controlling for seasonal trends, day of the week, week of the month, temperature and humidity, CO (RR=1.041 ∼1.051, 0-day lag) and NO₂(RR=1.024∼1.050, 3-day lag) were significantly associated with daily counts for respiratory disease in all age groups. O₃and SO₂were associated, with a 3-day lag in the age group under 15 years (O₃RR=1.047, 95% Cl=1.045-1.049; SO₂RR=1.018, 95% Cl=1.017-1.020) and with a 0-day lag in the age group 15 to 64 years (03 RR=1.035, 95% Cl=1.032-1.037; 502 RR=1.037, 95% Cl=1.035-1.039), in the age group over 65 years (O₃RR=1.042, 95% Cl=1.033-1.051; SO₂RR=1.029, 95% Cl=1.022-1.036). PMlo was weakly associated, with a 1∼day lag In the age group under 15 years (RR=1.011, 95% Cl=1.010-1.013) and with a 0-day lag in the age group 15 to 64 years (RR=1.021, 95% Cl=1.019-1.023), in the age group over 65 years(RR=1.025, 95% Cl=1.018-1.032) . In the' two pollutant model', the magnitudes of the recta alive risk for CO, NO₂nd O₃were maintained, but SO₂was not assoclated with daily counts for respiratory disease in the age group under 15 years after controlling for NO₂-PM□ was not associated in all age groups after controlling for CO, so the association with PM□ in the' single pollutant model' might be confounded by CO. In this study, the impact of PM□ on the respiratory disease was not large as compared with other pollutants. Conclusions : Air pollution in Seoul may Increase the Incidence of the respiratory disease, so more positive attention for the control of air pollution should be paid.

스트레스관리 프로그램이 만성정신분열병환자의 증상과 삶의 질에 미치는 효과

박현경,구정완,노영만,이강숙,박정일 가톨릭대학산업의학센타 산업의학연구소 2003 韓國의 産業醫學 Vol.42 No.1

This study examined the effects of stress-management programs on the symptoms and quality of life in the chronic schizophrenics. The subjects were the chronic schizophrenics who were registered and managed by one of the public health care centers in Seoul. The stress-management programs were provided 10 times. Positive and negative syndrome scale (PANSS) and quality of life were surveyed before and after the stress-management programs. The results were as follows. 1. The differences of positive symptoms, negative symptoms and general psychopathological symptoms before and after stress-management program were significantly different between the group which were provided with stress-management programs and the group which were not provided. 2. The differences of the quality of life before and after stress-management program were significantly different between the group which were provided with stress-management programs and the group which were not provided. These results indicate that stress-management programs have effects on relieving the symptoms and improving the quality of life of schizophrenics. Ultimately these results also suggest that stress-management programs be used as the supplementary means to treat schizophrenics.

일부 부인과 양성 질환자의 지방조직 및 혈청의 PCBs와 DDE 농도

박성균,이강숙,노영만,구정완,민선영,한진구,고원경,김미란,정재근,이종승,김진홍 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.1

목적 : 본 연구는 지방조직과 혈청의 PCBs와 DDE 농도를 측정하고, 이에 영향을 미치는 것으로 알려진 요인들과의 관련성을 평가하고자 하였다. 방법 : 유방암, 자궁내막증 등 유기염소계 화합물의 영향이 있는 것으로 알려진 호르몬 관련 질병을 제외한 부인과 환자 52명을 대상으로 지방조직과 혈청을 분석하였으며, 설문조사를 통하여 연령, 교육수준, 직업, 비만도, 흡연과 음주, 출산력, 수유력등을 조사하였다. 지방조직과 혈청의 PCBs와 DDE 농도는 가스크로마토그래피를 사용하여 측정하였다. 결과 : 지방조직의 경우, 13개 PCBs congeners 농도의 합은 중앙값이 48.29 ng/g, 기하평균값이 56.78 ng/g이었고, DDE 농도는 중앙값이 142.89ng/g, 기하평균값이 117.06 ng/g이었으며, 혈청의 경우는 PCBs congeners 농도의 합은 중앙값이 4.67 ㎍/L, 기하평균값이 4.85 ㎍/L이었고, DDE 농도는 중앙값이 1.75 ㎍/L, 기하평균값이 2.09 ㎍/L로 나타났다. 지방조직과 혈청의 DDE 농도 사이는 높은 상관성을 보였으나(r²=0.310, p=0,0002), PCBs는 상관성이 약한 것으로 나타났다(r²=0.029, p=0.2582). 영향요인을 범주화한 후 로그변환 시킨 지방조직과 혈청의 PCBs, DDE 평균의 차이를 분석한 결과, 지방조직의 DDE만이 출산자녀수(p=0.015), 초산연령 (p=0.014), 비만지수(p=0.035)와 연관성이 발견되었다 다중회귀분석의 결과 지방조직의 DDE는 출산자녀수가 적을수록, 초산연령이 늦을수록 증가하는 경향을 보였다. 결론 : 출산자녀수와 초산연령, 비만도가 지방조직의 DDE와 관련성을 보였으며, 또한 유기염소계 화합물의 장기간의 노출에 의한 영향을 평가하는데 있어서 혈청보다 지방조직이 더 유용한 생물지표임을 알 수 있었다. Objectives : This study was purposed to determine the levels of PCBs and DDE in adipose tissue and serum and to evaluate the relations with factors affecting these levels. Methods : We analyzed adipose tissues and sera from 52 gynecologic benign disease patients aged 27-78 years, except hormonal diseases such as breast cancer and endometriosis. We also surveyed age, education, occupation, body mass index (BMI), smoking, drinking, number of children, and duration of breastfeeding by questionnaires. Tissue and serum levels of PCBs and DDE were measured using gas chromatography. Results : The median and geometric mean levels of PCBs were 48.29 ng/g, 56.78 ng/g for adipose tissue and 4.67 ㎍/L, 4.85 ㎍/L for serum, and those of DDE were 142.89 ng/g, 117.06 ng/g for adipose tissue and 1.75 ㎍/L, 2.09 ㎍/L for serum, respectively. Adipose tissue and serum levels for DDE showed high correlation (r²=0.310, p=0.0002), but those of PCBs didn't (r²=0.029, p=0.2582). In analyses of the differences of the means of log transformed adipose tissue and serum PCBs and DDE levels for groups of potential covariates, only adipose tissue DDE levels were significantly associated with number of children (p=0.015), age at first birth (p=0.074) and BMI (p=0.035). In multiple regression analysis, adipose tissue DDE levels were significantly increased with decreasing number of children and increasing age at first birth. Conclusions : This study suggested that parity and adiposity were associated with levels of DDE in adipose tissue, and adipose tissue is a better biomarker than serum for evaluating the long-term exposure of organochlorines.

보건관리 대행사업장 근로자에서 건강증진에 대한 5년 사이의 지식, 태도 및 실천의 변화

임현우,김정아,안병용,박정일,구정완,이강숙 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.2

Before and after conducting the health promotion program by group occupational health service during 5 years, we surveyed knowledge, attitude and practice about general health (30 items) and occupational health(30 items) among 25 small and medium scale industry workers(before: 355 workers, after: 279 workers) for evaluation of effectiveness. The scores of knowledge for smoking, drinking, cholesterol, mental stress, management of hypertension, and risks in younger or women workers were significantly increased after conducting group occupational health service. The scores of attitude for controlling of fatty food consumption and cleaning workplace and bathing for health and that of practice for taking the periodic health examination and checking blood pressure were significantly increased but most of items in attitude and practice didn't be changed after services. According to sex, the scores of men were significantly increased in knowledge of general health, but there were not significant differences in age, job status and work duration group. In conclusion, through the group occupational health service during 5 years, only the scores of knowledge in general health were increased. It suggested that the effective program which can change workers' attitude and practice for health promotion, should be developed and conducted in small and medium scale industry workers.

모 컴퓨터 회사 근로자 건강증진 사업 전개를 위한 수요조사

임현우,안병용,최환석,박정일,김경수,이강숙,김정아,구정완 가톨릭대학산업의학쎈타 산업의학연구소 1997 韓國의 産業醫學 Vol.36 No.4

Before conducting the health promotion program, we surveyed the health risk appraisal(HRA) of 210 workers (186 men and 24 women) in a computer company, for the need assessment, selection of target population, priority setting, and as a standard for comparision after performing the program. The smokers were 115(88.6%), and drinkers (over 1 bottle of Soju per week) were 91(44.8%) in men. Entire women and 148(78.0%) men never or irregularly exercise. Type A personality were 73(39.2%) in men, 8(33.3%) in women, and 26(14.0%) of men and 6(25.0%) of women were high stress risk group. 53(25.2%) of men and 2(8.3%) of women were obese (BMI ≥25kg/m²), and workers who consumed exess of total calory compared with recommendation were 142(76.3%) in men and 18(75%) of women. By the health risk appraisal, it was suggested that smoking cessation program, drinking counselling, exercise prescription, stress management, and weight control program should be conducted effectively for the high risk group.