-1-,1997) Yang 1995 21 1979 1993 Chou & Lai(1998) 11.7% 41.4% (Brand et al,1985; Yano et al,1977; Klemp-et al,1997) (1989) 17.3% (1996) 61.1% 42.3% 25.5% (1991) 29.2% 19.3% Chen(1998) 2037 10.1% 0.77% 1980 6 10 1983-1985 13.6/1,000 6.4/1,000 1969 1. 2. 3. 4. (Harris, 1999)
(Killey & Pallella,1991) (Kern-et al, 1999;Peeters & Sennesael,1998) Mc Donald & Marino(1998) (Cleland et al,1995) Vannoni et al(1989) Kullich et al(1989) 300 Kullich (2000) 118 59.6% 60.19% 48-54% -2-
(P<0.05) 91.26% -3-
>7mg/dl >6mg/dl (Healy,1979) (Ferrans & Powers,1985;,1996) -4-
1. 2. 1. 6. 2. 7. 3. 4. 8. 5. 1. 2. 3. 4. 1. 2. 1995 1990 1994-5-
(Gout) >=7mg/dl Wyngaarden&Kelley,1976;,1998 Iglesias,1996 1977 Council for International Organization of Medical Sciences(C.I.O. M.S)1963 1966 1.1963 1 2 >=7mg/dl >=6mg/dl 2.1966 1 2 (colchicine) ( )Killey & Pallella(1991) -6-
.. ( ). ( ) (uric acid) (uric acid) (purine) Murry,1990) 1. 2. 3. vitamin B12 4. ( ) Eberhard et al(1998), Nakamura et al(1996) 60% 12% -7-
1. 2. 3. 4. Murry,1990;,1990;,1994;,1997 ( ) (Asymptomatic hyperuricemia) >=7mg/dl Loeb,1972 ( ) (Acute gout) 90% 50% (Nakamuya et al,1996) ( ) (Intercritical gout) (Intercritical gout) (Harris,1999) ( ) (Recurrent gouty arthritis) 60% -8-
78% 7% (Gutman,1973) 30% (Kozin & McCarty,1977) (Macfarlane,1985) ( ) (Chronic tophaceous gout) (Harris et al,1999) (Joel et al,1999; Shun et al,1997) 8mg/dl (ph=7) 90% (Mccary,1994; 1995) (Wortman,1998) Campion(1987) 8mg/dl 2% 9-10mg/dl 19.8% 10mg/dl 30% Yamanaka et al(1998) 350 4.6 6.6mg/dl(RR= 0.705,95CI=0.629 0.791) -0.1 0.6mg /dl (RR=0.451) -9-
Harris(1999) Peter(1979) (Asymptomatic hyperuricemia) (Agudelo,1998) (Acute phase) NSAIDS.colchi-cine corticosteroid analgesics NSAIDS ibuprofen (motrin),naproxen(naprosyn),piroxican(feldene) ketoprofen(orudis) (Wallace & Singer,1988) Agudelo & Wise(1989) 90% NSAIDS NSAID (Pollmann et al,1997; Allison et al,1992; Sanlder et al,1991) Colchicine 80% (Wallace & Sin ger,1988) <=10ml/minx -10-
(intercritical gout) colchicine 1936 (Cohen,1936) 85% (YU & Gutman,1961) colchicine NSAID (Recurrent gouty arthritis) (Chronic taphaceous gout) allopurinol (Mc Donald & Marino,1998; Fam,1998) (purine) (uric acid) -11-
-12- (glycine) (,1979;,1990;,1991;,1998) Fmmerson(1996) Wolfram(1995) Wolfram Bynum(1997) (eg. aspirin) (1994) (2000-3000c.c/
) (1996) Yamanaka(1996) Eastmond et al(1995) Colling & Wolfram(1987) DNA RNA (Asplin,1996) (Colling & Wolfram,1987) High purine diet Simmonds et al(1994) Cleland et al(1995) (Obesity and high lipidemia) -13-
