정신분열병 및 정신분열형 장애에 대한 올란자핀의 효과와 안전성

안용민,강대엽,권준수,김창윤,김철응,반건호,신영민,이기철,이동우,이중서,조현상,채정호,김용식 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 다기관 공동임상연구는 국내 환자를 대상으로 새로운 항정신병약물인 올라자핀의 치료 효과와 안전성을 확인하고자 시행되었다. 방 법 : 1999년 7월부터 2000년 3월까지 국내 10개 병원에 방문한 정신분열병 및 정신분열형 장애 105명을 대상으로 비대조 개방 임상연구를 시행하였다. 중등도 이상의 정신병 증상을 지니거나, 부작용으로 약물교체가 필요한 경우 또는 기분장애 증상의 치료가 필요한 환자를 대상으로 하였다. 2∼7일간의 약물 배설기간 후에 1일 10mg의 올란자핀을 투여하였고, 이후로 3∼7일 간격으로 용량을 조절하여 총 8주간 투여하였다. 치료 효과는 PANSS(Positive and Negative Syndrome Scale), BPRS(Brief Psychiatric Rating Scale), CGI(Clinical Global Impression-Severity), MADRS(Montgomery-Asberg Depression Rating Scale), HAM-A(Hamilton Rating Scale for Anxiety)로 판정하였다. 안전성 평가는 자발적인 이상반응 보고, 활력징후와 혈액 검사 및 SAS(Simpson-Angus Scale), BARS(Barnes Akathisia Rating Scale), AIMS(Abnormal Involuntary Movement Scale)척도를 이용하였다. 결 과 : 105명중에서 85.7%인 90명이 8주간의 치료를 완료하였다. 평균 최빈 용량은 일일 16.1(±4.7)mg이었고, 종료시점에서의 BPRS전체 점수가 기저 상태에 비해 40%이상 감소된 반응군은 69.5%이었다. PANSS의 양성 증후군과 일반정신병리 뿐만 아니라 음성 증후군 소척도에서도 유의한 감소를 보였으며, 이 감소들은 치료 초기부터 나타나서 8주간 지속되었다. 43.8%의 피험자가 중등도 이상의 우울증상을 같이 지니고 있었으며, 올란자핀에 의해 MADRS와 HAM-A가 유의하게 감소하였다. 치료 기간 동안에 활력징후에는 뚜렷한 변화가 없었으나 체중은 8주간 지속적으로 증가하였다. SAS와 AIMS는 감소하였으며, 정좌불능증을 제외한 나머지 추체외로 증상의 발생비율도 낮았다. 임상적인 증상이나 징후를 동반하지 않는 ALT/SGPT의 상승을 보였지만 프로락틴을 포함하는 대부분의 혈액 검사상 뚜렷한 이상 변화는 없었다. 결 론 ; 비록 본 임상연구가 비대조 개방 임상연구로서 많은 제한점을 가지고 있지만, 올란자핀이 기존 약물에 내약성을 보이거나 기분증상을 동반하는 정신병에 치료 효과가 있었다. 그리고 기존 항정신병약물 치료시에 문제가 되었던 추체외로 증상과 고프르로락틴 혈증을 포함하는 대부분의 부작용면에서 안전성을 보여 주었다. Objective : This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzpine for the treatment of Korean patients. Mothod : 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. Results : 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(±4.7%)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale)and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-Asberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms)and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed to significant changes during the trial. Conclusions : Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder.In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

HBV : 6-Year Efficacy of Entecavir Treatment in Patients with Nucleus(t)Ide-Naive Chronic Hepatitis B

