20－121

20 121 150 1 20 121 1 HbA1C 1 2 2 HbA1C 3 2 4 5 HbA1C 1 HbA1C -NH2 -CHO HbA1C 1 1 HbA1C HbA1C HbA1C HbA1C HbA1C 120 HbA1C HbA1C 1 2 2 HbA1C 120 10 10 10 3 β β 1 1 GAD ICA 2 4 HbA1C 2 1 2 5 2

20 121 150 2 20-122 a 1 2,000kcal b c d 1 a b 2 a c 3 a d 4 b c 5 c d 1 10 12 10 20 10 1 2,000kcal 60 2,000 0.6 4 300g 10 3,000ml 1 4,000ml 1 2,000kcal 15 30 3 b c 4

20 121 150 3 20 123 1 B1 2 B6 3 B12 4 C 5 D 5mEq/L ph 1 B1 B1 B1 CoA α α CoA B1 ATP NAD B1 1

20 121 150 4 20 124 a b c K d 1 a b 2 a c 3 a d 4 b c 5 c d HMG-CoA HIV P450 CYP3A3 P450 K K γ- γ- Ca 2+ K Ca 2+ K K K K K b c 4

20 121 150 5 20 125 a POS b POMRC c POMRC d 1 a b 2 a c 3 a d 4 b c 5 c d POS Problem-Oriented System POS 1964 1973 POS POS POS POMR Problem-Oriented Medical Record POS POMR Problem-Oriented Medical Record POMRC POMR POMR 4 POMR SOAP S Subject Data O Objective Data O A Assessment S O P Plan A POMR 1 a c 2

20 121 150 6 20 126 1 2 3 4 5 Ca Ca Ca Ca 99 1 Ca 10mg/dl Ca 1 1 Ca Ca Ca Ca Ca Ca Ca Ca Ca Ca 2+ Ca Ca Ca Ca Ca 3 3 D 3 Ca Ca Ca D Ca Ca Ca Ca D Ca Ca Ca Ca 4

20 121 150 7 20 127 1 IgA 2 3 4 5 IgE 20 2 IgE IgE 4

20 121 150 8 20 128 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d 3 250mg/dl 1 15 30 1 2 1 1 160 240kcal 100 120 1 2 a b 1

20 121 150 9 20 129 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d 170mg/dl 2 2 1 Microangiopathy Macroangiopathy 2 3 1 1 a d 3

20 121 150 10 20 130 40 175cm 65kg 126/70mmHg 11.0mg/dL 1 2 3 4 5 40 175cm 170cm 65kg BMI 21.2 25 11.0mg/dL Lesch-Nyhan 2 BMI 1 2,000mL 2

20 121 150 11 20 131 53 170cm 70kg 245mg/dL 220mg/dL HDL 40mg/dL 1 1 2,200 2,400kcal 2 1 1,600 1,800kcal 3 1 1,000 1,200kcal 4 1 20g 5 1 80g 53 1 170cm 70kg BMI BMI 24.2 25 1 20 TC TG HDL HDL-C 3 LDL LDL-C LDL-C TC HDL-C TG 5 LDL-C 161mg/dL TC 220mg/dL LDL-C 140mg/dl HDL-C 40mg/dL,TG 140mg/dL TC LDL-C TG HDL-C TC TG b 2004 LDL-C B1 1 25 30kcal 63.6kg 1590 1908kcal 1 3 2 20 25 1800kcal 20 25 360 450kcal 9 40 50g 4 5 2

20 121 150 12 20 132 1 2 3 4 5 60 30 10 40 25 20 1 3 2 3 4 5 2

20 121 150 13 20 133 1 2 1 30g 3 4 kg 20kcal 5 50 35 15 1 kg 30 40kcal 3 4 5 1 30g 20g 30g n-3 2 2

20 121 150 14 20 134 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d a 2 ph 2 c 1 3 d Na 1 Na b b c 4

20 121 150 15 20 135 a n 6 b LDL c d 1 a b 2 a c 3 a d 4 b c 5 c d 2 TXA2 PGI2 TXA2 PGI2 2 TXA2 PGI2 n 6 n 6 n 3 n 3 EPA TXA3 PGI3 EPA EPA TXA2 EPA TXA3 TXA2 PGI3 PGI2 EPA n 3 a LDL LDL LDL n 6 LDL HDL n 6 HDL n 3 LDL n 6 LDL b 2004 1 6g BMI 25 30 1 20 30mg 10 20mg 6 c d c d 5