(Hall et al,1967;o'sullivan,1972;currie,1972; Abbout et al,1988;rbboutt,1991) Takahashi(1994) (BMI) TG apolipoprotein HDL-C HDL2-C Chou & Chao(1999) TG.HDL-C apolipoprotein (P<0.01) Chou & Lai 1998 Acheson et al(1760) Hollister et al(1967) Filipinos,New Zealand Maoris,South Pacific Polynesians, American Indians, South African Negroes Japanese (Healey et al,1966; Prior & Rose,1964; Evans et al,1968; Beighton et al,1974; Oshima,1965) Nicholls & Scott(1972) Marinoff et al(1962) (Beinghton et al,1974;nicho lls & Scott,1972) (Hagerup,1973) (Excess alcohol intake) -14-
ALDH2-1 ATP ALDH2-2 (Yamanaka,1996) Jason et al(1982) 1.8g 8 0.25 0.35g 8.4 0.4 10.1 0.9mg/dl 3.1 0.7mM (Shichikawa,1974; Nishioka et 1974) Oshima(1965) 40% Zalokar et al(1974) (Gibson & Grahame,1974;Lieber et al,1962;) 30-50 (Jean et al,1994) (Hippocrates,1886) (Hikkenoklsen et al,1965) (F.N Brand et al,1985; Yano et al,1977; Klemp et al,1997; Chou & Lai, 1998) Boggild -15-
& Johansen (1997) Tikley et al(1998) 90 3.3:1 79% Koh & Chaip(1998) 77% 23% 50.9 30-50 guanine phosphoribosytransferase adenysosuccinate lyase(raul et al, 1998) (,1997;,1998) 5.3 10.4% (Prior et al,1966; Prior,1981; Darmawan et al,1992) Chou & Chao (1999) (P<0.001) apo- 1 Chang et al(1999) 27-16-
-17- HPRT(phosphoribosyltransferase) Chen & DuH et al(1998) 2037 14.2% 7.1% 1980 1.4% 1.3% 6 10 1992 (P<0.05) Chang(1997) 396 15.2% 4.8% 0.3% 1. (Coronary disease) (Fessel,1972) Gertler et al(1951) 40 4 (Karmer et al,1958) ( Kohn & Prozan, 1959) (Hansen, 1965) (Kinsey,1961) (Wsiss et al,1957; Herman, 1958; Beckett & Lewis, 1960) (Silman & Hochberg, 1993) Antti et al(1982) 40-69 3195 3160
-18- (Dreyfuss, 1960; Hansen, 1966) Takkunen & Reunanen(1977) Fessel(1980) Gelber et al (Ginsberg et al,1977 Newland,1975) 2. (Hypertension and renal disease) (Kinsey et al,196 1;Cannon et al,1966) Myers et al(1968) Zalokar(1974) Bengttsson & Tibblin(1974) Yano(1974) Grodzicki et al(1997) Franz(1980) 71
-19- (P<0.02) Miranda-Carus et al(1997) (P<0.005) 3. (Diabetes Mullitus) Bartels et al(1960) Berkowitz(1966) Whitehouse & Cleary(1966) 80% Yano(1977) Peter(1981) 5082 4 6.7% 5.5% Brand et al(1985) 5209 (Epstein et al,1965; Wilson et al,1981) Yano et al(1977) & Herman(1966) Moriwaki et al(1995) drug Salicylate chrorothiazide ethacrynic acid pyrazinamide angiotensin epinephrine norepinephrine diuretics cyclosporine A (Felix & Demartini,1965 Bengtsson,1978; Bruce et
