장기간 지속성 외래 복막투석을 시행 받은 환자의 임상적 특성

노현정(Hyun Jung Roh),류동렬(Dong Ryul Ryu),유태현(Tae Hyun Yoo),박형천(Hyeong Cheon Park),신석균(Suk Kyoon Shin),강신욱(Sin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

지속성 외래 복막투석은 도입 된지 20여년이 경과되어 현재 널리 쓰여지는 신대체 요법으로 혈액투석과 비교하여 사망률 면에서는 별 차이가 없으나 낮은 기술적 생존률로 인해 장기간 시행하기가 어려운 것으로 되어 있다. 본 연구에서는 국내의 장기 복막투석 환자들을 대상으로 장기 복막투석을 위한 요건과 투석 중 임상 양상의 변화를 조사하고자 하였다. 1981년 11월부터 1999년 3월까지 연세의료원에 내원하여 복막투석을 시행 받은 환자 중 10년 이상 복막투석을 시행 받은 환자 23명을 장기투석군으로 설정하였고, 이와 대조군인 단기투석군으로는 복막투석을 시행 받은 환자 23명을 장기투석군으로 설정하였고, 이와 대조군인 단기투석군으로는 복막투석 시작 후 4년 이내에 혈액투석으로 전환한 환자 22명과 4년 이내에 사망한 환자 41명을 대상으로 하여 후향적으로 분석하였다. 모든 환자에서 복막투석 시작 당시와 복막투석 시작 후 18개월간의 임상적 특성 및 체중, 생화학적검사 결과를 조사하였다. 장기 복막투석환자를 대상으로는 2년마다 추적 검사한 체중, 생화학적검사 결과를 조사하였다. 1) 평균 투석기간은 장기투석군 129.9±8.3개월, 혈액투석 전환군 20.2±11.1개월, 사망자군 18.9±14.7개월이었다. 2) 투석 시작 연령은 장기투석군 39.7±12.4세, 혈액투석 47.7±12.2세, 사망자군 60.9±13.8세로 장기 투석군의 연령이 낮았다. 당뇨병의 유병률은 장기 투석군 4.3%(1/23명), 혈액투석 전환군 31.8%(7/22명), 사망자군 61.0%(25/41명)으로 혈액투석 전환군과 사망자군에서 높았으며, 심혈관계 질환의 합병률은 장기투석군 4.3%(1/23), 혈액투석 전환군 4.5%(1/22), 사망자군 34.1%(14/41)로 역시 사망자군에서 높았다. 성과 체중에 따른 차이는 없었다. 3) 투석 시작 당시 혈청 creatinine은 장기투석군 16.7±6.2mg/dL, 사망자군 8.4±3.6mg/dL였고, 혈청 알부민은 장기투석군 3.5±0.6g/dL, 혈액투석 전환군 3.3±0.6g/dL, 사망자군 3.2±0.6g/dL, 로 장기투서군에서 유의하게 높았다. 4) 18개월간 세 군의 체중은 큰 변화가 없었으나 남자 사망자군은 18개월경 급격한 체중 감소가 있었고, 혈청 크레아티닌과 알부민은 세 군에서 모두 증가하였으나 장기투석군에서 더 현저하였다. 5) 10년간 장기 투석 환자를 추적 검사한 결과 체중은 여자 환자에서 처음 2년간 급속히 증가하였고 그 이외는 남녀 모두에서 큰 변화가 없었다. BUN, 혈청 크레아티닌, 알부민은 투석시작 후 2-4년까지 증가하다가 그 이후부터 서서히 감소하는 양상을 보였다. 결론적으로 단기 투석 환자군과 비교하여 장기 투석 환자는 젊은 연령에서 투석을 시작하였고 당뇨병, 심혈관계 질환력이 적으며 투석 시작 당시 영양학적 지표가 양호하였다. 또한 장기간 복막투석을 시행할 경우 투석 시작 후 4-6년경부터 영양학적 지표가 서서히 악화되기 시작하여 이시기부터 영양 상태의 개선을 위한 노력이 필요할 것으로 생각된다. Although CAPD has become firmly established as an effective mode of renal replacement therapy, it's technique survival rate is much inferior compared to hemodialysis. To date, few patients have been main- tained on this therapy for more than 10 years. To gain insights into clinical features of patients who had maintained over 10 years on CAPD in Korea, we retrospectively compared 23 patients who survived more than 10 years on PD(Long-term survivors, LTS) and 63 patients who died(Short-term survivors, STS-died, 41 patients) or changed to hemodialysis(STS-HD, 22 patients) within 4 years of initiating PD. For all patients, age, sex, diabetic history, prior cardiac events, body weight and biochemical profiles were analyzed. 1) The LTS were younger(39.7±12.4 vs. 47.7± 12.3 vs. 60.9±13.8 years) compared with STS-HD and STS-died. 2) The LTS had less cases of DM(4.3% vs. 31.8 % vs, 61%), and had less cases of prior cardiac events(4.3% vs. 4.5% vs, 34.1%) compared with STS-HD and STS-died. Sex ratio and body weight were comparable in three groups. 3) At the initiation of PD, the LTS had higher serum creatinine(16.7rng/dL vs. 12.4mg/dL vs, 8.4mg/ dL), albumin(3.53g/dL vs. 3.27g/dL vs, 3.20g/dL) lev- els compared with STS-HD and STS-died. 4) During 10 year CAPD treatment, LTS showed relatively stable body weight except the increase of body weight for the first 2 years in female. BUN, creatinine, protein, albumin constantly increased for the first 4 years, and then started to decline by 4 th to 6 th years. In conclusion, young age, non-diabetic history, less prior cardiac events and good nutritional status can predict the long-term survival on peritoneal dialysis. The evaluation of nutritional status and nutritional support by 4 th to 6 th years may be important in maintaining long-term survival in CAPD patients.

