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류마티스 관절염 환자에서 혈장 호모시스테인, 혈청 비타민 B12, 엽산 농도에 관한 연구
차훈석 ( Hoon Suk Cha ),전찬홍 ( Chan Hong Jeon ),고재현 ( Jay Hyun Koh ),이창근 ( Chang Keun Lee ),김진석 ( Jin Seok Kim ),김종원 ( Jong Won Kim ),강성욱 ( Seong Wook Kang ),송영욱 ( Yeong Wook Song ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3
Objective: Cardiovascular disease is the most frequent cause of death in rheumatoid arthritis(RA) patients and hyperhomocysteinemia is an independent risk factor for cardiovascular disease. We evaluated the status of homocysteine, vitamin B12 and folate in RA patients and the influence of the drugs used in RA on homocysteine and vitamin levels Methods: Fifty-six RA patients and 22 controls were studied. Plasma total homocysteine was measured by HPLC method and serum folate and vitamin B12 were measured by chemiluminescence immunoassay. In RA patients, age, sex, disease duration, medications and laboratory findings were analyzed. Results: Serum vitamin B12 level was significantly lower in RA patients compared to controls(p=0.033). No significant difference in serum folate level was found between RA patients and controls but plasma total homocysteine level was significantly higher in RA patients. There was no difference in plasma total homocysteine level between patients taking MTX with folate and controls, but plasma total homocysteine level was significantly higher in patients not taking MTX compared with controls(p=0.028). In RA patients taking only hydroxyl-chloroquine(HCQ) as a DMARD, there was significantly lower serum folate level(p=0.033) and higher plasma total homocysteine level(p=0.043) compared with controls. There was a significant negative correlation between plasma total homocysteine level and serum folate level in RA patients(r=-0.319, p=0.017). Conclusion: Plasma total homocysteine level was increased in RA patients but not in patients taking MTX and folate. These findings suggested that folate supplementation may be effective to prevent hyperhomocysteinemia in RA patients.
차훈석 ( Hoon Suk Cha ),전찬홍 ( Chan Hong Jeon ),최화정 ( Hwa Jung Choi ),안광성 ( Kwang Sung Ahn ),송영욱 ( Yeong Wook Song ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.2
Objective: The rheumatoid synovium is a hypoxic environment and hypoxia has been implicated to have a role in the pathogenesis of rheumatoid arthritis (RA). In this work, we tried to investigate the effect of hypoxia on the expression of matrix metalloproteinase (MMP)-1, -3 and tissue inhibitor of metalloproteinase (TIMP)-1 in rheumatoid and osteoarthritis (OA) fibroblast-like synoviocytes (FLS). Methods: FLS obtained from RA and OA patients were cultured under normoxic or hypoxic condition for 48 hours. Western blot analyses for MMP-1, -3 and TIMP-1 were performed. TIMP-1 mRNA levels were measured by Northern blot analysis. Results: Hypoxia increased MMP-1 expression in rheumatoid FLS compared with normoxia. TIMP-1 expression was decreased by hypoxia in rheumatoid FLS in both protein and mRNA levels. On the other hand, hypoxia did not significantly affect MMP-1, -3 and TIMP-1 expressions in OA FLS. Conclusion: These results suggest that microenvironment such as hypoxia may directly contribute to joint destruction in RA by increasing the ratio of MMP-1 to TIMP-1 production in FLS.
한국인 전신성홍반성루푸스 환자에서 HLA-DRB1, DQB1 대립유전자의 연관성 및 항인지질 항체와 항β<sub>2</sub> Glycoprotein I 항체에 관한 연구
이상곤,차훈석,양윤선,Lee, Sang Gon,Cha, Hoon Suk,Yang, Yoon Sun 대한면역학회 2002 Immune Network Vol.2 No.4
Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by diverse clinical manifestations and autoantibody production, which is known to be strongly influenced by genetic factors. Previous studies have revealed the associations of SLE with HLA class II alleles and antiphospholipid antibody system (anticardiolipin antibody (aCL) and anti-${\beta}_2$ glycoprotein I antibody (anti-${\beta}_2$ GPI)). Therefore, we studied the associations of HLA class II alleles with SLE and antiphospholipid antibody system. Methods: The genotyping for HLA-DRB1 and DQB1 alleles were performed in 61 SLE patients and 100 controls by the polymerase chain reaction (PCR)-sequence specific oligonucleotide probe method. ELISA tests for aCL and anti-${\beta}_2$ GPI were performed in 39 of the 61 SLE patients. The results were evaluated statistically by Chi-square test. Results: The frequencies of the HLA-$DRB1^*15$ and $DQB1^*06$ in SLE patients were significantly higher than those in controls. HLA-$DRB1^*12$ was significantly lower in SLE patients than controls. Nine of 39 patients were positive for aCL (IgG) and three were positive for aCL (IgM). One of 39 patients were positive for anti-${\beta}_2$ GPI (IgG) and none of them positive for anti-${\beta}_2$ GPI (IgM). Association of aCL with HLA class II alleles was not observed in our study. Conclusion: According to our results, it was found that HLA-$DRB1^*15$ and $DQB1^*06$ were associated with genetic susceptiblility and $DRB1^*12$ was associated with resistance to SLE in Korean population. No Association of aCL with HLA class II alleles was observed and the positive rate for anti-${\beta}_2$ GPI was very low.
