65세 이상 노인 환자에서 흉부외 수술 후 폐 합병증의 발생률 및 예측인자

류연주 ( Yon Ju Ryu ),박지영 ( Ji Young Park ),백수정 ( Su Jung Baik ),이진화 ( Jin Hwa Lee ),천은미 ( Eun Mee Cheon ),장중현 ( Jung Hyun Chang ) 대한내과학회 2004 대한내과학회지 Vol.67 No.1

배경: 최근 노인 환자의 수술 빈도가 증가함에 따라, 수술 후 폐 합병증이 수술 후 이환과 사망의 중요한 원인이 되고 있다. 방법: 전신 마취 하에 흉부외 수술을 받은 65세 이상의 환자 206명을 대상으로 수술 후 폐 합병증의 발생률과 예측인자를 후향적으로 조사하였다. 수술 후 폐 합병증은 수술 후에 새로 발생한 무기폐, 폐렴, 폐색전증, 급성호흡부전으로 정의하였다. 결과:수술 후 폐 합병증의 발생률이 13.6%(28/266)이었다. 수술 후 폐 합병 Background: As number of the older patients for general elective surgery is increasing, postoperative pulmonary complications in the elderly are common and are a significant source of morbidity and mortality. Methods: We retrospectively evaluated the inci

양성 기도협착질환에서 실리콘 기도스텐트의 임상경험 - Dumon 스텐트와 Natural 스텐트의 비교 -

류연주 ( Yon Ju Ryu ),유창민 ( Chang Min Yu ),최재철 ( Jae Chul Choi ),권용수 ( Yong Soo Kwon ),김호중 ( Ho Joong Kim ),김진국 ( Jhin Gook Kim ),서수원 ( Soo Won Suh ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.59 No.1

만성폐쇄성폐질환 환자에서 우울과 불안심리 평가

류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),심윤수 ( Yun Su Sim ),이진화 ( Jin Hwa Lee ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1

연구배경: 만성폐쇄성폐질환(chronic obstructive pulmonary disease, COPD) 환자군에서 우울증 및 불안장애의 유병률이 높고, 이는 치료경과 및 사망률에도 영향을 주는 것으로 알려져 있다. 저자들은 국내 연구가 미비한 COPD환자들의 우울과 불안심리에 대한 평가를 하고자 하였다. 방법: 2005년 9월부터 2006년 8월까지 이화의료원 호흡기내과에서 외래치료 중인 72명의 COPD환자와 정상 대조군 50명에서 Beck Depression Inventory (BDI)와 State-Trait Anxiety Inventory (STAI)로 설문조사를 시행하였고, 임상기록을 분석하였다. 결과: 1) 연령과 체질량지수, 혈청 알부민 수치는 환자군과 대조군간의 유의한 차이를 보이지 않았다(p>0.05). 우울심리는 BDI점수가 환자군 16(0-37), 대조군 12(1-30)으로 환자군에서 유의하게 높았고(p=0.001), 21점 이상의 우울집단은 환자군이 36%로 대조군 6%에 비해 많았다(p<0.0001). 환자군에서는 경증군 18%(4/22), 중등증군 30%(6/20), 중증군 52%(13/25), 심한 중증군 60%(3/5)로 중증일수록 빈도가 높았다(p=0.008). 2) 불안심리는 환자군에서 SAI점수 44(20-67), TAI점수 47(20-66)로 각각 대조군 39(26-65), 44(33-90)보다 유의하게 높았다(p=0.005, p=0.022). 환자군에서 BDI와 STAI점수는 상관관계를 보였고(p<0.001), 우울집단에서 불안점수가 유의하게 높았다. 3) COPD환자군에서 우울집단은 비우울집단보다 체질량지수, 기관지확장제후 FEV1의 예측치가 유의하게 낮았고, 현재 흡연자의 비율과 중증도, STAI점수가 유의하게 높았다(p<0.05). 4) 연령과 성별을 통제한 다변량 로지스틱 회귀분석상 95% 신뢰구간으로 비차비는 체질량지수 0.9(p=0.311), 현재 흡연자 3.2(p=0.051), 중증군이상 3.9로(p=0.027), 중증이상의 중증도가 유일한 우울증 발생의 독립적 위험요인이었다. 결론: COPD환자군에서 우울증과 불안심리가 흔하게 관찰되며, 체질량지수, 폐기능, 현재 흡연력이 우울관련 요인으로 특히 중증도가 높을수록 우울증과 불안장애의 관리가 필요함을 보여주었다. Background: Patients with chronic obstructive pulmonary disease (COPD) have often been reported to suffer from depression and anxiety possibly due to the exacerbation, hospitalization and mortality of COPD. However, scarce data are available in Korea. This study assessed degree of depression and anxiety, and evaluated the factors associated with depressive symptoms in COPD. Methods: The cross-sectional data on the lung function measurements, smoking behavior, body mass index (BMI), age, gender, depressive symptoms using Beck Depression Inventory (BDI) and anxiety using the State-Trait Anxiety Inventory (STAI) were evaluated in 72 outpatients with COPD and 50 controls without underling lung diseases from September, 2005 to October, 2006 in the Ewha medical center. Results: 1) The age, body mass index (BMI) and serum albumin levels were similar in the patients and controls. The BDI scores (16(0-37) vs. 12(1-30), p=0.001) and the prevalence of depression (36% vs. 6%, p<0.0001) were higher in the COPD patients than in the controls. In the COPD group, the prevalence of depression increased with increasing GOLD stage (p=0.008). The prevalence was 18%(4/22), in mild cases, 30%(6/20) in moderate cases, 52%(13/25) in severe cases and 60%(3/5) in very severe cases. 2) The SAI and TAI scores were higher in the COPD patients (44(20-67) and 47(20-66)) than in the healthy controls (39(26-65) and 44(33-90)). There were a significant correlation between the depression and anxiety scores (p<0.001). 3) A lower BMI, lower postbronchodilator FEV1, current smoking behavior and severity of COPD were univariately associated with the depressive group in COPD, 4) while multivariate logistic analysis revealed only the severe-to-very severe group (OR 3.9, 95% CI 1.2 to 12.9) to be independently associated with depressive symptoms. Conclusion: COPD is strongly associated with depression and anxiety. Therfore, screening for psychological problems in COPD patients is essential, particularly in patients with severe-to-very severe COPD. (Tuberc Respir Dis 2007; 62: 11-18)

결핵 환자에서 면역학적 지표로서의 sIL-2R, IFN-$\gamma$, Neopterin에 관한 연구

류연주,유금혜,김수현,이종수,천선희,서주영,Ryu, Yon-Ju,Ryu, Kum-Hei,Kim, Su-Hyun,Lee, Jong-Soo,Cheon, Seon-Hee,Seoh, Ju-Young 대한결핵및호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.53 No.3

연구배경 :결핵은 세포 매개성 면역반응이 병태생리에 중요한 역할을 하는 감염성 질환이다. 결핵균 항원으로 T 림프구가 활성화되면 여러 종류의 cytokine을 분비하며 T 림프구의 분화와 증식, 대식세포의 활성화를 촉진한다. 본 연구에서는 결핵의 중증도, 숙주의 면역상태 및 예후를 반영하는 지표로서 활성화된 T 림프구에서 만들어지는 IL-2의 수용성 수용체인 sIL-2R와 IFN-$\gamma$를 측정하였고 활성화된 대식세포에서 분비되는 neopterin을 측정하여 임상적 유용성을 판정하고자 하였다. 대상 및 방법 :활동성 폐결핵 환자 39명, 결핵성 림프절염 환자 6명의 치료전과 정상 대조군 10명에서 혈청 sIL-2R, neopterin, IFN-$\gamma$를 측정하였고, 결핵성 흉막염 환자 22명에서 치료전 혈청과 흉막액에서 각각 sIL-2R, ADA, neopterin을 측정하였다. 폐결핵 환자 39명을 ATS guidelines에 따라 중증도를 분류하였고, 사망한 1명과 결핵요양소로 전원된 2명을 제외한 36명에서 초치료 2개월 후 혈청 sIL-2R, neopterin과 IFN-$\gamma$를 측정하였다. 결 과 : 1) sIL-2R과 IFN-$\gamma$는 결핵환자에서 대조군에 비하여 증가된 경향을 보였다(p>0.05). Neopterin은 대조군 $4949{\pm}1242.l$ pg/ml, 폐결핵 $29.67{\pm}2132.8$ pg/ml, 결핵성 림프절엽 $3013{\pm}1877.3$ pg/ml, 결핵성 흉막염이 $2035{\pm}1216.4$ pg/ml로 결핵환자에서 대조군에 비하여 감소되는 경향을 보였으며, 폐결핵군과 결핵성 흉막염군에서는 통계적으로 유의하게 감소되어 있었다(p<0.05). 2) 폐결핵의 중증도가 심할수록 sIL-2R와 IFN-$\gamma$는 증가하였고, neopterin은 감소하였다(p<0.01). 3) 폐결핵 환자 36명에서 치료 후 측정한 sIL-2R는 $1071{\pm}l139.4$ U/ml에서 $1023{\pm}1920.9$ U/ml로(p>0.05), IFN-$\gamma$는 $41{\pm}52.8$ pg/ml에서 $22{\pm}23.9$ pg/ml로 각각 감소하였고 (p<0.05), neopterin은 $3158{\pm}2272.6$ pg/ml에서 $3737{\pm}2307.5$ pg/ml로 증가하였다(p>0.05). 이러한 결과는 경증군과 중등증군에 비해 중증군에서 현저한 변화를 보였고 임상적 경과와 상관성을 보였다. 4) 결핵성 흉막염 환자 22명에서 sIL-2R와 ADA는 혈청에 비하여 흉막액에서 유의하게 높은 값을 보였으나(p<0.01), neopterin은 차이가 없었다(p>0.05). 결 론 : 이상의 결과를 바탕으로 특히 중증군에서 치료 후에 sIL-2R, IFN-$\gamma$와 neopterin을 추적 관찰하면 숙주의 면역반응상태, 임상적 중증도 및 치료 반응성을 예측하는데 도움이 될 것으로 생각된다. 또한 결핵성 흉막염 환자에서는 국소적인 변역반웅의 활성화로 흉막액내의 면역학적 지표의 측정이 혈청 검사보다 특이적이며, 흉막액의 sIL-2R의 측정이 결핵성 흉막염의 진단에 유용할 것으로 생각된다. Background : The cell-mediated immune response plays an important role in tuberculosis. After being activated by mycobacterial antigens, T lymphocytes express a high affinity receptor (IL-2R) for interleukin-2 (IL-2) on their own surface and release a soluble fraction of the IL-2 receptor (sIL-2R) from the cell membrane into the circulation. Neopterin is a metabolite of guanosine-triphosphate, which is produced by stimulated macrophages under the influence of IFN-$\gamma$ with a T lymphocyte origin. Therefore, the utility of sIL-2R, IFN-$\gamma$ and the neopterin levels as immunologic indices of the cell-mediated immune response and severity of disease in patients with pulmonary tuberculosis was assessed. Methods : The serum sIL-2R, IFN-$\gamma$ and neopterin levels were measured in 39 patients with pulmonary tuberculosis, 6 patients with tuberculous lymphadenitis prior to treatment and 10 healthy subjects. The serum and pleural sIL-2R, neopterin and ADA levels were measured in 22 patients with tuberculous pleurisy. The patients with pulmonary tuberculosis were divided into a mild, moderate and severe group according to the severity by ATS guidelines. To compare the results from these patients with those of the pretreatment levels, the sIL-2R, IFN-$\gamma$ and neopterin levels were measured in 36 of the 39 patients(1 patient, expired; 2 patients were referred to a sanitarium) with pulmonary tuberculosis after 2 months of treatment. Results : 1) the serum sIL-2R and IFN-$\gamma$ levels were elevated in patients with tuberculosis when compared to those of healthy subjects (p>0.05). The neopterin concentration in the serum was significantly lower in patients with pulmonary tuberculosis($2967{\pm}2132.8$ pg/ml) than in healthy controls($4949{\pm}1242.1$ pg/ml)(p<0.05). 2) In the pulmonary tuberculosis group, the serum sIL-2R and IFN-$\gamma$ levels were higher in patients with severe disease than those in patients with mild and moderate disease. However, the neopterin levels declined as the pulmonary tuberculosis became more severe (p<0.01). 3) The mean serum sIL-2R and IFN-$\gamma$ levels declined from $1071{\pm}1139.4$ U/ml to $1023{\pm}1920.9$ U/ml(p>0.05), $41{\pm}52.8$ pg/ml to $22{\pm}23.9$ gm/ml(p<0.05), respectively, after 2 month of treatment. The mean serum neopterin levels increased from $3158{\pm}2272.6$ pg/ml to $3737{\pm}2307.5$ pg/ml(p>0.05) after a 2 month of treatment. These findings were remarkable in the severe group of pulmonary tuberculosis with a clinical correlation. 4) In the patients with tuberculous pleurisy, the serum sIL-2R and ADA were significantly higher than those in the pleural fluid, However, the neopterin levels in the sera and pleural effusion were similar. Conclusion : On the basis of this study, sIL-2R, IFN-$\gamma$ and neopterin measurements may not only provide an insight into the present state of the cell-mediated immune response, but also serve as parameters monitoring of the prognosis of the disease, particularly in patients with severe pulmonary tuberculosis. In addition, an assay of the pleural sIL-2R levels might signal a stimulated local immunity including T cell activation in the tuberculous pleural effusion.

