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Annual Report on the External Quality Assessment Scheme for Clinical Parasitology in Korea (2017)
J Lab Med Qual Assur 2018;40:21-26
Published online March 31, 2018
© 2018 Korean Association of External Quality Assessment Service.

Eun Jeong Won1, Ji Seung Jung1, Myung Geun Shin2, Jong Hee Shin2, Soon Pal Suh2

1Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, Gwangju, Korea,
2Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Eun Jeong Won Department of Parasitology and Tropical Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea Tel: +82-61-379-2701 Fax: +82-61-375-5834 E-mail: Parasite.woni@jnu.ac.kr
援먯떊옄: 썝젙 슦)61469 愿묒<떆 룞援 諛깆꽌濡 160, 쟾궓븰援 쓽怨쇰븰 湲곗깮異⑺븰援먯떎 Tel: 061)379-2701, Fax: 061)375-5834, E-mail: Parasite.woni@jnu.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract

Annual proficiency surveys were conducted in March, May, and August of 2017 as the Korean Association of External Quality Assessment Service. Overall, four image samples (MPI-17-01, MPI-17-02, MPI-17-03, MPI-17-04) in the first trial, three image samples (MPI-17-05, MPI-17-06 , MPI-17-07) in the second trial, and a slide specimen (MPS-17-01) using parasite samples in the third trial were distributed to participating institutions. The first and second trial specimens were prepared by photographing slides made of formalin-ether concentrate of positive samples stored for educational purposes. The slide distributed in the third trial was prepared using cellophane tape, which was stored after diagnosis of the patients infected with Enterobius vermicularis. There were 191 participating institutions in the first, 204 in the second, and 212 in the third trial. The correct identification rates were 27.2% for MPI-17-01 Diphyllobothrium species (sp.), 96.6% for MPI-17-02 no parasite, 67.5% for MPI-17-03 Metagonimus yokogawai, 71.2% for MPI-17-04 Balantidium coli, 99.0% for MPI-17-05 Taenia sp., 99.0% for MPI-17-06 Trichuris trichiura, 92.7% for MPI-17-07 Cryptosporidium sp., and 96.7% for MPS-17-01 E. vermicularis. The current external quality assessment for clinical parasitology was performed using image samples and standard slides. Surveys of parasitic infections should be accompanied by continuous education on various parasitic infections, for which there was lack of experience of inspection in clinical laboratories. In the future, it will be necessary to establish a standard material using parasitic samples, and ultimately to conduct a survey on whole series of tests for the diagnosis of parasitic diseases.

