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1 Original Article J Sasang Constitut Med 2013;25(1): 뇌졸중환자의체질별혈액학적특성 -1 개한방병원의입원환자를중심으로 - 전수형 김종원 류동훈 김규곤 이용태 동의대학교한의과대학사상체질과, 동의대학교데이터정보학과, 동의대학교한의과대학생리학교실 Abstract Hematologic Characteristics of Stroke Inpatients according to Sasang Constitution in One Korean Medicine Hospital Soo-Hyung Jeon, Jong-Won Kim, Dong-Hoon Ryu, Kyu-Kon Kim, and Yong-Tae Lee Dept. of Sasang Constitutional Medicine, College of Oriental Medicine, Dongeui Univ. Dept. of Data Information Science, Dongeui Univ., Dept. of Physiology, College of Oriental Medicine, Dongeui Univ. Objectives The purpose of this study is to know hematologic characteristics of patients with stroke in Sasang Constitutional Medicine which will be helpful for the prevention and treatment of stroke Methods We collected data from 111 patients who received treatment as a stroke inpatient at one Korean medicine hospital in Busan, Korea. A Sasang Constitutional Medicine(SCM) specialist diagnosed their Sasang Constitutional types based on the four diagnosis standard of SCM and herbal medicine reaction. Results of hematologic tests were classified according to gender, age, stroke types and Sasang Constitutional types and analysed by SAS system. Results 1. Male's mean value of RBC count, Hemoglobin and Hematocrit was lower than normal range. 2. The mean value of hscrp of above age 65 group was 3.19 times significantly higher than under age 65 group. 3. The mean value of platelet of cerebral hemorrhage group was significantly higher than cerebral infarction group. 4. The mean value of triglyceride of Taeeumin was significantly higher than Soyangin and Soeumin. Conclusions For the prevention of stroke, appropriate treatment of stress, trauma and infections is needed and male require a regular and balanced meals. Especially Taeeumin need to eat small meals to avoid excessive accumulation of energy Key Words : Stroke, Hematologic Tests, Triglycerides Received December 10, 2012 Revised December 13, 2012 Accepted February 07, 2013 Corresponding Author Soo-Hyung Jeon Dept. of Sasang Constitutional Medicine, Dong-eui Medical Center, 62 Yangjeong-ro, Busanjin-gu, Busan, , Republic of Korea Tel : Fax : jsoohyung@hanmail.net C The Society of Sasang Constitutional Medicine. All rights reserved. This is an open acess article distributed under the terms of the Creative Commons attribution Non-commercial License ( creativecommons.org/licenses/by-nc/3.0/)

