• Clinical and Experimental Pediatrics
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• 제49권3호
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• pp.329-331
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• 2006

알캅톤뇨증은 상염색체 열성으로 유전하는 드문 질환으로 homogentisic acid oxidase 결핍에 의해 homogentisic acid가 체내 축적되고 소변으로 다량 배설되는 대사 이상 질환이다. 주로 도미니카 공화국과 슬로바키아에서 보고되고 있으나 한국에는 아직 보고된 바 없다. 증상으로는 소아 때에는 주로 배뇨 후 시간이 지나면 소변 색이 검어지는 특징이 보이고, 나이가 들면서 연골과 결체 조직의 착색, 관절염, 갈색증, 심장 질환, 신장 질환 등이 발생할 수 있다. 특별히 효과가 입증된 치료제는 없는 것으로 보고되고 있고, 진단은 뇨유기산분석을 통해 할 수 있다. 저자들은 내원 당시 13개월이었던 여자 환아에서 기저귀에 묻은 소변이 시간이 지나면서 연분홍 갈색빛을 보여 시행한 뇨유기산분석에서 homogentisic acid (normal range <2 mmol/molCr)가 1,158.3 mmol/molCr로 현저한 증가 소견을 보여 보고하는 바이다. 재검사에서도 역시 910.7 mmol/molCr 로 증가된 소견을 보였으며 환아 신체 어디에서도 연갈색이나 검은색의 착색된 부위를 찾을 수 없었다. 환아는 현재 ascorbic acid 투여하며 추적관찰 중이다.

• 대한유전성대사질환학회지
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• 제16권3호
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• pp.123-134
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• 2016

Mitochondrial disease is a group of disorders caused by dysfunctional mitochondria, the organelles that generate energy for the cell. Diagnosis of mitochondrial disease is difficult, subtle, and has many problems. It is more likely to miss the diagnosis of mitochondrial disease, especially in borderline cases where the symptoms of the disease are not severe. In this regard, urine organic acid analysis is noninvasive and can increase the sensitivity and specificity through repeated load test with few changes according to the specimen. And, It is considered to be suitable as a screening test for mitochondrial diseases because it has a great advantage of distinguishing from organic aciduria, urea cycle disorder and fatty acid oxidation disorder which may have similar symptoms. The purpose of this study was to investigate the clinical features and age distribution of mitochondrial diseases diagnosed by organic acid analysis and to establish the policy of diagnosis and treatment based on this study.

• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.41-44
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• 2016

We report here a case of maternal 3-methylcrotonyl-coenzyme A carboxylase (3-MCC) deficiency in a Korean woman. Her 2 infants had elevated 3-hydroxyisovalerylcarnitine (C5-OH) on a neonatal screening test by liquid chromatography-tandem mass spectrometry (LC-MS/MS), but normal results were found on urine organic acid analysis. The patient was subjected to serial testing and we confirmed a maternal 3-MCC deficiency by blood spot and breast milk spot test by LC-MS/MS, serum amino acid analysis, urine organic acid and molecular genetic analysis that found c.838G>T (p.Asp280Tyr) homozygous mutation within exon 9 of the MCCB gene. Especially, we confirmed marked higher levels of C5-OH on breast milk spot by LC-MS/MS, in the case of maternal 3-MCC deficiency vs. controls.

• 대한유전성대사질환학회지
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• 제15권2호
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• pp.65-71
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• 2015

Since the secretion of specific chiral isomers in urine (or plasma) is very crucial to diagnose some inborn metabolic disorders, clinical application of dual column achiral differential method has been performed for the absolute configuration of chiral compounds. Extracted from the acidified urine with diethyl ether, carboxylic functional group of organic acid (stereoisomers of the volatile) was derivatized with (-)-menthylation or (S)-(+)-3-methyl-2-butylation and followed by O-trifluoroacylation. Each of the enantiomers was accurately separated from the library matched double column (achiral) with a retention index (I). In various inborn metabolic disease urines, absolute chirality was identified correctly in the urine (10 patients) with inborn metabolic disease (including secretion of D, L- lactic acid, D, L-3-hydroxybutyric acid, and D, L-2-hydroxyglutaric acid). In this study, we identified and isolated the volatile diastereomer as a useful diagnostic marker, this successful application to urine specimens may be useful for diagnostic classification of inherited metabolic disorders.