만성 간질환에서 당뇨병의 유병률

이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),홍성관(Sung Kwan Hong),노현정(Hyun Jung Roh),최병주(Byung Joo Choi),안상훈(Sang Hoon An),서일(Il Suh),한광협(Kwang Hyup Han) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

N/A The insulin resistance and the altered glucose metabolism in chronic liver disease increase the alteration of glucose intolerance and the prevalence of diabetes mellitus. The prevalence of DM is higher in advanced cirrhosis than in early cirrhosis and higher in C-viral hepatitis or alcoholic liver disease than in B-viral hepatitis. The purpose of this study is to assess the prevalence of DM in chronic liver disease in Korea. Methods : We reviewed the medical records of 417 patients with chronic liver disease who visit the Yonsei University Sevrance Hospital from January 1994 to March 1998. We examined fasting blood sugar, biochemical study and abdominal ultrasonography. DM was defined on the basis of fasting hyperglycemia (fasting blood sugar exceeding 140 mg/dl) at least two consecutive samples or active treatment with insulin or oral hypoglycemic agents. Results :1) The DM prevalence was 16.8%(70 cases) in total patients and 25.0% (56 cases) in cirrhotic patients. 2) According to sex, there was no statistically significant difference in DM prevalence(16.8% in men and 18.1% in women P=0.78). 3) The DM prevalence was increased with increasing of age(0% in below 30 years, 4.9% in 31-40, 19.6% in 41-50, 22.9% in 51-60, 21.3% in 61-70 and 44.4% in over 71 years, P<0.01). 3) According to severity of liver disease, the DM prevalence was higher in uncompensated cirrhosis than in compensated cirrhosis(2.3% in chronic viral carrier, 8.8% in chronic hepatitis, 17.9% in cirrhosis Child class A, 33.9% in class B, 29.5% in class C). 4) According to cause of liver disease, the DM prevalence was higher in C-viral hepatitis and alcoholics than in B-viral hepatitis(12.1% in B-viral hepatitis, 35.1% in C-viral hepatitis, 40.0% in alcoholics). Conclusion : The prevalence of diabetes in the patients with chronic liver disease is much higher than in general population. And the DM prevalence is increased in advanced cirrhosis and C-viral or alcoholic hepatitis. The early diagnosis and treatment of DM in chronic liver disease patients are important. (Korean J Med 57:281-287, 1999)

