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박재선 중앙대학교 의과대학 의과학연구소 1993 中央醫大誌 Vol.18 No.1
The purpose of the present study was to investigate the effect of school entrance examination on an adolescent's mental disorder, and to secure effective measures to cope with school entrance test stress syndrome. For the analysis of this study, 318 adolescents wee chosen, who were admitted to the Department of Psychiatry in Pilding Hospital and Yongsan Hospital, Chung Ang University Medical Center from January 1981 to December 1991. They consisted of 36 examinees with little stress for school entrance examination, 132 examinees with school entrance test stress, and 150 adolescents with general mental disorder. Data were processed by SPSS/PC+ Program and were statistically analysed by chi-square test and F-test. The results were as follows. 1. The rate of adolescents among the total psychiatric in-patients was 15.3%, and the rate of examinees among the total adolescent psychiatric in-patients was 16.7%, Among examinees, 78.6% were admitted due to school entreance test stress. 2. In the correlative analysis between social changes and annual rates of hospitalzation among adolescent psychiarric in-patients, there were some characteristic features, such as the increasing tendency of the numbers of adolescent psychiatric in-patients annually, and the more increased number of hospitalization in younger and female group. Yet, in recent years, the proportion of adolescent cases were decreased. These findings suggested that the rates of the adolescent mental disorders were higher in the social atmosphere of a political turmoil, while these rates were lower in the period of educational and economical stability. 3. The clincial manifestations showed that the examinee group suffered from more neurotic discorders, more frequent complaints of depressive symptoms, more somatization and more interpersonal sensitivity than the control group. Also, the former group experienced more serious psycho-social stresses in school or social life than the latter group. 4. The examiness'mental disorders were frequently intiated or exacervated due to under-achievement of their school performance, obsessive compulsive personality traits, an excessive top class complex, or parental over-compensation mechanism. In the subtypes of school entrance test stress syndrome, the examiness showed more melancholic manifestaions such as the emptiness types, the sulmp types, or the despair types than the control group. 5. The study showed that in the spring semester(of each year), more examinees were accompanied by their fathers when they were admited to open ward than the control group. Their improvement was quicker, their hospitalization was shorter and consequently they were discharged from the hospital more quickly than the control group. The examinees were given more anti-psychotics or anti-anxiety drug, but they experienced less psychotherapy than the control group. 6. In comparison with the control group, the examinees were shown to use the somatization more frequently as a device of resistance to the hospital's therapeutic milieu. Against this resistance it was effective to try supportive psychotherapy such as reassurnace and clarification or sedation. Also, against the parental resistanc, extinction technique such as observation or indifference was proved to be more effective than the direct attack technique which tried to eliminate the morbid symbiotic relationship between parents and children.
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상품화된 HBsAg 정성 검사 시스템 3종과 HBsAg 정량 검사 시스템 2종의 분석능 평가
박재선,최정인,임지훈,정윤성,이선호,박능화,신정우,나양원,남창우,차영주,김성률 대한진단검사의학회 2013 Laboratory Medicine Online Vol.3 No.3
