불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

정치적 합리성, 실질적 합리성과 정책의 기본적인 개념

제갈욱,김완섭 순천향대학교 사회과학연구소 2005 순천향 사회과학연구 Vol.10 No.3

근본적으로 합리성 개념은 사회학적인 측면에서 기술적, 경제적, 사회적, 법적, 그리고 정치적인 합리성으로 구분된다. 정책학적인 측면에서는 실제적 또는 종합적 합리성의 개념을 추가하고 있다. 정책선택의 저변에는 다양한 합리성의 기초가 자리잡고 있다. 본 연구는 정책선택의 기본적인 개념이 되는 합리성의 개념과 합리성과 정책의 연계성에 관해 설명하고자 한다.

중국거주 조선족 여성의 영적 안녕정도가 정신건강에 미치는 영향

정성덕,이종범,김진성,서완석,배대석,박순재,주열,염형욱,김승원,김구묘,안영록,황대홍,표미자,조창열,정태길 영남대학교 의과대학 2004 Yeungnam University Journal of Medicine Vol.21 No.2

자아초월 정신의학이 체계화되면서 영성(spirituality)은 인성의 한 부분이라는 이론이 대두되었는데 이 영성은 정신건강에 큰 영향을 미친다고 했다. 인간의 성향 중 영적 안녕 정도를 파악하여 그 정도가 정신건강 중 허위성 경향, 정신병적 경향 및 불안과 우울 경향 등에 어떠한 영향을 미치는지를 조사하고저 본 연구를 실시하였다. 대상은 중국의 연변 조선족 자치구에 거주하는 여성 400명을 대상으로 하여 한국판 영적 안녕척도를 사용하여 영적 안녕정도를 파악하였다. 영적 안녕척도의 총점과 이 척도의 2개 하위 척도인 종교적 안녕과 실존적 안녕 척도 양자로 평가한 성적이 불안-우울통합척도와 정신분열증 척도 및 허위성 척도로 평가한 성적에 미치는 영향을 검증하기 위하여 상관관계분석 및 회기분석을 실시하였다. 그 결과는 다음과 같다. 1) 영적 안녕척도로 평가한 조선족 여성의 총점은 68.29로 한국의 기독교 여성이 평가한 100.65보다 훨씬 낮은 점수였다. 2) 불안·우울통합척도로 평가한 총점은 44.88로 연변노인이 평가한 점수와 일개지역의 한국농촌주민이 평가한 점수와 비슷한 결과였다. 3) 허위성 척도로 평가한 성적은 평균 74.57로 70점 이상이 86%(344명)이었으나 영적 안녕 성적과 허위성 성적 간에는 유의한 상관이 없었다. 4) 영적 안녕총점은 정신분열증 척도로 평가한 정신병적 경향에 유의한 영향을 미치지 않았으나 종교적 안녕하위척도의 성적은 정신병적 경향을 높여준데 비하여 실존적 안녕하위척도의 성적은 정신병적 경향을 낮게 해주었다. 5) 영적 안녕척도의 총점 및 두 하위척도인종교적 안녕과 실존적 안녕은 불안과 우울에유의한 상관을 보였는데 영적 안녕총점이 높을수록 불안·우울 총점이 다소 낮아지는 경향을 보였다. 6) 종교적 안녕 하위척도와 불안과 우울과의 관계는 종교적 안녕점수가 높을수록 불안과 우울을 각각 다소 유의하게 높여주었으며 이에 비하여 실존적 안녕하위척도와 불안과 우울과의 관계는 실존적 안녕정도가 높을수록 불안 및 우울점수는 유의하게 낮아졌다. 이와 같은 성적을 미루어볼 때 연변에 거주하는 조선족 여성이 평가한 영적 안녕정도는 정신병적 경향과 불안 및 우울에 유의한 상관을 보였으면 이 척도의 하위 척도인 종교적 안녕정도는 정신건강에 부정적인 영향을 미치는 반면 실존적 안녕정도는 정신건강에 긍정적 영향을 미친 결과로 평가되었다. 이러한 결과는 공산주의 사회에서 실존적 안녕은 긍정적인 가치관으로 평가되는 반면 종교적 안녕은 정신건강에 부정적으로 작용한 것을 입증해 주었다고 하겠다. Background: Spirituality has been an important part of Transpersonal Psychology and is believed to have a large effect on the mental health because it has been systematized. The aim of this study was to determine the level of spiritual disposition on human beings along with its effects on one's mental health. Materials and Methods: The study targeted 400 women residing in Youn-Gil city of JiLin Prov., which is a district of the Cho-Sun tribe in China. Their spiritual well-being was studied using the Spiritual Well-being Scale-Korean Version. The spiritual well-being scale consists of 2 sub-scales of religious well-being and existential well-being. The study was evaluated using a lie scale, psychotic trend, and a combined anxiety-depression scale. The results were considered to be factors of one's mental health. The correlation between the spiritual well-being and each tendency was analyzed by regression analysis. Results: The total score of the Cho-Sun tribal women according to the spiritual well-being scale was 68.29 which was much less than the 100.65 of Korean Christian women. There was no significant correlation between the spiritual well-being and the Lie trend. However, it was found that 86%(344) of Cho-Sun tribal women scored above 70 in the Lie trend with a mean score of 74.57 which is higher than normal populations. Regarding the correlation between the spiritual well-being and psychotic trend, the psychotic trend became significantly higher when the religious well-being was at a high level. On the other hand, the psychotic trend became significantly lower when the existential well-being was at a high level. Regarding the correlation between the spiritual well-being and anxiety, the anxiety was significantly higher when the religious well-being was at a high level. However, the anxiety level was significantly low when the existential well-being was at a high level. Regarding the correlation between the spiritual well-being and depression, the depression level was somewhat significantly high when the religious well-being was at a high level. However, the depression level was significantly low when the existential well-being was at a high level. Conclusion: This study evaluated the effects of spiritual well-being on a person's mental health among Cho-Sun tribal women in Youn-Gil city of JiLIn Prov., P.R. of China. The results found that the religious well-being, which is a sub-scale of spiritual well-being, had negative effects while the existential well-being had positive effects on the mental health. These results proved that a person's religious disposition had negative effects on their mental health in a communitarian society.

