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채석래,차영주 중앙대학교 의과대학 의과학연구소 1998 中央醫大誌 Vol.23 No.3
1991년 3월부터 1998년 7월까지 중대 부속 용산병원 임상병리과에 의뢰된 혈액질환 환자 및 림프종의 골수 전이 여부를 알고자 했던 환자 218명의 골수 흡인 검체를 대상으로 고정도분염법에 의한 염색체 검사를 실시하여 다음과 같은 결과를 얻었다. 1. 급성골수성백혈병 40예 중 23예(58%)에서 염색체 이상소견을 보였으며, 중요한 염색체 이상으로는 8;21 전좌(4예), 15;17 전좌(3예), 11번 전좌(2예), 5번 결실(1예), 7번 결실(4예), 8번 획득(2예) 등이 있었으며, 3개 이상의 염색체 결함이 있는 경우가 3예 있었다. 2. 림프구성 백혈병 15예 중 7명(47%)에서 염색체 이상소견을 보였으며, 중요한 염색체 이상으로는 9;22 전좌(3예) 및 과배수성 염색체(1예)가 있었다. 3. 만성골수증식성질환 20명 중 만성골수성백혈병 7명 모두에서 9;22 전좌가 있었다. 4. 골수이형성증후군 16예 중 10예(63%)에서 염색체 이상소견을 보였으며, 특히 RA에서의 염색체 결함의 빈도가 대체로 높았다. International prognostic scoring system에 따른 염색체 예후양호군은 6예, intermediate group은 7예, 불량군은 3예이었으며, 주요 결함으로서 5번 결실(2예), 7번 결실(1예), 8번 획득(3예) 및 5;22 전좌 1예등이었다. 5. 다발성골수종, 림프종 및 기타 혈액질환 환자에서는 특이한 염색체 결함은 발견되지 않았다. 이상과 같은 결과로서 염색체 검사는 혈액질환의 진단 및 예후결정에 중요한 역할을 한다고 사료되지만 염색체 제작과정이 까다롭고 시간이 걸리며, 판독자의 실력에 따라 판독에 차이가 있을 수 있으므로 많은 경험을 쌓아야 하며, 분자생물학적 진단을 병행한다면 감도 및 특이도를 더 높일 수 있으리라 사료된다. Cytogenetic analyses of 218 patients with hematologic diseases and lymphoma were performed by MTx-treated high-resolution banding technique and the results were as follows. 1. Twenty three cases (58%) of 40 acute myelogenous leukemias revealed cytogenetic defects, and main defects were t(8;21), t(15;17), t(11q23;variable), -5, -7/del(7q), +8, and complex defects. 2. Seven cases (47%) of 15 lymphocytic leukemias revealed cytogenetic defects, and main defects were 5(9;22) and hyperdiploid chromosome. 3. In 20 cases of chronic myeloproliferative disorders, all of 7 chronic myelogenous leukemia had t(9;22). 4. Sixteen cases(63%) of 16 myelodysplastic syndromes revealed cytogenetic defects, and main defects were del(5q), -7, +8, and 5(5;12). The frequency of cytogenetic defects in the refractory anemia appeared high. According to the international prognostic scoring system(IPSS), 6 cases were classified as good, 7 cases as intermediate and 3 cases as poor karyotype group. 5. Other hematologic disease, lymphoma or multiple myeloma cases did not have disease-specific cytogenetic abnormalities. In conclusion, cytogenetic study plays an important role in the diagnosis and differential diagnosis of hematologic diseases as well as prediction of prognosis, and molecular study together with cytogenetic interpretation by skilled expert would raise sensitivity and specificity in the detection of genetic defects.
송은영,김세림1,최영숙1,차영주4,양주석2,채석래3,김세림,최영숙,차영주,양주석,채석래 대한진단검사의학회 2008 Annals of Laboratory Medicine Vol.28 No.3
Background : Current status of external quality assessment (EQA) of laboratory tests for syphilis in Korea was analyzed to find out the problems that should be improved in the future. Methods : Based on the data from the external quality assessment program performed twice a year by the Immunoserology Subcommittee of the Korean Association of Quality Assurance for Clinical Laboratory from the year 2004 to 2006, discordance rates were analyzed according to the test method and commercial kit used. Results : Among the laboratories participating in the EQA program for syphilis test, about 90% of them used non-treponemal tests and about 55% treponemal tests. The non-treponemal tests included RPR (rapid plasma reagin) and VDRL tests used in 88% (363/412) and 11% (45/412), respectively, of the laboratories. The discordance rates were 2.2% for RPR test and 3.6% for VDRL. For the treponemal tests, Treponema pallidum hemagglutination assay (TPHA) was used in 60-76% and Immunochromatography assay (ICA) in about 30% of the laboratories in 2006. A high discordance rate of over 10% was reported in both TPHA and in ICA methods, possibly due to a low titer (1:1 in VDRL) of EQA samples in 2005. Analysis of the accumulated data from year 2004 to 2006 showed that the discordance rates of TPHA, ICA, and FTA-ABS were 4.6%, 3.7%, and 2.7%, respectively. Conclusions : For syphilis tests, RPR test, TPHA, and ICA are mainly used in Korea. A high discordance rate is still reported in TPHA and ICA, especially when testing samples with a low titer. Further analysis of data and education of laboratory personnel are needed for the improvement of the EQA program. (Korean J Lab Med 2008;28:207-13)