DBPIA-NURIMEDIA

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1 대한구강내과학회지 Vol. 34, No. 1, 2009 부산대학교치과대학구강내과학교실 목적 ; 본연구는가스분석검사기의일종인 Oral Chroma R (CHM-1, Osaka, Japen) 를이용하여건강검진센터에내원하는환자를대상으로전신질환판정검사에서이상소견을가진환자에서구취를일으키는휘발성황화합물을측정비교하여전신질환이구취에미치는영향을알아보고자하였다. 방법 ; 수집된자료는통계분석프로그램인 Statistical Package for the Social Science12.0(SPSS Inc, Chicago, IL, USA) 을이용하여구강검사 (CPI index, 탐침시출혈유무, 설태의유무 ) 결과및각검사별전신질환의유무에따른황화수소, 메틸머캅탄, 황화디메틸의농도를교차분석으로분석하였다. 결과 ; 휘발성황화합물과관계있는질환은간질환과담낭질환이라는사실을확인할수있었으며그외골밀도와혈압, 지질검사등에서의관련성도관찰되어추후연구가더필요할것으로생각된다. 주제어 : 휘발성황화합물, 전신질환, 구취 1)Ⅰ. 서 구취는구강및인접기관에서나는불유쾌한냄새로일반적으로호기의냄새중에서도타인으로하여금불쾌감을느끼게하는악취를말한다. 1,2) 복잡하고다양한대인관계를맺고있는현대인들에게구취는사회생활및정신건강에중요한영향을미치는문제점으로대두되어왔다. 3) 구취의원인은크게나누어전신적원인, 구강내원인, 심인적원인, 생리적원인등으로나누어볼수있다. 전신적원인으로는신장질환, 간질환, 당뇨, 호흡기장애, 탈수등에의하여구취가발생될수있으며, 4) 공복, 기상, 월경, 흡연, 약물섭취시에도생리적으로구취가발생될수있다고보고된바있다. 5) 심인적원인으로는가상구취, 구취공포 교신저자 : 고명연부산시서구아미동 1 가 10 번지부산대학교치과대학구강내과학교실전화 : Fax: myko@pusan.ac.kr 원고접수일 : 심사완료일 : * 이논문은부산대학교자유과제학술연구비 (2 년 ) 에의하여연구되었음 론 증, 자가구취등이있으며, 6,7) 구강내원인으로는불량한구강위생상태, 치주질환, 설태, 식편압입, 비위생적인의치, 부적절한보철물, 구강암종등을들수있다. 2,4,8,9) Spouge 와 Spielman 등 4,10) 은구취는구강건강상태에의해가장큰영향을받는다고주장하였고 Finkelstein 등 11,12) 은구강다음으로빈번한구취의원인을제공하는것이비강과관련된구조물이라고생각했으며구개열등의두개안면기형을가진환자들은구강과비강의악취에이환되기쉽다고주장하였다. Tonzetich 13) 는지속적인구취의원인이위장관궤양, 내출혈, 열공허니아, 당뇨병, 간경화증, 백혈병, 요산혈증및많은특성이없고원인불명인질병들과같은질환과관련이있다고하였고 Attia 와 Marshall 14) 은전신질환이구취의원인이될수는있으나이는매우드물다고주장하였다. 장등 15) 은타액내아미노산이구취발생에미치는영향에대해보고하였다. Rosenberg 16,17) 는구취를일으키는분자들중특정아미노산의분해시발생하는휘발성황화합물이전체휘발성화합물중 90% 를차지하여주요성분은황화수소 (hydrogen sulfide, H 2 S) 와메틸머캅탄 (methyl mercaptan, CH 3SH) 그리고황화디메틸 (dimethyl sulfide, (CH 3 ) 2 S) 이라고보고 11

2 하였다. 또한전신질환과연관되어구취를야기하는분자에관한연구에서당뇨와폐암에서는휘발성인 aceton분자가, 그리고간질환에서는휘발성황화물이구취를일으키는것으로보고되었다 ) 이등 19) 은전신질환에따른휘발성황화합물의농도를비교연구하였다. 그러나표본수가작고조사한전신질환의범위가제한적이었다. 아직전신질환과휘발성황화합물의농도를비교연구한논문은아직충분하지않은실정이다. 구취의진단을위해구취를객관적으로측정하는방법에는검사자의감각수용기에의존하거나, 20) 구취의질적인측정을위해서는가스분석검사기 (Gas Chromatography) 21) 와미생물배지를이용한항균검사 22) 등을이용한다. Tonzetich 23) 은가스분석법을이용하여구강내기체에서황화수소, 메틸머캅탄농도와감각적으로느끼는구취사이에높은상관관계가있다고하였으며구취를감소시키기위해서는메틸머캅탄을억제하는것이대단히중요하다고언급하였다. 전통적방법은 Gas Chromatography를사용했다. 구취원인물질의정확한규명을위해서는 Gas Chromatography가유용하지만많은시간과비용이소요되는단점이있다. 최근에는휴대용기구은 Halimeter R 를사용하여구취의주원인물질이라고보고된휘발성황화합물의농도를빠르게측정함으로써개인의구취를보다용이하게측정할수있게되었다. 24) 그러나 Halimeter R 는 Gas Chromatography에비해간편하지만구취를일으키는주요성분인황화수소, 메틸머캅탄, 황화디메틸의각값을측정하지못하는단점이있다. 