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급성 심근경색증 환자의 예후인자로서 내원 시 혈당의 유용성
승기배 ( Ki Bae Seung ),조명찬 ( Myeong Chan Cho ),박승정 ( Seung Jung Park ),김은정 ( Eun Jung Kim ),박오장 ( Oh Jang Park ),정명호 ( Myung Ho Jeong ),안영근 ( Young Keun Ahn ),김주한 ( Ju Han Kim ),김영조 ( Young Jo Kim ),채성철 대한내과학회 2010 대한내과학회지 Vol.79 No.1
Background/Aims: It has been suggested that admission hyperglycemia is associated with poor clinical outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to assess the relationship between admission hyperglycemia and short-long term prognosis in patients with AMI. Methods: A total of 6,030 AMI patients without a previous history of diabetes were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into three groups according to the levels of admission glucose levels: group I (<140 mg/dL, n=3,307), group II (140~199 mg/dL, n=1,946), and group III (≥200 mg/dL, n=777). In-hospital and one-year mortality were compared among three the groups. Results: The mean age was 64.3±13.3, 65.9±12.7, and 67.7±13.0 years in group I, II and III, respectively. The proportion of female gender (23.9%, 29.5%, 35.0%; p<0.001), Killip class III-IV (8.9%, 12.3%, 28.3%; p<0.001), ST-segment elevation myocardial infarction (54.6%, 71.5%, 71.7%; p<0.001), and in-hospital mortality (3.5%, 7.5%, 19.7%; p<0.001) increased with higher tertiles of elevated values of initial serum glucose. Hazard ratio (HR) for mortality rate were significantly increased in group II [HR=1.19, 95% confidential interval (Cl) 1.02~1.40, p=0.032], and in group III [HR=1.91, 95% Cl 1.59~2.30, p=0.001], compared with group I. And also significant differences were existed between group II and group III [HR =1.55, 95% Cl 1.27~1.88, p=0.001]. Conclusions: Admission glucose in patients with AMI provides incremental prognostic value, and significantly correlates with in-hospital and one-year mortalities.
Q 파 심근경색과 비 - Q 파 심근경색의 임상경과 및 관동맥조영술 소견의 비교
정기영(Ki Young Chung),홍석근(Suk Keun Hong),이명룡(Myung Yong Lee),조주희(Joo Hee Zo),김준수(June Soo Kim),김치정(Chee Jeong Kim),조명찬(Myeong Chan Cho),박영배(Young Bae Park),이명묵(Myoung Mook Lee),최윤식(Yun Shik Choi),서정돈(Ju 대한내과학회 1991 대한내과학회지 Vol.40 No.1
Despite of having smaller infarct size and better left ventricular function, patients with non-Q wave myocardial infarction has been reported to have an high late cardiac event rate, and long term prognosis is ultimately comparable to that of patients with Q wave myocardial infarction. This is because there is more viable tissue in the perfusion zone of infarct-related artery rendering myocardium more prone to reinfarction. To compare the prognosis and clinical characteristics of Q wave myocardial infarction with those of non-Q wave myocardial infarction, 390 patients with acute myocardial infarction were reviewed and analyzed retrospectively. Patients were classified according to electrographic results into Q wave infarction (n=336) and non-Q wave infarction (n=54). Predischarge coronary angiography, gated blood pool scan, end treadmill exercise test were performed. There was no significant difference in sex, age, angina history, previous myocardial infarction, location of infarction, and severity of coronary disease; Q wave myocardial infarction did have higher peak CK (1733.9±1432.6 vs. 511.1±588.8 IU; P<0.01) and CK-MB fraction level (334.2±371.5 vs. 78.7±128.5; P<0.01). Predischarge treadmill exercise test showed no significant difference in the exercise duration, ST segment change, and chest pain. In gated blood pool scan, ejection fraction of left ventricle did not show significant difference, but proportion of normal left ventricular wall motion was significantly higher in non-Q wave infarction. (21/257 vs. 19/42; P<0.01). The extent of coronary artery disease and degree of coronary artery stenosis was not different between two groups, but high degree obstruction (>90%) of infarct related artery was more frequent in Q wave myocardial infarction (134/187 vs. 19/35; P<0.05). During follow-up, in-hospital mortality was significantly higher in Q wave myocardial infarction (13% vs. 2%, p<0.01). But postdischarge mortality and the rate of reinfarction did not different between two groups. Further prospective studies should be performed to clarify the clinical behaviors and long-term prognosis in patients with non-Q wave myocardial infarction.