al,1993) Pyrazinamide Cullen(1956) (Yu et al,1957) Hollander(1957) Laragh et al(1958) Oren(1958) Bergtsson et al(1974) (Thomson,1970) (dose-dependent) (Betglund et al, 1976) Gilles et al(1996) salicyate chlorothiazide ethacrynic acid Angiotensin epinephrine nor-epinephrine (Felix & Demartini,1965) salicylate chlorothia zide (paradoxical eff ect) 10mg/dl 10mg/dl chlorothiazide chlorothiazide 1.5gm (Demartini et al,1962; Cannon et al,1963) cyclosoprine A (Bruce et al,1993; Lin et -20-
al,1989) (,1990;,1996;,1997;,1998) (tophi) 10 20-21-
(Aboulafia et al,1999;reed,1999) (Johnson et al,199 9) -22-
(block) 120 116 1 2 3 4 1 2 3 4 1 2 3 4 1. 2. 3. -23-
-24-4. 5. 6. likert 11 likert 150 150mg 1 2 1 / 3 1 / 4 2 4 / 5 7 / 11 likert HPLC ( ) 10 Cronbach's 0.70 0.90 Cronbach's 0.78
( ) 1. 2. 3. 4. 5. HPLC (High-pertormance liquid chromatography) (1998) uricase ( ) HPLC HPLC uricase -25-
SAS for window 6.11 version t-test pair t-test Chi-square test Mutiple logistic regression -26-
-27-54 (93.10%) 4 (16.90%) 45 (77.59%) 13 (22.41%) 19 (32.76%) ( ) 13 (22.41%) 20 (34.48%) 9 (15.52%) 28 (48.28%) ( ) 4 (6.90%) 10 (17.24%) 18 (31.03%) 15 (21.37%) 28 (47.45%) 10 (16.95%) 9 (15.25%) 47 (81.03%) 43 (74.14%) 7 (12.07%) 11 (18.64%) 4 (6.90%) 4 (5.93%) 49 (84.48%) 5 (8.62%) 3 (5.17%) 51 (87.93%) 3 (5.17%) 9 (15.52%) 18 (31.03%) 8 (13.79%) 24 (41.38%) 38 (65.52) 19 (32.96)
35 (60.34) 21 (36.21%) 2 (3.45%) 32 (55.04%) 28 (48.16%) ( 1) 2) (P<0.05) ( 3) - - -28-
(P<0.05)( 4) 5 6 (P<0.01) P<0.6 7 ( - ) (P<0.01) ( 9) 48 10 29 29 (X 2 =13.95 P<0.01) (addjust odds ratio) 5.08(95% CI=1.92 13.39 P<0.01) -29-
(P<0.05) (P<0.05)( 10) (P<0.05) ( ) (P<0.05)( 11 12) P>0.05 (P<0.05)( 13 14) -30-
-31-30-50 1997 klemp et al,1997 Chou & Lai,1998) Hikkelsen et al(1965) Boggild & Johansen(1997) 15 65.52% 32.76% (Felix & Demartini,1965; Bengtsson,1978; Bruce,1993) 51.6%
Darmawan et al(1992) Chou & Chao(1999) 2 (P>0.05) (P<0.05)( 3) Kullich(1989) (P<0.05) -32-
(P<0.05) (P<0.6) Vannoni et al(1989) Kullich et al 300 ( 2 4 5 6 7) (P<0.05) Campion(1987) 8mg/dl 2% 9 10mg/dl 19.8% 10mg/dl 30% Yamanaka et al(1998) 350 4.6 6.6mg/dl(RR=0.705,95CI=0.629-0.791) -0.1 0.6mg/dl (RR=0.451) -33-
5.8(addjust odds ratio=5.8,95%ci= 1.92-13.39,P<0.01) Fmmerson(1996) Wolfram(1995) (Kullich,1989;Vannoni et al,1989;cleland et al,1995) (,1997;,1991) -34-
(Healey et al,1966; Darmawan et al,1992; Prior,1964) (P>0.05) Chou (1998) 11.7 41.4 Chang(1999) 15.2, 4.8 0.3 ( ) (P<0.05) Tilky et al(1998) 90 79% -35-
Peter,1981; Wilson,1981 Grodzicki et al,1997) -36-
1. 2. 3. 4. 5. 6. 7. -37-
1. 2. 3. (contineous care) (nursing) 4. 1. 2. 3. -38-
1. 2. -39-
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-41-
-42-
-43-
-44-
-45-
-46-
-47-
-48-
-49-
-50-
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