Keywords : Quality control, Parasitology
꽌 濡

븳엫긽寃궗젙룄愿由ы삊쉶뿉꽌뒗 옄諛쒖쟻씤 李몄뿬떊泥湲곌쓣 긽쑝濡 엫긽湲곗깮異 遺꾩빞뿉꽌 떊鍮숇룄議곗궗瑜 젣怨듯븯怨 엳떎. 븳엫긽寃궗젙룄愿由ы삊쉶 엫긽誘몄깮臾쇳븰遺꾧낵瑜 以묒떖쑝濡 援궡 엫긽誘몄깮臾쇨궗떎쓽 닔以씠 諛쒖쟾븯뒗 뜲 뵲씪 紐⑤뱺 빆紐⑸뱾뿉 빐 醫낇빀쟻씤 떊鍮숇룄議곗궗 봽濡쒓렇옩쓣 젣怨듯븯뒗 寃껋쓣 紐⑺몴濡 吏궃 10뀈媛 紐⑤뱢쓣 솗빐솕吏留, 援젣쟻씤 떊鍮숇룄議곗궗궗뾽뿉 鍮꾧탳븯뿬 떎냼 誘명씉븳 젏씠 엳쓣 닔諛뽰뿉 뾾뿀떎[1-4]. 듅엳 엫긽湲곗깮異 遺꾩빞뒗 슦닔寃궗떎 떊엫씤利앺룊媛 빆紐 以 엫긽誘몄깮臾쇱뿉 냽빐 엳吏留, 遺遺 諛곗뼇씠 릺吏 븡怨, 씠뿉 뵲瑜 몴以臾쇱쭏쓽 솗蹂닿 留ㅼ슦 뼱졄떎뒗 젏, 빟젣 媛먯닔꽦 寃궗쓽 븘슂꽦씠 궙떎뒗 젏씠 떎瑜 엫긽誘몄깮臾 빆紐⑷낵뒗 겕寃 떎瑜대떎. 쁽옱 援궡 엫긽寃궗떎뿉꽌 떆뻾븯뒗 湲곗깮異⑷궗뒗 二쇰줈 옣궡湲곗깮異⑹뿉 吏묒쨷븯뿬 쁽誘멸꼍쓣 씠슜븳 蹂寃寃쎈쾿쓣 씠슜븯怨 엳떎[5]. 援궡 옣궡湲곗깮異⑹쓽 쑀蹂묐쪧씠 媛먯냼븿뿉 뵲씪 洹 誘쇨컧룄뒗 媛먯냼븳 諛섎㈃, 쁽誘멸꼍쟻 吏꾨떒踰뺤 愿李곗옄뿉 뵲씪 二쇨쟻씠硫, 寃寃 寃쎈젰뿉 뵲瑜 李⑥씠媛 諛쒖깮븷 닔 엳떎뒗 븳怨꾨 媛뽮퀬 엳떎. 吏湲덇퉴吏뒗 援궡뿉꽌 솢슜 媛뒫븳 湲곗깮異 愿젴 몴以臾쇱쭏쓽 蹂닿툒씠 뼱젮썙 蹂寃寃쎈쾿뿉 븳 궡遺젙룄愿由щ뒗 誘몄쭊븳 떎젙씠硫, 떊鍮숇룄議곗궗瑜 넻븳 쇅遺젙룄愿由 뿭떆 씠誘몄뿉 쓽議댄븷 닔諛뽰뿉 뾾뒗 떎젙씠뿀떎[5,6]. 씠踰 2017뀈 떊鍮숇룄議곗궗쓽 湲곗깮異⑷궗 봽濡쒓렇옩뿉꽌뒗 湲곗〈 씠誘몄肉먮쭔 븘땲씪 湲곗깮異 떆猷뚮 씠슜븳 뒳씪씠뱶瑜 젣옉븯뿬 諛고룷븯怨 씠뿉 븳 寃寃쎈뒫젰쓣 鍮꾧탳꺕遺꾩꽍븯怨좎옄 븯떎. 삉븳 2017뀈 떊鍮숇룄議곗궗쓽 湲곗깮異⑷궗 봽濡쒓렇옩 寃곌낵瑜 醫낇빀쟻쑝濡 遺꾩꽍븯怨, 吏 愿由ъ닔以, 臾몄젣젏 遺꾩꽍, 뼢긽諛⑹븞 벑쓣 젣떆븯怨좎옄 븯떎.

옱猷 諛 諛⑸쾿

1. 떊鍮숇룄議곗궗 諛⑸쾿

2017뀈 떊鍮숇룄議곗궗궗뾽 3, 5, 8썡뿉 嫄몄퀜 3쉶 떆뻾븯쑝硫, 1李⑤뒗 4媛쒖쓽 씠誘몄 寃泥(MPI-17-01, MPI-17-02, MPI-17-03, MPI-17-04), 2李⑤뒗 3媛쒖쓽 씠誘몄 寃泥(MPI-17-05, MPI-17-06, MPI-17-07), 留덉留 3李⑤뒗 湲곗깮異 떆猷뚮 씠슜븳 뒳씪씠뱶 寃泥(MPS-17-01)瑜 李몄뿬湲곌뿉 諛곕븯떎. 1李⑥뿉뒗 븯떒뿉 媛濡 궗씠利 留덉빱瑜 룷븿떆궓 씠誘몄 뙆씪쓣 媛 臾명빆떦 1媛쒖뵫 젣옉븯뿬 諛고룷븯떎. 2李⑥뿉뒗 븯떒뿉 媛濡 諛 꽭濡 궗씠利 留덉빱瑜 룷븿떆궓 씠誘몄 1媛쒖 븿猿 媛긽 솚옄쓽 엫긽쟻 諛곌꼍쓣 젣떆븯怨 씠瑜 portable document format (PDF) 뙆씪濡 諛고룷븯떎. 3李⑥뿉뒗 湲곗깮異 異⑸씠 룷븿맂 뒳씪씠뱶瑜 250뿬 媛 젣옉븯뿬 媛 湲곌뿉 諛고룷븯떎. 紐⑤뱺 떊泥怨 寃곌낵엯젰, 寃곌낵뙋젙 벑 븳엫긽寃궗젙룄愿由ы삊쉶 솃럹씠吏뿉 援ъ텞맂 떊鍮숇룄議곗궗 봽濡쒓렇옩(http://eqas.keqas.org/)쓣 씠슜븯떎.

