제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

표면근전도와 적외선체열촬영을 이용한 요통의 평가

이강진,최인성,이소영,한재영,이삼규,채홍재,이성과,문재동 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3

목적 : 요통환자에서 요통의 유무와 강도를 평가하고자 표면근전도를 이용하여 근육 활동성의 차이를 검증하였고 적외선체열촬영을 이용하여 제표면 온도의 변화를 측정하였다. 방법 : 요통환자군 16명과 대조군 16명에 대하여 요부에 부착한 표면전극에서 얻은 근전도 신호와 적외선체열촬영 결과를 비교하였다. 교란요인의 영향을 배제하기 위하여 연령과 성별 그리고 비만도에 따라 정상 대조군과 요통환자군을 짝짓기하여 각각 16명씩 선정하였다. 결과 : 정적표면근전도 실시 결과 우측의 경우 중앙값이 요통환자군에서 198.1 ㎶, 정상대조군에서는 161.3 ㎶로 통계적으로 유의한 차이가 있었고(p<0.01), 좌측은 요통환자군에서 194.2 ㎶, 정상대조군에서 180.5 ㎶로 유의한 차이는 없었다. 동적표면근전도 실시 결과 재신전시와 굴곡시 근전위의 비가 우측의 경우 요통환자군에서 중앙값이 1.12였고 정상 대조군은 1.39로서 두 군간에 유의한 차이가 있었고(p=0.027), 좌측의 경우도 요통환자군에서는 1.08이었고 정상 대조군에서는 1.21로 유의한 차이가 있었다(p=0.036). 적외선체열촬영결과 ΔT가 0.5 ℃ 이상의 차이가 있을 때 이상이 있는 것으로 정하면, 요통환자군에서는 16명 모두 이상자로 판정되었고, 정상 대조군에서는 16명중 3명이 이상자로 판정되어 민감도는 100 %, 특이도는 81.3 % 였다. 표면근전도를 이용한 요통의 진단은 민감도가 78.6 %이고 특이도가 72.2 %였으며, 적외선체열촬영은 민감도가 100 %였고 특이도가 87.5 %였다. 결론 : 이러한 결과로 볼 때 표면근전도 검사법과 적외선체열촬영은 요통을 간접적으로 평가하는데 도움이 되는 검사법이며, 적외선체열촬영이 표면근전도검사법에 비하여 보다 정확한 검사법으로 판단된다. Objectives : We studied the efficacy of surface electromyography(SEMG) and digital infrared theimographic imaging (DITI) in the assessment of low back pain both(LBP) Methods : We compared electromygraphic signals from electrodes placed in the lumbar area and the digital theimographic images in 16 LBPpatients and 16 control subjects. The LBP patients and the control subjects were matched for age, gender, and body mass index(BMI) to adjust for any confounding effects Results : In the static analyses of SEMG, median value was 198.1 ㎶ for the controls on the right side, and they were 194.2 ㎶ and 180.5㎶ on left side respectively. There was a statistically significant difference between the two groups on the right side(p<0.01), but not on the left side. In the dynamic analyses of the SEMG, the median values of the extension per flexion ratio of right side were 1.12 for LBP patients and 1.39 for controls. and those on the left side were 1.08 and 1.21 respectively. There were statistically significant differences in both sodes(p<0.05). The sensitivity and specificity were 100% and 81.3% in DITI, 78.6% and 72.2% in SEMG. Conclusions : These results indicate that SEMG and DITI are useful methods for indirect assessments of LBP, and that DITI is more sensitive and specific than SEMG.

KAL기 추락에 의한 대량재해의 개인식별

강신몽,이원태,고영창,최상규,김윤희,이홍석,서재관,윤중진,이혜경,최득린,김종열,윤창육,변명식,이장홍 大韓法醫學會 1991 대한법의학회지 Vol.15 No.2

Individual identification is an important part in medicolegal field especially in mass disaster. At July, 27, 1989, KAL KE-803 was crashed on landing at Tripoli International Airport, Liba. The plane was caught in fire and sixty eight Koreans were sacrified. The majority of victims were severely charred and injured. The authors examed all dead bodies and successfully identified all the cases through visual, anthropological, odontological, radiological and pathological methods including fingerprint and blood typing.

