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Helicobacter pylori 감염에서 CagA 및 VacA 발현과 위 상피세포 증식과의 관계
김남일(Nam Il Kim),이중현(Jung Hyun Lee),이영실(Yeoung Sil Lee),이재욱(Jae Uk Lee),이구(Goo Lee),서정일(Jeong Ill Suh),양창현(Chang Heon Yang),이창우(Chang Woo Lee),윤환중(Hwan Jung Yun),장태정(Tae Jung Jang),김정란(Jung Ran Kim),하경 대한내과학회 2000 대한내과학회지 Vol.58 No.5
N/A Background : Infection with Helicobacter pylori (H. pylori) has been associated with an increased risk for developing gastric cancer. This risk is further enhanced with CagA positive H. pylori strains. Increased epithelial cell proliferation is associated with an increased risk for gastric cancer. The aim of the study was to investigate whether the gastric epithelial cell proliferation was related to the expression of CagA and VacA in H. pylori infection. Methods : The subjects were 77 patients who had undergone diagnostic esophagogastroduodenoscopy with biopsy; 18 gastritis, 18 gastric ulcer, 17 duodenal ulcer and 24 gastric cancer. The expression of cytotoxic genes was determined indirectly by assaying serum IgG antibodies to specific antigens of H. pylori. Gastric epithelial cell proliferation was assessed using immunohistochemical method using Ki-67 monoclonal antibody. Acute and chronic inflammation, intestinal metaplasia and glandular atrophy were scored according to the updated Sydney system. Results : Ki-67 labeling index, acute and chronic inflammation were significantly higher in H. pylori infected persons (n=70, 90.9%) than in uninfected persons (n=7, 9.1%) (p<0.05), but the difference in intestinal metaplasia and glandular atrophy between the two groups was not statistically significant. Ki-67 labeling indices in persons infected with CagA positive strains (n=56, 80.0%) were significantly higher than in persons infected with CagA negative strains (n=14, 20%) (0.55±0.13 vs 0.37±0.17, p<0.05), but the differences in acute and chronic inflammation, intestinal metaplasia and glandular atrophy between the two groups were not statistically significant. No significant difference was found in Ki-67 labeling index, acute and chronic inflammation, intestinal metaplasia and glandular atrophy according to expression of VacA. Conclusion : Gastric mucosal cell proliferation, which might be closely involved in the pathogenesis of gastric carcinoma, was significantly higher in CagA positive H. pylori infected persons.(Korean J Med 58:516-525, 2000)
포스터 전시 : 위장관 ; 장중첩증으로 발견된 소장 임파종 1예
정희철 ( Hee Chul Jung ),김남일 ( Nam Il Kim ),김성자 ( Sung Ja Kim ),이구 ( Goo Lee ),양창헌 ( Chang Heon Yang ),이창우 ( Chang Woo Lee ),정기훈 ( Gee Hoon Jung ),김정란 ( Jung Ran Kim ),서정일 ( Jeung Ill Suh ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
<증례> 33세 남자가 내원 1개월 전부터 간헐적인 상복부와 제대주위 통증이 있어 타병원에서 두 차례 상부위장관내시경검사를 시행하여 위염 진단 하에 치료 하던 중 증상호전이 없어 내원하였다. 내원당시 체중감소는 없었으며 이학적소견상 상복부와 제대주위에 경도의 압통이 있었지만 반발통은 없었고 덩어리나 임파선은 촉지되지 않았다. 검사실소견상 백혈구 8,460/㎣, 헤모글로빈 14.9g/㎗, 혈소판 281,000/㎣이였으며 말초혈액도말검사, 간기능검사, 혈청
만성 B 형 간염에서 인터페론과 라미뷰딘의 단독치료와 병합치료의 효과 비교
장재식(Jae Sik Jang),김성욱(Sung Wook Kim),정소연(So Yeon Jung),김남일(Nam Il Kim),이구(Goo Lee),서정일(Jeong Ill Suh),양창헌(Chang Heon Yang),이창우(Chang Woo Lee),남경수(Kyung Soo Nam),김철호(Cheorl Ho Kim) 대한내과학회 2001 대한내과학회지 Vol.60 No.4
