전신성 홍반성 루푸스 환자에서 Ga - 67 - Citrate 스캔의 임상적 의의

이순구(Sunn Kgoo Rhee),김성숙(Seong Suk Kim),정민수(Min Soo Jeong),이강욱(Kang Wook Lee),신영태(Young Tai Shin),노흥규(Heung Kyu Ro) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

N/A Objectives: We studied to evaluate the relationship between disease activity of lupus nephritis and renal uptake of Ga-67 citrate Methods: Nineteen cases of SLE were evaluated to test a relationship between the renal accumulation of Ga-67 citrate and pathological or clinical parameters. Results: 1) On the 19 patients, 12 (63%) patients had lupus nephritis, among them 7 (58%) patients had renal uptake above Grade 3. And 7 (37%) patients without lupus nephritis had renal uptake below Grade 2. 2) The BUN value of the patients with renal uptake above Grade 3 (group B, 44.0±43.6 mg/dl) were higher than that of the patients with renal uptake below Grade 2 (group A, 12.1±5.9 mg/dl) significantly (p<0.01), 3) The systolic blood pressure was 144±35 mmHg in group B and 115±22mmHg in group A, which was significantly different (p<0.01). And the diastolic blood pressure was 88±23mmHg in group E and 74±12 mmHg in group A, which was significantly different (p<0.01). 4) The degree of renal Ga-67 citrate uptake showed inverse correlation with the degree of serum albumin level (r=-0.64, p<0.01) and correlation to the degree of 24-hours urine protein amount (r=0.54, p<0.05). 5) The serum C3 level was 29.0±18.0 mg/dl in group B and 41.2±26.7 mg/dl in group A, which was significantly different (p<0.01). The serum C4 level was 8.7±3.2 mg/dl in group B and 23.9±16.3mg/dl in group A, which was significantly different (p<0.05). 6) Renal disease activity was 7.3±1.5 in group B and 2.3±1.5 in group A, which was significantly different (p<0.01). 7) In group B, renal biopsy findings were membranous lupus GN in 3 cases, diffuse proliferative lupus GN in 2 cases, and focal and segmental lupus GN in 2 cases. 8) Among the patients with renal uptake above Grade 3, six patients were evaluated after immunosuppressive therapy. Ga-67 citrate were accumulated with the Grade below 2. Serum C3 and albumin values increased and BUN and serum creatinine values were normalized. And renal and extrarenal disease activities were improved, significantly. Conclusion: We could have suggested that Ga-67 citrate scan is useful to diagnose and to estimate the activity of lupus nephritis.

전신성 홍반성 낭창의 체액성 면역 기능에 관한 연구

최영환(Young Hwan Choi),이정호(Jeong Ho Lee),신승훈(Seung Hun Shin),이순구(Sunn Kgoo Rhee),구대회(Dae Hoe Ku),이강욱(Gang Wook Yi),김상용(Sam Yong Kim),신영태(Young Tai Shin) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

N/A To investigate the humoral immune function in patients with systemic lupus erythematosus (SLE), peripheral blood T cell subsets, and serum levels of IgG, IgA and IgM were measured in 11 patients with SLE and 17 healthy controls. IgG and IgA production by peripheral blood lymphocytes to pokeweed mitogen triggering were also evaluated. The results were as follows: 1) Serum IgG, IgA and IgM levels in patients with SLE were more significantly elevated than those of the healthy controls. 2) T cell subsets in patients with SLE were not different from those of the healthy controls. 3) Spontaneous in vitro IgG production from peripheral blood lymphocytes was significantly higher in patients with SLE than that of healthy controls (p<0. 01), but pokeweed mitogen-stimulated in vitro IgG production was significantly lower in patients with SLE(p < 0. 005). Spontaneous in vitro IgA production in patients with SLE increased without statistical significance compared with the healthy controls, but pokeweed mitogen-stimulated in vitro IgA production slight1y decreased in patients with SLE without statistical significance. 4) Stimulation indices of in vitro IgG and IgA production were significantly lower in patients with SLE than those the of healthy controls(p<0.005). It is suggested that there is a preactivation of B cells in vivo of patients with active SLE. Furher studies on the mechanism of cellular interactions in B-cell immunoglobulin production in vitro of patients with SLE should be pursued.

비세균성 신염환자에서 신장내 67Ga - Citrate 흡수에 관한 연구

김삼용(Sam Yong Kim),노흥규(Heung Kyu Ro),신영태(Young Tai Shin),이강욱(Kang Wook Lee),정민수(Min Soo Jeong),이순구(Sunn Kgoo Rhee) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2

N/A Ga-67 citrate scan has been requested for detection or follow-up of inflammatory or neoplastic disease. Visualization of Ga-67 citrate in the kidneys at 48 and 72 hr post injection is usually interpreted as evidence of renal pathology. But precise mechanisms of abnormal Ga-67 uptake in kidneys were unknown. We undertook a study to determine the clinical value of Ga-67 citrate imaging of the kidneys in 68 patients with primary or secondary nephropathy confirmed by renal biopsy and 66 control patients without renal disease. Renal uptake in 48 to 72 hr images was graded as follows: Grade 0=background activity;1=faint uptake greater than background; 2= definite uptake, but less than lumbar vertebrae;3 same uptake as lumbar vertebrae, but less than liver; 4=same or higher uptake than liver. The results were as follows. 1) 42 of 68(62%) patients with noninfectious nephritis showed grade 2 or higher Ga-67 renal uptake but only 10 percent of control patients showed similar uptake. 2) In 14 patients with systemic lupus erythematosus, 8 of 9 (89%) patients with lupus nephritis exhibited marked renal uptake. 3) 36 of 41 patients (88%) with combined nephrotic syndrome showed Grade 2 or higher renal uptake. 4) Renal Ga-67 uptake was correlated with clinical severity of nephrotic syndrome determined by serum albumin level, 24 hr urine protein excretion and serum lipid levels. 5) After complete remission of nephrotic syndrome, renal uptake in all 8 patients who were initially Grade 3 or 4, decreased to Grade 1 or 0. In conclusion, we think that the mechanism of renal Ga-67 uptake in nephrotic syndrome might be related to the pathogenesis of nephrotic syndrome. In systemic lupus erythematosus, Ga-67 citrate scan is useful in predicting renal involvement.

급성신우신염의 임상적 고찰

신영태,신승훈,이순구,이정호,이강욱 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

A clinical retrospective study was undertaken in 81 patients with acute pyelonephritis admitted to the Department of Internal Medicine, Chungnam National University Hospital from January 1983 to December 1989. The results were as follows : 1. Total number of patients studied was 81(M/F ratio, 1 : 4.4). The M/F ratio of 22 complicated patients (27.2%) was 1 : 2.7 2. The predisposing factors associated with complicated patients were as follows : 7 cases of urinary tract stone, 7 cases of pregnancy, 4 cases of neurogenic bladder and each one case of prostatic hypertrophy, ureter cancer, bladder diverticulum and polycystic kidney disease. 3. The common subjective symptoms on admission were fever and chills, frank pain, nausea and vomiting. High body temperature and CVA tenderness were noted in 61% and 95% of patients respectively. And 50.6% of patients revealed right CVA tenderness and 28.4% in left, 16% in both respectively. There was no difference in symptoms and signs between complicated and uncomplicated groups 4. In 50 patients(61.7%) microorganisms were isolated on the urine culture specimens. The most common organism was E. coli(80%), and followed by Staphylococcus aureus and Serratia odorifera. E coli was the most frequent pathogen in both female and male patients, and in complicated and uncomplicated groups. (In sensitivity test of complicated and uncomplicated groups). In sensitivity test of causative pathogens to antibiotics, E coli was sensitive to amikacin(93%), tobramycin(83.3%) and gentamycin(79.4%) and 88.9 percent of E coli were ressistant to ampicillin 5. In urinary examination on admission, pyuria was noted in 81% of patients, and proteinuria and microscopic hematuria were noted in 68% and 44% of patients respectively. 6. Within 3 days after antibiotics treatment deference was occured in 73.5% of total patients, and complicated patients revealed delayed defeverence compared to uncomplicated ones.