운동선수의 임장불안에 대한 연구

홍관이,이광재,김두경,부기원,노성규,한상준,박기동,오수일,문병용,이철규,박장평,엄기진,박남환 江原大學校附設 體育科學硏究所 1984 江原大學校附設體育科學硏究所論文集 Vol.- No.9

This study is designed to grasp the elements and situations of stage fright in order to propose a part of ways to cope with it. We make 511 top-class high school players, male and female, in the central districts (Seoul, Inchon, Kyungki, Chungbuk, and Kangweon Province) on object of questionnaire, and get the following results. Through players generally have all-round characters they show weakness in the superiority and emotional stability while showing strength in the sonformity. This fact comes to be related to the elements which cause stage fright. Physiological changes also have many effects on the symptom of stage fright. Especially, stage fright increases when players show sensitive reaction to the self-consciousness of final consequence which comes from the tension or uneasiness of sympathetic nerve, Thus, it turns out that players make use of reducing psychological burden by physical exercise or adjusting the level of demanded result in order to release the stage fright.

「한국 평신도들에게 영향을 주는 각종 기도 형태들에 대한 현실 진단 및 사목적 전망」에 대한 논평

이관홍 가톨릭대학교 사목연구소 2003 司牧硏究 Vol.11 No.-

학교체육 활성화 방안에 대한 연구(Ⅰ) : 강원대학교 교양체육 운영방법의 개선을 중심으로

이광재,문병용,노성규,박기동,홍관이,한상준,유옥재,엄기진,정청자,오수일,김윤래,박장평,부기원 江原大學校附設 體育科學硏究所 1986 江原大學校附設體育科學硏究所論文集 Vol.- No.11

Try to find a scheme for activation to College Physical Education, this Report informs the various kinds of Survey and process those were projected for improvement of management methods on Cultural Physical Education in Kang Weon National University. From experimentally carried out "Sports events Choosing System" not as usual be inforced "Total practical Skill System", Following Positive effects and sujestions were Presented; 1. "Sports events choosing system" gave birth to more students' interesting and more voluntary participation to the sports events they chose, and sports skill and instruction level was elevated due to charge of expert according to each sports events. This system would be managed continuously hereafter for it related to life sports. 2. This System needs to closed cooperations between College and Community, for the facilities of community are utilized by college. 3. To complete the plan for activation of college Physical Education, additionally, the successional study ; namely "autonomous extracurricular sports activity" should be excuted hereafter.

전치 태반의 임상적 고찰

홍관표,이성동,김왕수,정종일,장하종,정혁,한세준 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.1

This study was undertaken for the clinical evaluation and statistical analysis on the 38 cases of placenta previa who were admitted and treated from March 1, 1988 to Feb. 28, 1991. The results were as follows : 1. The incidence of placenta previa was one per 53 deliveries or 1.90% 2. There were 57.9 % total placenta previa, 21.1 % partial placenta previa, 13.1 % low-lying placenta previa and 7.9% marginal placenta previa. 3. Placenta previa has occured more often in multipara (63.2%) than primigravida 4. More than one-third (38.8%) cases of placenta previa had delayed admission until labor occured for some time following vaginal spotting has first time been noticed. More instructive prenatal education should be emphasized 5. Lower segment transverse section rate was 63.2%, classical cesarean section rate was 15.8% and cesarean hysterectomy was 9.8%. The rest of them were treated by vaginal deliveries of 5 cases(13.2%) 6. The perinatal loss associated with placenta previa was considered still higher : the premature death was 15.8% and term death was 2.6%. The problem of prevention of prematurity still remains to be studied. 7. There was no maternal mortality in our study

천연자원을 이용한 간기능 증진제 개발 연구 : Benzo(a)pyrene에 의해 유도된 간기능 장해에 미치는 천궁 추출액의 영향 The Effect of cnidii Rhizoma on Benzo(a)pyrene Induced Hepatotoxicity

윤수홍,이송애,하헌,박은주,오관현 효성여자대학교 부설 한국환경위생연구소 1993 환경위생연구 Vol.3 No.1

민간에서 주로 사용되는 약용식물들 중 간독성 의 발현 저해 및 간기능 보호 효과가 우수한약물을 찾아 임상적인 약효를 밝혀보고자 하는 실험과정으로 탄소화합물의 불완전 연소및 열분해에 의해 생성되는 간장해 물질인 benzo(a)pyrene으로 유도한 rats의 간독성발현에 미치는 천궁 수침액의 예방 및 치료 효과를 실험하여 다음과 같은 결과를 얻었다. 1. 천궁 수침액의 투여는 B(a)P 투여로 현저하게 증가된 혈청 및 간장의 AST, ALT,LDH, ALP 활성을 유의성 있게 감소시켰다. 2. B(a)P 투여로 증가한 혈청 total cholesterol 및 phospholipid 함량은 천궁 수침액의투여로 감소시킬 수 있었으나 그 효과는 현저하지 않았다. 3. 천궁의 투여는 B(a)P에 의한 간독성 발현을 유의성 있게 감소시켰으며 그 효과는전처리가 후처리에 비해 우수하였다. The present study was undertaken to compare the pharmacologicalactivity of crude Cnidii Rhizoma reported with the clinical uses in the orientalmedicine. Crude Cnidii Rhizoma used for the treatment of anemia, body chill,menstural irregularity and menstural pain as hematic, tonic effector, sedative,adodyne and clear extravasated blood. Therefore we tested the effects of Cnidii Rhizoma water extract on the liver-protective activities in the rats. The results obtained from liver microsomal enz-yme assay, measurement of serum and liver alanine, aspartate aminotransferaseand lipid accumulation indicated that Cnidii Rhizoma extract showed significantliver-protective activies against benzo(a)pyrene poisoning.

Pseudomonas sp. HJ에 의한 Poly(Hydroxybutyric-Co-Hydroxyvaleric) Acid의 생산

손홍주,민관필,이상준 부산대학교 유전공학연구소 1995 분자생물학 연구보 Vol.11 No.-

하수처리장의 활성오니를 분리원으로 하여 수십종의 PHA 생산균을 분리하였다. 일반적으로 hydroxyvalerate monomer unit의 전구물질로 알려져 있지않은 glucose로부터 비교적 많은 PHA를 생산하는 균주를 공시균으로 선정하여 형태학적, 배양적, 생리학적 제 특성을 검토한 결과 Pseudomonas 속으로 동정되었다. 균체 생육을 위한 최적 배양온도 및 배양 pH는 각각 37℃와 7.0이었으며, 최적 탄소원으로서 glucose 1%, 최적 질소원으로서 (NH_4)_2SO_4 0.2%, K_2HPO_4 0.3%, KH_2PO_4 0.45%였다. 최적 PHA 생산조건을 조사하기 위하여 2단계 배양법을 이용하였다. PHA 생산은 배지성분중 NH_4, SO_4, Mg가 결핍되었을 때 향상되었고, 그중 NH_4의 결핍시 PHA 축적률과 HV monomer의 함량이 가장 높았다. C/N molar ratio 95.2에서 PHA 축적률이 가장 높았다. 공시균주 Pseucomonas sp. HJ는 alkane, alkanoic acid, alcohol을 탄소원으로 하여 PHB/HV를 생산하였다. PHA의 생산량과 HV monomer의 함량은 이용된 기질에 따라 다양하였으며, 특히 hexadecane와 propionate를 탄소원으로 하였을 때 PHA중의 HV monomer의 함량이 49∼74mol%로 매우 높았다. ^1H-NMR로서 공시균으로부터 분리정제된 PHA의 조성을 분석한 결과 PHB/HV copolymer임을 알 수 있었다. To produce PHA(polyhydroxyalkanoic acid) from microbe, dozens of microorganism have been screened from sewage sludge. Selected a strain HJ out of 50 strains of PHA producing bacteria has a capability of accumulating large amounts of PHB/HV copolymer when grown in batch culture with a single carbon source(glucose) that was not generally considered as precusor of hydroxyvalerate monomer unit. The strain HJ was identified as the genus Pseudomonas with respect to morphological, cultural, and biochemical characteristics. The optimal temperature and pH for cell growth were 37℃ and 7.0. The optimal medium compositions for cell growth were glucose 1% as a carbon source, (NH_4)_2SO_4 0.2%, as a nitrogen source, K_2HPO_4 0.3%, and KH_2PO_4 0.45%. To investigate the optimal condition for PHA production two-step cultivation method was employed. PHA production was induced by deficiency of NH^+_4, SO^2_4, Mg^+2. Besides carbon source, deficiency of all nutrients stimulated PHA productivity but deficiency of NH^+_4 stimulated the most HV monomer content. The highest PHA production was C/N molar ratio 95.2. Pseudomonas sp. HJ was also able to produc PHB/HV copolymer when cultivated on alkane, alkanoate, alcohol as carbon sources. Especially Pseudomonas sp. HJ was able to incorporate hydroxyvalerate into PHB/HV to level as high as from 49 to 74 mol% when grown in a medium containing hexadecane and propionate. The purified PHA was identified PHB/HV copolymer by ^1H-NMR analysis.

인체 대장암 및 자궁경부암에서 PCR-SSCP법을 이용한 Ki-ras 암유전자의 점돌연변이에 관한 연구

박영홍,백낙환,김현찬,김상효,홍관희,김기태,이기영 인제대학교 1994 仁濟醫學 Vol.15 No.2

인체 대장암 20례와 자궁경부암 10례의 암조직을 대상으로 c-Ki-ras 유전자 codon 12와 13에서의 점돌연변이를 알아보고자 polymerase chain reaction(PCR)과 single-strand conformation polymorphism(SSCP) 검사법을 시행하였다. 대장암의 경우 20례중 9례(45%)에서, 자궁경부암의 경우 10례중 1례(10%)에서 양성으로 나왔다. 대장암에서는 codon 12에서 GGT가 TGT로의 치환이 4례로서 가장 많았으며, AGT, CGT로의 치환이 각 1례였고 codon 13에서는 GGC가 GAC로의 치환이 2례, TGC로의 치환이 1례인 것으로 나타났다. 자궁경부암의 경우 codon 12에서 GGT가 AGT로의 치환이 1례인 것으로 나타났다. In an attempt to clarify the role of genetic alteration in the genesis of human colorectal and cervical cancers, tissue specimens from 20 patients with colorectal cancer and 10 patients with cervical cancer were examined for the presence of point mutation in K-ras2 exon 1 by single strand conformation polymorphism analysis of PCR product. Exon I of c-Ki-ras2 was amplified by polymerase chain reaction(PCR) and comparison was made between the normal and mutated genes by nondenaturing polyacrylamide gel electrophoresis(PAGE) of PCR product and nucleotide sequence analysis using asymmetric PCR with direct sequencing. Genomic DNA from white blood cells were used as normal control and those from A427 cell line were used as mutated control. 1.PCR product from A427 cell line showed a distinct migration shift pattern compared to the normal control in PAGE and the direct sequencing indicated that nucleotide sequence of codon 12 was mutated from GGT to GAT. In addition, there was a loss of normal allele in A427 cell line. 2.PCR product from 9 cases(45%) out of a 20 colon cancer patients showed migration shifts in PAGE, and all of these 9 patients invariably demonstrated mutation of ras gene, either in codon 12(6 cases:30%) or 13(3 cases:15%). The base substitutions in codon 12 were: from GGT to AGT(1), CGT(1), or TGT(4). Base changes in codon 13 were from GGC to TGC(1) or GAC(2). 3.PCR product from 1 cases(10%) out of a 10 cervical cancer patients showed migration shrifts in PAGE, Invariably demonstrated mutation of ras gene in codon 12. The base substitutions was from GGT to AGT(1) TQE incidence of point mutation of c-Ki-ras in colon cancer was high, however, it was low in cervical cancer, which showed the relation of ruts gene mutation with colon cancer. PCR -SSCP analysis is a simple, rapid and efficient method of detection of point mutation, especially when dealing with multiple samples.