본연구는가스분석검사기의일종인 Oral Chroma R (CHM-1, Osaka, Japen) 를이용하여건강검진센터에내원하는환자를대상으로전신질환판정검사에서이상소견을가진환자에서구취를일으키는휘발성황화합물을측정비교하여전신질환이구취에미치는영향을알아보고자하였다. 따라서본연구를통해저자는구취의원인에대한광범위한진단기준과치료를위한기초자료로활용하고자하였으며또한전신질환에원인이있는경우필요한검사방법을제안하기위한자료로활용하고자한다. 1. 연구대상 Ⅱ. 연구대상및방법 2008 년 4 월에서 9 월사이에부산대학교병원건강 증진센터를방문하여구강검진을포함한전신질환에대한종합검진을시행한환자들중본연구에동의한 182 명을대상으로하였고, 그중남성이 112 명, 여성이 70 명이었고, 연령분포는 20 세에서 72 세였다. 2. 연구방법 부산대학교병원임상시험심사위원회 (IRB) 에본연구과제에대한심사를신청하여승인을받았다 ( 부산대학교병원임상위 , ). 1) 구강검진구강검진을시행하여첫번째, 치주조직검사로, 치주상태를판단하는 3 개의기준으로출혈여부, 치석존재유무, 치주낭존재유무를포함하는지역사회치주지수 (CPI; Community Periodontal Index) 를사용하였으며, 치은염증과구취와의관계를따로알아보기위해치은염증의기준인탐침시출혈여부를기준으로 0= 건전치주조직, 1= 탐침시출혈의기준을추가적으로조사기록하였다. 세번째는설태의존재유무에대한검사로 0= 설태가없는군, 1= 설태가앏고설유두가보이거나, 설태가두껍고설유두가안보이는군으로나누어조사, 분류하였다. 2) 전신질환의진단전신질환의진단은부산대학교병원건강증진센터의전문의에의하여이루어졌고, 폐기능검사, 골밀도검사, 후두경검사, 심전도검사, B 형간염검사, 갑상선초음파검사, 동맥경화검사, 대장내시경검사, 고혈압검사, 흉부 X-ray 검사, 복부초음파검사, 여성생식기관련검사, 위내시경검사, 복부촬영검사, 전립선초음파검사, 지질검사, 당뇨검사에따라질환이있는군과없는군으로각각분류하였다. 3) 구강내휘발성황화합물농도측정구강내휘발성황화합물농도는 ppb 및 ng/10ml 단위로측정할수있는구취측정장치인 Oral Chroma R (CHM-1, Osaka, Japan) 를사용하여측정하였다. 측정은기상 3 시간후에공복인상태로구강내가스를샘플링하였다. 코로호흡을하라고지시하면서입속의공기를 1 분간머물게한후, 포장에서꺼낸샘플링용시린지를피검자의입안깊숙이넣고입술을가볍게물면서입을다물게하고, 시린지의피스톤을최후방위치까지끌어당겨구강내가스를시린지안에 12

3 충만하게한후, 피스톤을눌러서시린지안의가스를구강내로일단돌려보내고다시피스톤을후방으로끌어당겨시린지내를구강내가스로충만하도록하였다. 이를 3 회반복하였고, 그동안혀가시린지선단에닿지않도록주의하였다. 본체톱판넬측의가스주입구에샘플링한가스를주입한후 8 분간휘발성황화합물의농도를측정분석하였다. 4) 통계분석수집된자료는통계분석프로그램인 Statistical Package for the Social Science12.0(SPSS Inc, Chicago, IL, USA) 을이용하여구강검사결과및각검사별전신질환의유무에따른황화수소, 메틸머캅탄, 황화디메틸의농도를교차분석으로분석하였다. Ⅲ. 연구결과 1. 구강상태에따른휘발성황화합물의농도 CPI 지수가높은군은낮은군에비해황화수소와메틸머캅탄의농도가유의하게높았다 (p 0.05, Table 1). 탐침시출혈이있는군은없는군에비해황화수소와메틸머캅탄의농도가유의하게높았다 (p 0.05, Table 2). 설태가높은군이낮은군에비해메틸머캅탄의농도가다소높은경향을보였다 (p=0.114, Table 3). 2. 전신질환에따른휘발성황화합물의농도 구강내요인이전혀없는표본 (CPI index = 0, 설태없음, 탐침시출혈없음 ) 은 182 명중 4 명이었다. 상관관계를분석하기에는표본수가너무작았다. 구강내요인이없는표본 4 명중전신질환이있는표본전부가휘발성황화합물농도가높았던검사는폐기능검사였다. 지질검사에서이상소견이있는군이없는군보다황화수소의농도가비교적높은경향을보였다 (Table 4, p=0.086). 지질검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가유의하게높았다 (Table 5, p=0.036). 지질검사에서이상소견이있는군이없는군보다디메틸설파이드의농도가비교적높은경향을보였다 (p=0.130). 수축기 140 이상이완기 90 이상을기준을로정한혈압이높은군이낮은군에비해메틸머캅탄의농도가 비교적높은경향을보였다 (p=0.113). 골밀도검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가비교적높은경향을보였다 (Table 5, p=0.099). B 형간염검사에서이상소견이있는군이없는군보다디메틸설파이드의농도가비교적높은경향을보였다 (Table 6, p=0.069). 복부초음파검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가비교적높은경향을보였다 (Table 5, p=0.088). 