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저용량의 corticosteroid 복용이 B형 간염 바이러스 재활성화에 미치는 영향
이향이 ( Hyang Ie Lee ),곽금연 ( Geum Youn Gwak ),박문경 ( Moon Kyung Park ),서현주 ( Hyun Joo Suh ),이준혁 ( Joon Hyeok Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6
Background/Aims: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. Methods: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. Results: A total of 16 patients were included. They were 45.4±16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. Conclusions: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.(Korean J Med 74:619-623, 2008)
대전 지역에서 급성 A형 간염의 유전자형에 따른 임상 특성 고찰
이영우 ( Young Woo Lee ),양현웅 ( Hyeon Woong Yang ),이진아 ( Jin A Lee ),윤기호 ( Ki Ho Yun ),양성은 ( Seong Eun Yang ),이민지 ( Min Ji Lee ),박세영 ( Se Young Park ),김새희 ( Sae Hee Kim ),이향이 ( Hyang Ie Lee ),이윤정 ( Yun Ju 대한내과학회 2011 대한내과학회지 Vol.80 No.5
Background/Aims: Acute viral hepatitis A is a major health problem in Korea and the influx of genotype IIIA is thought to be one reason. We examined the differences in the clinical characteristics and laboratory findings of genotypes IA and IIIA in Daejeon. Methods: From November 2009 to June 2010, 81 patients positive for IgM anti-HAV were enrolled prospectively. The hepatitis A was genotyped using real-time polymerase chain reaction. The clinical characteristics and laboratory results were compared on the Results: The mean patient age was 32.6±7.4 years. The mean hospitalization was 7.7±2.4 days. The patient occupation varied. Clinically, vomiting and diarrhea were relatively more prevalent in genotype IIIA than in IA. Abdominal pain and skin spots were relatively more prevalent in genotype IA than in IIIA. The hemoglobin, peak aspartate aminotransferase (AST) level, and C-reactive protein were statistically higher in genotype IIIA than in IA. The distributions of the peak AST, alanine aminotransferase (ALT) and total bilirubin values tended to be perched in genotype IIIA than in IA. The international normalized ratio (INR) tended to be slightly prolonged in genotype IIIA than in IA. Conclusions: Recently, genotype IIIA of acute viral hepatitis A has become prevalent in Daejeon. Hepatitis A genotype IIIA probably causes worse laboratory abnormalities than genotype IA.
무증상 다발성 골수종(Asymptomatic Multiple Myeloma)에서 발생한 위장관 아밀로이드증 1예
김새희 ( Sae Hee Kim ),이윤정 ( Yun Jung Lee ),정성희 ( Sung Hee Jung ),현우진 ( Woo Jin Hyeon ),이향이 ( Hyang Ie Lee ),양현웅 ( Hyeon Woong Yang ),김안나 ( Anna Kim ),차상우 ( Sang Woo Cha ),강동욱 ( Dong Wook Kang ) 대한장연구학회 2009 Intestinal Research Vol.7 No.2
Amyloidosis is a disorder characterized by extracellular deposition of amyloid materials in multiple organs and tissues. Amyloidosis commonly shows a systemic involvement. Gastrointestinal involvement is common in amyloidosis and is usually asymptomatic. The gastrointestinal manifestations include gastroparesis, diarrhea, steatorrhea, constipation, intestinal pseudo-obstruction, and bleeding. The diagnosis of amyloidosis is difficult because there are absence of systemic symptoms and nonspecific endoscopic findings. Asymptomatic multiple myeloma is an asymptomatic plasma-cell proliferative disorder associated with a high risk of progression to symptomatic multiple myeloma or amyloidosis. Recently, we experienced a 60-year-old man who presented with hematochezia and weight loss as manifestations of gastrointestinal amyloidosis involving the stomach and the colon induced in asymptomatic multiple myeloma confirmed by endoscopic biopsies and bone marrow biopsy. We report a case with a review of the literature. (Intest Res 2009;7:123-128)