N/A Background: Alpha-interferon achieves HBeAg seroconversion in about 30 to 40% of patients with chronic hepatitis B, and recently discovered lamivudine, an oral nucleoside analogue, inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B effectively. In this study, we compared the efficacy and safety of alpha-interferon, lamivudine and their combination regimen. Methods: Fourty chronic hepatitis B patients, who were diagnosed through HBV DNA, HbeAg positivity, alanine aminotransferase elevation, and liver biopsy were enrolled in this study. Twelve patients were treated with 500 MU of alpha-interferon subcutaneously 3 times a week for 6 months, 9 patients were treated with 150 mg of lamivudine and alpha-interferon, and 19 patients were treated with 150 lamivudine daily for 6 months. Results: After treatment, all of the three groups showed rapid decline in HBV DNA level, but lamivudine group showed more clearance of HBV DNA than interferon group (alpha-interferon: 75%, combination group: 89%, lamivudine group: 100%, respectively) (p=0.04). HBeAg seroconversion rate was 25% for interferon group, 11% for combination group, 26% for lamivudine group, showing no difference between three groups (p =0.705). Mean serum ALT level and rate of ALT normalization during therapy showed no differnece (83% for interferon group, 78% for combination group, 84% for lamivudine group). Conclusion: It is suggested that the efficacy of combination interferon/lamivudine therapy appears disappointing and further study should be done for appropriate combination or monotherapy of lamivudine for patients with chronic hepatitis B.(Korean J Med 60:342- 348, 2001)
경주지역에서 식물제제에 의한 급성 간손상 환자의 임상적 고찰
천우정(Woo Jung Chun),윤병구(Byung Gu Yoon),김남일(Nam Il Kim),이구(Goo Lee),양창헌(Chang Heon Yang),이창우(Chang Woo Lee),서정일(Jeong Ill Suh) 대한내과학회 2002 대한내과학회지 Vol.63 No.2
배경: B형 간염 백신의 도입 이후 우리나라에서는 바이러스에 의한 급성 간손상은 감소하는 추세에 있는 반면에 식물제제나 건강식품에 의한 약인성 간손상이 증가하고 있는 추세이나, 급성 간손상에 대한 일치된 진단방법과 원인평가의 기준이 없는 실정이다. 이에 저자들은 경주 인근지역의 급성 간손상의 분포와 특성, 식물제제에 의한 급성 간손상의 빈도와 원인물질, 임상양상 등을 알아보고, 원인평가기준으로 제시된 CIOMS 진단점수표와 Maria & Victorino 진단점수표를 비교, 분석하였다. 대상 및 방법: 1997년 4월부터 2001년 3월까지 급성 간손상으로 동국대 경주병원에 입원한 150예의 환자 중에서 이전 간질환의 병력이나 상습적인 음주력, 대사성 간질환 및 간담도 질환, 바이러스성 간염과 자가면역성 간염을 제외한 78예를 대상으로 하였으며, 명확한 약제의 복용력이 있으면서 ALT, ALP, Total bilirubin 중 한 가지 이상이 정상범위 상한의 2배(2N) 이상이며, 약제복용 중단후 특별한 치료없이 간검사가 정상으로 회복된 경우만을 대상으로 선택하였으며, 각각의 예에 대해 복용약제, 간손상의 양상, 약제 중단 후 회복기간, 음주력, 다른 간담도질환의 존재 여부, 의심되는 약제의 재투여 여부, 바이러스성 간염 표지자, AST, ALT, TB, ALP 등을 후향적으로 조사하였고, 각 예를 식물제제에 의한 군과 양약제에 의한 군으로 구분하여 두 군간의 특성을 비교하였다. 또한 CIOMS 진단 점수표와 M&V 진단 점수표의 유용성과 일치성을 비교하였다. 결과: 4년 동안 급성 간손상으로 입원한 환자는 150예였고, 그 중 약인성 간손상이 78예(52.0%)로 가장 높은 빈도를 보였다. 원인약제로는 양약이 39예(50.0%)였으며, 식물제제와 건강식품 또한 39예(50.0%)였다. 그 중 한약제가 23예(58.9%)였고, 환약 5예(12.8%), 인진쑥 3예(7.7%), 사슴 액기스 3예(7.7%), 키토산이 2예(5.1%), 호박소주, 잉어, 풀뿌리 등이 각 1예(2.6%)였다. 간손상의 양상은 간세포성 간손상이 48예(61.5%)로 가장 많았고 두 군간에 유의한 차이는 없었다(p>0.1). CIOMS와 M&V 진단점수표 간에 등급이 일치하는 경우는 2예(2.6%)에 불과하여 kappa값을 이용한 카이제곱 검정으로 계산이 되지 않을 만큼 매우 낮은 일치율을 보였다. 결론: 급성 간손상으로 입원한 환자들에게서 약인성 간손상의 빈도가 증가하고 있고, 그 중 식물제제에 의한 간손상의 비중이 높음을 확인할 수 있었으며, 간손상의 가능성이 있는 양약제 및 식물제제의 무분별한 남용에 대해 사회적 경각심을 고취시켜야 할 것으로 생각된다. 