복부초음파검사에서이상소견이있는군이없는군보다디메틸설파이드의농도가비교적높은경향을보였다 (Table 6, p=0.091). Ⅳ. 총괄및고찰 구취로인한사회적, 정신적문제는고대로부터많은인간관계속에서중요시되어왔으며이에대한관심은현대에이르러더욱증가하여구취의원인과치료법에대한다양한연구결과구취의원인은크게전신적, 생리적, 심리적, 구강내원인등으로구분할수있으며, 이중구강내원인이구취발생에가장강력하게작용 (80 90%) 한다고밝혀졌다. 2,25-27) 또한구취의치료방법으로식이요법, 치아및치주처치, 혀세정법, 다양한구강양치액을이용한치료법등이임상적으로주로적용되고있다. 구취는구강내원인뿐만아니라전신질환에의해서도발생한다는보고가있었으며 18,28) 이러한구취는전신질환을진단하는데중요한정보를제공한다. Rosenberg 16,17) 는구취를일으키는분자들중특정아미노산의분해시발생하는휘발성황화합물이전체휘발성화합물중 90% 를차지하여주요성분은황화수소와메틸머캅탄그리고황화디메틸이라고보고하였다. 또한전신질환과연관되어구취를야기하는분자에관한연구에서당뇨와폐암에서는휘발성인 aceton 분자가, 그리고간질환에서는휘발성황화물이구취를일으키는것으로보고되었다 ) 김등 25) 은간, 담낭의기능이상은황화합물, 신질환은암모니아, 당뇨는캐톤산화합물이관련되어있다고했다. 구취의치료를더욱성공적으로수행하기위해서보다광범위한진단기준과그에따른치료법을고려해야하여이를위해전신질환이구취에미치는영향에대한객관적인자료가필요하게되었다. 이등 19) 은이에대한연구를시행한바있으나표본수가작고조사한질환수도작은단점이있었다. 본연구에서는건강검진센터에내원하는환자를대상으로질환과 13

4 Table 1. Analysis of numbers of patient who visit health care center according to the VSC(Volatile Sulfur Compound) concentration level and the Community Periodontal Index. 0~111 ppb H 2S ppb 112 ppb CPI 1 Code 0 (N=58) Code 1 (N= 3) 1 2 Code 2 (N=50) Code 3 (N=42) Code 4 (N=29) ~25 ppb CH 3SH ppb 26 ppb CPI 1 Code 0 (N=58) Code 1 (N= 3) 2 1 Code 2 (N=50) Code 3 (N=42) Code 4 (N=29) ~7 ppb (CH 3) 2S ppb 8 ppb CPI 1 Code 0 (N=58) Code 1 (N= 3) 1 2 Code 2 (N=50) 41 9 Code 3 (N=42) Code 4 (N=29) CPI 1 (Community Periodontal Index) Code 0 = Normal Code 1 = Bleeding on Probing Code 2 = Calculus deposit Code 3 = Pokets depth 5mm Code 4 = Pokets depth 6mm 휘발성황화합물과의관계를알아보고자했다. 부산대학교병원건강증진센터를방문하여구강검진을포함한전신질환에대한종합검진을시행한환자들중본연구에동의한 182 명을대상으로가스분석검사기의일종인 Oral Chroma R 를이용하여구취를측정하여전신질환이구취에미치는영향을객관화하고자하였다. 이번연구결과에서 Oral Chroma R 의 user's guide 29) 에서제시하는농도 ( 황화수소 112 ppb, 메틸머캅탄 26 ppb, 황화디메틸 8 ppb) 를기준으로두군으로나누어구강내요인과전신질환검사결과이상소견이있는군과없는군과의관계를조사하였다. 구강내요인인 CPI index와탐침시출혈여부는황화수소와메틸머캅탄과유의한상관관계 (p 0.05) 14

5 Table 2. Analysis of numbers of patient who visit health care center according to the VSC concentration level and bleeding on probing. 0~111 ppb H 2S ppb 112 ppb BOP 1 Negative (N=36) 30 6 Positive (N=146) ~25 ppb CH 3SH ppb 26 ppb BOP 1 Negative (N=36) 30 6 Positive (N=146) ~7 ppb (CH 3) 2S ppb 8 ppb BOP 1 Negative (N=36) 29 7 Positive (N=146) BOP 1 (Bleeding on Probing) Negative = No bleeding on probing Positive = Bleeding on Probing Table 3. Analysis of numbers of patient who visit health care center according to the VSC concentration level and the tongue coating. 0~111 ppb H 2S ppb 112 ppb TC 1 Negative (N=24) 17 7 Positive (N=158) ~25 ppb CH 3SH ppb 26 ppb TC 1 Negative (N=24) 19 5 Positive (N=158) ~7 ppb (CH 3) 2S ppb 8 ppb TC 1 Negative (N=24) 18 6 Positive (N= 158) TC 1 (tongue coating) Negative = Normal Positive = tongue coating