Human immunodeficiency virus(HIV) 감염자에 있어서 3제 병용요법의 치료효과 및 안전성

홍성관(Sung Kwan Hong),박윤수(Yoon Soo Park),조정호(Jeong Ho Cho),노현정(Hyun Jung Roh),김효열(Hyo Yeol Kim),장경희(Kyung Hee Chang),송영구(Young Goo Song),김준명(June Myung Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : Antiretroviral combination therapy with one protease inhibitor and two reverse transcriptase inhibitors is profoundly suppressive of HIV replication. To determine the efficacy and safety of the triple combination therapy in persons with HIV infection in Korea, we analyzed the response of therapy in terms of immunity and viral load. Methods : Ten persons with HIV infection, who were treated with triple combination therapy at least 12 months at Yonsei University College of Medicine from 1997 to 1999 were studied. The triple combination therapy regimen consisted of two reverse transcriptase inhibitors (zidovudine or didanosine, lamivudine) and one protease inhibitor (indinavir). We analyzed the levels of HIV RNA, CD4+ cell counts, β2MG, and p24Ag before and after treatment. Adverse drug reactions during therapy were described. Results : The mean age of patients at treatment was 38.7 years. Nine patients were male, and 1 patient was female. Six patients received triple combination therapy as initial treatment, while 4 patients received it as re-treatment. The mean level of HIV RNA was 129,222 copies/mm3 before treatment. RNA level decreased to less than 500 copies/mm3 (non-detectable range) at 1 month in 7 of 10 patients, at 12 months in 9 of 10 patients. The mean CD4+ cell counts was 206/mm3 before treatment, and 376/mm3 after 12 months treatment. The β2MG decreased to 2.7 mg/L from 2.8 mg/L after 12 months of treatment. The p24Ag was positive in 3 of 10 patients and negative in all of the patients at 3 months treatment. Mild hyperbilirubinemia (5 cases) was the most frequent adverse reaction followed by flank pain (3 cases), skin rash (2 cases), abdominal discomfort (2 cases), and mild elevation of AST/ALT (1 case). Conclusion : The triple combination therapy in HIV infection appeared to be generally well tolerated, and was able to profoundly sustain suppression of HIV replication.(Korean J Med 58:582-589, 2000)

Lovastatin 및 Isoprenylation 억제제에 의한 배양한 백서 사구체 혈관간세포의 사멸과 세포골격 변형

박형천(Hyeong Cheon Park),권건호(Kun Ho Kwon),노현정(Hyun Jung Roh),강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

Lovastatin은 세포내 cholesterol 합성에 관여하는 3-hydroxy-3methylglutaryl coenzyme A(HMG CoA) reductase를 경쟁적으로 억제하는 약제로 HMG CoA로부터 mevalonate 생성을 억제한다. 최근 mevalonate와 중간 대산 산물의 생성을 억제시킬 경우 Rho 단백질을 포함한 저분자 guanosine triphosphate(GTP) 결합 단백질의 isoprenylation 억제 과정을 통해 세포골격 변형과 세포 사멸을 유발할 수 있을 것으로 보고되어 종양 세포를 포함한 여러 종류의 세포를 대상으로 활발한 연구가 진행되어 왔다. 그러나 lovastatin에 의한 백서 사구체 혈관간세포(mesangial cell)의 사멸과 세포 형태 변형에 대한 연구는 거의 없고, geranylgeranyltransferase I과 farnesyltransferase를 각각 선택적으로 억제하는 GGTI-286과 L-744,832에 의한 백서 사구체 혈관간세포 사멸과 세포골격 변형에 관한 연구는 아직까지 없는 실정이다. 이에 저자 등은 백서에서 추출한 사구체 혈관간세포를 배양하여 lovastatin, GGTI-286, 그리고 L-744,832에 각각 노출하여 혈관간세포에 대한 이들 약물의 직접적인 사멸 유발 효과를 Hoechst 33258 염색, DNA 분절, 그리고 유세포분석으로 알아보았다. 또한 이들 약물 투여에 따른 혈관간세포내 actin 스트레스 섬유의 변화를 형광현미경으로 관찰하고, 동시에 세포외적으로 투여한 GGPP와 FPP로 인한 lovastatin에 의한 세포골격 변형과 사멸의 가역성 여부를 실험하여 다음의 결과를 얻었다. 1) Lovastatin은 배양 시간과 약물 농도에 비례하여 혈관간세포 사멸을 유발하였다. Isoprenoid인 GGPP의 세포외적 투여는 lovastatin에 의한 혈관간세포 사멸을 완전히 가역화였고, FPP의 세포외적 투여는 부분적인 사멸 억제 효과를 나타내었다. 2) 선택적인 isoprenylation 억제제인 GGTI-286은 lovastatin과 같이 배양 시간과 약물농도에 비례하여 혈관간세포 사멸을 유발하였다. 그러나 L-744,832는 대조군에 비행 유의하게 혈관간세포 사멸을 유발하는 효과가 없었다. 3)Lovastatin에 의해 유발된 혈관간세포 사멸에서 사멸 억제와 관련이 있는 Bcl-2 발현의 변화를 관찰할 수 없었다. 4) Lovastatin과 GGTI-286은 혈관간세포의 세포골격 변형과 세포골력을 이루는 actin 스트레스 섬유의 파괴를 유발하였으며, GGPP 또는 FPP의 세포외적 투여는 세포 형태 변형과 actin스트레스 섬유의 파괴를 완전히 가역화 하였다. 5)Lovastatin과 GGTI-286은 저분자 GTP결합 단백질 중 세포골격 구서오가 사멸 조절에 관여하는 RhoA 단백질의 isoprenylation을 억제하였고, GGPP의 세포외적 투여는 lovastatin의 효과를 가역화 하였다. Products of mevalonate pathway, such as farnesyl pyrophosphate(FPP) and geranylgeranyl pyrophospha- te(GGPP) play a critical role in protein isoprenylation. Lovastatin, which blocks mevalonate production is an isoprenylation inhibitor reported to alter cytoskeletal architecture and induce apoptosis in a variety of cell lines. Exogenous isoprenoids reversed the effects of lovastatin, suggesting the importance of isop- renoid products for cytoskeletal organization and apoptosis. The aim of this study was to define the effects of lovastatin and isoprenylation inhibitors on induction of apoptosis and cytoskeletal changes in cultured rat glomerular mesangial cells. In addition, GGPP and FPP were added exogenously with lovastatin to determine which metabolite played a more important role in apoptosis and cytoskeletal changes, respectively. Lovastatin and GGTI-286 induced changes in the degree of RhoA isoprenylation was assessed to further support the role of protein isoprenylation in apoptosis and cytoskeletal changes. The results obtained were as follows; 1) Lovastatin induced apoptosis of cultured glomerular mesangial cells in a time and dose-dependent manner independent of bcl-2. The GGPP completely reversed the proapoptotic effects of lovastatin, while FPP partially reversed it. 2) GGTI-286, a specific inhibitor of protein geranylgeranyltransferase, induced apoptosis of cultured glomerular mesangial cells in a time and dose-dependent manner similar to lovastatin. But L-744,832, a specific inhibitor of protein farnesyltransferase, did not induce apoptosis compared to control group. 3) Lovastatin and GGTI-286 induced actin stress fiber disruption, but L-744,832 failed to induce actin stress fiber disruption in cultured glomerular mesangial cells. Both GGPP and FPP completely reversed the cytoskeletal changes induced by lovastatin. 4) Cultured glomerular mesangial cells treated with lovastatin or GGTI-286 were associated with decreased isoprenylation of RhoA, a protein reported to be involved in actin cytoskeletal organization and cell survival. Such finding further supports the role of protein isoprenylation inhibition in mesangial cell apoptosis and cytoskeletal change induced by isoprenylation inhibitors. In conclusion, lovastatin and GGTI-286 induced apoptosis in cultured glomerular mesangial cells. The effect of lovastatin was completely reversed by addition of GGPP and only partially by FPP, suggesting a critical role for geranylgeranylated proteins in cultured glomerular mesangial cell apoptosis. The actin cytoskeletal change induced by lovastatin was completely reversed by addition of GGPP or FPP, sug- gesting both geranylgeranylated and farnesylated proteins are involved in actin cytoskeletal change.

미만성 증식성 낭창성 신염의 임상상 및 예후인자

최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),하성규(Sung Kyu Ha),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),신석균(Suk Kyun Shin),황재하(Jae Ha Hwang),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),김주성(Joo Seong Kim 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group<n=12). The mean age of the patients was 27.4 years and the mean follow-up duration was 51 months. Lupus nephritis developed at a mean 9.7 months after SLE diagnosis and mean duration of nephritis was 39.2 months. Mean serum creatinine was 1.6mg/ dL, 24 hour proteinuria was 4,873mg, and anti-DNA antibody was positive in 8196 of patients at the time of renal biopsy. Activity index and chronicity index were 10.4 and 2.8, respectively. Overall 5 year renal survival rate was 7596 and no difference between steroid single therapy and cyclophosphamide combination therapy was observed. Factors affecting therapeutic response included delayed development of nephritis(3.1 vs 13.8 months, p<0.05) and elevated serum creatinine level(0.9 vs 1.9mg/dL, p<0.05), which were associated with poor therapeutic response. Other clinicopathologic, biochemical and immunologic parameters were not different between the therapeutic response group and the therapeutic non-response group. In conclusion, delayed development of lupus nephritis and elevated serum creatinine at nephritis presentation are poor prognostic factors of DPLN, but further randomized prospective study{including divided cytoxan intravenous pulse therapy and oral therapy, with long-term follow-up) is necessary.

이차성 부갑상선 기능 항진증을 가진 복막투석 환자에서 경구 칼시트리올 치료 반응에 관여하는 요인

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)×100/initial PTH(%),△PTH during oral calcitriol therapy for 3 and 6 months(group I ; △PTH >30%, group II ; △PTH <30%). Result: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22μg and during 6month 0.43 0.24μg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7±196.5 vs. 871.0±478Apglml, 6.2±2.6 vs. 13.1±5.2mm, 5.0±1.3 vs. 5.7±1.3mg/dl, 93.7±4L1 vs. 171.9±137.6IU/L, 40.1±34.9 vs. 73.5±37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1±266.6 vs. 889.7±485.4pg/ml, 6.4±2.7 vs. 14.5±5.1mm, 107.9±80.1 vs. 180.7±121.5IU/L, 40.5± 32.9 vs. 81.8±35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between △PTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.

IgA 신증의 예후인자로서 선택적 단백뇨지수의 의의

구영석(Young Suck Goo),강이화(Ea Wha Kang),이상철(Sang Cheol Lee),한승혁(Seung Hyeok Han),경희두(Hee Doo Kyung),정재헌(Jae Hun Jung),윤수영(Soo Young Yoon),최소래(So Rae Choi),노현정(Hyun Jung Roh),박형천(Hyeong Cheon Park),강신욱(Sh 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.5

목 적 : 선택적 단백뇨지수(selective proteinuria index , SPI)는 신증후군 환자의 조직학적 변화 및 스테로이드 치료에 대한 반응을 알 수 있는 예후인자로 알려져 있다. 단백뇨를 보이는 IgA 신증 환자에서 사구체 기저막의 음전하 소실이 나타나고, 신기능이 저하된 IgA 신증 환자에서 안지오텐신 전환효소 억제제가 비선택적 공(pore)의 반경을 감소시키는 것으로 보고되고 있어 선택적 단백뇨지수의 개념을 적용할 수 있다. 또한 신증후군 환자에서 선택적 단백뇨지수가 사구체 손상 뿐만 아니라 세뇨관간질의 손상 정도를 반영하는 것으로 알려져 있고, IgA 신증의 예후가 사구체경화와 세뇨관간질의 손상 정도와 밀접한 관련이 있는 것으로 보고되고 있어 IgA 신증 환자에서 선택적 단백뇨지수가 사구체와 세뇨관간질의 손상 정도를 반영할 수 있을 것으로 생각하였다. 본 연구는 IgA 신증에서 선택적 단백뇨지수와 다른 예후인자들의 연관성을 살펴보고, 선택적 단백뇨지수가 예후인자로서 의미가 있는지 알아보고자 하였다. 방 법 : 1990년 1월부터 2000년 1월까지 연세의료원에 내원하여 신장 조직 검사로 IgA 신증을 진단 받은 환자들 중 진단 당시에 신기능이 정상이었으며, 24시간 소변검사와 선택적 단백뇨지수를 측정한 81명을 대상으로 후향적으로 분석하였다. 환자들을 선택적 단백뇨지수 정도에 따라 고선택성(SPI≤0.1, n =6), 중등도 선택성(0.1< SPI≤0.2, n =33), 비선택성(SPI> 0.2, n =42)군으로 나누어 임상 소견과 신부전의 발생 차이를 비교하였다. Kaplan - Meier 생존곡선을 이용하여 예후인자에 따른 신부전의 발생 차이를 알아보기 위해 혈청 크레아티닌이 1.5 mg/ dL 이상이고 진단 당시보다 혈청 크레아티닌이 2배 이상 증가한 경우를 신부전으로 정의하였다. 또한 IgA 신증에서 신증후군을 보인 28명을 대상으로 선택적 단백뇨지수에 따른 스테로이드나 세포 독성 약물 치료의 반응을 살펴보았다. 결 과 : 1) 선택적 단백뇨지수에 따라 분류한 세군에서 24시간 단백뇨(0.52±0.35, 1.85±1.55, 2.79±2.51 g/ day, p<0.05), 고혈압(0, 4, 11명, p< 0.05), Haas 분류법(Ⅰ+Ⅱ : 5명, 21명, 6명, Ⅲ : 1명, 9명, 13명, Ⅳ+Ⅴ : 0명, 3명, 23명, 각각 고선택성, 중등도 선택성, 비선택성, p=0.01)은 의미 있는 차이를 보였다. 그러나 연령, 성별, 추적관찰 기간, 혈뇨, 24시간 크레아티닌 청소율, 혈청 크레아티닌은 세군간에 통계학적인 차이가 없었다. 2) Cox의 비례위험 회귀모형으로 분석하였을 경우, 신부전으로의 진행은 혈청 크레아티닌 (Exp (B)=4.2, p<0.001), 24시간 크레아티닌 청소율(Exp (B)=2.1, p<0.05), 선택적 단백뇨지수 (Exp (B)=1.7, p<0.05), 고혈압(Exp (B)=1.6, p<0.05)과 연관이 있었다. 3) IgA 신증에서 신증후군 소견을 보인 환자는 28명으로 고선택성 단백뇨군에서는 신증후군의 발생이 없었다. 약물 치료 결과는 중등도 선택성 단백뇨군에서 신증후군 양상을 보인 9명 중 N/A

기능평가에 기초한 선행사건 중심의 중재가 장애 학생의 문제행동, 과제수행행동, 과제성취도에 미치는 영향

노현정,이소현 한국정서.행동장애아교육학회(구.한국정서학습장애아교육학회) 2003 정서ㆍ행동장애연구 Vol.19 No.4

The purpose of this study was to investigate the effectiveness of functional assessment and antecedents-based intervention to reduce problem behaviors, improve task engagement and task achievement of students with disabilities in special education classroom. Descriptive functional assessment were conducted to identify antecedent that were functionally related to problem behaviors and task engagement. The first hypothesis for everyone was "when tasks incorporate his preferences". The second hypothesis for student 1 was "when completing tasks with teacher in close proximity". The second hypothesis for student 2 was "when completing tasks not together but alone". Using reversal design, hypotheses were tested and were accepted. After then, intervention package derived from the results of the assessments were examined within multiple-baseline design across three subjects. Functional assessment and antecedents-based intervention resulted in reduction in problem behavior, increase in task engagement, and improvement in task achievement. The effects of intervention were generalized to the inclusive regular class with a general education teacher.

기능평가에 기초한 선행사건 중심의 중재가 장애학생의 문제행동, 과제수행행동, 과제성취도에 미치는 영향 : based intervention on the problem behavior, task engagement, task achievement with disability students

노현정 이화여자대학교 교육대학원 2003 이화교육논총 Vol.13 No.-

The purpose of this study was to investigate the effectiveness of functional assessment and antecedents-based intervention to reduce problem behaviors and improve task engagement, task achievement with disability students in special education classroom In the present study, three students in special education classroom for severe behavioral problem participated in a descriptive functional assessment process designed to yield a useful understanding of their problem behavior. Functional assessment were conducted to identify antecedent including instructional and curricular variables that were functionally related to problem and task engagement in classroom. Structured interviews, and observations led to one or two hypotheses for each of the participants. The first hypothesis statement for everyone was "when tasks incorporate his preferences, problem behavior will decrease, and task engagement will increase". The second hypothesis statement for student I was "when completing tasks with teacher in close proximity, problem behavior will reduce, and task engagement will behavior better". The second hypothesis statement for student 2 was "when completing tasks not together but alone, problem behavior will decrease, and task engagement will increase". Using reversal design, hypotheses were tested in the context of ongoing classroom activities and were accepted. After then, Intervention package derived from the results of the assessments were examined within multiple-baseline design across subjects. The results from the present study are as follows : 1. Functional assessment and antecedents-based intervention resulted in immediate reduction in problem behavior. 2. Functional assessment and antecedents-based intervention resulted in significantly increased task engagement 3. Functional assessment and antecedents-based intervention led to effectively improved task achievement 4. The effects of functional assessment and antecedents-based intervention in special education classroom were showed good generality to general education teacher in the inclusive regular class.

복막 투석 환자에서 약제에 의해 발생한 유미복(Chylous ascites) 1예

강신욱,한대석,이호영,유태현,황재하,송현용,류동렬,노현정,노현진,최규헌,신석균 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.6

A chylous ascites, especially drug-induced, is very rare complication in CAPD. The diagnostic criteria for the drug-induced chylous peritoneal dialysate include 1) turbid dialysate developed within Chrs after the administration of causative drug, 2) no clinical symptoms being suggestive of peritoneal inflammation, 3) the fluid containing normal leukocyte counts and being negative for bacterial and fungal culture, and 4) it disappeared spontaneously after the withdrawal of the assumed causative agent and never recurred thereafter. We report a case of chylous ascites emerging after use of manidipine, dihydropyridine calcium channel blocker, in a patient undergoing CAPD. The chylous ascites in that patient was improved after discontinuation of manidipine.