전신성 괴사성 혈관염에서 다발성 단신경염의 임상적 고찰
김진석 ( Jin Seok Kim ),차훈석 ( Hoon Suk Cha ),서기현 ( Gi Hyun Seo ),안홍준 ( Hong Joon Ahn ),이창근 ( Chang Keun Lee ),고재현 ( Jae Hyun Koh ),김현숙 ( Hyeon Sook Kim ),최동철 ( Dong Chull Choi ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1
Background: The vasculitides are heterogeneous clinical syndromes characterized by inflammation of blood vessels. There are no pathognomonic symptoms. Mononeuritis multiplex is an acute or subacute asymmetric sensory motor syndrome involving discrete peripheral nerves and is known to occur in many illnesses including certain types of systemic vasculitis. Our purpose was to evaluate the clinical manifestations and significance of mononeuritis multiplex in systemic necrotizing vasculitis. Patients & Methods: Eight patients who were diagnosed as systemic necrotizing vasculitis at Samsung Medical Center between 1995 and 1997 were reviewed. Vasculitis was diagnosed by ACR criteria for each vasculitis and microscopic polyangiitis was diagnosed by the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis. Three were diagnosed as Churg-Strauss syndrome, 3 as polyarteritis nodosa, and 2 as microscopic polyangiitis. In most cases, vasculitis was confirmed by a biopsy specimen showing infiltration of granulocytes, lymphocytes, and/or plasma cell into vessel walls. Occasionally, polyarteritis nodosa was confirmed by mesenteric or renal arteriography which showed microaneurysms. EMG/NCV was performed in seven patients who had neuropathy. Results: Seven of the eight patients presented with mononeuritis multiplex and one had no neuropathy. Four patients presented with neuropathy as the first symptom, and three developed neuropathy within 3 weeks after the onset of vasculitis symptoms. The peroneal nerve and sural nerve were involved in all seven patients. The median nerve, ulnar nerve and posterior tibial nerve were involved in four, two and six patients, respectively. All seven patients had lower extremity involvement. Two showed only lower extremity involvement and five had both lower and upper extremity involvement. Isolated upper extremity involvement was not seen. All patients with mononeuritis multiplex were improved by treatment with cyclophosphamide and steroid therapy. Conclusion: Mononeurtis multiplex is a common manifestation of vasculitis and occurs early in the course of systemic vasculitis. Prognosis of mononeuritis multiplex is excellent, although it may take up to one year to recover.
김진석 ( Jin Seok Kim ),차훈석 ( Hoon Suk Cha ),고재현 ( Jay Hyun Koh ),서기현 ( Gi Hyun Seo ),이창근 ( Chang Keun Lee ),김병준 ( Byoung Joon Kim ),최화정 ( Hwa Jung Choi ),한정호 ( Joung Ho Han ),오원환 ( Won Hwan Oh ),고은미 ( E 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3
Objective: The synovium in rheumatoid arthritis(RA) is characterized by an increase in the thickness of lining layer and infiltration of cells into the sublining area. Histomorphologic studies of RA have indicated that initial destruction is more closely related to the presence of transformed appearing proliferating synovial cells than to the presence of subsynovial or periarticular inflammation. Based on the fact that synovial lining cells have some properties of transformed appearing cells, we examined the expressions of Fos, Jun and Myc oncoproteins in the synovial tissue from patients with rheumatoid arthritis and osteoarthritis. Methods: Synovial tissues from 15 patients with RA and 15 with osteoarthritis(OA) were studied by the immunohistochemical staining technique. Nine of 15 RA sped men were from arthroscopic synovectomy and the other 6 were from total knee replacement arthroplasty. Result: In all specimen studied, Myc and Fos were expressed in the synovial lining cells and Myc, Fos and Jun were expressed in the sublining cells, including lymphocytes, other inflammatory cells and blood vessels. Lymphocytes in the diffuse infiltrates showed increased expression of three oncoproteins compared to lymphocytes in the nodular aggregates. When oncoprotein expressions in RA were compared to OA, Fos and Myc expressions in the synovial lining cell layer were significantly higher in RA than in OA and Jun, Fos and Myc expressions in inflammatory cells were significantly higher in RA than in OA. The expressions of Fos and Myc were significantly correlated with the degree of synovial hypercellularity. In RA, the expressions of all three oncoproteins were increased in synovectomy group than joint replacement group. Conclusion: We observe that there are increased expressions of Myc, Fos and Jun in RA synovium than OA. These changes are more prominent in synovectomy group than joint replacement group, which suggest the differential expression of oncoproteins according to disease progression.