( Dae Geon Ahn ),( Yu Jin Ko ),( Sang Wook Lee ),( Hyun Woong Lee ),( Hyung Joon Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background/Aims: Entecavir(ETV) had a potent antiviral ef- ficacy in patients with chronic hepatitis B(CHB). The aims of our study provide data with long-term ETV treatment and to explore useful predictor for efficacy of ETV treatment in treatment- naive patients with CHB. Methods: 156 treatment-naive patients with CHB, who visited Chung-Ang University Hospital between January 2007 and January 2010, were enrolled in this study (115 males, and 90 HBeAg positive). Mean age, baseline serum ALT level and serum HBV DNA level were 49 years (range, 22-79), 207 IU/L (range, 11-898) and 7.7 log10copies/ml (range, 3.6-10.6), respectively. They were treated with ETV 0.5 mg/d. The mean duration of treatment was 50 months (range, 25-79). All patients were assessed for virological response (HBV DNA<116 copies/mL), biochemical response (ALT<40 IU/mL). Results: In 90 HBeAg-positive and 66 HBeAg-negative ETVtreated patients, the rates of virological response increased with the duration of therapy from 60.6% (94/155) at year 2, 81.5% (75/92) at year 4 to 94.7% (18/19) at year 6. The rates of biochemical response were 87.7% (136/155), 93.5% (86/92) and 84.2(16/19) at year 2,4 and 6. Up to 6 years, mean reduction of baseline HBV DNA (log10copies/mL) was -6.0 in HBeAg-positive, and -4.6 in HBeAg-negative. We experienced one case of genotypic ETV resistance (0.6%) and four case of virological breakthrough (2.6%) without genotypic ETV resistance. In univariate analysis, only HBeAg-negative (P=0.048) was important predictive factor for virological response at year 4. In multivariate analysis, there was no useful predictor for efficacy of ETV treatment. Conclusions: ETV treatment for up to 6 years maintained or increased rates of HBV DNA suppression and ALT normalization with a very few resistance. ETV can be continued in treatement-naive patients with detectable HBV DNA at year 2, because long-term ETV leads to a virological response in the most of patients.

Feasibility of α-fetoprotein as a diagnostic tool for hepatocellular carcinoma in Korea

( Dae Geon Ahn ),( Hyung Joon Kim ),( Hyun Kang ),( Hyun Woong Lee ),( Si Hyun Bae ),( Joon Hyoek Lee ),( Yong Han Paik ),( June Sung Lee ) 대한내과학회 2016 The Korean Journal of Internal Medicine Vol.31 No.1

Background/Aims: The aim of this study was to evaluate the feasibility of α-fetoprotein (AFP) as a diagnostic tool for hepatocellular carcinoma (HCC) in Korean patients. Methods: We retrospectively reviewed the medical records of HCC and cirrhosis patients at three hospitals. For each HCC patient, a cirrhosis patient matched for age, sex, etiology, and Child-Pugh classification was selected by simple random sampling. The performance of AFP in the diagnosis of HCC was determined using receiver operating characteristic curve analysis. Results: A total of 732 patients with HCC or cirrhosis were selected for each case and the control groups. The mean age was 54 years, and 72.4% of patients were male. The mean serum AFP levels in the HCC group and cirrhosis group were 3,315.6 and 117.2 ng/mL, respectively (p < 0.001). The area under the receiver operating characteristic curve for all HCC patients was 0.757. The sensitivity, specificity, and positive predictive value of AFP was 50.55%, 87.70%, and 80.43%, respectively, at a cut-off of 20 ng/mL; 37.70%, 95.90%, and 90.20%, respectively, at a cut-off of 100 ng/mL, and 30.05%, 97.27%, and 91.67%, respectively, at a cut-off of 200 ng/mL. A cut-off of 100 ng/mL was more sensitive than one of 200 ng/mL with equivalent specificity and positive predictive value. Conclusions: The cut-off AFP value for early-stage HCC was 17.4 ng/mL. Our study cautiously suggests that AFP has a role in the diagnosis of HCC, and that the appropriate value of AFP for the diagnosis of HCC may be 100 ng/mL rather than 200 ng/mL.