2. 愿由щЪ吏

1李⑥뿉뒗 湲곗깮異 뼇꽦냼寃 3媛 諛 쓬꽦냼寃 1媛쒕, 2李⑥뿉뒗 湲곗깮異 뼇꽦냼寃 3媛쒕, 3李⑥뿉뒗 湲곗깮異 뼇꽦냼寃 1媛쒕 룷븿떆궎怨좎옄 븯떎. 湲곗깮異⑹ 꽑異⑸쪟, 씉異⑸쪟, 議곗땐瑜 諛 썝異⑸쪟瑜 떎뼇븯寃 룷븿떆耳 遺꾨같븯뒗뜲, 1李⑥뿉뒗 씉異⑸쪟 1醫(ova of Metagonimus yokogawai), 議곗땐瑜 1醫(ova of Diphyllobothrium nihonkaiense), 썝異⑸쪟 1醫(cyst of Balantidium coli)쓣, 2李⑥뿉뒗 꽑異⑸쪟 1醫(ova of Trichuris trichiura), 議곗땐瑜 1醫(ova of Taenia saginata), 썝異⑸쪟 1醫(cyst of Cryptosporidium parvum)쓣, 3李⑥뿉뒗 꽑異⑸쪟 1醫(ova of Enterobius vermicularis)쓣 꽑蹂꾪븯떎. 씠誘몄 寃泥대뒗 援먯쑁슜쑝濡 蹂닿 以묒씤 뼇꽦 떆猷뚯쓽 룷瑜대쭚由-뿉뀒瑜 냽異뺤븸쓣 씠슜븯뿬 젣옉븳 뒳씪씠뱶瑜 珥ъ쁺븯뿬 젣옉븯떎. 3李 떊鍮숇룄議곗궗뿉 諛고룷븳 뒳씪씠뱶뒗 濡쒗뙋뀒씠봽踰뺤뿉꽌 슂異 異⑸쓣 솗씤븯뿬 슂異⑹쬆쓣 吏꾨떒븳 썑 蹂닿 以묒씠뜕 濡쒗뙋뀒씠봽瑜 씠슜븯뿬 젣옉븯떎. 젣옉븳 뒳씪씠뱶뒗 湲곗깮異 異⑸ 寃寃쎌뿉 닕젴맂 2씤씠 寃寃쏀븯뿬 슂異 異⑸쓣 솗씤븳 寃쎌슦留 꽑蹂꾪븯뿬 몴以 뒳씪씠뱶濡 諛고룷븯떎.

3. 寃곌낵 뙋젙 諛 빐꽍

湲곗깮異 룞젙 醫낆닔以源뚯 留욌뒗 寃쎌슦 삉뒗 엫긽쟻쑝濡 냽닔以쓽 룞젙씠 쓽誘멸 엳떎硫 냽닔以源뚯 留욌뒗 寃쎌슦瑜 ‘쟻젅(acceptable)’븯떎怨 뙋젙븯떎. 씠 湲곗뿉 留욎 븡 떟쓣 븯嫄곕굹 떟븯吏 븡 寃쎌슦 ‘遺쟻젅(unacceptable)’濡 뙋젙븯떎. 1李 떊鍮숇룄議곗궗쓽 寃쎌슦 씠誘몄 궗씠利덉쓽 삤瑜섎줈 씤븳 씪遺 湲곌뿉꽌쓽 삤뙋룆 媛뒫꽦씠 젣湲곕릺뼱 쟾泥 湲곌쓽 寃곌낵媛믪쓽 씪移섎룄媛 80%뿉 誘몃떖씠硫 뙋젙쓣 蹂대쪟븯떎.