• Clinical and Experimental Pediatrics
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• 제52권2호
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• pp.199-204
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• 2009

목 적 : 발열을 동반한 발작은 소아기에 흔한 문제이며, 단순 열성경련은 간질로 진행되는 경우는 거의 없고 예후가 매우 좋다. 그러나 복합 열성경련과 신경학적인 이상이 동반된 경우, 간질의 가족력이 있는 경우 및 1시간이내의 짧은 발열에 동반된 경우 등은 간질로 진행될 위험이 높고 선천성 대사 질환과 같은 기저 질환이 있을 가능성이 높다. 따라서 본 연구는 복합 열성경련의 환아의 유기산 분석을 통하여 어떠한 대사 질환들이 있는지 알아보고자 시행되었다. 방 법 : 1997년 7월부터 2005년 6월까지의 8년 동안 발작을 주소로 유기산 분석이 의뢰되었던 환아 중에서 복합 열성경련으로 진단되었으며 정맥혈 가스 분석, 암모니아, 간 기능 검사, 소변 검사 등의 통상적인 검사를 시행한 정보가 있었던 278명을 후향적으로 분석하였다. 결 과 : 정보가 있었던 278명의 환자 중에서 기본 검사가 모두 정상인 경우는 132명이었고, 한 가지라도 비정상소견을 보였던 환자는 146명이었다. 가장 흔한 비정상소견은 산혈증으로 58명이었고, 고 암모니아혈증(55명), 저혈당(21명), 케톤산혈증(12명) 등의 순이었다. 통상적인 검사가 정상인 군에서 유기산분석이 비정상소견을 보인 경우는 26명으로 19.7%였으며, 호흡연쇄효소의 이상이 대부분을 차지하였다(23명). 통상적인 검사가 비정상소견을 보였던 146명 중 유기산 분석에서 비정상소견을 보인 경우는 104명으로 71.2%였으며, 통계적으로 의미 있게 높았다(P<0.05). 원인질환으로는 사립체호흡연쇄효소의 이상이 29명, 케톤분해장애가 27명, 피루브산탈수소효소 결핍증과 제2형 글루타르산혈증이 각각 9명의 순이었으며, 제3형 3-메칠글루타콘산혈증 6명, 비오틴분해효소 결핍증 5명, 프로피온산혈증 4명 등이 뒤를 잇고 있으며, 그 외 다양한 질환들이 1-2명씩 진단되었다. 결 론 : 복합 열성경련의 경우에는 정맥혈 가스 분석, 암모니아, 간 기능 검사, 소변 검사 등의 통상적인 검사를 반드시 시행하여야 하며, 비정상소견을 보이는 경우에는 반드시 소변 유기산 분석을 시행하여야 할 것으로 판단된다. 검사소견이 정상일지라도 상당수의 환자에서 호흡연쇄효소의 이상 환자들이 진단되고 있으므로 단순 열성경련이 아니라고 판단된 경우에는 유기산 분석을 시행하여야 된다고 판단된다.

• 대한유전성대사질환학회지
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• 제11권1호
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• pp.52-73
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• 2011

Since we have started organic acid analysis on Jul. 1997, we have been collecting data about organic acidemias in Korea. The data presented here is our 3 years experience in organic acid analysis. We have collected 712 samples from major university hospitals all over the Korea, large enough for relatively accurate incidence of organic acid disorders. We are using solvent extraction method with ethylacetate, MSTFA for derivatization and quantitation of 83 organic acids simultaneously. Out of 712 patients sample, 498 patients sample (70%) showed no evidence of organic acid abnormalities. Out of 214 remaining samples we have found very diverse disorders such as methylmalonic aciduria(6), propionic aciduria (10), biotinidase deficiency (6), maple syrup urine disease (3), isovaleric aciduria (4), tyrosinemia type II (4), tyrosinemia type IV (1), glutaric aciduria type I (1), glutaric aciduria type II (22), 3-methylglutaconic aciduria type I (3), 3-methylglutaconic aciduria type III (7), HMG-CoA lyase deficiency (1), hyperglyceroluria (2), cytosolic 3-ketothiolase deficiency (55), mitochondrial 3-ketothiolase deficiency (3), 3-hydroxyisobutyric aciduria (2), L-2-hydroxyglutaric aciduria (2), fumaric aciduria (2), lactic aciduria with combined elevation of pyruvate (most likely PDHC deficiency) (28), lactic aciduria without combined elevation of pyruvate (most likely mitochondrial respiratory chain disorders) (35), SCAD deficiency (3), MCAD deficiency (1), 3-methylcrotonylglycineuria (1), orotic aciduria (most likely urea cycle disorders) (7) and 2-methylbranched chain acyl-CoA dehydrogenase deficiency (1). In conclusion, though the incidence of indivisual organic acidemia is low, the incidence of overall organic acidemia is relatively high in Korea. Most of the patients showed some signs of neurological dysfunction. In other words, organic acid analysis should be included in the diagnostic work up of all neurological dysfunctions.

• 환경위생공학
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• 제16권1호
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• pp.91-101
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• 2001