Background: Currently used techniques for quantitation of HBsAg often yield discordant results; therefore, development of quantitation techniques that can detect HBsAg with high accuracy has become very important. Recent advances have led to the development of several HBsAg detection systems. Here, we evaluated the performance of 3 newly developed detection systems, which can detect HBsAg both qualitatively and quantitavely, and determined the concordance among their results. Methods: Four hundred and thirty two samples assigned to 4 groups-patient group, dilution group, weakly reactive group, and linearity groupwere subjected to qualitative and quantitative detection of HBsAg by using the 3 systems developed by 3 major manufacturers; Abbott Architect,Roche E170 and Siemens Centaur XP. Results: The results for the qualitative analyses were closely concordant among the three systems (98.3%) for all 432 samples. In 123 samples that were determined as HBsAg-negative, E170 (76%) distributed frequently at the upper half level (0.5-1.0) of negative reference range, compared with Architect (11%) and Centaur XP (22%). In particular, in 65 samples that were diluted from the strongly positive samples to obtain weakly positive samples, the average index values obtained using Architect (3.6 S/CO), E170 (4.2 COI) and Centaur XP (11.4 index value) differed significantly (P <0.0001). In the antiviral treatment group and the post-liver transplantation group, no inconsistency was observed among the results of the qualitative and quantitative assays. In the 18-fold serially diluted samples, no linearity was observed. Conclusions: Because of the possibility of false-positive detection in the HBsAg-negative samples, regular management of equipment and appropriate selection of reagents are very important. In weakly positive samples, quantitative assay has not to be replaced for qualitative assay. Therefore, the qualitative assays should be used for screening the samples, whereas the quantitative assays should be used for monitoring the Hepatitis B virus (HBV) load in the samples determined as HBsAg-positive. The qualitative index value should not be interpreted as a quantitative measure of HBV load. 배경: 간염 검사법들은 과거부터 꾸준하게 개선되어 왔으나 저농도 혈청 값, 비특이반응, 돌연변이 등으로 인하여 위음성 결과 들이 보고되어 주요 공급사들에서는 특이도가 높은 단클론 항체와다클론 항체들을 사용하고 항체의 종류를 추가하여 불일치 반응들을 줄이고자 하였다. 따라서 최근에 새로이 개발된 주요 검사법들을 이용하여 그 분석능을 비교하고자 하였으며, 정성검사 값을정량검사로써 준용하여 해석하려는 사례들이 있으므로 정성검사index value와 정량검사 농도 값을 비교하고자 하였다. 방법: HBsAg 검사에서 음성, 약양성, 강양성 결과를 보인 검체, 환자군별로 구분한 간치료군과 간이식군의 검체, 혈청은행에서 양성으로 확정된 검체들을 포함한 총 432검체들을 대상으로 주요 3사의 제품들로 정성검사와 정량검사를 실시하였다. 약양성 검체들은 강양성 검체들을 희석하여 약양성 결과를 보이도록 제조하였으며, 이들을 대상으로 정성검사와 정량검사를 실시하였다. 강양성 검체들을 18단계 계대 희석하여 제조한 검체들을 대상으로 정성검사와 정량검사를 실시하였다. 결과: 세 회사 장비 간의 정성검사 일치율은(425/432, 98.3%)로 매우 우수하였다. 음성 검체에서 정성검사의 결과 값은 세 회사 장비에서 모두 일치하였으나 index 값을 0.25범위로 나누어 본 결과0.75-1.0 미만인 검체들은 Architect (2%)와 Centaur XP (8%)에 비하여 E170 (12%)에서 더 많았다. 또한 Architect 3검체(2.43%)에서정성검사와 정량검사 간의 차이를 보였다. 양성 결과 값을 보인309검체에서 Architect 6검체(1.94%), E170 14검체(4.53%)에서 정성과 정량간의 결과 값이 달랐고 index 값은 1.29-3.76 S/CO범위에있었다. 약양성으로 제조한 65검체들에서 정성 검사 평균 값은 Architect3.6 S/CO, E170 4.2 COI, Centaur XP 11.4 index value였고Architect과 E170 (P<0.0001), E170과 Centaur XP (P<0.0001), Architect과Centaur XP (P<0.0001)에서 유의한 차이를 보였다. 간치료군과 간 이식군에서의 세 회사 간의 정성 검사와 정량 검사 결과는 모두 일치하였다. 강양성 검체들을 18계단 희석한 검체들에서직선성을 보이지 않았다. 결론: 음성 검체 일부에서는 index value가 상대적으로 높게 나타나서 위양성을 보이거나 항원-항체 모두 양성 결과를 보일 위험이있다. 이는 장비의 백그라운드 값이 높아지거나 시약의 비특이 반응으로 나타날 수 있으므로 정기적인 장비 관리와 적절한 시약의선택이 필요하다. 약양성 검체들에서 정성검사에서는 양성이지만정량검사에서는 음성인 검체들이 보이므로 정량검사에서는 위음성으로 판정될 수도 있다. 그러므로 정량검사 결과로 정성검사를판정하여서는 안되며 단지 모니터링에서만 사용하여야 한다. 강양성 검체들을 계단희석하여 제조한 검체들에서 정성검사와 정량검사들은 검체별로 서로 상이한 결과를 보이므로 정성검사에서 보고되는 index value를 정량검사의 결과로 준용하여 해석해서는 안된다.
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