寃 怨

2017뀈 湲곗깮異⑷궗 떊鍮숇룄議곗궗寃곌낵뒗 Table 1뿉 젙由ы븯떎. 李몄뿬湲곌 1李⑥뿉꽌 191湲곌, 2李⑥뿉꽌 204湲곌, 3李⑥뿉꽌 212湲곌씠뿀떎. 1李⑥쓽 寃쎌슦 MPI-17-01 Diphyllobothrium species (sp.)뒗 27.2%, 湲곗깮異⑹씠 뾾뿀뜕 MPI-17-02뒗 96.6%, MPI-17-03 Metagonimus yokogawai뒗 67.5%, MPI-17-04 Balantidium coli뒗 71.2%쓽 젙떟瑜좎쓣 蹂댁떎. 2李⑥쓽 寃쎌슦 MPI-17-05 Taenia sp.뒗 99.0%, MPI-17-06 Trichuris trichiura뒗 99.0%, MPI-17-07 Cryptosporidium sp.뒗 92.7%쓽 젙떟瑜좎쓣 蹂댁떎. 3李⑥쓽 寃쎌슦 MPS-17-01 Enterobius vermicularis뒗 96.7%쓽 젙떟瑜좎쓣 蹂댁떎. 寃곌낵蹂닿퀬꽌뒗 怨듯넻蹂닿퀬꽌 湲곌蹂꾨낫怨좎꽌 몢 媛吏 삎깭濡 젣怨듯븯뒗뜲, 怨듯넻蹂닿퀬꽌뿉뒗 빐떦 쉶李⑥뿉 룷븿맂 湲곗깮異 吏꾨떒뿉 듅吏뺤쟻씤 냼寃ш낵 諛곕븳 씠誘몄瑜 젣怨듯븯怨, 湲곌蹂 蹂닿퀬꽌뿉꽌뒗 媛 湲곌쓽 寃곌낵媛믨낵 뙋젙냼寃, 洹몃━怨 쟾泥닿린愿뿉꽌 쓳떟븳 寃곌낵媛믪쓽 醫낅쪟 諛 닔 遺꾩쑉쓣 젣怨듯븯떎(Fig. 1).

Table 1 . Performance of laboratories in microscopic examination of stools in clinical parasitology.

Trial no.Specimen no.No. of participants Organisms identified with acceptable accuracyNo. (%) Organisms identified with unacceptable accuracyNo. (%)
Trial IMPI-17-01*191Diphyllobothrium sp.52 (27.2)Subtotal139 (72.8)
Trichostrongylus65 (34.0)
Enterovirus vermicularis36 (18.8)
Ascaris sp.17 (8.9)
Metagonimus yokogawai7 (3.7)
Fasciola hepatica /Fasciola buski6 (3.1)
Hookworm4 (2.1)
Paragonimus sp.2 (1.0)
Trichostrongylus orientalis1 (0.5)
Trichostrongylus sp.1 (0.5)
MPI-17-02191No parasite observed185 (96.9)Subtotal6 (3.1)
Schistosoma japonicum2 (1.0)
Enterovius vermicularis1 (0.5)
Chilomastix mesnili1 (0.5)
Diphyllobothrium sp.1 (0.5)
No response1 (0.5)
MPI-17-03*191Metagonimus yokogawai129 (67.5)Subtotal62 (32.5)
Enterovius vermicularis44 (23.0)
Clonorchis sp.12 (6.3)
Diphyllobothrium sp.1 (0.5)
Fasciola hepatica /Fasciola buski1 (0.5)
Giardia lamblia1 (0.5)
Hymenolepis nana1 (0.5)
No parasite observed1 (0.5)
Trichostrongylus1 (0.5)
MPI-17-04*191Balantidium coli136 (71.2)Subtotal55 (28.8)
No parasite observed51 (26.7)
Clonorchis sp.1 (0.5)
Entamoeba histolytica /E. disper1 (0.5)
Giardia lamblia1 (0.5)
Taenia sp.1 (0.5)
Trial IIMPI-17-05204Taenia sp.202 (99.0)Subtotal2 (1.0)
Ecchinococcus sp.1 (0.5)
Trichuris trichiura1 (0.5)
MPI-17-06204Trichuris trichiura202 (99.0)Subtotal2 (1.0)
Taenia sp.1 (0.5)
Trichomonas hominis1 (0.5)
MPI-17-07204Cryptosporidium sp.189 (92.7)Subtotal15 (7.4)
Entamoeba histolytica /E. disper5 (2.5)
Cystoisospora (Isospora) belli3 (1.5)
Endolimax nana2 (1.0)
Entamoeba coli1 (0.5)
Entamoeba hartmanni1 (0.5)
No parasite observed3 (1.5)
Trial IIIMPS-17-01212Enterobius vermicularis205 (96.7)No parasite observed7 (3.3)