또한 식물제제에 의한 간손상의 빈도가 높은 한국적 특성에 맞는 새로운 진단 점수표가 필요할 것으로 생각된다. Background: The prevalence of acute viral liver injury is decreasing, but drug induced liver injury by herbal medicine and health foods is on an increasing trend after introduction of vaccination. Nevertheless, there is no consensus of diagnostic method and causality assessment for acute liver injury. Therefore, the cause, clinical features, prevalence and pattern of acute liver injury caused by herbal medicine and health foods in Gyeongju area were analyzed. Moreover, Council for International Organization of Medical Science (CIOMS) scale and Maria and Victorino (M&V) scale, clinical scales for causality assessment in hepatotoxicity were compared. Methods: 78 patients in whom there was definite evidence of taking medicine and there was one more increase of over 2N (upper limit of the normal range) in alanine aminotransferase (ALT) or total bilirubin (TB) or alkaline phosphatase (ALP) and self-remitted after drug stop were selected excluding patients with previous liver disease history and history of alcohol, metabolic liver disease and hapatobiliary disease and viral, autoimmune, unknown origin hepatitis among 150 patients of admission due to acute liver injury, from April 1997 to March 2001. Each case was investigated retrospectively about taken medicine, the pattern of liver injury, recovery period after drug stop, history of alcohol, other hepatobiliary disease, pregnancy, recent hypotension, rechallenge and viral markers of hepatitis, aspartate aminotransferase (AST), ALT, TB, ALP. Also, herbal medicine and western medicine groups were compared and consistency with CIOMS scale and M&V scale were investigated. Results: For four years, among 150 cases, drug-induced liver injury were 78 cases (52.0%), occurred the highest prevalence. In taken medicine, western medicine were 39 cases (50.0%), herbal medicine and health foods were 39 cases (50.0%), too. Among those cases, herbal medication were 23 cases (58.9%), pellet 5 cases (12.8%), In-jin-ssuk 3 cases (7.7%), deer extract 3 cases (7.7%), kitosan 2 cases (5%) and pumpkin extract, carp, plant roots was 1 case (2.5%) respectively. In the pattern of liver injury, hepatocellular liver injury were 48 cases (61.5%), occurred the highest prevalence. Between CIOMS and M&V scale, best correlation were only 2 cases (2.6%), therefore, their agreement was very low. Conclusion: The prevalence of drug induced liver injury is on an increasing trend in Gyeongju area and acute liver injury caused by herbal medicine and health foods had very high incidence was ascertained. Therefore, we should attend to indiscreet use of herbal medicine and health foods and should give a warning to our society. And a new clinical scale suitable for characteristic of our country that had high prevalence of liver injury caused by herbal medicine and health food is needed. (Korean J Med 63:141-150, 2002)
포스터 전시 : 간 ; Fusobacterium nucleatum에 의한 간농양 1예
정소연 ( So Yean Jung ),정희철 ( Hee Chul Jung ),이창화 ( Chang Hwaa Lee ),천우정 ( Woo Jung Chun ),김남일 ( Nam Il Kim ),김성자 ( Sung Ja Kim ),이구 ( Goo Lee ),서정일 ( Jeung Ill Suh ),이창우 ( Chang Woo Lee ),하경임 ( Gyoung Y 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-
<증례> 45세 여자가 2개월 전부터 발생한 간헐적인 발열 및 전신 쇠약감을 주소로 내원하였다. 환자는 2개월 전부터 발열 및 오한이 있어 개인 의원에서 상기도 감염 진단하에 약물치료를 받았으나 내원 전날까지 증상의 호전과 악화가 반복되어 내원하였다. 과거력상 2년전 고혈압을 진단 받고 치료중인 것 외에는 특이 사항이 없었다. 이학적 검사상 전신 상태는 양호하였고 복부 촉진에서 압통이 있는 부위는 없었으며 간이나 비장의 종괴는 만져지지 않았다. 검사실