In order to propose a optimum method increasing accuracy and reproducibility in analysis of urine lead levels, we compared matrix modifier addition method and microwave digestion method. The results were as follows ; 1. Where the concentration of $Pd(NO_3)_2$(matrix modifier) was $50mg/{\ell}$, and ashing temperature was $900^{\circ}C$, the results were optimum. In case of matrix modifier addition method, the average coefficient of variation (CV) of normal man was 24.1%, and lead worker was 7.9%. The average urine lead levels of standard were $10.42\mu{g}/{\ell}$ and $19.89\mu{g}/{\ell}$ , the accuracies compared to reference values were 97.0% and 92.6%, respectively. 2. Microwave digestion temperature($160~180^{\circ}C$), time(15~25min) and the ratio of urine/ashing acid(1:1~4:1) did not significantly affect lead absorbance and background absorbance. Therefore we set up a optimum analytical conditions as follows: temperature, $160^{\circ}C$; time, 15min; the ratio of urine/ashing acid, 4:1. after samples were digested by the above analytical conditions, lead absorbance and background absorbance was measured at $450^{\circ}C$ as ashing temperature. The average coefficient of variation (CV) of normal man was 12.4%, and lead worker was 6.2%. The average urine lead levels of standard urine were $10.66\mu{g}/{\ell}$ and $23.31\mu{g}/{\ell}$, the accuracies compared to reference values were 99.3% and 103.9%, respectively. From the results, we suggest that microwave digestion method is a more favorable method than matrix modifier addition method because of easiness to reduce organic matter, possibility to analysis at low temperature and accuracy.

• 대한임상검사과학회지
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• 제42권1호
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• pp.16-21
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• 2010

It has been well known that organic industrial solvents such as toluene, xylene and styrene are environmental health hazards causing occupational diseases to workers. The detection of biological metabolites of toluene, xylene and styrene in blood, urine, breast milk, saliva, and hair of workers exposed to these organic industrial solvents is a useful tool for assessing the amount of organic industrial solvents. Therefor, the external analytical quality assurance program is extremely important work for increasing reliability of the data analyzed in the special health examination laboratory. We evaluated the results of analysis by Korean analytical quality assurance program from the second half 2007 to the first half 2009. The number of participants for analytical quality assurance program for both mandatory item and one of optional items, hippuric acid and methylhippuric acid were 116-122, 116-122 and 105-115 laboratories, respectively. The proficient rate of the special health examination laboratories analyzed both mandatory item and optional item, hippuric acid and methylhippuric acid were 92-98%, 92-98% and 96-98%, respectively. We can conclude from our data that the analytical quality assurance program is a essential tool for improvement of reliability on the data analyzed in the special health examination laboratories.

• Safety and Health at Work
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• 제2권3호
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• pp.229-235
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• 2011

Objectives: In this study, we summarized the External Quality Assessment Scheme (EQAS) for the biological monitoring of occupational exposure to toxic chemicals which started in 1995 and continued until a $31^{st}$ round robin in the spring of 2010. The program was performed twice per year until 2009, and this was changed to once a year since 2010. The objective of the program is to ensure the reliability of the data related to biological monitoring from analytical laboratories. Methods: One hundred and eighteen laboratories participated in the $31^{st}$ round robin. The program offers 5 items for inorganic analysis: lead in blood, cadmium in blood, manganese in blood, cadmium in urine, and mercury in urine. It also offers 10 items for organic analysis, including hippuric acid, methylhippuric acid, mandelic acid, phenylglyoxylic acid, N-methylformamide, N-methylacetamide, trichloroacetic acid, total trichloro-compounds, trans,trans-muconic acid, and 2,5-hexanedione in urine. Target values were determined by statistical analysis using consensus values. All the data, such as chromatograms and calibration curves, were reviewed by the committee. Results: The proficiency rate was below 70% prior to the first round robin and improved to over 90% for common items, such as PbB and HA, while those for other items still remained in the range of 60-90% and need to be improved up to 90%. Conclusion: The EQAS has taken a primary role in improving the reliability of analytical data. A total quality assurance scheme is suggested, including the validation of technical documentation for the whole analytical procedure.

• 대한유전성대사질환학회지
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• 제22권1호
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• pp.28-36
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• 2022

목적: 혈장 아미노산(PAA) 및 소변 유기산(UOA) 분석에서 비정상적인 대사 산물의 검출은 리 증후군과 같은 임상 미토콘드리아 질환을 진단하는 데 사용되었다. 본 연구에서는 PAA 및 UOA 분석의 진단적 가치와 유효성을 검토하였다. 방법: 이 논문은 2003년에서 2018년 사이에 단일 3차 진료 센터에서 진단된 리 증후군 환자에 대상으로 후향적 연구로 진행되었다. 전체 미토콘드리아 시퀀싱 및 핵 DNA 관련 미토콘드리아 유전자 패널 분석을 통해 미토콘드리아 DNA (mtDNA) 돌연변이 관련 리 증후군에 대해 19명의 환자가 양성이었고 57명의 환자는 음성인 것으로 밝혀졌다. 그 이후에 PAA 및 UOA 분석 결과를 비교하였다. 결과: 두 그룹 간의 PAA 및 UOA 분석 결과를 비교한 결과, mtDNA 돌연변이 양성 Leigh 증후군과 mtDNA 돌연변이 음성 Leigh 증후군 그룹 간에 비정상적인 대사 산물은 뚜렷한 차이를 보이지 않았다. 결론: PAA 및 UOA 분석은 리 증후군을 진단하거나 mtDNA 돌연변이 관련 리 증후군을 선별하기 위한 부적절한 검사 방법이다. 그러나 UOA 분석은 여전히 리 증후군에 대한 적합한 선별 검사일 수 있다.