채인호(In Ho Chai),한규록(Kyoo Rok Han),고경수(Kyung Soo Ko),류오열(O Yeol Ryoo),신원석(Won Sock Shin),조명찬(Myung Chan Cho),김철호(Cheol Ho Kim),이명묵(Myoung Mook Lee),최윤식(Yun Shik Choi),서정돈(Jung Don Seo) 대한내과학회 1991 대한내과학회지 Vol.41 No.6
To evaluate the survival and embolic events of idiopathic dilated cardiomyopathy (IDCMP), we followed up 80 patients diagnosed as IDCMP between 1984 and 1989 on the basis of clinical findings and echocardiography. We analyzed the clinical parameters, echocardiographic findings, and outcome. The following results were obtained: 1) Eighty patients, 58 male and 22 female (male: female = 2.6:1), with a mean age of 54±12 years (18 to 79 years) were included in this study. They were followed up for a mean of 30±26 months (ranging from 1 to 111 months). 2) By Kaplan-Meier method, the survival rates for 1, 2, and 5 years were 72%, 65%, and 58%, respectively. During the follow-up period, 27 patients died, and 24 of them (89%) died within 2 years of initial diagnosis. The causes of death were aggravation of congestive heart failure (22 cases, 81% of total deaths), sudden death (4 cases, 15%), and cerebrovascular disease (1 case, 4%). 3) There were significant differences (p<0.05) between the survivors and those who died in left ventricular end systolic dimension (34.7±6. 2 vs 38.8±6.5 mm/m), left ventriclar end diastolic dimension (41.2±616 vs 45.2±7.2 mm/m²), and ejection fraction (39.2±8.4 vs 34.1±7.6%), but age, sex, presence of embolism, clinical features, and electrocardiographic findings did not seem to influence the prognosis. 4) Cerebral embolism was found in 17 patients (21.3%), but including atrial fibrillation, there were no clinical variables predicting embolic events. Our data showed that 1) patients with idiopathic dilated cardiomyopathy had poor prognosis, 2) enlarged left ventricular end systolic dimension and end diastolic dimension, and decreased ejection fraction could be regarded as poor prognostic factors, 3) but there were no significant predictive factors for embolism.
백서에서 경구적 알콜 투여 후 간 및 위 Alcohol dehydrogenase(ADH) 활성도의 변화
윤세진,엄재호,조명찬 충북대학교 의과대학 충북대학교 의학연구소 1992 忠北醫大學術誌 Vol.2 No.1
Alcohol dehydrogenase(ADH)는 알콜대사에 중요한 효소로서 주로 간세포에 존재하고 그외 위장관에 소량씩 존재하는 것으로 보고되어 있다. 알콜상습음주자는 많은 양의 알콜에 잘견디며 또한 혈중 알콜 제거율이 증가되어 있다고 보고되어 왔는데, 이때에 간 ADH가 어떤 역할을 하는지에 대한 많은 논란이 있어왔다. 그러나 간 ADH는 알콜상습음주로 인해 그 활성도의 증가가 되지 않는 것으로 정착되어 가고 있으며, 본 연구에서도 백서를 대상으로 실험한 결과 상기보고와 일치함을 확인할 수 있었다. 또한 알콜상습음주시 위 ADH활성도의 증가도 없음을 관찰할 수 있었다. 따라서 알콜상습음주자가 많은 양의 알콜에 견디는 이유는 간 및 위 ADH활성도의 증가가 아닌 다른 요인이 있음을 추측할 수 있었다. A major pathway for ethanol metabolism involves alcohol dehydrogenase, an enzyme of cytosol that catalyzes the conversion of ethanol to acetaldehyde. Regular drinkers tolerate large amount of alcoholic beverages and develope increased rates of blood ethanol clearance. The longstanding debate about whether chronic alcohol consumption enhances the activity of hepatic ADH has been existed. However, ADH activity has now been reported not to increase after ethanol feeding, a finding consistent with our experimental observation in the rats. We also observed that increment of gastric ADH activity after chronic alcohol consumption was not found. So, we could guess that the regular drinkers might be existed some factors that have developed metabolic tolerance independent of hepatic and gastric ADH activities changes.