2 SH Jeon et al. 15 I. 緖論 뇌졸중은우리나라에서암에이어사망원인 2위이고일생중걸릴확률이 75.61% 1 인질환으로급성기에는주로양 한방협진을통해입원치료가이루어진다. CT, MRI 검사와함께혈액검사가시행되는데그결과를환자의체질, 성별, 나이, 뇌졸중유형등과관련지어분석하여유의한특성을알게된다면뇌졸중의치료와예방에많은도움이될것으로생각된다. 본학회에앞서보고된최 2 와황 3 의연구중에서뇌졸중환자의혈중지질수치를체질별로비교하였고타학회의논문에서도중풍관련연구는대체로혈중지질에대한연구 4-7 가많았다. 일반적으로뇌졸중관련검사에는지질검사가반드시시행되고있으나뇌졸중의원인규명과치료선택을위해다양한검사가이루어지고있다. 1 최근다수의뇌졸중환자를대상으로다양한혈액검사를통해체질별혈액학적특성을밝힌연구가없고연구대상의일반적특성을앞선송 8, 최 2, 황 3 의연구와비교하면최근뇌졸중환자의발생경향성을짐작하는데도움이될것으로생각되어본연구를계획하였다. 우선 2010년 1년동안뇌졸중으로입원치료한환자의혈액검사결과중공통된 25개항목의값을수집하여성별, 나이, 뇌졸중유형, 사상체질별로구분하여혈액학적특성을살펴보았고통계적으로유의한결과를얻었기에이를보고하는바이다. Ⅱ. 硏究方法 1. 연구대상 2010년 1월부터 12월까지부산소재 OO 한방병원사상체질과에입원한중풍환자중에서뇌자기공명영상 (Brain-MRI) 또는뇌컴퓨터단층촬영 (Brain-CT) 검사를통해뇌졸중으로진단받고본원에서입원초기에혈액검사를시행한환자의혈액검사결과자료를수집 하였다. 본연구는동의대학교부속한방병원의 IRB 자문을통해심사대상아님을확인하였고본원연구윤리규정을준수하였다. 2. 연구방법 1) 사상체질진단입원당일환자의체형, 용모를관찰하고문진을통한성격과병증관련정보를근거로사상체질전문의가 1차체질진단을하였다. 처방한체질처방에대한약물반응을근거로최종적으로체질을진단하였다. 입원기간이 1주일이내로매우짧아호전반응을확인하기어려운경우는연구대상에서제외하였고입원기간중에체질처방이바뀌는경우퇴원시탕약을기준으로하였다. 2) 뇌졸중유형뇌내출혈, 거미막밑출혈, 뇌실내출혈의출혈뇌졸중은뇌출혈 (Cerebral hemorrhage) 그룹으로분류하였다. 열공경색 (lacunar infarction) 과일과성허혈발작 (transient ischemic attack) 은대상에서제외하였고그외허혈뇌졸중은뇌경색 (Cerebral infarction) 그룹으로분류하였다. 3) 연령분류 노인복지법 제26조 ( 경로우대 ) 와 기초노령연금법 을근거로하여노인의일반적인기준인 65세를기준으로 36세부터 64세까지의대상자는 65세미만그룹 (36-64yr) 으로 65세에서 94세까지의대상자는 65 세이상그룹 (65-94yr) 으로분류하였다. 4) 혈액검사결과수집본연구에서수집한혈액검사결과는뇌졸중발병일과무관하며입원일을기준으로가장먼저실시한혈액검사결과를사용하였다. 주로입원당일또는다음날아침채혈하여본원임상병리실로보내어져

3 16 Hematologic Characteristics of Stroke and SCM Table 1. General Characteristics of Subjects Sasang Constitution, N (%) Soyangin Taeeumin Soeumin Total, N (%) Gender Female 11(9.91) 26(23.42) 20(18.02) 57(51.35) Male 19(17.12) 23(20.72) 12(10.81) 54(48.65) Age (7.21) 15(13.51) 10(9.01) 33(29.73) (19.82) 34(30.63) 22(19.82) 78(70.27) CVA * type Cerebral infarction 24(21.62) 43(38.74) 22(19.82) 89(80.18) Cerebral hemorrhage 6(5.405) 6(5.405) 10(9.01) 22(19.82) Total 30(27.03) 49(44.14) 32(28.83) 111(100.00) * : Cerebro vascular accident 분석된것이다. 