6 Table 4. Analysis of numbers of patient who visit health care center according to the H2S concentration level and the systemic disease. H 2S ppb 0~111 ppb 112 ppb PFT 1 Absence(N=121) Presence(N=61) BMD 2 Absence(N=167) Presence(N=15) 12 3 Laryngoscopy Absence(N=174) Presence(N=8) 5 3 ECG 3 Absence(N=165) Presence(N=17) 10 7 HBV 4 serology Absence(N=174) Presence(N=8) 5 3 throid U/S 5 Absence(N=176) Presence(N=6) 4 2 colonoscopy Absence(N=177) Presence(N=5) 3 2 hormonal study Absence(N=153) Presence(N=29) 21 8 blood pressure Absence(N=140) measurement Presence(N=42) Chest X-Ray test Absence(N=169) Presence(N=13) 8 5 Abdominal U/S Absence(N=102) Presence(N=80) Gynecologic Absence(N=162) examination 6 Presence(N=20) 14 6 EGDS 7 Absence(N=29) Presence(N=153) Abdominal Absence(N=165) X-ray test Presence(N=17) 11 6 Prostatic U/S Absence(N=172) Presence(N=10) 5 5 Lipid profile Absence(N=75) Presence(N=107) DM 8 test Absence(N=141) Presence(N=41) PFT 1 (pulmonary fuction test) BMD 2 (bone mineral density) ECG 3 (electrocardiogram) HBV 4 (hepatitis B virus) U/S 5 (ultrasonograpy) pelvic examination and endovaginal ultrasonography 6 EGDS 7 (esophagogastroduodenoscopy) DM 8 (diabets mellitus)

7 Table 5. Analysis of numbers of patient who visit health care center according to the CH3SH concentration level and the systemic disease. 0~25 ppb CH 3SH ppb 26 ppb PFT 1 Absence(N=121) Presence(N=61) BMD 2 Absence(N=167) Presence(N=15) 13 2 Laryngoscopy Absence(N=174) Presence(N=8) 4 4 ECG 3 Absence(N=165) Presence(N=17) 10 7 HBV 4 serology Absence(N=174) Presence(N=8) 5 3 throid U/S 5 Absence(N=176) Presence(N=6) 5 1 colonoscopy Absence(N=177) Presence(N=5) 3 2 hormonal study Absence(N=153) Presence(N=29) blood pressure Absence(N=140) measurement Presence(N=42) Chest X-Ray test Absence(N=169) Presence(N=13) 8 5 Abdominal U/S Absence(N=102) Presence(N=80) Gynecologic Absence(N=162) examination 6 Presence(N=20) 12 8 EGDS 7 Absence(N=29) Presence(N=153) Abdominal Absence(N=165) X-ray test Presence(N=17) 10 7 Prostatic U/S Absence(N=172) Presence(N=10) 4 6 Lipid profile Absence(N=75) Presence(N=107) DM 8 test Absence(N=141) Presence(N=41) PFT 1 (pulmonary fuction test) BMD 2 (bone mineral density) ECG 3 (electrocardiogram) HBV 4 (hepatitis B virus) U/S 5 (ultrasonograpy) pelvic examination and endovaginal ultrasonography 6 EGDS 7 (esophagogastroduodenoscopy) DM 8 (diabets mellitus)

8 Table 6. Analysis of numbers of patient who visit health care center according to the (CH3)2S concentration level and the systemic disease. 0~7 ppb (CH 3) 2 Sppb 8 ppb PFT 1 Absence(N=121) Presence(N=61) BMD 2 Absence(N=167) Presence(N=15) 13 2 Absence(N=174) Laryngoscopy Presence(N=8) 7 1 ECG 3 Absence(N=165) Presence(N=17) 12 5 HBV 4 Absence(N=174) serology Presence(N=8) 3 5 throid U/S 5 Absence(N=176) Presence(N=6) 5 1 colonoscopy hormonal study blood pressure measurement Chest X-Ray test Absence(N=177) Presence(N=5) 4 1 Absence(N=153) Presence(N=29) 8 11 Absence(N=140) Presence(N=42) Absence(N=169) Presence(N=13) 10 3 Abdominal U/S Absence(N=102) Presence(N=80) Gynecologic Absence(N=162) examination 6 Presence(N=20) 13 7 EGDS 7 Absence(N=29) Presence(N=153) Abdominal Absence(N=165) X-ray test Presence(N=17) 12 5 Prostatic U/S Lipid profile Absence(N=172) Presence(N=10) 7 3 Absence(N=75) Presence(N=107) DM 8 Absence(N=141) test Presence(N=41) PFT 1 (pulmonary fuction test) BMD 2 (bone mineral density) ECG 3 (electrocardiogram) HBV 4 (hepatitis B virus) U/S 5 (ultrasonograpy) pelvic examination and endovaginal ultrasonography 6 EGDS 7 (esophagogastroduodenoscopy) DM 8 (diabets mellitus)

9 를보였고황화디메틸과유의한상관성은관찰할수없었는데이는구취에주로영향를미치는인자는황화수소와메틸머캅탄이라는결과를뒷받침한다. 25) 설태가높은군이낮은군에비해메틸머캅탄의농도가높은경향을보였다 (p=0.114). 구강내요인이없는표본은수가작아서상관성을분석하기어려웠으나구강내요인이없는표본 4 명중전신질환이있는표본전부가휘발성황화합물농도가높았던검사는최대로들이마신후끝까지뱉어낸공기양그래프중초반 1 초간뱉어낸숨의양을측정한폐기능검사였고그황화합물은황화디메틸이였다. 이것은구강내요인과상관성이적었던황화합물은황화디메틸이였다는결과와는상반된결과로보인다. 이는구강내요인은주로황화수소와메틸머캅탄의농도에주로영향을미치며폐기능장애는황화디메틸의농도에영향을미칠것이라는가설을세울만한자료가될수있을것이다. 이에대해서향후좀더많은표본을확보한연구가필요하리라생각된다. 혈액내 LDL-Cholesterol, Triglyceride, HDLcholesterol, Free Fatty Acid 을측정하는지질검사에서이상소견이있는군이없는군보다황화수소의농도가비교적높은경향을보였다 (p=0.086). 지질검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가유의하게높았다 (p=0.036). 지질검사에서이상소견이있는군이없는군보다황화디메틸의농도가비교적높은경향을보였다 (p=0.130). 지질검사와구취와의관계는지금까지연구된바가없었다. 구강내요인인설태의유무와지질검사간상관관계분석에서유의성이있는결과 (p=0.05) 가나온것, 즉설태가있는군은지질검사상이상소견이많다는결과로미루어휘발성황화합물과지질검사간관계를간접적으로설명할수있을것으로추정해본다. 