Clostridium difficile 관련 설사의 진단에서 S상결장경 검사의 유용성
김새희 ( Sae Hee Kim ),정성희 ( Sung Hee Jung ),이윤정 ( Yun Jung Lee ),현우진 ( Woo Jin Hyeon ),유영욱 ( Young Wook Yoo ),이향이 ( Hyang Ie Lee ),양현웅 ( Hyeon Woong Yang ),김안나 ( An Na Kim ),차상우 ( Sang Woo Cha ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3
Background/Aims: Clostridium difficile is an important cause of diarrhea in hospitalized patients. C. difficile-associated diarrhea (CDAD) is usually diagnosed following a stool test for C. difficile cytotoxin or stool culture for the presence of toxigenic C. difficile. However, the reported sensitivities of these tests are variable. Sigmoidoscopy may be an effective diagnostic method in patients with a false-negative stool test for cytotoxin. This study examined the role of flexible sigmoidoscopy in the diagnosis of CDAD. Methods: Among the patients who had diarrhea and were examined with sigmoidoscopy in Eulji University Hospital between January 2005 and July 2008, 102 patients suspected of having antibiotic-associated diarrhea (AAD) based on their clinical symptoms were enrolled. Of the 102 patients, 74 were diagnosed with CDAD based on C. difficile cytotoxin or sigmoidoscopic findings of pseudomembranous colitis. The medical records of these 74 patients were reviewed retrospectively. Results: Of the 74 patients, sigmoidoscopic findings revealed a pseudomembrane in 63 patients (85.1%) and colitis in nine (12.2%), while two patients (2.7%) appeared normal. Of the 63 patients with pseudomembranous colitis at sigmoidoscopy, the stool C. difficile cytotoxin assay was negative in 27 (42.9%). Conclusions: Flexible sigmoidoscopy was highly sensitive in pseudomembranous colitis and is useful in diagnosing patients with a delayed or negative stool test for C. difficile cytotoxin. Therefore, we recommend flexible sigmoidoscopy in patients suspected of having C. difficile-associated diarrhea for the diagnosis of CDAD. (Korean J Med 78:318-324, 2010)
유영욱 ( Young Wook Yoo ),정성희 ( Sung Hee Jung ),이윤정 ( Yun Jung Lee ),이성훈 ( Sung Hoon Lee ),김새희 ( Sae Hee Kim ),이향이 ( Hyang Ie Lee ),양현웅 ( Hyeon Woong Yang ),김안나 ( Anna Kim ),차상우 ( Sang Woo Cha ),강동욱 ( Do 대한장연구학회 2008 Intestinal Research Vol.6 No.1
Ulcerative colitis is associated with various extraintestinal manifestations. Skin lesions can occur in 9-19% of patients with ulcerative colitis. Pyoderma gangrenosum is the most severe dermatologic complication that is associated with ulcerative colitis. It is a painful, chronic ulcerating skin disease of unknown cause. The lesions usually appear on the pretibial area, but may also be found elsewhere. Diagnosis is clinical as there are no accepted histological diagnostic criteria. Systemic steroid therapy remains the treatment of choice in most patients, but various other agents have been used with occasional success including topical antibiotics, cyclosporine and infliximab. We experienced a case of pyoderma gangrenosum that developed on both pretibial areas in a 41-year-old female patient with active ulcerative colitis. The patient was treated with a corticosteroid and sulfasalazine. We report this case with a review of the literature. (Intest Res 2008;6:80-84)