관찰항목은 AST, ALT, Total Protein(TP), Albumin, BUN, Creatinine (Crea), Na, K, Total cholesterol (T-clo), Triglycerides (TG), HDL-cholesterol (HDL-C), high sensitivity C-reactive protein (hscrp), activated partial thromboplastin time (aptt), prothrombin time- international normalized ratio (PT-INR), RBC count, WBC count, Hemoglobin, Hematocrit (Hct), Mean corpuscular volume (MCV), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC), Platelet, Red cell distribution width (RDW), Platelet distribution width (PDW), Mean platelet volume (MPV) 으로총 25가지이다. 검사의정상범위는본원임상병리실의기기와시약에따른기준값을사용하였다. 5) 통계분석통계분석은 SAS 9.1 프로그램을사용하였다. 남성과여성, 65세이상과 65세미만, 뇌경색과뇌출혈환자군사이에혈액검사결과의평균값의유의한차이가있는지알아보기위해 t-검정을하였고태양인을제외한세체질간의평균값의차이를보기위해일반선형모형 (GLM, general linear model) 을이용하여분산분석 (ANOVA) 를하였으며, F-검정의결과체질간유의한차이가있는항목에대하여 Duncan의다중비교 (multiple comparison) 를하였다. 오차범위는 5% 로하여 p<0.05일때통계적으로유의성을인정하였다. Ⅲ. 硏究結果 1. 연구대상의일반적특성연구대상자 111명의평균연령은 69.96세 ( 여성 73.09세, 남성 66.67세 ) 이고여성이 57명, 남성이 54명이다. 65세미만이 33명, 65세이상이 78명이고뇌경색이 89명, 뇌출혈이 22명이고태음인 49명, 소음인 32 명, 소양인 30명이며태양인은없다 (Table 1). 뇌경색환자 89명중여성은 42명, 남성은 47명이고 65세미만은 21명, 65세이상은 68명이고체질은태음인 43명, 소양인 24명, 소음인 22명순으로나타났다. 체질, 연령, 성별을모두고려하면태음인 65세이상여성이 20명으로가장많고소음인 65세미만여성이 1명으로가장적고소양인 65세미만여성대상자는한명도없다 (Table 2). 뇌출혈환자 22명중여성은15 명, 남성은 7명이고 65세미만은 12명, 65세이상은 10명이고체질은소음인 10명, 태음인 6명, 소양인 6명순서로나타났다. 체질, 연령, 성별을모두고려하면소음인 65세미만여성과 65세이상여성이각각 4명으로가장많다 (Table 2). 2. 성별차이성별차이를보기위해검사결과의평균을비교하는 t-검정을시행하였다. ALT, Creatinine, Na, Total cholesterol, HDL cholesterol, RBC count, WBC count, Hemoglobin, Hematocrit, MCH, MCHC, Platelet 검사항

4 SH Jeon et al. 17 Table 2. Frequency Table Classified by all Category Cerebral infarction Cerebral hemorrhage Gender Age Sasang Constitution, N Soyangin Taeeumin Soeumin Total, N Female Male Female Male Total Table 3. T-Test to see the Gender Difference Variables Normal range Female(N=57) Male(N=54) Mean SD Mean SD p-value AST 8~ ALT 5~ TP 6.3~ Albumin 3.5~ BUN 8~ Crea 0.6~ Na 137~ K 3.5~ T_cho 130~ TG 40~ HDL_C F:34~81 M:32~ hscrp 0~ aptt 25~ PT_INR 0.8~ RBCcount F:3.7~5.2 M:4.5~ WBCcount 4~ Hemoglob F:12~15 M:14~ <.001 Hct F:36~46 M:42~ MCV F:81~99 M:80~ MCH 27~ <.001 MCHC 32~ <.001 Platelet 140~ RDW 11.5~ PDW 11~ MPV 6.4~ F: female, M: male