이에대한향후추가적인연구가필요할것으로생각된다. 혈액검사상 HBV Ag, Ab 유무를판단하는 B 형간염검사에서이상소견이있는군이없는군보다황화디메틸의농도가비교적높은경향을보였다 (p=0.069). 간, 담낭, 담도, 췌장, 비장, 콩팥, 충수돌기등이관찰이가능한복부초음파검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가비교적높은경향을보였다 (p=0.088). 복부초음파검사에서이상소견이있는군이없는군보다황화디메틸의농도가비교적높은경향을보였다 (p=0.091). 복부초음파상의이상소견은간질환이대부분이고소수가신장질환과담낭질환이었다. 복부초음파검사상이상소견과메 틸머캅탄, 디메틸설파이드의이러한관계는간질환의휘발성황화합물이구취를일으킨다는 Rogenberg 16) 의연구를지지하는결과로생각할수있다. 뚜렷한상관관계를관찰할수없었던이유는복부초음파이상소견이간질환이외에신장질환도포함하고, 구강내요인을모두배제하면표본수가너무작아지는단점때문에구강내요인을배제할수없었기때문으로추정할수있다. 향후신장질환과담낭질환, 간질환을분리하여휘발성황화합물과의관계연구와더불어 Akiko 30) 등이구강내요인과암모니아와의관계를연구한바있지만신장질환과질소화합물등과의관계의연구도필요하리라생각된다. X-ray 촬영을통해골밀도를측정한골밀도검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가비교적높은경향을보였다 (p=0.099). 수축기 140 이상이완기 90 이상을기준으로한혈압이높은군이낮은군에비해메틸머캅탄의농도가비교적높은경향을보였다 (p=0.113). 혈압측정결과와골밀도검사상의이상소견과휘발성황화합물의관계원인에대한것은현재까지시행된연구가없으며향후지속적인연구가더필요할것으로생각된다. 당뇨와황화합물과의유의적상관관계는발견할수없었는데이는전신질환과연관되어구취를야기하는분자에관한연구에서당뇨와폐암에서는휘발성인아세톤분자가, 그리고간질환에서는휘발성황화물이구취를일으킨다는결과를뒷받침한다 ) 향후케톤화합물과의관계에대한연구가더필요할것으로생각된다. 휘발성황화합물과관계있는질환은간질환담낭질환이라는사실을확인할수있었으며그외골밀도와혈압지질검사등에서의관련성도관찰되어추후연구가더필요할것으로생각된다. 치과의사는구취를호소하며의원을방문하는환자들을흔히접하게된다. 구취를호소하는환자의정확한진단과치료를위해치과의사는구취의원인에대해서치태, 치석, 설태, 치아우식증, 치주질환, 구강연조직감염, 구강암, 구강캔디다증, 의치, 혀질환, 불량보존물및보철물, 구강건조증등의구강내적인원인이주를이루겠지만, 구강내적인부분과함께구강외적인부분도고려해야한다. 구강외적원인중전신질환에대한고려가필요하며, 이는과거력청취와현재전신질환유무에대한문진및필요할경우지질검사, 골밀도검사, 복부초음파검사, B 형간염검사, 혈압검사등의검사를시행해볼것을제시하는바이다. 19

10 Ⅴ. 결론 본연구는전신질환을평가하는검사법과구취간상관관계를알아보고자부산대학교병원건강증진센터를방문하여구강검진을포함하여전신질환에대한종합검진을시행한환자들중본연구에동의한 182 명 ( 남 112 명, 여 70 명, 연령분포 세 ) 을대상으로구강검사및전신질환에대한평가를실시하였고, Oral Chroma R 로구취의지표가되는구강내휘발성황화합물의농도를측정하여아래와같은연구결과를얻었다. 1. CPI 지수가높은군은낮은군에비해황화수소와메틸머캅탄의농도가유의하게높았다.(p 0.05) 탐침시출혈이있는군은없는군에비해황화수소와메틸머캅탄의농도가유의하게높았다 (p 0.05). 2. 지질검사에서이상소견이있는군이없는군보다메틸머캅탄의농도가유의하게높았다 (p 0.05). 지질검사에서이상소견이있는군이없는군보다황화수소의농도가비교적높은경향을보였다 (p=0.086). 3. 혈압검사, 골밀도검사 (p=0.099), 복부초음파검사 (p=0.088) 의메틸머캅탄농도와지질검사 (p=0.130), B 형간염검사 (p=0.069), 복부초음파검사 (p=0.091) 의디메틸설파이드농도가비교적높은경향을보였다. 참고문헌 1. Rosenberg M, Septon I, Eli I et al. Halitosis measurement by an industrial sulphide monitor. J Periodontol 1991;62: Tonzetich J. Production and origin of oral malodor - A review of mechanism and methods of analysis. J Periodontol 1977;48: 손원영, 전양현, 이진용, 조한국, 홍정표. 타액선기능이구취에미치는영향에관한연구. 