당뇨병 환자에서의 우울 및 관련증상에 관한 예비적 연구

고승현,정종현,홍승철,한진희,이성필,안유배,송기호,Ko, Seung-Hyun,Jeong, Jong-Hyun,Hong, Seung-Chul,Han, Jin-Hee,Lee, Seung-Pil,Ahn, Yoo-Bae,Song, Ki-Ho 한국정신신체의학회 2004 정신신체의학 Vol.12 No.2

목적 : 당뇨병은 인단 발생하면 질병 경과의 조절은 어느 정도 가능하나 대부분 완치가 어렵고 평생동안 치료와 자기관리론 요하는 만성질환으로, 이러한 합병증은 혈당을 가능한 정상인에 가깝도록 유지함으로서 합병증의 발생 및 진행을 억제할 수 있다. 당뇨병 진단이후 만성질환에 대한 합병증 발생에 따른 두려움, 혈당을 정상화시키기 위한 생활습관의 갑작스런 개선, 당뇨병 치료를 위한 약물 복용 및 인슐린 주사, 당뇨병성 합병증의 발생 등은 정서적 스트레스로 작용할 가능성이 크다. 이에 저자들은 자가보고식 우울증 척도를 기준으로 당뇨조절과 관련된 요인들을 확인해보고자 하였다. 방법: 2004년 3월부터 2004년 9월까지 가톨릭대학교 성빈센트병원 내분비내과에서 치료 중인 환자 60명을 대강으로 하였으며, 이 중 Beck의 우울척도(Beck Depression Inventory, BDI)점수를 기준으로 20점 이하인 군을 비우울군, 21점 이상인 군을 우울군으로 하였다. 이들에 대하여 사회 인구학적인 변인, 혈액화학 검사, 단백뇨검사, 당화혈색소검사 및 Spielberger의 상태-특성불안 척도(State-Trait Anxiety Inventory, STAI), Bagby의 감정표현불능척도(Tronto Alexithymia Scale), 고경봉의 스트레스반응척도(Stress Response Inventory)를 사용하여, 우울군과 비우울군 간의 차이론 비교하였다. 결과: 1) 대상군 60명의 평균나이는 $50.3{\pm}9.7$세(연령분포 : $24{\sim}67$세)였으며, 이중 남자가 51.7%(31명), 여자가 48.3%(29명)이었고, 평균 유병기간은 $47.1{\pm}61.5$개월, 평균 신체질량지수는 $25.2{\pm}4.3$으로 측정되었다. 총 60명중에서 비우울군은 47명(평균나이 $48.9{\pm}9.8$세, 남자 51.1%(24명), 여자 48.9%(23명))이었고, 우울군은 13명(평균나이 $55.4{\pm}7.2$세, 남자 53.8%(7명), 여자 46.2%(6명))이었다. 2) 두군 간에서 평균연령이 우울군에서 유의하게 높았으나($55.4{\pm}7.2$세 vs. $48.9{\pm}9.8$세)(p=0.031), 성별, 신체질량지수, 당뇨병 유병기간, 교육정도, 직업 등의 인구학적 변인에서 유의한 차이는 없었다. 또한 혈중 크레아틴 농도가 우울군에서 유의하게 높게 측정되었으나$(0.91{\pm}0.14\;vs.\;0.8{\pm}0.14)(p=0.26)$, 공복 시 혈당, 식후 혈당, 당화혈색소 및 단백뇨검사 등의 검사에서는 유의한 차이가 없었다. 3) 우울군과 비우울군의 스트레스 반응척도의 평균점수는 각각 $59.7{\pm}24.9,\;31.5{\pm}22.0$으로 두군 간의 유의한 차이를 보이고 있었다(p=0.000). 4) 상태불안 및 특성불안, 감정표현불능척도에서는 우울군과 비우울군 간의 유의한 차이가 없었다. 결론: 이상의 결과에서 우울증상이 있는 당뇨환자에 있어서 당조절의 지표라고 여겨지는 혈당 및 당화혈색소 등은 악화되어있지 않았으나, 당뇨병의 장기적인 합병증과 관련되어있을 것으로 생각되는 혈중 크레아틴의 농도가 증가되어있고, 스트레스에 매우 취약한 상태라는 점이 확인되었다. 우울증이 있는 당뇨환자의 치료에 있어서 이에 대한 통합적인 접근이 필요할 것이며, 추가적인 연구가 필요할 것으로 생각된다. Objectives: Diabetes mellitus is a heterogeneous, chronic, progressive disease characterized by hyperglycemia and abnormality in protein, carbohydrate, fat metabolism. Recent studies have reorted two times prevalence of depression in individuals with diabetes compared to individuals without diabetics. This study was designed to investigate glycemic