5 18 Hematologic Characteristics of Stroke and SCM Table 4. T-Test to see the Difference between under age 65 and above 65 Variables Normal range 36-64yr (N=33) 65-94yr (N=78) Mean SD Mean SD p-value AST 8~ ALT 5~ TP 6.3~ Albumin 3.5~ BUN 8~ Crea 0.6~ Na 137~ K 3.5~ T_cho 130~ TG 40~ HDL_C F:34~81 M:32~ hscrp 0~ aptt 25~ PT_INR 0.8~ RBCcount F:3.7~5.2 M:4.5~ WBCcount 4~ Hemoglob F:12~15 M:14~ Hct F:36~46 M:42~ MCV F:81~99 M:80~ MCH 27~ MCHC 32~ Platelet 140~ RDW 11.5~ PDW 11~ MPV 6.4~ F: female, M: male 목에서유의한차이가있는것으로나타났다 (Table 3). 3. 연령별차이 65세이상그룹과미만그룹의차이를보기위한 t- 검정결과 hscrp, PT-INR, RBC count, Hemoglobin, Hematocrit 검사항목에서유의한차이가있는것으로나타났다.(Table 4) 4. 뇌졸중유형별차이뇌경색과뇌출혈환자군의차이를보기위한 t-검 정결과 Albumin, Platelet, RDW, PDW, MPV 검사항목에서유의한차이가있는것으로나타났다 (Table 5). 5. 체질별차이 AST, ALT, TG, MCHC, Platelet, PDW 검사항목에서체질간유의한차이가있는것으로나타났다. AST, ALT, MCHC, PDW에있어서태음인과소양인이소음인보다유의하게큰것으로나타났고태음인과소양인간유의한차이는확인할수없었다. TG에있어서태음인이소양인과소음인보다유의하게큰것으로나타났고소양인과소음인간유의한차이는확인할

6 SH Jeon et al. 19 Table 5. T-Test to see the Difference between Cerebral Infarction and Hemorrhage Variables Normal range Cerebral infarction (N=89) Cerebral hemorrhage (N=22) Mean SD Mean SD p-value AST 8~ ALT 5~ TP 6.3~ Albumin 3.5~ BUN 8~ Crea 0.6~ Na 137~ K 3.5~ T_cho 130~ TG 40~ HDL_C F:34~81 M:32~ hscrp 0~ aptt 25~ PT_INR 0.8~ RBCcount F:3.7~5.2 M:4.5~ WBCcount 4~ Hemoglob F:12~15 M:14~ Hct F:36~46 M:42~ MCV F:81~99 M:80~ MCH 27~ MCHC 32~ Platelet 140~ RDW 11.5~ PDW 11~ MPV 6.4~ F: female, M: male 수없었다. Platelet에있어서소음인이소양인과태음인보다유의하게큰것으로나타났고소양인도태음인보다유의하게큰것으로나타났다 (Table 6). Ⅳ. 考察 본연구는단일기관연구이고샘플사이즈가적어자료가치우칠가능성이많다고생각되어뇌졸중의역학관련자료를찾아서서로비교해보았다. 뇌졸중유형에서뇌경색이 89명 (80.2%), 뇌출혈이 22명 (19.8%) 으로대략 8:2의비율로뇌경색이많았는데뇌 졸중의 80% 정도가뇌경색으로알려져있고 9 한방병원에입원하는뇌출혈과뇌경색환자의비율이 2:8 정도로뇌경색이훨씬더높은비율을차지한다는보고 10 와유사한결과를보였다. 성별에서뇌경색은남자 47명, 여자 42명으로남자가많은반면뇌출혈은여자 15명, 남자 7명으로여자가 2.14 배많았는데뇌졸중발생률이남자에서여자보다높다는통계자료 1 와비교해뇌경색의경우는유사하게나타났으나뇌출혈의경우는다른결과를나타내었다. 나이에있어서 65세이상이 78명 (70.27%) 으로 65세미만 33명 (29.73%) 보다 2.36배많았고체질별로세분하면소양인은 2.75배, 태음인은 2.27배, 소음인은 2.2배로체질

7 20 Hematologic Characteristics of Stroke and SCM Table 6. Constitutional Difference by General Linear Models(ANOVA) Variables Normal range Soyanin (N=30) Taeeumin (N=49) Soeumin (N=32) Duncan' multiple p-value Mean SD Mean SD Mean SD comparison AST 8~ a b c b=a>c ALT 5~ a b c b=a>c TP 6.3~ Albumin 3.5~ BUN 8~ Crea 0.6~ Na 137~ K 3.5~ T_cho 130~ TG 40~ a b c b>a=c HDL_C F:34~81 M:32~ hscrp 0~ aptt 25~ PT_INR 0.8~ RBCcount F:3.7~5.2 M:4.5~ WBCcount 4~ Hemoglob F:12~15 M:14~ Hct F:36~46 M:42~ MCV F:81~99 M:80~ MCH 27~ MCHC 32~ a b c a=b>c Platelet 140~ a b c c>a>b RDW 11.5~ PDW 11~ a b c b=a>c MPV 6.4~ a, b, c : Duncan' multiple comparison F: female, M: male 에관계없이 65세이상이 65세미만보다많았는데연령증가에따라뇌졸중유병률이상승한다는보고와다르지않은결과를보였다. 