HCC : PE-042 ; Feasibility of α-fetoprotein as a screening and diagnostic tool for hepatocellular carcinoma (multicenter study)

( Dae Geon Ahn ),( Hyung Joon Kim ),( Hyun Woong Lee ),( Si Hyun Bae ),( Joon Hyeok Lee ),( Yong Han Paik ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Recent systematic reviews show that the quality of evidence supporting the use of AFP as a diagnostic and screening test for hepatocellular carcinoma (HCC) is limited. The Korean Liver Cancer Study Group recommended the cutoff value of 200ng/mL as a diagnostic tool. The aim of this study was to evaluate the feasibility of AFP as a screening and and to explore the optimal level of AFP for HCC diagnosis Methods: We retrospectively reviewed the medical records of HCC (all cases were biopsy proven) and cirrhosis patient have available data in 3 hospitals. A total of 1,560 patients were classified into three groups: 564 were cirrhosis controls, 766 were patient with early stage HCC (n = 123 very early, n = 643 early) and 230 were patient with late stage HCC. The performance of AFP in three groups was compared with each other. The AFP sensitivity, specificity, positive and negative predictive values were calculated. Results: The mean age was 54 years in cases, and 56 years in control. Male was dominant in both groups (case, 81.1% vs. control, 65.7%). The mean AFP was significantly higher in patients with overall HCC (early, late) than in those with liver cirrhosis. [early HCC, 2,769ng/ml (1-200,000) , late HCC, 9,818ng/ml (1-639,100), control, 20ng/ml (0.61-1,753)]. (p< 0.0001) Area under the receiver operating characteristic curve for those overall HCC with cirrhosis is 0.78. The sensitivity, specificity, and PPV of AFP was 52.6%, 87.7%, 88.3% at a cutoff of 20ng/ml; 36.9%, 95.9%, 94.1% at a cutoff of 100ng/ml and 29.5%, 98.0%, 96.3% at a cutoff of 200 ng/ml. As a screening tool for HCC , a cutoff of 100ng/ml is more sensitive than 200 ng/ml with equivalent specificity and PPV. The optimal AFP cutoff value was 8.2ng/ml leading to a sensitivity of 66.9% and a specificity of 75.7%. Conclusions: Our study cautiously suggested that the optimal value of AFP in the diagnosis of HCC might be switched 200 ng/ml to 100ng/ml.

HCC : PE-042 ; Feasibility of α-fetoprotein as a screening and diagnostic tool for hepatocellular carcinoma (multicenter study)

( Dae Geon Ahn ),( Hyung Joon Kim ),( Hyun Woong Lee ),( Si Hyun Bae ),( Joon Hyeok Lee ),( Yong Han Paik ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Recent systematic reviews show that the quality of evidence supporting the use of AFP as a diagnostic and screening test for hepatocellular carcinoma (HCC) is limited. The Korean Liver Cancer Study Group recommended the cutoff value of 200ng/mL as a diagnostic tool. The aim of this study was to evaluate the feasibility of AFP as a screening and and to explore the optimal level of AFP for HCC diagnosis Methods: We retrospectively reviewed the medical records of HCC (all cases were biopsy proven) and cirrhosis patient have available data in 3 hospitals. A total of 1,560 patients were classified into three groups: 564 were cirrhosis controls, 766 were patient with early stage HCC (n = 123 very early, n = 643 early) and 230 were patient with late stage HCC. The performance of AFP in three groups was compared with each other. The AFP sensitivity, specificity, positive and negative predictive values were calculated. Results: The mean age was 54 years in cases, and 56 years in control. Male was dominant in both groups (case, 81.1% vs. control, 65.7%). The mean AFP was significantly higher in patients with overall HCC (early, late) than in those with liver cirrhosis. [early HCC, 2,769ng/ml (1-200,000) , late HCC, 9,818ng/ml (1-639,100), control, 20ng/ml (0.61-1,753)]. (p< 0.0001) Area under the receiver operating characteristic curve for those overall HCC with cirrhosis is 0.78. The sensitivity, specificity, and PPV of AFP was 52.6%, 87.7%, 88.3% at a cutoff of 20ng/ml; 36.9%, 95.9%, 94.1% at a cutoff of 100ng/ml and 29.5%, 98.0%, 96.3% at a cutoff of 200 ng/ml. As a screening tool for HCC , a cutoff of 100ng/ml is more sensitive than 200 ng/ml with equivalent specificity and PPV. The optimal AFP cutoff value was 8.2ng/ml leading to a sensitivity of 66.9% and a specificity of 75.7%. Conclusions: Our study cautiously suggested that the optimal value of AFP in the diagnosis of HCC might be switched 200 ng/ml to 100ng/ml.

