고요산혈증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이종은,이준숙,이찬구,이한정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : Serum uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities. The aim of this study is to evaluate risk factors which influence hyperuricemia in the citizens of Asan. Method : The study design was cross-sectional and research subjects were 1086 citizens of Asan. General characteristics, cigarette smoking, alcohol consumption, and past history were obtained by interview using a structural questionnaire. Also, we measured height, weight and blood pressure, and serum uric acid of the subjects. Results : The mean serum uric acid level was 5.27 ㎎/㎗ in men and 4.01 ㎎/㎗, in women, In the multiple logistic regression analysis, statically significant risk factors of hyperuhcemia were gender, body mass index, blood lead concentration, and serum creatinine. Conclusion : Our results suggest that gender, body mass index, blood lead concentration, and serum creatinine might be the most important risk factors of hyperurcemia. Education program as well as routine check-up for serum uric acid was highly recommended for the effective prevention of hyperuricemia.

골다공증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이남수,이상건,이상범,이상우,이선정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analyzed the relating factors. Method : A population-based sample of 1086 adults in Asan-city, Korea was investigated with questionnaires and height, weight, Information regarding the general characteristics(gender, age, economic state), lifestylef exercise, smoking, alcohol),medical history(progestin, GH, steroid, calcitonin, PTH), demographic parameter, obesity, stress, and family history was collected through an interview using a structural questionnaire. The level of obesity was measured by the body mass index(BMI). BMD(Bone mineral density) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Osteoporosis was considered to be T-score below -2.5. Results : The prevalence of osteoporosis increased progressively with age, decreased with BMI and predominant in women by the result of x^(2) -test, T-test. Age, weight, BMI were significantly correlated with osteoporosis by the result of Pearson correlation ana1ysis(P<0.05). And age, gender, BMI, family history of osteoporosis were proved to be significant risk factors of osteoporosis by the result of multiple logistic regression(P<0.05). Conclusion : These results suggest that age, gender, BMI might be the most important risk factors of osteoporosis. And the history taking about family history of osteoporosis is helpful for diagnosing osteoporosis.

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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새로운 연노출의 효과지표로서의 혈장 δ-aminolevulinic acid 측정의 유용성

이금원,황보영,김용배,리갑수,이성수,장봉기,함정오,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

To evaluate the usefulness of the measurement of plasma δ - aminolevulinic acid (ALAP) as a new effect indicator of lead exposure, the association of ALAP with blood lead, DMSA chelatable lead and bone lead with a special emphasis of genetic interaction of ALAD polymorphism was studied with 419 lead exposed workers and 85 non-lead exposed workers. Lead workers were recruited from storage battery industries, secondary smelting industries and other lead using industries and non-lead workers selected from electronic refrigerator manufacturing industry. Blood lead, DMSA chelatable lead and bone lead were chosen for parameters of lead exposure. Plasma and urinary ALA were selected for the effect parameter of lead intoxication. Information for age, smoking, drinking habit and body mass index were also obtained. Job duration for lead workers was also collected. The overall prevalence of the variant allele, ALAD type 1-2 or 2-2(ALAD2) in lead exposed workers was 10.0% (42 out of 419 lead workers) which was not differed from control workers (9.4% : 8 out of 85). The means blood lead and DMSA chelatable lead of lead workers with ALAD 1(ALAD type 1-1) were lower than those of lead workers with ALAD2, but the differences were not statistically significant. On the other hand, the mean of tibia lead of lead workers with ALADI was higher than that of lead workers with ALAD2, but the difference was not statistically significant. DMSA chelatable lead showed highest correlation with log transformed plasma ALA(LALAP)(r=0.682) and blood lead and tibia lead had r=0.650, r=0,402 correlation coefficient with LALAP respectively On the other hand. log transformed urinary ALA(LALAU) had lower correlation coefficient with all three parameters of lead exposure than LALAP. The equation of robustic simple linear regression of blood lead on LALAP was LALAP=2.0439+0.0165PbB in ALADI lead workers and LALAP=2.031+0.0121PbB in ALAD2 lead workers. ALAD genotype in the multiple regression analysis of blood lead with LALAP after adjusting for possible confounders(sex, ago, BMI, smoking and drinking status and job duration) showed significant main effect on LALAP resulting lower LALAP in ALAD2 lead workers than ALADI lead workers. On the other hand, effect modification of ALAD genotype was observed in the multiple regression analysis of tibia lead with LALAP after adjusting for possible confounders, but there was no significant effect of ALAD genotype in the multiple regression analysis of DMSA chelatable lead with LALAP after covariate adjustment. With above results, plasma ALA was found to be a useful effect parameter of lead exposure compared with urinary ALA. It was also observed that ALAD polymorphism made significant effect on the association of blood and tibia lead with ALAP. Thc lower plasma ALA in ALAD2 lead workers suggested supportive effect of ALAD2 in lead exposure.

업종에 따른 연 취급 사업장의 기중 연 농도 및 연 노출 수준 평가

이병국,김용배,리갑수,안현철,김화성,이용진,황규윤,장봉기,이성수,안규동 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

In order to obtain an useful information for health management and biological monitoring of lead exposed workers, Authors tried to investigate air lead level and the lead exposed level of workers in lead industry according to occupational category. The subjects in our study were 2074 workers in 7 lead-using industries, and study subjects were divided into 4 occupational categories such as storage battery industry (type 1), primary smelting industry (type 2), secondary smelting industry (type 3) and litharge making industry (type 4). Blood zincprotoporphyrin concentration (ZPP), blood lead concentration (PbB) and urinary δ -aminolevulinic acid (ALAU), hemoglobin (Hb), hematocrit (Hct) were selected as the indices of lead exposure. Personal variables such as age, work duration were also collected. The results were as follows. 1. The geometric mean air lead in 9 lead-using industry was 0.1133±4.3120 ㎎/㎥, and that in type 1, 2, 3 and 4 was 0.1038±3.4952 ㎎/㎥, 0.0429±3.4329 ㎎/㎥, 0.1877±2.5123 ㎎/㎥ and 0.9961±5.2910 ㎎/㎥, respectively. 2. The mean ZPP in 9 lead-using industry was 53.1±28.0 ㎍/㎗, and that in type 1, 2, 3 and 4 was 52.0±24.8 ㎍/㎗, 48.0±16.4 ㎍/㎗, 109.8±85.6 ㎍/㎗ and 74.3±37.8 ㎍/㎗, respectively. There was significant difference in ZPP according to occupational category (P<0.01). The percents of lead workers whose ZPP were above 100 ㎍/㎗ in type 1, 2, 3 and 4 were 4.0%, 1.7%, 34.3% and 21.6%, respectively. 3. The mean PbB in lead-using industry was 26.0±11.2 ㎍/㎗, and that in type 1, 2, 3 and 4 was 25.3±11.1 ㎍/㎗, 26.7±8.8 ㎍/㎗, 50.3±15.2 ㎍/㎗ and 36.4±11.0 ㎍/㎗, respectively. There was significant difference in PbB according to occupational category (P<0.01). The percents of lead workers whose PbB were above 40 ㎍/㎗ in type 1, 2, 3 and 4 were 10.4%, 7.7% 71.9% and 43.2%, respectively. 4. While the correlation of Hb corrected PbB with ZPP was higher than non corrected PbB, the correlation of log-transformed ZPP with PbB was higher than non corrected ZPP. 5. Simple linear regressions of PbB and corrected PbB as independent variable with ZPP, log-transformed ZPP and ALAU as dependent variable were statistically significant (P0.01). Coefficient of determination of corrected PbB with other variables was higher than non corrected PbB. As the result of this study, it was suggested that reconsideration of environmental and biological monitoring program was highly recommended for secondary smelting and litharge making industry.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

연작업자들의 신기능 평가에서 요중 δ-aminolevulinic acid 측정의 의의

이병국,이숙,김용배,리갑수,김화성,황규윤,장봉기,이성수,안규동 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

To clarify the effect of occupational lead exposure on renal function 241 lead workers working and 56 non lead workers were studied in 5 lead acid battery industries. Study variables for renal effect were urinary N-acetyl-β-D-glucosaminidase(NAG), urinary total protein(U-TP), blood urea nitrogen(BUN), serum creatinine(S-Cr), and serum uric acid(S-Ua). On the other hand, blood lead(PbB), zinc protoporphyrin in whole blood(ZPP), and delta-aminolevulinic acid in urine(δ-ALA) were selected for the variables of lead exposure. Information on age, work duration, smoking and drinking history were also obtained. The results obtained were as follows. While the mean values of lead exposure indicators of lead workers were significantly different from non-exposed ones, the mean values of BUN, U-TP and S-Cr of renal function indicators of exposed were also different from non-exposed. BUN, U-TP and NAG showed statistically significant correlation with PbB and ZPP, and NAG revealed also statistically strongly significant correlation with δ-ALA. On multiple regression using renal fuction indicators as a dependent variable and δ-ALA, age, work duration,lead exposure,smoking and drinking as independent variables, only δ-ALA contributed to NAG.

모 연취급장 근로자들의 연폭로지표들과 혈압과의 관련성

임상복,김용배,이용진,리갑수,김화성,황규윤,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1998 순천향산업의학 Vol.4 No.1

In order to investigate the relationship between blood lead with other lead exposure indices and blood pressure in occupationally lead exposed male workers, 629 workers(515 lead exposed workers and 114 non lead exposed workers) in a storage battery factory were studied. Blood lead(PbB), zinc protoporphyrin(ZPP) and urinary δ-aminolevulinic acid(ALAU) were selected as an index of lead exposure. Height and weight were also meaured with calibrated automatic height-weight machine to produce fatness index directly. Personal information on smoking and drinking history were also collected. Blood pressure was mearured by trained nurses with automatic sphingomanometer. All workers took at least 30 minute rest before their measurement of blood pressure. The results obtained were as follows: 1. The prevalence rate of hypertension of lead exposed and non-exposed workers were 3.5% in both group without any difference. 2. There were no differences of systolic and diastolic pressure between groups divided by lead exposure, smoking habit, drinking habit. but the increase of age group made the difference of diastolic pressure, and only differenct of systolic pressure observed in age group of less than 20 and that of more than 40. 3. In pearson's correlation analysis, PbB was correlated with systolic pressure significantly, but not with diastolic pressure. PbB was also correlated with pressure difference(systolic pressure-diastolic pressure). 4. There were no significant increase of systolic, diastolic pressure and pressure difference by the increase of PbB and ZPP grouping. 5. Stepwise multiple regression analysis using systolic pressure as dependent variable and PbB, ZPP, ALAU, age, work duration, smoking habit, drinking habit and fatness (weight*0.9/height-100) as independent variables, revealed that PbB, age, drinking habit and fatness in order were significantly contributed to the dependent variable. 6. Stepwise multiple regression analysis using diastolic pressure as dependent variable and PbB, ZPP, ALAU, age, work duration, smoking habit, drinking habit and fatness (weight*0.9/height-100) as independent variables, revealed that ALAU, age and fatness in order were significantly contributed to the dependent variable. 7. Stepwise multiple regression analysis using pressure difference as dependent variable and PbB, ZPP, ALAU, age, work duration, smoking habit, drinking habit and fatness(weight*0.9/height-100) as independent variables, revealed that PbB, age and fatness in order were significantly contributed to the dependent variable. 8. Logistic analysis of hypertensive conditions with categorized blood lead and other selected categorized independent variables indicated that only age(40> and 40≤) and fatness(1.0> and 1.0≤) were significantly contributed to dependent variable with 95% significant odd ratio confidence interval. With above results, lead exposure in terms of blood lead seemed to be minimally contributed to the raise of blood pressure, and the effect of blood lead was found to be more prominent on the pressure difference than the systolic and diastolic pressure themselves.

모 축전지 회사 근로자들의 연폭로 지표에 대한 경시적 관찰

강명식,김용배,이용진,리갑수,김화성,황규윤,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1998 순천향산업의학 Vol.4 No.1