그러나뇌출혈의경우 65세이상이 10명 (45.5%) 으로 65세미만 12명 (54.5%) 보다오히려적었다. 따라서본연구에서뇌출혈의경우는일반적인역학관련자료와다른결과가나타났는데차후더많은수의뇌출혈환자를대상으로추가연구가이루어져야지역적인특징인지아니면작은샘플로인한치우침인지를밝혀낼수있을것이라생각된다. 혈액검사결과뇌졸중남성이여성보다빈혈가능 성이높은것으로나타났다. 남성의 RBC count, Hemoglobin, Hematocrit의평균값이여성보다모두유의하게큰것으로나타났으나정상범위보다모두낮게나타났다. 본연구는대조군이없고같은지역일반인을대상으로영양상태를조사한연구를찾지못하여부득이하게안동지역 50세이상중년및노인인구를대상으로영양상태를조사한이 11 의연구와비교해보았다. 본연구의대상자평균연령이 세이므로이의연구대상자중에서고령인 70세이상인그룹과비교하였다. 이의연구대상자는남성 106 명, 여성 130명이었고이들의적혈구용적률의평균

8 SH Jeon et al. 21 값은각각 43.4% 와 39.1% 로본연구의 40.53%, 37.38% 와비교하여남녀모두크고정상범위였다. 즉뇌졸중환자가일반인에비해영양상태가나쁘고남성이여성보다더나쁠가능성이있다고추측할수있으나추후계획된대조군연구를통해검정이필요할것으로생각된다. 65세이상그룹의 hscrp 평균값이 65세미만보다 3.19배높고정상범위보다 2.38배높게나타나염증소견이높은것으로나타났다. C-반응단백 (CRP) 은폐렴구균에의한감염에서회복된사람에게서처음발견되었으며매우예민한급성기반응물질로심근경색, 스트레스, 외상, 감염, 염증, 수술, 종양에서증가한다. 12 고감도 C-반응단백 (hscrp) 검사는 CRP검사의정밀도와예민도를높여서낮은범위의 CRP도측정할수있는검사이다. 많은코호트연구에서 hscrp 증가와심뇌혈관질환및뇌졸중발생과의관련성이보고되었으며건강한성인에서 hscrp수치가증가함에따라뇌졸중발생위험도가 2-3배증가하는것으로보고되었다. 1 뇌졸중의주요원인인죽상경화도혈관내피세표의손상에의해발생하는일종의만성염증성질환 1 이고일반적으로고령일수록운동기능과면역기능이떨어져다양한병원균에취약해폐렴과같은각종염증을가질가능성이커지기때문에 hscrp 결가가높아진것으로추측된다. 뇌경색과뇌출혈환자군의비교에서뇌출혈이뇌경색보다혈소판수치의평균값이유의하게컸는데 2005년김 13 의뇌경색과뇌출혈초기혈액검사비교연구와같은결과를보였다. 혈소판은혈관손상후생성되는여러가지혈소판자극물질에의해활성화되는데뇌출혈이뇌경색보다뇌혈관손상이크기때문일것으로생각된다. 태양인을제외한세체질의비교에서중성지방의경우예상대로태음인의중성지방평균값이소양인과소음인에비해유의하게크게나타났고정상범위를초과하였다. 중성지방은고에너지의대사연료이며에너지저장의가장유용한형태 12 로태음인이식성이좋고흡취지기가강하기때문일것이라쉽게생각할 수있는부분이다. 본학회에보고된 2010년최 14 의연구에서중성지방평균값이태음인 (133.50), 소양인 (114.97), 소음인 (99.91) 순서로유의하게높게나타난결과와유사하게나타났다. 최의연구는다양한질환이포함된 1084명의체질확진자를대상으로하였고본연구는 111명의뇌졸중환자를대상으로한것인데최의연구결과와비교해중성지방평균값이소양인은 3.04%, 소음인은 8.5% 큰데비해태음인은 28.35% 크고정상범위를초과한것을보아중성지방수치의증가는타체질보다태음인에게있어뇌졸중의발생과연관성이있을것이라추측해볼수있다. Ⅴ. 結論 본원뇌졸중입원환자 111명의혈액검사결과를성별, 나이, 뇌졸중유형, 사상체질별로비교한결과다음과같은결론을얻었다. 1. 뇌졸중입원환자중남성이빈혈가능성이높은것으로나타났는데남성의식습관과영양상태의불량이원인으로생각되며뇌졸중예방을위해남성의경우규칙적이고균형잡힌식사가필요할것으로생각된다. 2. 나이가많을수록염증소견이높게나타났고뇌졸중의원인이될수있으므로평소스트레스, 외상, 감염등에대한적절한치료와예방이뇌졸중예방과관련이있을것으로생각된다. 3. 중성지방의증가는다른체질보다태음인에게있어뇌졸중의발생과연관성이있을것이라생각되며태음인은에너지과잉축적을피하기위한소식이가장필요할것으로생각된다. 향후다기관연구를통해데이터수와지역적한계를극복하고혈액검사에영향을줄수있는질환군을배제하고일반인을대조군으로하는추가연구가필요할것으로생각된다.