20 121 150 16 20 136 1 IgE 2 1 3 4 50mL/ 5 3 IgA 30 40 20 IgA IgA 1 IgE IgA 1 60 10 1998 1 35.7 2 35.0 15 2003 40 2 3 70mL/ 70mL/ 4 5 5

20 121 150 17 20 137 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d 2 2 SLE Na Na VLDL LDL VLDL LDL d 1 1 3.5 g 2 6.0g/dl 3.0g/dl 3 250 mg/dl 4 1 2 b a c 2

20 121 150 18 20 138 50 160cm 60kg BMI 23.4kg/m2 GFR 2 1 20 25kcal/kg 1.0 1.2g/kg 10g/ 2 25 30kcal/kg 1.0 1.2g/kg 10g/ 3 25 30kcal/kg 0.8 1.0g/kg 7 8g/ 4 35 40kcal/kg 0.8 1.0g/kg 7 8g/ 5 35 40kcal/kg 0.6g/kg 7g/ 1 2 3 1 2 2 3 2+ 3 3 A B A 1g/day B GFR GFR GFR GFR 1g/day A B B 1 3 A 2+ 100mg/dl 1 1500ml 1.5g 3 B 3 A 1 3 A GFR 25 30kcal/kg/day 1 20 25kcal/kg/day 3 B 4 GFR 30 35kcal/kg/day 35 40kcal/kg/day CAPD 30 35kcal/kg/day 2 1.0 1.2g/kg/day 3 A 0.8 1.0 g/kg/day 4 0.6 0.8 g/kg/day 2 3 A 7 8g/day 4 5 7g/day 7 8g/day CAPD 8 10g/day 2 4 5 3

20 121 150 19 20 139 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d TSH 20 50 Merseburg T3 T4 TSH TSH K 20 40 ACTH K 30 50 80 90 10 20 Na 20 50 T3 T4 TSH b c 4

20 121 150 20 20 140 COPD 1 2 3 4 5 COPD 50 8 2 COPD COPD COPD COPD 1 COPD COPD PEM COPD COPD 3 4 COPD COPD BCAA PEM BCAA 5 COPD COPD 1 2 3 QOL 4 5 5 1 5

20 121 150 21 20 1413 1 2 3 4 5 O 157 16 2005 1 558 2 225 3 205 4 55 5 28 6 27 7 25 18 3 6 48 6 20 2 7 3 4

20 121 150 22 20 142 1 2 3 IgG 4 B 5 IgE IgG IgA 1 2 IgM IgG IgG B T 3 4 IgE IgE IgE IgE 5 5

20 121 150 23 20 143 1 2 3 4 5 1 2 1 ACTH 3 5 2 3 1 2 Active factor Stress factor Harris-Benedict 1.0 1.2 1.2 1.1 3 90 3 1 5 6 4 5 3

20 121 150 24 20 144 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d Systemic inflammatory response syndrome, SIRS SIRS SIRS SIRS 1 38 36 2 90/ 3 20/ 32mmHg 4 12,000/mm2 4,000 10 4 2 SIRS SIRS 1 2 3 4 SIRS SIRS SIRS a c 2

20 121 150 25 20 145 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d 5 1 2 3 4 5 a b d c 4

20 121 150 26 20 146 1 2 A β 3 4 5 IgA IgA A β 1 2 2 100 60 80 2

20 121 150 27 20 147 1 2 3 4 5 2 10 1 3

20 121 150 28 20 148 1 2 80 3 A 4 5 20 PEM PEM PEM PEM PEM 50 PEM 40 60 40 85 5 12 PEM PEM PEM 80 80 90 60 80 60 85 95 60 85 60 2 A D 20 20 30 30 50 50 1 3 4 5 2 2 2

20 121 150 29 20 149 1 2 3 4 5 WHO 13g/dL 12g/dL 11g/dL 33 TIBC 1 1,000mL 32 34 2 20 95 1 2 5 30kcal 150kcal 350kcal 3 4 4

20 121 150 30 150 a b c d 1 a b 2 a c 3 a d 4 b c 5 c d a c 2