송란 ( Ran Song ),우두현 ( Doo Hyun Woo ),이연아 ( Yeon Ah Lee ),이상훈 ( Sang Hoon Lee ),이향이 ( Hyang Ie Lee ),신준범 ( Joon Beom Shin ),홍승재 ( Seung Jae Hong ),한정수 ( Chung Soo Han ),유명철 ( Myung Chul Yoo ),양형인 ( Hyu 대한내과학회 2007 대한내과학회지 Vol.73 No.2
Background: This retrospective study was performed to investigate the clinical effects of mizoribine with using methotrexate (MTX) or mizoribine alone on those patients with rheumatoid arthritis (RA) who showed an ineffective response or intolerance to the MTX. Methods: The patients were divided into two groups: (1) combination therapy of mizoribine with MTX and (2) mizoribine alone. All the patients took 100 mg mizoribine daily for at least 16 weeks. Before and after administration of mizoribine for 16 weeks, we assessed the clinical variables such as the visual analogue pain scale (VAS), the tender joint counts (TJC), and the swollen joint counts (SJC). At each time, the laboratory parameters including the ESR, CRP, complete blood count (CBC), liver enzymes and creatinine were also measured. Disease activity scores (by the DAS28) and the adverse effects were determined at baseline and after 16 weeks. Results: Fifty patients were recruited in this study (mizoribine plus MTX group: n=35, mizoribine group: n=15). There were no significant differences in the initial laboratory values between the two treatment groups. After treatment for 16 weeks, the DAS28 was decreased significantly in the mizoribine plus MTX group (4.7±1.14 vs. 3.9±0.97, respectively, p<0.05). Yet the mizoribine alone group did not showed any significant change of the DAS28 (4.3±0.56 vs. 3.9±0.37, respectively, p=0.076). Mild gastrointestinal disturbance was the most common adverse effect. The incidence of adverse effects was similar in both treatment groups (20% vs. 27%, respectively). Conclusions: Mizoribine in combination with MTX was effective for RA patients who showed an ineffective response or intolerance to MTX. Furthermore, this treatment can be considered to be relatively safe.(Korean J Med 73:192-199, 2007)
연구논문 : 대전과 충청남북도에 거주하는 만성 C형간염 환자에서 페그인터페론 알파 2a와 2b의 초치료 효과 비교
김정일 ( Jeong Il Kim ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),이헌영 ( Heon Young Lee ),이태희 ( Tae Hee Lee ),강영우 ( Young Woo Kang ),이향이 ( Hyang Ie Lee ),김안나 ( An Na Kim ),남순우 ( Soon Woo Nam ),박병출 ( By 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4
목적: 페그인터페론 알파 2a와 알파 2b는 만성 C형간염의 표준치료제로 사용되고 있으나 두 약제의 치료반응을 비교한 연구는 거의 없는 실정이다. 본 연구는 만성 C형간염의 초치료로서 리바비린과의 병합요법 시 페그인터페론 2a와 2b의 치료 효과와 부작용을 비교해 보고자 하였다. 대상과 방법: 2004년 1월부터 2007년 7월까지 대전과 충청남북도에 위치한 7개의 대학병원에서 만성 C형간염 또는 이로 인한 대상성 간경변증으로 진단받고 페그인터페론과 리바비린 병합요법을 시행한 환자 97명의 의무기록을 후향적으로 분석하였다. 페그인터페론 알파 2a군이 48명, 2b군이 49명이었으며, HCV 유전자형 1형에 감염된 환자에 대해서는 페그인터페론 알파 2a (180 ?g/주) 또는 알파 2b (1.5 ?g/kg/주) 및 리바비린(1,000~1,200 mg/일)을 48주간, 비1형 환자에 대해서는 위와 동일한 용량의 페그인터페론과 리바비린(800 mg/일)을 24주간 투여하였다. 결과: 전체 환자에서 페그인터페론 알파 2a와 2b의 조기 바이러스반응(89.6% vs. 89.7%), 치료 종료 바이러스반응(79.2% vs. 79.5%) 및 지속바이러스반응(72.9% vs. 73.5%)은 두 약제 간에 유의한 차이가 없었다. 