9 22 Hematologic Characteristics of Stroke and SCM Ⅵ. 感謝의글 이논문은 2011년도동의대학교교내연구지원을받아수행된연구임 (Grant No. 2011AA129) Ⅶ. 參考文獻 1. Clinical Research Center For Stroke. CLINICAL PRACTICE GUIDELINE FOR STROKE. Seoul:Clinical Research Center For Stroke, 2009:3-4,19-20,72-75, (Korean) 2. Choi JY, Park SS. A Clinical Study for 157 Cases of CVA by Sasang Constitutional Medicine. J Sasang constitut Med. 1998;10(2): (Korean) 3. Hwang MW, Lee SK, Choe BK, Song IB, Koh BH. The Research on the Sasang Constitutional Characteristics of Stroke Inpatients. J Sasang constitut Med. 2005;17(1): (Korean) 4. Son YH, Lee SH, Kim JK, Jeong HY, Kim YK, Kwon JN. A Clinical Study on Blood Lipids as a Risk Factor of Cerebral Infarction. Journal of pharmacopuncture. 2008;11(4):49-58.(Korean) 5. Kim JH, Kang KW, Yu BC, Choi SM, Baek HK, Lim SM et al. A Case-Control Study on Blood Lipids as a Risk Factor of Stroke. Korean J. Orient. Int. Med. 2007;28(4): (Korean) 6. Ko HY, Jun CY, Park JH, Yoon YS, Lee SD, Han CH, et al. A relationship between stroke and Sasang constitution in Korea. Orient pharm Exp Med. 2005;5(4): (Korean) 7. Lee SW, Lee MG, Park SW, Son JW, KIm DJ, Kang BG, et al. A Study on the Relationship between Sasang Constitution and Serum Lipids in CVA Patients. Korean J. Orient. Int. Med. 2006;27(2): (Korean) 8. Song IB. A clinical study of the stroke treatment based on Sasang Constitutional Medicine. J Sasang Constitut Med. 1996;8(2): (Korean) 9. Korean Neurological Association. Neurology. Seoul: koonja, 2007: (Korean) 10. National federation of department of heart system of oriental internal medicine, colleges of oriental medicine. Today's oriental stroke treatment - EBM Approach. Seoul:Seowondang, 2010:17-19.(Korean) 11. Lee HS, Kwun IS, Kwon CS. Anthropometric Measurements and Biochemical Nutritional Status of the Older Residents (50 years and over) in Andong Area (2). J Korean Soc Food Sci Nutr. 2008;37(12): (Korean) 12. The Korean Society for Laboratory Medicine. Laboratory Medicine. 4th edition, Seoul:Epublic, 2011: ,307. (Korean) 13. Kim JW, Shim JC, Kim JK, Kim JH, Baek KM, Lee HE, et al. The Hematologic Study on acute stage of Cerebral Infarction Patients and Cerebral Hemorrhage Patients. The Korean Journal of Joongpoong. 2005; 6(1):17-23.(Korean) 14. Choi AR, Lee SW, Koo DM. A Study on the Serum Lipid, Digestive Enzymes and Thyroid Hormone in Sasang Constitutional Medicine. J Sasang constitut Med. 2010;22(2): (Korean)

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical