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한국인에서 Iohexol의 혈장 청소율을 이용한 사구체 여과율의 측정
강우헌 ( Kang U Heon ),권태근 ( Kwon Tae Geun ),김대중 ( Kim Dae Jung ),강명재 ( Kang Myeong Jae ),백현정 ( Baeg Hyeon Jeong ),여호명 ( Yeo Ho Myeong ),임영환 ( Im Yeong Hwan ),김정아 ( Kim Jeong A ),이방훈 ( Lee Bang Hun ),김범 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2
배 경 : Iohexol (Omnipaque^(?))은 혈장 청소율이 GFR과 일치하는 물질로, 서구에서는 iohexol의 배설단계의 혈장 농도와 그 반감기를 이용하여 혈장 청소율을 계산하고 이를 보정하여 GFR을 추정하고 있다 [Bro¨chner-Mortensen (B-M)법]. 그러나 아직 한국인을 대상으로 그 방법이 정립된 바 없으며 또 가장 적절하고도 편리한 혈장 농도 측정 시간 및 횟수에 대해서는 논란이 있는 실정이다. 이에 저자들은 iohexol외 혈장반감기를 이용한 위와 같은 측정법을 검체 횟수 및 시간 간격을 달리하여 한국인에 적용하였을 때 GFR 측정의 정확도 및 크레아티닌 청소율을 비롯한 여러 GFR 계측 공적들의 정확도를 다음과 같이 검증하였다. 방 법 : 신장질병이 없는 한국인을 대상으로 (n=19) iohexol 정주 후 HPLC로 측정한 14시점의 혈장 농도들을 이용하여 2구획 모델에 의한 iohexol의 혈장 청소율 (CL-T)을 구하였다. 이를 기준으로 첫째 배설단계의 8시점의 농도를 이용하여 B-M법으로 계산된 청소율 (CL-M8), 둘째 그 중 각각 3, 2시점의 농도를 가지고 같은 방법으로 계산된 청소율 (CL-M3, CL-M2), 셋째 CCr를 비롯한 여러 계측 공식들을 이용한 GFR 예측치를 비교하였다. 각 측정치의 정확도는 CL-T를 기준으로 하여 -0.1≤(측정값-CL-T)/CL-T≤0.1를 만족하는 정도 (%)로 평가하였다 (DOQI guideline). 결 과 : CL-T, CL-M8, CL-M3와 CL-M2는 각각 101.9±24.0, 101±18.7, 101.7±18.6,101.9±곤19.5 mL/min/1.73 ㎡로서 서로 차이가 없었으며 CL-M8의 정확도는 74%이었고, CL-M3, CL-M2의 정확도는 각각 84%, 79%로 상호간에 차이가 없었다. GFR 계측 공식 중에서는 MDRD 공식이 비교적 정확하였다 (47%). 결 론 : 이상에서 저자들은 신장질환이 없는 우리나라 사람을 대상으로 iohexol을 이용하여 B-M 보정법으로 사구체 여과율 측정하였을 때 2회의 검체 채취로도 정확하게 사구체 여과율을 측정할 수 있음을 확인하였으나 향후 GFR 값이 다양한 보다 많은 환자를 대상으로 추가 연구가 필요할 것으로 생각한다. Background : Plasma clearance of iohexol (Omnipaque^(?)) which used widely in radiologic procedure is considered as useful method for estimation of GFR because iohexol is neither reabsorbed nor secreted from tubule after filtered as inulin and its extrarenal clearance is negligible. Plasma clearance of iohexol can be calculated from two compartment model or one compartment model with Bro¨chner Mortensen (B-M) modification which convenient and reliable. But there were controversies about sufficient sampling numbers and times for B-M modification of iohexol clearance. Methods : Nineteen healthy Korean without renal disease underwent measurement of iohexol clearance. Iohexol was given as a single iv dose, and 14 blood sample were drawn up to 300 min. A reference GFR was iohexol clearance calculated from two-compartment model using 14 samples (CL-T). From 8, 3 and 2 samples clearances were calculated by B-M modification (CL-M8, 3 and 2 respectively). The accuracy of estimates was evaluated as percent of estimates falling within 10% above or below the reference GFR. Accuracy of CCr and equations for GFR estimation were also compared. Results : CL-T, CL-M8, CL-M3 and CL-M2 were not different (101.9±24.0, 101.9±18.7, 101.7±18.6, 101.9±19.5 mL/min/1.73 m² respectively). Accuracy of CL-M8, 3 and 2 were not different (74%, 84% and 79% respectively, p>0.05). MDRD equation had higher accuracy (47%) compared with other equations. Conclusion : These results indicate that sampling simplified method might be reduced to only two without accuracy loss in Korean without renal disease.
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헬리코박터 파이로리 제균치료 후 위점막 Matrix Metalloproteinase-9 (MMP-9) 변화 면역조직화학연구
안혁수 ( An Hyeog Su ),김인희 ( Kim In Hui ),이승옥 ( Lee Seung Og ),강명재 ( Kang Myeong Jae ),김대곤 ( Kim Dae Gon ),이수택 ( Lee Su Taeg ) 대한소화기학회 2004 대한소화기학회지 Vol.43 No.2
Background/Aims: In this study, we analysed the changes of matrix metalloproteinase-9 (MMP-9) expression in the gastric antral epithelium in respect to H. pylori eradication. Methods: Twenty patients with H. pylori-positive chronic gastritis or peptic ulcer were studied. The expression of MMP-9 in the gastric antral biopsy specimens were compared before and after H. pylori eradication using immunohistochemical study. The positive rates and intensity of MMP-9 staining were evaluated at surface mucous cells and pyloric gland cells. Results: The positive rate of MMP-9 staining in antral mucosal epithelial cells of H. pylori chronic gastritis is 63.8%. The positive rates of MMP-9 staining in the surface mucous cells and pyloric gland cells were 75.5% and 52.0% before H. pylori eradication, respectively. On the contrary, the rates were 85.5% and 82.0% after eradication. The MMP-9 overexpression in the pyloric gland cells were noticeably increased after H. pylori eradication. Strong positive staining of MMP-9 was increased significantly after H. pylori eradication in the pyloric gland cells. Conclusions: These results suggest that MMP-9 over-expression is associated with H. pylori infection as a host inflammatory response. The increased expression after H. pylori eradication indicates that MMP-9 may have a important role in remodeling or early tissue repairing process of gastric mucosa. (Korean J Gastroenterol 2004; 43:90-95)
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Ehanol에 依하여 損傷된 胃粘膜 上皮의 回復에 關한 實驗的 硏究
최삼임,이혜수,고범권,장성강,강명재,조남표,조성남,김상호 의과학연구소 1992 全北醫大論文集 Vol.16 No.2
This study aimed to investigate muoosal damage and restitution in the rat stomach after absolute ethanol instillation. Four me. of absolute ethanol was instilled to stomach and gastric mucosa was exposed to it for 30 and 45second , and then examined at immediately, 10 minute, 30 minutes, 60 minutes and 6 hours. Morphological studies of gastric tissue were performed by means of epon-toluidine blue section, H&E, and periodic acid Schiff(pAS) stains. The results were as follows. 1. Immediately after exposure to absolute ethanol far 30· seconds(time 0), surface mucous cells and the cells lining the gastric pits were damaged and exfoliated, but the gastric gland cells were not damaged. 2. Immediately after exposure to absolute ethanol for 45 seoends(time 0), superficial epithelium was necrotic and cellular damage was evident in the gastric glands beneath the damaged surface and gastric pits. Some inflammatory reaction was also noted. 3. Hyperemia and hemorrhage in the gastric mucosa were evident in almost all experimental groups 4. Epithelial restitution was begun to observe at 30 minutes in both 30 and 45 seconds-exposure groups, and almost completely restituted at 60 minutes after ethanol exposure. Surface mucous cells in restituted area were somewhat different from normal mucous cells morphologically. 5. According to damage of surface mucous cells, cytoplasmic PAS-positive granules were markedly decreased, but the PAS-positivity was also restored with restitution of mucous cells(even if weaker reaction than in normal mucous cell). It is thought that absolute ethanol-induced mocosal damage is striking even if the exposure time is brief, and epithelial restitution is achieved for 30 or 60 minutes after ethanol exposure. The mechanism of epithelial restitution might be resulting from migration of undamaged epithelial cells.
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