Abbreviation: sp., species..

*Excluded from evaluation because of low consensus.


Figure 1.

Summary report of clinical parasitology program. (A, B) Summary of all participants. (C) Summary of each laboratory.


怨 李

湲곗깮異⑷궗 봽濡쒓렇옩뿉꽌쓽 떊鍮숇룄議곗궗궗뾽 쟻젅븳 몴以臾쇱쭏쓽 솗蹂닿 뼱젮슫 깛뿉 솗릺湲 뼱젮슫 븳怨꾨 媛吏怨 엳뼱, 湲곗깮異 異⑸ 씠誘몄瑜 씠슜븳 寃寃쎈뒫젰뿉 븳 鍮꾧탳꺕遺꾩꽍쓣 닔뻾빐 솕떎[4]. 씠踰 2017뀈 1李 떊鍮숇룄議곗궗쓽 寃쎌슦 媛 湲곗깮異 吏꾨떒쓣 쐞븳 ova 삉뒗 cyst 씠誘몄瑜 1媛쒖뵫 젣怨듯븯뒗뜲, 쟾궛떆뒪뀥뿉꽌 援ы쁽릺뒗 怨쇱젙뿉꽌 씠誘몄쓽 媛濡 湲몄씠媛 엫쓽濡 異뺤냼릺硫댁꽌 異⑸ 紐⑥뼇씠 솢怨〓릺怨 궗씠利 留덉빱媛 吏㏃븘吏뒗 쁽긽씠 씪遺 湲곌뿉꽌 솗씤릺뿀떎. 紐⑤뱺 湲곌뿉꽌 룞씪븳 쟾궛떆뒪뀥쓽 삤瑜섍 솗씤릺吏뒗 븡븯쑝굹, 룞씪븳 議곌굔씠 媛젙릺뼱빞 븯뒗 떊鍮숇룄議곗궗궗뾽쓽 쟾젣瑜 媛먯븞븯뿬 쟾泥 湲곌쓽 寃곌낵媛 씪移섎룄媛 80%뿉 誘몃떖씠뿀뜕 湲곗깮異 뼇꽦냼寃 3媛쒖뿉 빐꽌뒗 뙋젙쓣 蹂대쪟븯떎. 씠썑 媛濡 諛 꽭濡 궗씠利 留덉빱瑜 異붽븯怨 PDF뙆씪濡 삎떇쓣 諛붽퓭 씠誘몄 寃泥댁쓽 엫쓽쟻씤 솢怨≪쓣 諛⑹븯怨좎옄 븯쑝硫, 媛긽 솚옄쓽 엫긽쟻 諛곌꼍쓣 異붽濡 젣떆븿쑝濡쒖뜥 湲곗깮異 룞젙뿉 룄쓣 二쇨퀬옄 븯떎. 씠瑜 넻빐 2李 떊鍮숇룄議곗궗뿉꽌뒗 92.7%-99.0%쓽 넂 젙떟瑜좎쓣 蹂댁뿬, 씠誘몄 寃泥대 씠슜븳 쟻젅븳 닔以쓽 떊鍮숇룄議곗궗媛 씠琉꾩쭏 닔 엳뿀떎怨 뙋떒릺뿀떎. 븯吏留 꽑異⑸쪟 諛 議곗땐瑜 異⑸뿉 鍮꾪빐 썝異⑸쪟씤 Cryptosporidium sp.뒗 젙떟瑜좎씠 鍮꾧탳쟻 궙怨, 떎뼇븳 삤떟쓣 蹂댁떎. 씠뒗 援궡 寃궗떎뿉꽌 썝異⑸쪟뿉 븳 寃寃 寃쏀뿕씠 긽쟻쑝濡 쟻湲 븣臾몄쑝濡 뙋떒릺뿀떎. 떎젣 援궡 엫긽寃궗떎뿉꽌 蹂寃궗쓽 궡遺젙룄愿由 쁽솴쓣 뙆븙븳 뿰援ш껐怨쇱뿉 뵲瑜대㈃, 떎닔 湲곌(74.4%)뱾씠 썝異⑸쪟 吏꾨떒쓣 쐞븳 듅닔뿼깋쓣 떆뻾븯怨 엳吏 븡怨 엳떎怨 떟蹂븯떎[5]. 썝異⑸쪟뿉 빐꽌뒗 쁽誘멸꼍쟻 吏꾨떒踰뺤씠 긽쟻쑝濡 궙 誘쇨컧룄瑜 蹂댁엫 옒 븣젮吏 궗떎씠硫[7], 씠瑜 蹂댁셿븯湲 쐞빐 ELISA (enzyme-linked immunosorbent assay)踰뺤씠굹 떎뼇븳 以묓빀슚냼뿰뇙諛섏쓳쓣 씠슜븯뒗 吏꾨떒踰뺤씠 씠슜맆 닔 엳吏留, 臾댁뾿蹂대떎룄 듅닔뿼깋씠 鍮꾩슜 슚怨쇱쟻씠떎[5]. 臾댁뾿蹂대떎룄 꽕궗 솚옄뿉꽌 썝異⑸쪟 媛먯뿼씠 쓽떖릺뒗 寃쎌슦뿉뒗 썝異⑸쪟 吏꾨떒쓣 쐞븳 듅닔뿼깋쓣 떆뻾븯뒗 寃껋씠 쁽옱 寃궗떎 떎젙뿉 쟻빀븯由щ씪怨 뙋떒맂떎.