또한 HCV 유전자형에 따라 각 바이러스반응을 분석하였을 때도 유전자 1형과 비1형 모두에서 두 약제 간에 유의한 차이를 발견할 수 없었다. 총 97명 중에 치료를 조기 중단한 환자는 10명(10.3%)이었고, 페그인터페론 알파 2a와 2b가 각각 7명(14.6%), 3명(6.1%)이었으나 유의한 차이는 없었다. 부작용으로는 독감양 증상이 가장 흔하였으며, 부작용의 종류별 발생빈도는 두 약제간에 유의한 차이가 없었다. 결론: 만성 C형간염 환자의 초치료로서 리바비린과의 병합치료 시 페그인터페론 알파 2a와 2b 간에 치료효과와 부작용 발생빈도에 있어 유의한 차이가 없었다. Backgrounds/Aims: Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. Methods: Ninety-seven patients were treated with peginterferon alpha-2a (180 ?g/week, n=48) or peginterferon alpha-2b(1.5 ?g/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. Results: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peg-interferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. Conclusions: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients. (Korean J Hepatol 2008;14:493-502)
라미부딘과 아데포비어에 순차 내성을 보인 만성 B형 간염 환자에서 라미부딘/아데포비어 병합요법의 항바이러스 효과
서현주 ( Hyun Joo Suh ),박문경 ( Moon Kyung Park ),이향이 ( Hyang Ie Lee ),곽금연 ( Geum Yeon Gwak ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ),이준혁 ( Joon Hyeok Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5
목적: LMV과 ADV의 단독치료에 순차내성을 보인 만성 B형 간염 환자에서 LMV과 ADV의 병합투여 후 항바이러스 효과를 알아보고자 하였다. 대상 및 방법: 1997년부터 2007년 사이 LMV와 ADV에 순차적으로 바이러스 돌파현상을 보였던 만성 B형 간염 환자들을 대상으로 하였고, 이들 중 LMV과 ADV 병합치료를 받은 18명의 환자들을 후향 분석하였다. 결과: LMV-ADV 병합치료 시행 후 추적관찰 기간의 중앙값은 17개월(범위, 6-27)이었다. 병합치료 0, 3, 6, 12, 24개월의 평균 DNA역가는 6.08±0.95, 4.05±1.66, 3.17±1.58, 3.18±2.16, 2.35±1.52 log10 IU/mL였고 전체 18예 중 16예(88.9%)에서 HBV DNA의 역가가 20,000 IU/mL 미만으로 감소하였다. HBeAg의 혈청전환은 단 1예(7.1%)에서만 관찰되었고 12예(66.7%)에서 혈청 ALT가 정상화되었다. 병합치료 12개월과 14개월째 바이러스 반등이 있었던 환자가 2예 있었다. 혈청 ALT는 12예(66.7%)에서 정상으로 감소하였다. 일차치료 실패를 보인 경우는 2예(11.1%)가 있었다. 결론: 이번 연구에서 LMV과 ADV에 순차적으로 내성을 보인 환자들에게 LMV-ADV 병합치료를 시행하고 단기간 추적관찰하였을 때 88.9%에서 효과가 있었다. 이는 다른 항바이러스제의 사용이 여의치 않을 때 LMV-ADV의 병합치료가 도움이 될 수 있음을 보여준다. Background/Aims: The aim of this study was to elucidate the antiviral efficacy of lamivudine (LMV)-adefovir (ADV) combination therapy in chronic hepatitis B patients who showed resistance to LMV and ADV consecutively. Methods: A retrospective review was performed in eighteen patients with chronic hepatitis B who developed virologic breakthroughs during LMV-ADV sequential mono-therapy and treated with LMV-ADV combination therapy. Results: The median duration of follow up was 17 months (range, 6-27) after the start of LMV-ADV combination therapy. Mean HBV DNA level in log10 IU/mL was 6.08±0.95, 4.05±1.66, 3.17±1.58, 3.18±2.16, and 2.35±1.52 at 0, 3, 6, 12, and 24 months, respectively. Sixteen patients (88.9%) showed HBV DNA reduction below detection limit (<20,000 IU/mL). HBeAg seroconversion was observed in one patient (7.1%) after 8 months of combination therapy. Virologic breakthrough occurred in only one patient after 21 months of combination therapy. Viral rebound occurred in two patients at 12 months and 14 months of combination therapy. Normalization of serum ALT was achieved in twelve patients (66.7%). Primary non-response was observed in two cases (11.1%). Conclusions: LMV-ADV combination treatment was effective in 88.9% of patients with resistance to LMV and ADV in a short-term follow up. It may be applied as a bridge therapy until another effective antiviral regimen becomes available. (Korean J Gastroenterol 2009;53:305-310)