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- 저자 : 문경상 ( Kyoung Sang Moon ) (검색결과 3 건)
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Henoch-$Sch{\ddot{o}}nlein$(HS) 신염에서 장기 스테로이드와 Azathioprine의 병합치료 효과
문경상,진소영,김은미,Moon, Kyoung-Sang,Jin, So-Young,Kim, Eun-Mi 대한소아신장학회 1998 Childhood kidney diseases Vol.2 No.2
목 적 : HS 신염은 확정된 특별한 치료지침이 없으며, 신염의 정도가 심한 경우 단일 스테로이드 요법으로 치료 효과가 좋지 않으므로 장기간 스테로이드 투여 및 azathioprine의 병합에 의한 치료 효과를 관찰하기 위해 본 연구를 시행하였다. 대상 및 방법 : Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP)로 진단 받은 후 심한 단백뇨(40 mg/hr/$m^2$ 이상)를 보인 HS 신염 환아 5례(남자 2례, 여자 3례)를 대상으로 신장 생검을 실시하여 ISKDC grade III 이상을 보인 환아를 대상으로 하였고 치료방법은 1)스테로이드 pulse치료를 격일로 6회 정주한 다음, 2) 경구로 스테로이드를 2mg/kg/day(최대 80mg/day) 1개월 투여한 후 1 mg/kg/day으로 1 개월 투여하고 2년간 격일로 1mg/kg/day경구 투여하였다. 3)스테로이드 pulse치료 시행 뒤 azathioprine(2 mg/kg/day)을 2년간 병합하여 경구 투여하였다. 단백뇨 및 미세 혈뇨를 추적 검사하여 임상적 관해 여부를 조사하였고 추적 신장조직 검사를 시행하였다. 결 과 :발병 평균 연령은 $10.5{\pm}3.4$년이었으며 HSP에서 신염으로의 발병 기간은 2주에서 5개월로 평균 $7.4{\pm}7.4$주이었다. 24시간 뇨단백은 평균 $4857.8{\pm}2046.1$ mg/day이었다. 임상적 관해는 5례 중 4례($80\%$)로 단백뇨 소실의 평균기간은 $5{\pm}2.4$개월, 미세혈뇨의 소실 기간은 평균 $13.3{\pm}2.9$개월이었다. 병리학적 소견은 ISKDC 분류로 Crade IIIb가 3례, Grade VI가 2례로 추적 신장 조직 검사를 시행한 4례 중 3례에서 조직학적으로 호전된 양상을 보였다. 결 론 : 아직까지 HS 신염에 대한 확정된 치료 지침이 없는 상황에서 본 연구의 장기간 스테로이드 경구 투여 및 azathioprine의 병합 요법이 임상적, 조직학적으로 효과가 있는 것으로 생각되며 앞으로 더 많은 환아에서 추적 관찰이 필요하다. Purpose : There is no specific treatment guidelines for Henoch-$Sch{\ddot{o}}nlein$(HS) nephritis. Therefore we performed this study to observe the effect of long term steroid therapy combined with azathioprine Methods : Treatment protocols; 1) Steroid pulse therapy: methylprednisolon 30 mg/kg/dose, maximum 1 gm, intravenolisly 6 times for alternate day. 2) Oral steroid was given 2 mg/kg/day for 1 month, 1 mg/kg/day for following 1 month and alternate day oral steroid combined with azathioprine 2 mg/kg/day for 2 years. Results : Time period from HSP to onset of HS nephritis was between 2 weeks to 5 months with mean $7.4{\pm}7.4$ weeks. Clinical remission were seen in 4 cases out of 5 ($80\%$). Mean time period with disappearance of proteinuria and microscopic hematuria were $5{\pm}2.4$ month and $13.3{\pm}2.9$ month respectively. On pathologic findings by ISKDC, 3 cases were grade IIIb, 2 cases were grade IV in first kidney biopsies and showed pathologic improvement in follow up tidneybiopsiesafterlyearstreatment. Conclusion : As there is no definitive treatment for HS nephritis so far, our study of long term oral steroid therapy with azathioprine was effective in clinical and histologic aspect. Therefore further study in HS nephritis with in a large group will be needed in the future.
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서은숙,이동환,문경상 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1
Object: Many studies on the effect of long-term treatment with anticonvulsant on thyroid function in children have been reported. Because the mechanism and metabolism of each drugs are different, the effect of anticonvulsants on thyroid function is controversial. And it has been reported that competitive binding with serum protein, increased intrahepatic excretion and more recently effects on hypothalamus and pituitary gland make changes in thyroid hormones. Therefore, we checked T₃, T₄, TSH levels of the patients who have been taking anticonvulsants for more than 1 years, in order to the influence of carbamazepine and valproic acid on thyroid function. Method: 38 patients (male 18, female 18) who have been diagnosed as epilepsy during the period of Jan 1996 to Dec 1996 at SoonChunHyang University Hospital, and being treated with anticonvulsant, the serum levels of triiodothyronine(T₃) thyroxine(T₄) and TSH were measured were measured by RIA. Result: Of these 38 patients, 18 were males and 18 were females. The mean age of the patients was 9.46 ±3.86(2 to 17 years old) years old. In 10 cases were treated with valproic acid, in 7 cases received carbamazepine and in 11 cases were treated with combined therapy. In valproic acid treated group, T₃, T₄, TSH levels were 145.05±25.34ng/dl, 8.86±2.17㎍/dl, 2.73±0.86 μU/ml respectively. In Carbamazepine treated group. T₃, T₄, TSH levels were group, T₃, T₄, TSH levels were 162.06 ±26.78ng/dl, 9.66 ±4.18㎍/dl 2.01 ±0.78 μU/ml respectively. Although the levels of T₃, T₄, TSH were within normal range, they were relatively decreased compared to the control group. The carbamazepine treated group was revield lower T₃, T₄ levels compared to those treated with valproic acid, but we couldn't find out statistical significance. Conclusion: In our study we found out long-term treatment with anticonvulsants including carbamzepine and valproic acid had effects on thyroid function and follow-up test with larger group of patients should be proceeded.
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