씠踰 2017뀈 1李 떊鍮숇룄議곗궗 以 MPI-17-01 Diphylloboth異밿um sp.뒗 27.2%濡 留ㅼ슦 궙 젙떟瑜좎쓣 蹂댁씠硫댁꽌 9媛쒕줈 떎뼇븳 삤떟쓣 젣떆븯뒗뜲, 씠뒗 씠誘몄 솢怨≪쑝濡 씤븳 systemic error留뚯쑝濡쒕뒗 꽕紐낇븯湲 뼱젮썱떎. 씠뒗 룊냼 寃궗떎뿉꽌 젒븯湲 뼱젮슫 愿묒젅뿴몢議곗땐利앹쓽 寃쎌슦 寃寃 寃쏀뿕쓽 遺議깆쑝濡 씤븳 뙋룆 삤瑜섏씪 媛뒫꽦쓣 떆궗븯떎. 吏궃 2015뀈 떊鍮숇룄議곗궗뿉꽌룄 寃궗떎뿉꽌 룊냼 젒븷 닔 엳뒗 렪異⑸뿉 빐꽌뒗 넂 젙떟瑜좎쓣 蹂댁吏留, 遺꾩꽑異 쑀異⑹씠굹 솢냼議곗땐뿉 빐꽌뒗 궙 씪移섎룄瑜 蹂댁뿬 떎젣 寃궗떎뿉꽌 떎뼇븳 湲곗깮異⑹쬆뿉 븳 寃寃 寃쏀뿕쓽 遺議깆쑝濡 쐞뼇꽦 삉뒗 쐞쓬꽦 寃곌낵瑜 蹂댁씪 닔 엳쓬쓣 떆궗븳 諛 엳떎[4]. 윭떆븘뿉꽌룄 蹂寃寃쎄궗뿉 븳 쇅遺젙룄愿由щ 媛긽 뒳씪씠뱶 뙋룆쓣 씠슜븯뿬 떆뻾븯쓣 븣, 썝異⑸쪟굹 겕湲곌 옉 湲곗깮異 異⑸뿉 븳 뙋룆뒫젰씠 寃궗떎留덈떎 떎뼇븯怨 씪移섏쑉씠 궙떎怨 蹂닿퀬븳 諛 엳떎[8]. 뵲씪꽌 湲곗깮異⑷궗쓽 떊鍮숇룄議곗궗뒗 떎젣 寃궗떎뿉꽌 젒븷 닔 엳뒗 떎뼇븳 湲곗깮異⑹쬆뿉 븳 吏냽쟻씤 援먯쑁씠 룞諛섎릺뼱빞 븷 寃껋쑝濡 뙋떒맂떎.