Adult respiratory distress syndrome in Korean patients with SLE: causes and prognostic factors

김완욱 ( Wan Uk Kim ),김성일 ( Seong Il Kim ),민준기 ( Jun Ki Min ),김석찬 ( Seok Chan Kim ),이상헌 ( Sang Heon Lee ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.1998 No.1

Adult Respiratory Distress Syndrome in Korean Patients with Sle / Causes and Prognotic Factors

김완욱(Wan Uk Kim),김성일(Seong Il Kim),민준기(Jun Ki Min),김석찬(Seok Chan Kim),이상헌(Sang Heon Lee),박성환(Sung Hwan Park),홍연식(Yeon Sik Hong),조철수(Chul Soo Cho),김호연(Ho Youn Kim) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

류마티스 관절염 환자에서 Methotrexate와 관련된 간질성 폐렴

김지연 ( Ji Yeon Kim ),김완욱 ( Wan Uk Kim ),김성일 ( Sung Il Kim ),류완희 ( Wan Hee Yoo ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),김석찬 ( Seok Chan Kim ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),이연수 ( Youn So 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

The use of oral methotrexate in a low dose given once weekly has become the mainstay of therapy for active and sustained rheumatoid arthritis. Pneumonitis can be expected to occur in patients taking low doses of methotrexate for rheumatoid arthritis. The pathology suggests that methotrexate pneumonitis is a hypersensitivity reaction although arguments have been put forth that it is idiosyncratic. Treatment of presumed methotrexate pneumonitis, even while waiting for special stains, cultures, or tissue sections from bronchoscopic biopsy, should be glucocorticoids given intravenously or by mouth. Empirical antibiotic treatment can be used until infectious causes are ruled out. In recent years there has been an increase in the number of reports of pulmonary complications associated with low-dose methotrexate therapy for rheumatic diseases. Among these complications interstitial pneumonitis has been most often reported (more than 35 cases since the first report in 1983). We report a case of methotrexate-associated pulmonary complication in rheumatoid arthritis confirmed by trans-bronchoscopic lung biopsy, which resolved by treatment of corticosteroid therapy.