항혈소판제 병합요법이 소화성 궤양 발생에 미치는 영향

안대건 ( Dae Geon Ahn ),김범진 ( Beom Jin Kim ),김정욱 ( Jeong Wook Kim ),김재규 ( Jae Gyu Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.2

목적: 아스피린 단독투여 및 클로피도그렐을 병합투여한 환자군에서 상부위장관 합병증의 발생을 조사하고 해당 환자군의 임상적 특징을 분석하여, 항혈소판제 투여 환자에서 위장관계 합병증 발생의 예후 인자에 대한 기초 자료를 마련한다. 대상 및 방법: 중앙대학교병원에서 2009년 1월부터 2011년12월까지 관상동맥 조영술을 시행받았던 환자를 후향적으로 조사하였다. 추적기간 내에 상부위장관 내시경을 시행한 194명을 대상으로 분석을 시행하여 항혈소판제의 복용 방법에 따라 단독 및 병합요법군으로 분류하였다. 해당 환자군의 인구학적 특성, 과거력 및 소화성 궤양의 발생 유무 등을 분석하였다. 결과: 항혈소판제 투약 이후 추적관찰 기간 중 11명의 환자에서 십이지장궤양이 발생하였는데 단독투여군에서 2.02%, 병합요법군에서 9.47%로, 병합요법군에서 비율이 유의하게 높았다(HR 5.24, 95% CI 1.03-26.55, p<0.05). 유의한 출혈을 보인 환자는 병합요법군에서만 4.2% 발생하였으나 통계적으로 유의한 차이는 없었다(p=0.78). 양성자 펌프 억제제를 복용 중인 환자 169명을 대상으로 분석을 시행한 결과 24명의 환자에서 위궤양이 발생하였고 단독투여군에서 4.87%, 병합 요법군에서 22.98%로 병합요법군에서 비율이 유의하게 높았다(HR 3.40, 95% CI 1.02-11.27, p<0.05). 결론: 항혈소판제 병합요법은 출혈을 동반하지 않은 십이지장궤양의 발생을 증가시켰고 양성자 펌프 억제제를 복용 중인환자에서는 출혈을 동반하지 않은 위궤양의 발생을 증가시켰다. 따라서 임상의들은 항혈소판제 병합요법을 시행 중인 고위험 환자군에서는 소화성 궤양의 발생에 유의하여야 하며, 적극적인 진단을 위한 내시경 검사를 고려하여야 한다. Background/Aims: Increased incidence of coronary artery disease has led to the increased use of dual antiplatelet therapy composed of aspirin and clopidogrel. We investigated the incidence of gastrointestinal complications in patients who received single or dual antiplatelet therapy and analyzed their clinical characteristics in order to predict the prognostic factors. Methods: Between January 2009 and December 2011, we retrospectively reviewed the medical records of patients who underwent coronary angiography at Chung-Ang University Hospital (Seoul, Korea). One hundred and ninety-four patients were classified into two groups: aspirin alone group and dual antiplatelet group. Clinical characteristics, past medical history, and presenceof peptic ulcer were analyzed. Results: During the follow-up period, 11 patients had duodenal ulcer, the event rate was 2.02% in the aspirin alone group and 9.47% in the dual antiplatelet group (hazard ratio [HR] 5.24, 95% CI 1.03-26.55, p<0.05). There was no significant difference in the rate of significant upper gastrointestinal bleeding: 0% vs. 4.2% (p=0.78). In patients who received proton pump inhibitor (PPI), 24 patients had gastric ulcer, the event rate was significantly different between the two groups: 4.87% vs. 22.98% (HR 3.40, 95% CI 1.02-11.27, p<0.05). Conclusions: Dual antiplatelet groups had a higher incidence of duodenal ulcers without significant bleeding compared with the aspirin alone group. In patients who received PPI, the dual antiplatelet therapy group had a higher incidence of gastric ulcers without significant bleeding compared with the aspirin alone group. Therefore, physicians must pay attention to high risk groups who receive dual antiplatelet therapy and aggressive diagnostic endoscopy should also be considered. (Korean J Gastroenterol 2014,64:81-86)