湲곗깮異 異⑸쓽 떒씪 씠誘몄瑜 씠슜븳 떊鍮숇룄議곗궗濡쒕뒗 寃寃쎌옄媛 떎젣쟻쑝濡 쁽誘멸꼍쓣 떎猷⑤뒗 쁺뿭源뚯뒗 뙋떒븷 닔 뾾뒗 븳怨꾧 엳湲 븣臾몄뿉 3李 떊鍮숇룄議곗궗뿉꽌뒗 몴以 뒳씪씠뱶瑜 젣議고븯뿬 諛고룷븿쑝濡쒖뜥 씠瑜 洹밸났븯怨좎옄 븯떎. 洹 寃곌낵 96.7%쓽 떎닔 湲곌뿉꽌 몴以 뒳씪씠뱶瑜 씠슜븳 쟻젅븳 寃寃쎈뒫쓣 媛吏怨 슂異⑹쬆쓣 吏꾨떒븷 닔 엳쓬쓣 솗씤븯떎. 2015뀈룄 126湲곌뿉 鍮꾪빐 1.5-1.7諛 利앷븳 李멸湲곌 닔瑜 媛먯븞븯뿬 뼢썑 씪遺 湲곗깮異 醫낅쪟뿉 뵲瑜 닔湲 뿬遺뿉 뵲씪 몴以 뒳씪씠뱶肉 븘땲씪 媛긽 뒳씪씠뱶瑜 씠슜븳 뙋룆 뿭떆 쟻슜븷 닔 엳쑝由щ씪 蹂몃떎[4,8].

씠踰 2017뀈 떊鍮숇룄議곗궗쓽 湲곗깮異⑷궗 봽濡쒓렇옩뿉꽌뒗 씠誘몄 寃泥 諛 몴以 뒳씪씠뱶瑜 넻븳 쇅遺젙룄愿由щ 닔뻾븯떎. 쁽옱뒗 二쇰줈 옣궡湲곗깮異⑹쓣 吏꾨떒븯湲 쐞븳 蹂寃寃쎄궗留뚯쓣 긽쑝濡 븯怨 엳吏留, 뼢썑 삁븸留ㅺ컻꽦 湲곗깮異 諛 議곗쭅移⑤쾾 湲곗깮異 벑 떎뼇븳 湲곗깮異⑹쭏솚쓽 吏꾨떒쓣 쐞븳 떊鍮숇룄議곗궗媛 씠琉꾩졇빞 븷 寃껋씠떎. 삉븳 뼢썑 湲곗깮異 떆猷뚮 씠슜븳 몴以臾쇱쭏쓣 솗蹂댄븯뿬 沅곴레쟻쑝濡쒕뒗 湲곗깮異⑹쭏솚쓽 吏꾨떒쓣 쐞븳 寃궗쓽 씪젴 怨쇱젙쓣 븘슦瑜대뒗 떊鍮숇룄議곗궗媛 씠琉꾩졇빞 븷 寃껋씠떎.

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