Elevated Serum Levels of Syndecan-1 Are Associated with Renal Involvement in Patients with Systemic Lupus Erythematosus

Kim, Ki-Jo,Kim, Ji-Young,Baek, In-Woon,Kim, Wan-Uk,Cho, Chul-Soo Journal of Rheumatology Pub. Co 2015 The Journal of rheumatology Vol.42 No.2

<P><B>Objective.</B></P><P>Syndecan-1 (SDC-1) is a major constituent of the endothelial glycocalyx, which plays a role in maintaining vascular homeostasis and functions as a glomerular filtration barrier. SDC-1 is readily shed into the blood under various conditions, but the clinical implication of circulating SDC-1 in patients with systemic lupus erythematosus (SLE) remains unclear. We aimed to investigate the association of serum SDC-1 level with certain clinical manifestations of SLE.</P><P><B>Methods.</B></P><P>We measured serum SDC-1 levels by ELISA in 111 patients with SLE, 18 with rheumatoid arthritis (RA), and 20 healthy subjects, and investigated its association with clinical manifestations and laboratory variables.</P><P><B>Results.</B></P><P>Serum SDC-1 levels were higher in patients with SLE than in those with RA and healthy controls (both p < 0.001) and were positively correlated with SLE Disease Activity Index (SLEDAI; r = 0.367, p < 0.001) and anti-dsDNA antibody level (r = 0.259, p = 0.007), but inversely correlated with serum C3 and CH50 levels (r = −0.305, p = 0.001 and r = −0.244, p = 0.012). Patients with active nephritis had higher serum SDC-1 levels than patients with inactive nephritis and those without nephritis (both p < 0.001). In addition, serum SDC-1 levels were correlated with renal SLEDAI score (r = 0.540, p < 0.001) and excretion of proteinuria as measured by spot urine protein/creatinine ratio (r = 0.538, p < 0.001). In 14 patients with lupus nephritis (LN) whose serum samples were obtained at the time of renal biopsy, there was a positive correlation between serum SDC-1 levels and activity index (r = 0.632, p = 0.015).</P><P><B>Conclusion.</B></P><P>Serum SDC-1 levels are increased in SLE patients with nephritis, indicating that SDC-1 might be a useful serum biomarker for active LN.</P>

Effect of Cyclosporine on Circulating Interleukin-10 and Interleukin-12 in Pateints with Severe, Refractory Rheumatoid Arthritis

Kim, Jeong-Sun,Kim, Wan-Uk,Cho, Mi-La,Youn, Jee-Hee,Lee, Suk-Kyeong,Chae, Eun-Young,Min, Jun-Ki,Hong, Yeon-Sik,Lee, Sang-Heon,Park, Sung-Hwan,Cho, Chul-Soo,Kim, Ho-Youn 가톨릭대학교 2000 Bulletin of The Catholic Research Institutes of Me Vol.28 No.-