controls, anxiety, alexithymia, stress responses between depressed diabetic patients and non-depressed diabetic patients. Methods The subjects were 60 diabetic patients(mean age : $50.3{\pm}9.7$ years, 31 men and 29 women) who were confirmed to have diabetes depending on the laboratory findings as welt as clinical symptoms at the St. Vincent Hospital Diabetes Clinic, from Mar. 2004 to Sep. 2004. Laboratory test including, blood chemistry. glycated hemoglobin, urinalysis for proteinuria and Korean version of Beck Depression Inventory(BDI), State and Trait Anxiety Inventory(STAI), Toronto Alexithymia Scale(TAS) and Stress Response Inventory(SRI) were used for assessment. Based on BDI scores, all diabetics were divided into 13 depressed-diabetics group(above 20 point) and 47 non-depressed group(below 20 point). We compared demographic data. glycemic controls, STAI, TAS and SRI scores between two groups by independent t-test. Results : 1) Depressed diabetic groups were 13(mean age : $55.4{\pm}7.2$ years, 7 men and 6 women) and non depressed groups were 47(mean age $48.9{\pm}9.8$ years, 24 men and 23 women). In depressed diabetics, compared with non-depressed group, manifested aged(p=0.031), but other demographic data showed no difference between two groups. 2) No significant differences were noted in FBS, PP2h, Hb A1C, total cholesterol, HDL-cholesterol, SGOT/SGPT, BUN levels between depressed and non-depressed groups. But, blood creatine levels of depressed group were significantly increased than non-depressed group(p=0.026). 3) No significant differences were found in the score of STAI, STAI-S, STAI-T, TAS between depressed and non-depressed groups. 4) The SRI scores of depressed groups were significantly higher than non-depressed groups$(59.7{\pm}24.9\;vs.\;31.5{\pm}22.0)(p=0.000)$. Conclusion : The above results suggest that depressed diabetic patients are have more stress responses and higher blood creatine levels. However, there were no differences in laboratory data related to glycemic controls, and anxiety. alexithymia levels between two groups. We suggest that physicians should consider integrated approaches for psychiatric problems in the management of diabetes.