MSP를 이용한 무선 mpg에 관한 연구

박대건(Dae-Geon Park),박승규(Seung-Kyu Park),안호균(Ho-Gyun Ahn) 대한전기학회 2014 대한전기학회 학술대회 논문집 Vol.2014 No.7

Polyimide nanohybrid films with electrochemically functionalized graphene

Yoo, Dae‐,Geon,Park, Sung Soo,Noh, Chi‐,Woo,Shin, Inho,Lim, Ki‐,Hyun,Son, Jinha,Ahn, Suk‐,kyun,Ha, Chang‐,Sik John Wiley Sons, Ltd 2019 Polymer international Vol.68 No.8

<P><B>Abstract</B></P><P>Graphite was functionalized electrochemically in a potassium fluoride solution and used to prepare polyimide (PI)/graphene nanohybrid films. The as‐made electrochemically fluorinated graphene (EFG) was used to prepare nanohybrid films with colorless PI, which was synthesized from 4,4′‐(hexafluoroisopropylidene) diphthalic anhydride and bis(trifluoromethyl) benzidine by <I>in situ</I> polymerization. The surface functionalization of graphite was characterized by powder XRD, TEM with energy dispersive X‐ray spectroscopy elemental mapping, X‐ray photoelectron spectroscopy, Raman spectroscopy, and TGA. The microstructure of the films was characterized by Fourier transform IR spectroscopy, XRD and SEM. The film properties were measured using a universal testing machine, TGA, dynamic mechanical analysis, four‐point probe, UV–visible spectroscopy and water contact angle analysis. EFG improved the tensile strength and modulus of the nanohybrid films by 20% and 50%, respectively. The glass transition temperature and electrical conductivity of the nanohybrid films were 12 °C and nine orders of magnitude higher than those of the neat PI film, respectively. The nanohybrid film maintained 80% optical transmittance even after the addition of 0.1 wt% EFG. © 2019 Society of Chemical Industry</P>

상염색체 우성 다낭신 환자의 뇌혈관 합병증

이중건(Jung Geon Lee),안규리(Gu Rie Ahn),황대연(Dae Yeon Hwang),황영환(Yeong Hwan Hwang),김기원(Ki Won Kim),이서진(Seo Jin Lee),나기영(Ki Young Na),한진석(Jin Suk Han),김성권(Sung Gwon Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.1

N/A Background : ADPKD is one of the most common hereditary renal disease in adult and is a systemic disorder with a variety of cardiovascular manifestations. To elucidate the clinical characteristics of cerebrovascular complications in Korean ADPKD patients, we reviewed the medical records of ADPKD patients who was registered in ADPKD clinic of Seoul National University Hospital. Methods : A total of 18 adult patients were included and their sex ratio was 8:10. The median age of ADPKD diagnosis was 45.5 year(range 19-85), and age at cerebrovascular accident(CVA) was 52 years(22-82). The median duration from hypertension to CVA was 8 years(0-30). Results : There were 5 cases of infarction, 4 cases of intracerebral hemorrhage, 4 cases of subarachnoid hemorrhage, and 4 cases of transient ischemic attack. Other clinical parameters of ADPKD were not different from patients who were not complicated with CVA. Intracranial aneurysms were detected in 6 patients and their median age at diagnosis was 47.5 years(33-66). Four cases were manifested as subarachnoid hemorrhage. Five cases were diagnosed through TFCA, and two of them were revealed as multiple aneurysms. Five cases received surgical treatment and five of six cases improved without any neurologic sequeale. MR angiography(MRA) were taken in 16 asymptomatic patients, and multiple aneurysms were newly detected in one of them. Conclusion : Cerebrovascular complications in Korean ADPKD patients were not significantly different from western patients. Intracranial aneurysms must be included in differential diagnosis in ADPKD patients who manifest an acute neurologic symptoms, and high-risk group need to be screened selectively with MRA.(Korean J Med 58:75-82, 2000)

한국인 상염색체 우성 다낭신 가계에서의 유전자 아형분석

이중건,안규리,황대연,황영환,어현선,채회진,이은주,조종태,김연수,한진석,김성권,이정상 대한신장학회 2000 대한신장학회잡지 Vol.19 No.4