Background : To investigate the effect of cyclosporine on interleukin-10 (IL-10) and interleukin-12 (IL-12) in patients with rheumatoid arthrtis (RA) Methods : A 10-week randomized, double blind, placebo-control study of cyclosporine RA who had residual inflammation and isability despite partial reponses to prior maximal tolerated dose of methotrexate (<15 mg/week) and low dose prednisone (<10 mg/day). The clinical and laboratory variables, and circulating leves IL-10 and IL-12 measered by enzymelinked immunosorbent method, were compared between patients (cyclosporine group) treated with cycloporine plus methotreaxte and those (placebo group) treated with placebo plus methotrexate at the entry and 16 weeks of the study. Results : On the 16 weeks into the clinical trial, the cyclosporine group (n=17), compared with the placebo group (n=17), had higher degree of decreases in tender joints, patients global assessment, patients self assessed disability, C-reactive protein as well as having more patients with over 20% improvement. The comparison of the circulating IL-10 and IL-12 at the entry and 16 weeks of the study showed significant decreases of IL-12(median-313 versrs -14 pg/ml, p=0.002) and a significant increase of IL-10 (median 55 versus-12 pg/ml, p <0.001) in the cyclosporine group compared with the placebo group. The degree of IL-10 increases strongly correlated with the degree of IL-12 decreases in the cyclosporine group (r=0.572, p=0.016). Among the cyclosporine group, the improved patients (n 10), compared to the non-improved patients (n=7), had higher rate of increase in the circulating IL-10 (median 172.0 versus 85.2%, p=0.01). The rate of increase of IL-10 strongly correlated with the rate of improvement of joint scores (r=0.718, p=0.001) after administration of cyclosporine. Conclusion : Our results suggest that the therapeuic effect of cyclosporine is achieved by correcting Th1/Th2 imbalance (a shift Th1 type to Th2 type), which may be in the pathogenesis of RA, and circulating IL-10 is useful to assess the clinical improvements in patients with RA after administration of cyclosporine. (Korean Journal of BRM 9(1):19-30, 1999)

Enhanced T Cell Proliferative Response to Type II Collagen and Synthetic Peptide CII(255-274) in Patients with Rheumatoid Arthritis

Kim, Ho-Youn,Kim, Wan-Uk,Cho, Mi-La,Lee, Suk-Kyeong,Youn, Jee-hee,Sung-Il Kim*,Wan-Hee Yoo**,Jae-Ho Park***,Min, Jun-Ki,Lee, Sang heon,Park, Sung-Hwan,Cho, Chul-Soo 가톨릭대학교 2000 Bulletin of The Catholic Research Institutes of Me Vol.28 No.-

Objective : To determine the presence of specific immune recognition of type II collagen (CII) and its immunodominant epitope CII (255-274) in patients with rheumatoid arthritis(RA). Methods : T cell proliferative responses to bovine CII and synthetic peptide encompassing CII (255-274), by peripheral blood mononuclear cells (PBMC) and synovial fluid mononuclear cells (SFMC) from RA patients, and PBMC from osteoarthritis (OA) patients and healthy controls were assayed by mixed lymphocyte culture. Results : Stimulation index (SI) and the number of positive T cell responses (SI≥2) to CII were higher in RA patients (n=106) than in OA patients(n=26) and healthy controls (n=34). T cell responses to CII (255-274) were also enhanced in RA and correlated well with those to CII. In SFMC, positive responses to CII using SFMC were stronger and more prevalent than peripheral responses. SI and positive responses to CII were higher in early RA than in late RA. IgG antibodies to CㆍII in SF inversely correlated with T cell responses to CII. Conclusion : T cell responses to CII or CII(255-274) were enhanced in RA, especially in early disease. Synthetic peptide CII (255-274) as well as CII could be recognized as immunogenic antigens by T cells, particularly those in SF. These observations suggest that CII reactive T cells play an important role in the pathogenesis of RA. Peripheral tolerance induction using CII(255-274) might be useful in the treatment of RA. (Arthritis and Rheumatism 42(10):2085-2093, 1999)

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients with Community-Acquired Pneumonia

Kim, Ji Hye,Seo, Joo Wan,Mok, Jeong Ha,Kim, Mi Hyun,Cho, Woo Hyun,Lee, Kwangha,Kim, Ki Uk,Jeon, Doosoo,Park, Hye-Kyung,Kim, Yun Seong,Kim, Hyung Hoi,Lee, Min Ki The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.74 No.5

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (${\geq}65$ years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ${\rho}$=0.408 with p<0.001; procalcitonin and PSI, ${\rho}$=0.293 with p=0.003; procalcitonin and mortality, ${\rho}$=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.