한국인 제2형 당뇨병환자에서 심혈관계 자율신경병증의 특성

고승현,이정민,김성래,이원철,차봉연,손호영,안유배,권혁상,조재형,유기동,박용문,송기호,윤건호 대한당뇨병학회 2006 Diabetes and Metabolism Journal Vol.30 No.3

-Background: Diabetic autonomic neuropathy has a significant negative impact on survival and quality of life in type 2 diabetic patients. Especially cardiovascular autonomic neuropathy (CAN) is clinically important, because of its correlation to cardiovascular death. Therefore, we investigated the prevalence of CAN in Korean type 2 diabetic patients.Methods: 1798 type 2 diabetic patients, 727 males and 1071 females, visited Diabetes Clinic at St. Vincent Hospital, Korea, were included from January 2001 to December 2005. Clinical evaluation, laboratory test and assessment of diabetic complication were completed. Standard test for CAN were performed: 1) heart rate variability (HRV) during deep breathing (E/I ratio) 2) Valsalva maneuver 3) 30:15 ratio 4) blood pressure response to standing. CAN score was determined according to the results of the test as following: 0 = normal, 1 = abnormal.Results: Mean age and diabetic duration of patients were 56.7 ± 10.9, and 9.4 ± 7.5 years. Normal and abnormal CAN were detected in 815 (45.3%) and 983 (54.7%) of the patients, respectively. Abnormal E/I, valsalva, and 30:15 ratio were found in 333 (18.5%), 717 (39.9%), and 546 (30.4%) patients, respectively. Age, diabetic duration, postprandial hyperglycemia, HbA1c, C-reactive protein, and microalbumuria levels were significantly different between normal and abnormal CAN groups. 49 (6.0%) patients of normal and 100 (10.2%) patients of abnormal CAN group showed previous attack of stroke (P = 0.004). In addition, diabetic foot was more frequent in patients with CAN (normal vs. abnormal, 14 (1.7%) vs. 73 (7.4%), P < 0.05).Conclusion: CAN is frequently found in Korean type 2 diabetic patients. It was associated with diabetic duration, uncontrolled diabetes, increased albumin excretion rate, presence of retinopathy, postprandial hyperglycemia. (J Kor Diabetes Assoc 30:226~235, 2006) 연구배경: 심혈관계 자율신경병증은 제2형 당뇨병환자에서 심혈관질환과 관련된 사망과 깊은 관련이 있기 때문에, 무증상 환자에서 조기에 발견하고 적절한 치료 및 철저하게 혈당을 조절함으로써 이와 관련된 심혈관질환의 발생이나 사망을 줄일 수 있을 것으로 기대된다. 본 연구에서는 우리나라 제2형 당뇨병환자에서 심혈관계 자율신경병증의 유병률과 심혈관계 자율신경병증 (CAN)이 있는 환자의 특성에 대하여 조사하였다.방법: 2001년 1월부터 2005년 12월까지 가톨릭대학교 성빈센트병원 당뇨병센터에 내원한 25세부터 75세 사이의 제2형 당뇨병환자를 대상으로 하였다. 심혈관계 자율기능 검사는 Ewing의 방법에 따라 한 명의 검사자가 반복적인 심호흡 호기와 흡기시 (E/I 비), 체위 변화시 (30:15 비), 발살바 수기시 심박동수의 변화를 측정하였다. 심혈관계 자율신경병증의 정의는 미국당뇨병학회의 권고사항에 따라 E/I 비는 연령과 관련된 참고치를 이용하였고, 30:15 비는 1.03 미만, 발살바 비는 1.2 미만일 때를 비정상으로 정의하였다. 각 세가지 항목에 대하여 정상은 0점, 이상은 1점으로 계산하였고, 총 1점 이상을 심혈관계 자율신경병증으로 정의하였으며 세가지 항목의 점수를 합산하여 3점을 최대값으로 정의하였다. 결과: 총 1,798명의 환자를 대상으로 하였고, 전체 환자의 평균 연령은 56.7 ± 10.9세, 평균 당뇨병 유병기간은 9.4 ± 7.5년이었다. 총 점수가 1점 이상인 환자는 총 983명으로, 전체 대상 환자의 54.7%에서 심혈관계 자율신경검사의 이상을 보였고, E/I 비, 발살바 비 및 30:15 비는 각각 333명 (18.5%), 717명 (39.9%)와 546명 (30.4%)에서 비정상 소견을 보였다. 총 점수가 1점인 환자들에서는 E/I 비가 99명 (17.2%), 발살바 비 344명 (59.7%), 30:15 비 133명 (20.1%)에서 이상 소견을 보여 세가지 항목 중에서는 발살바 비의 이상이 가장 흔하게 관찰되었다. 총 점수가 1점 이상인 환자들에서, 심혈관계 자율신경병증이 없는 제2형 당뇨병환자들에 비하여 평균 연령, 당뇨병 유병기간이 길었고 고혈압 및 이전에 뇌혈관질환 및 당뇨병성 족부병변의 과거력이 있는 환자가 더 많았다. 비정상군에서 공복혈당, 혈중 크레아티닌, 당화혈색소 및 식후 혈당치가 의미있게 높았으며 미세단백뇨 값이 더 높았다. 또한 당뇨병성 망막증이 없는 경우 53.0%의 환자에서 자율신경검사가 정상이었으나, 증식성 망막증이 있을 경우 14.1%의 환자에서만 정상결과를 보였다

2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea

고승현,김성래,김동준,오승준,이혜진,심강희,우미혜,김준영,김난희,김재택,김종화,김혜진,정인경,홍은경,조재형,목지오,윤건호 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.5

As in other countries, type 2 diabetes is major health concern in Korea. A dramatic increase in the prevalence of type 2 diabetes and its chronic complications has led to an increase in health costs and economic burdens. Early detection of high risk individuals,hidden diabetic patients, and improvement in the quality of care for the disease are the first steps to mitigate the increase in prevalence. The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the ‘3rd Clinical Practice Guidelines’ at the end of 2010. In the guidelines, the committee recommended active screening of high risk individuals for early detection and added the hemoglobin A1c level to the diagnostic criteria for type 2 diabetes based on clinical studies performed in Korea. Furthermore, the committee members emphasized that integrating patient education and self-management is an essential part of care. The drug treatment algorithm based on the degree of hyperglycemia and patient characteristics were also updated.