김지향 ( Ji Hyang Kim ),안석진 ( Suk Jin Ahn ),김진석 ( Jin Seok Kim ),차훈석 ( Hoon Suk Cha ),한정호 ( Jeong Ho Han ),고은미 ( Eun Mi Koh ),송재훈 ( Jae Hoon Song ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
Relapsing polychondritis is a rare autoimmune disease of unknown etiology with episodic but potentially progressive inflammatory manifestations. Auricular, articular and nasal manifestations are the most frequent disturbances. Fever is one of the manifestations of this disease but it rarely appears as an initial presentation. In this situation, the diagnosis is delayed until other manifestations are obvious. We report a case of relapsing polychondritis, which was presented as fever of unknown origin. Ten months after the onset of fever, auricular chondritis appeared and gave us the key to diagnosis.
고재현 ( Jae Hyun Koh ),홍석주 ( Suk Joo Hong ),안홍준 ( Hong Joon Ahn ),안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),안중모 ( Joong Mo Ahn ),김현숙 ( Hyun Sook Kim ),서연림 ( Yeon Lim Seo ),고은미 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.3
Objective: The purpose of the study is to describe the magnetic resonance imaging (MRI) findings and to investigate useful sequences of MRI in inflammatory myopathies. A third goal is to correlate MRI findings with the grade of histopathologic severity. Methods: Sixteen patients (13 women, 3 men), aged 21~74 years (median age of 49) with inflammatory myositis (examined with both MRI and muscle biopsy) were studied. Ten patients were diagnosed with polymyositis and 6 with dermatomyositis. Conventional T1-weighted (SE 366/12) and T2-weighted (SE 4766/90) fast spin-echo and fat-suppressed T1-weighted MR images with contrast enhancement (FSAT T1 CE) were obtained. Ratios between the signal intensities of a muscle and the signal intensities of subcutaneous fat in the same tomographic sections were calculated to objectively represent the degree of signal intensities. Semi-quantitative grading of severities in muscle biopsy specimen was examined based on invasion of inflammatory cells and necrosis, degeneration and regeneration of muscle fiber by a neuromuscular pathologist. Results: FSAT T1 CE could objectively describe the severity of involvement in inflammatory myopathies. The quadriceps muscle group, especially the vastus muscle tended to be most severely and frequently involved in inflammatory myositis with FSAT T1 CE (statistically insignificant). The vastus intermedius muscle was more severely involved in dermatomyositis than polymyositis. The signal intensity of abnormal muscle sampled by biopsy correlated positively with the grade of muscle biopsy. Conclusion: MRI shows promise in identifying pathologic muscle in patients suspected of having one of the inflammatory myopathies. The degree of signal intensity on MRI may reflect the severity of grade in muscle biopsy.
결체 조직 질환에서 조직학적으로 확진된 통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상상과 흉부 HRCT 소견의 비교 및 방사선학적 변화와 임상적 지표와의 연관성
안중경 ( Joong Kyong Ahn ),고은미 ( Eun Mi Koh ),이유선 ( You Sun Lee ),차훈석 ( Hoon Suk Cha ),정만표 ( Man Pyo Chung ),한정호 ( Jung Ho Han ),오대근 ( Dae Kun Oh ),이경수 ( Kyung Soo Lee ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.3
Objective: The purpose of this study is to assess the clinical characteristics and the serial changes of high resolution CT (HRCT) findings and to correlate those with the results of clinical parameters in biopsy proven nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) with connective tissue diseases (CTD). Methods: Retrospective analysis was made of forty patients with CTD diagnosed of NSIP and UIP from a single tertiary hospital between January 1996 and February 2006. Results: UIP was common in rheumatoid arthritis, systemic sclerosis and Sjogren`s syndrome, while NSIP was frequent in polymyositis/dermatomyositis. No significant difference was found in the clinical characteristics of patients with NSIP and UIP. In initial HRCT findings, extents of honeycombing and reticulation pattern were significantly more in UIP-CTD than in NSIP-CTD. In bronchoalveolar lavage (BAL) results, proportion of alveolar macrophages was significantly higher in NSIP-CTD than in UIP-CTD. In NSIP-CTD, significant increment in the extent of reticulation and honeycombing was noted in the serial HRCT findings despite the aggressive treatment. Significant correlation was found between leukocytosis and honeycombing change in NSIP-CTD. Despite no significant difference of survival between two groups, patients with UIP-CTD seem to have a higher mortality than those with NSIP-CTD. Conclusion: It is suggested that chest HRCT and BAL fluid analysis may be helpful in the differential diagnosis of NSIP- and UIP-CTD and leukocytosis in initial blood test might be predictive of honeycombing progression in NSIP-CTD. Further study will be required to compare with the prognosis of NSIP- and UIP-CTD.