대한구강내과학회지 1998;23: Spielman AI, Bivona P, Rifkin BR. Halitosis. A common oral problem. Dent J Dec 1996;62(10): Tonzetich J. Production and origin of oral malodor : a review of mechanisms and methods of analysis. J. Periodontol 1977;48: Hawkin C. Real and imaginary halitosis. Br Med J 1987;294: Uchida Y. Case of self-halitosis patient. Dent Outlook 1974;43: Berg M, Fosdisk L.S. Studies in periodontal disease, II. Putrefactive organism in mouth. J Dent Res 1946;25: Mcnamara TF, Alexander JF, Lee M. The role of microorganism in the production of oral malodor. Oral Surg 1972;34: Spouge JD. Halitosis - A review of its causes and treatment. DentPractit 1964;14: Finkelstein Y, Talmi Yp, Bar Z J, Zohar Y. Otitis media with effusion as a presenting symptom of chronic sinusitis. J Laryngol Otol 1989;103: Finkelstein Y, Ophir D, Talmi YP. Adult-onset otitis media with effusion. Arch Otolaryngol Head Neck Surg 1994;120: Tonzetich J. Oral malodor-an indicator of health status and oralcleanliness. Int Dent J 1977;28: Attia E.L., Marshall K.G. Halitosis. Can Med Assoc J 1982;126: 장수경, 안용우, 고명연, 박준상. 구취와타액내아미노산의상관성비교연구. 대한구강내과학회지 2004; 29: Rosenberg M. Bad Breath-Diagnosis and treatment. U Toronto Dent 1990;3: Rosenberg. Bad Breath Research Perspectives. 2nd ed, Seoul, 1998, Shinhung Inc, pp Chen S, Zieve L, Mahadevan V. Mercaptans and dimethyl sulfide in the breath of patients with cirrhosis of liver. Effect of feeding methionine. J Lab Clin Med 1970;75: 이돈녕, 안용우, 고명연, 박준상. 전신질환이구취에미치는영향. 대한구강내과학회지 2004;29: Nara F. The relationship between the halitosis and oral conditions of the periodontal patients. J Jpn Assoc Periodontol 1977;19: Solis-Gaffer M, Niles H.P. Instrumental evaluation of mouth odor in a human clinical study. J Dent Res 1975;54: Tachibana Y. The relation between pyorrhea alveolaris and H2S producing bacteria in human mouth. J Stomatol Soc Jpn 1957;24: Tonzetich J. Direct gas chromatographic analysis of sulphur compounds in mouth air in man. Arch Oral Biol 1971;16: Rosenberg M, Septon I, Eli I, Brenner S, Gelemter I, Gabbay J. Halitosis measurement an industrial sulphide moniter. J periodontol 1991;62: 김영구, 구취 (Oral Malodor) 입냄새의원인과치료방법. 20