MIN6 세포에서 저산소 손상시 Inducible Nitric Oxide Synthase (iNOS)의 발현

고승현,안유배,윤건호,김성래,권혁상,김지원,이정민,문성대,송기호,김승범,류경열 대한당뇨병학회 2006 Diabetes and Metabolism Journal Vol.30 No.5

Improved understanding of the molecular structure of pyrolysis fuel oil: towards its utilization as a raw material for mesophase pitch synthesis

고승현,최종은,임혜진,Miyawaki Jin,윤승호,전영표 한국탄소학회 2019 Carbon Letters Vol.29 No.3

Structural characterization of pyrolysis fuel oil (PFO) was conducted via 1H NMR and 13C NMR to elucidate its molecular structure and evaluate the feasibility of using PFO as a raw material for mesophase pitch synthesis. The average structural parameters were calculated based on the data from elemental analysis and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS), as well as 1H NMR and 13C NMR data. The resultant structural features of PFO were compared with those of fluidized catalytic cracking-decant oil (FCC-DO). Based on the calculated parameters, we proposed average molecular models of PFO and FCC-DO. The molecular model of PFO showed that it had an aromatic structure consisting of three aromatic rings and one naphthenic ring fused with one pericondensed and two catacondensed aromatic carbons, as well as a short alkyl side chain (with only a methyl group). This structural feature of PFO demonstrated that it is highly favorable for use as a raw material for mesophase pitch synthesis. The empirical findings in this study provide an in-depth understanding of the molecular structure of PFO as well as FCC-DO and can offer insights for future research on the utilization of PFO and other petroleum heavy oils.

치위생사 포스터 : 수술 후 주의사항 설명의 임상적 중요성

고승현,김지영,이호경,강미화,신은영 대한치주과학회 2009 대한치주과학회 학술대회자료집 Vol.2009 No.1

Oxidative thermal treatment of petroleum feedstock and its influence on the behavior of mesophase formation

고승현,최종은,하승재,이철위,전영표 한국공업화학회 2019 한국공업화학회 연구논문 초록집 Vol.2019 No.0

Mesophase pitch is one of the key precursors for the preparation of high performance carbon materials. In this study, we have conducted oxidative thermal treatment of fluidized catalytic cracking-decant oil (FCC-DO), and investigated its effect on the formation of mesophase pitch. The oxidative treatment was performed at temperatures between 200 °C and 300 °C with air-blowing. And the resulting products were analyzed by Fourier transform infrared spectroscopy (FTIR), elemental analyzer (EA), and polarized-light microscopy. As a result, it was found that the oxidative treatment definitely facilitated the formation of mesophase pitch.

고농도 포도당에 의한 췌장성상세포의 활성화와 안지오텐신 2의 변화

고승현,홍옥기,이민경,박은혜,이성수,안유배,송기호,차봉연,손호영,김명준,정인경,윤건호 대한당뇨병학회 2005 Diabetes and Metabolism Journal Vol.29 No.4

급성 약물 중독 환자에서 의도성 여부에 따른 임상적 분석

고승현,이경원 대한응급의학회 2012 대한응급의학회지 Vol.23 No.5

Purpose: Korea has one of the highest suicide rates of countries belonging to the Organization for Economic Cooperation and Development (OECD). In development of emergency medical services (EMS) and emergency medicine in Korea, one of the characteristics of suicide in Korea is the means of committing suicide, which is intentional acute drug poisoning. The aim of this study is to compare the characteristics of acute drug poisoning victims between intentional poisoning and accidental poisoning. Methods: A retrospective study was conducted for the year 2011. The study group included adults (over 16 years old)with acute drug poisoning. We followed the American Association of Poisoning Control Center definition of acute poisoning. Exclusion criteria were 1) a victim of adverse effect of therapeutic dose, 2) a victim of chronic exposure,3) missing data on emergency medical records, and 4)unknown cause of poisoning. During the study period, 195patients were enrolled. Results: In comparison between the intentional poisoning group and the unintentional poisoning group, no statistical difference was observed in mean age, sex ratio, initial vital signs in the emergency department (ED), and time from exposure to ED. However, the initial mental state in the ED,transportation, previous suicide history, ED treatment,length of stay in the ED, and Poisoning Severity Score (PSS) showed statistical difference (p<0.05). Conclusion: We concluded that intentional drug poisoning is associated with more serious progress and outcome than unintentional poisoning in a group of Korean adults. Prevention and public education will be needed in order to decrease the rate of suicide poisoning in Korea.

Co-free cathode materials(제목수정)

고승현,이철위,임지선 한국공업화학회 2013 한국공업화학회 연구논문 초록집 Vol.2013 No.1