Lead poisoning is still prevalent and one of important occupational disease in Korea. To prevent undue high lead burden and maintain good health condition of lead workers in lead using industries, periodic health examination and regular biological monitoring of lead workers are often required in addition to the fundamental improvement of their working condition. To evaluate the effect of comprehensive occupational health program with regular biological monitoring on the level of lead exposure of lead workers in lead using industries, 11 year database from 1983 to 1994 of one storage battery factory was reviewed. From 1983 to end of 1986 only periodic health examination was provided to the lead workers, but from 1987 comprehensive occupational health program with regular biological monitoring was provided to maintain better health condition of lead workers. Selected study variables for lead exposure were blood lead(PbB), zinc protoporphyrin in blood(ZPP), δ-aminolevulinic acid in urine(ALAU), hemoglobin(Hb), hematocrit(HCT). Information on sex, age and work duration was also reviewed. 5 years data from 1983 to 1987 and 3 years data from 1990, 1993 and 1994 were available for all lead exposure indices except ALAU which has only 5 years data from 1983 to 1997. The results of 11 years longitudinal observation of lead indices are all follows: 1. The mean value of ZPP of lead workers in 1983 was 148.7±73.1 ㎍/㎗(Male: 145.5±72.3, Female: 168.1±79.1), whereas that of ZPP of lead workers in 1994 was decreased to 64.3±32.7 ㎍/㎗(Male: 60.2±28.8, Female: 95.2±43.4). 2. The mean value of PbB of lead workers in 1983 was 56.4±18.8 ㎍/㎗(Male: 55.59±19.1, Female: 59.6±19.1), whereas that of PbB of lead workers in 1994 was dcreased to 35.4±11.9 ㎍/㎗(Male: 35.7±12.0, Female: 32.8±10.8). 3. The mean value of Hb of lead workers in 1983 was 14.1±1.4 g/㎗(Male: 14.4±1.1, Female: 11.7±0.8), whereas that of Hb of lead workers in 1994 was increased to 15.6±1.5 g/㎗(Male: 15.9±1.2, Female: 12.9±1.1). 4. Blood lead is most highly correlated with ZPP(r=0.522, male:0.54 and female:0.50) and also correlated with ALAU and work duration also. 5. The simple regression analysis of PbB and ZPP showed different coefficient of regression by the measurement year, but there was no difference of coefficient of regression between sex. The slope of equation of pooled data for 1983-1986 without comprehensive occupational health program was 2.16 and differed from that of pooled data for 1987-1994(1.25). This difference suggests that the unit effect of blood lead on ZPP was relatively smaller in later period of comprehensive occupational health program than carly period without comprehensive program. The slope change in the analysis of linear regression of PbB on ZPP in lead workers can be used to evaluate the possible effect of health intervention to prevent undue high lead absorption in lead using industries. 6. 11 years occupational health service in this storage battery factory brought out considerable improvement of health status of lead workers in terms of decrease of PbB and ZPP and increase of Hb and the improvement was more remarkable after the introduction of comprehensive occupational health program.

기능성 소화불량증환자에서 Winstal® 투여에 관한 임상경험

이창형,김영탁,금민수,권중구,안병철,윤영미,권영오,김성국,최용환,정준모 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.3

목적 : 기능성 소화불량증은 소화, 흡수등 장관의 기능적인 이상과 관련되어 있을 것으로 생각되며 복합소화효소제(Winstal®)를 투여하여 그 임상효과를 평가하고자 본 연구를 실시하였다. 대상 및 방법 : 1994년 3월 부터 6월까지 경북대학교병원 내과를 방문한 기능성 소화불량증을 호소하는 환자 20명을 대상으로 Winstal®을 1회 1정씩, 1일 3회 식후 30분내에 경구로 2주간 투여하였다. 결과 : 소화불량증의 증상은 복부불쾌감, 복부팽만감, 식욕부진 및 오심, 복부동통, 공기연하증, 고창 및 구토순이었으며, 증상의 개선은 복부불쾌감이 76.4%(13/17)로 가장 높았으며, 그 다음으로 복부팽만감 및 공기연하증이 66.5%(10/15, 6/9)이었고, 오심 61.5%(8/13), 식욕부진 53.8%(7/13), 복부동통 41.6%(5/12), 고창 37.5%(3/8)이었다. 각 환자별 종합적인 증상의 개선도는 현저한 개선이 2예(10%), 중등도 개선이 3예(15%), 약간개선이 11예(55%), 불변이 4예(20%)이었으며 종합적인 유효율은 80%(16/20)이었다. 부작용은 한 예에서도 관찰되지 않았다. 결론 : 본 제제는 기능성 소화불량증 환자의 증상개선에 추천할 만한 유효한 약제로 생각된다. Dyspepsia is a common symptom in gastroenterologic practice and trigger for numerous consultations with physician. The treatment of chronic functional dyspesia is unsatisfactory. This study was performed to evaluate the efficacy of the digestive compound (Winstal®) on 20 functional dyspepsia patients. On open trial, all patients were given 6 tablets daily for 2 weeks and we evaluated the efficacy of this preparation according to the degree of the improvement. The improvement of symptoms was 76.4%(13/17) in abdominal discomfort, 66.5%(10/15, 6/9) in abdominal distension and aerophagia, 61.5%(8/13) in nausea, 53.8%(7/13) in abdominal pain, and 37.5% (5/12) in flatulence, respectively. Overall effectiveness of subjective symptoms was 80% (16/20) and there were no untoward effects of the preparations during this study. As a result, We think that this preparation is an effective one to relieve symptoms of functional dyspepsia.