11 서울, 2008, 신흥인터내셔날, pp Richter J L. Diagnosis and treatment of halitosis. Compendium of Continuing Education in Dentistry 1996;17: Scully C, Oprter S R, Greenman J et al. Breath odour : etiopathogenesis, assessment, and management. European J Oral Sciences 1997;105: Gorden S M, Szidon J P, Krotoszyasky B K et al. Volatile organic compounds in exhaled air for patients with lung cancer. Clin Chem 1985;31: ABILIT Co. : User's Guide Version 3.00, Osaka, 2003, ABILIT Co., pp Akiko Amano, Yasuo Yoshida, Takahiko Oho, Toshihiko Koga : Monitoring ammonia to assess halitosis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2002;94: ABSTRACT - The Relationship Between Systemic Diseases and Oral Volatile Sulfur Compound Soo-Min Ok, D.D.S., Il-Ho Tae, D.D.S.,M.S.D., Myung-Yun Ko, D.D.S.,M.S.D.,Ph.D. Department of Dentistry, College of Dentistry, Pusan National University This study was conducted to investigate the relationship between systemic diseases and oral malodor. The author measured the volatile sulfur compound(vsc) of the patients who visited Pusan National University Health Promote Center for a comprehensive medical testing. The patients were examined gingival bleeding on probing, CPI index, tongue coating. Their systemic diseases were diagnosed by the specialist. 182 patients consisted of 112 males and 70 females. In this study, Oral Chroma R was used to measure oral malodor. This equipment could measure the concentration of intraoral VSC (hydrogen sulfide, methyl mercaptan, dimethyl disulfide). All data were analylized using Statistical Package for the Social Science 12.0 R The result of this study was the followings. 1. There was significant difference of numbers of patient who visited health care center according to the VSC concentration level and the Community Periodontal Index, bleeding on probing, tongue coating. 2. The subjects with hyperlipidemia showed the high level of CH 3SH concentration (p=0.036). The concentration of H 2S tends to be high in the group with abnormal findings on pulmonary fuction test(p=0.086). The concentration of CH 3SH in the groups with abnormal findings on lipid profile test(p=0.130) and bone mineral density test(p=0.099) and abdominal ultrasonograpy(p=0.088) tends to be higher than the other group. 3. The concentration of (CH 3) 2S in the group with abnormal findings on blood pressure test(p=0.113), hepatitis B virus serology(p=0.069), Abdominal ultrasonograpy(p=0.091) tend to be higher than the other group. Key words: Volatile sulfur compound, Systemic disease, Halitosis 21

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