원발성 위암과 후두암, 폐암 병발의 1례

최주영 ( Ju Young Choi ),장혜정 ( Hye Jeong Chang ),이민진 ( Min Jin Lee ),심성신 ( Sung Sin Sim ),류연주 ( Yon Ju Ryu ),문진욱 ( Jin Uk Moon ),이진화 ( Jin Hwa Lee ),천은미 ( Eun Mi Chun ),장중현 ( Jung Hyun Chang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.3

A multiple primary malignant tumor is a disease mainly encountered in the of the older age groups. Attempts should be made to rule out a second primary malignant neoplasm in the elderly patients with unusual signs and symptoms. We encountered a case of a 67-year-old male with triple primary malignant tumors of the stomach, larynx, and lung. The patient had been treated with a subtotal gastrectomy for early gastric cancer in 1991 and a Laser laryngectomy for the laryngeal squamous cell carcinoma in 2003. In 2005, lung cancer was found with the biopsy revealing an adenosquamous carcinoma. Systemic chemotherapy was performed. (Tuberc Respir Dis 2006; 61: 279-284)

이달의 X-선 : 전폐절제술 후 흉강개구부의 화농성 분비물을 보인 환자

강인숙 ( In Sook Kang ),정지민 ( Ji Min Jung ),류연주 ( Yon Ju Ryu ),김유경 ( Yoo Kyung Kim ),이진화 ( Jin Hwa Lee ),천은미 ( Eun Mee Cheon ),남동기 ( Dong Ki Nam ),장중현 ( Jung Hyun Chang ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.1

고령의 역류성 식도염 환자의 위험인자들의 임상적 평가

박창한 ( Chang Han Park ),정성애 ( Sung Ae Jung ),류연주 ( Yon Ju Ryu ),조지윤 ( Ji Yoon Jo ),김영신 ( Young Sin Kim ),정혜경 ( Hye Kyung Jung ),김도영 ( Doe Young Kim ),유권 ( Kwoon Yoo ),문일환 ( Il Hwan Moon ) 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

N/A The elderly patients with reflux esophagitis are less likely to feel or report their symptoms than the younger patients, even though they are more prone to complications such as bleeding, stricture or Barrett`s esophagus. In this study we tried to investigate risk factors in the elderly patients who had endoscopically diagnosed reflux esophagitis. Methods: Clinical data of six hundred and eighty seven patients with reflux esophagitis were reviewed. Results: Among the 687 patients with reflux esophagitis, two hundred and thirteen (31%) were 60 or more than 60 years old. The frequency of accompanying hiatal hernia in the elderly group (age≥60) was significantly higher than the younger group (age<60) (16.9%, 36/213 vs. 3.4%, 16/474, p<0.05). There was significant difference according age in the female group (0.9%, 1/114 vs. 22.7%, 22/97, p<0.05). The frequency of atropic gastritis was significantly higher in the elderly group than in the younger group , while other factors such as smoking, H. pylori & peptic ulcer disease were not different between the two groups. Conclusion: Among the risk factors of reflux esophagitis, the existence of hiatal hernia seems to be suggested more relevant to the development of this condition in the elderly group.(Kor ean J ournal of Gastrointestinal Motility 2002;8:139-145)

객담 도말 양성 환자에서 폐결핵과 비결핵 항산균 폐질환의 구별을 위한 결핵균 PCR 검사의 유용성

유창민 ( Chang Min Yu ),고원중 ( Won Jung Koh ),류연주 ( Yon Ju Ryu ),전경만 ( Kyeong Man Jeon ),최재철 ( Jae Chol Choi ),강은해 ( Eun Hae Kang ),서지영 ( Gee Young Suh ),정만표 ( Man Pyo Chung ),김호중 ( Ho Joong Kim ),권오정 ( O 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.6

만성폐쇄성폐질환 환자에서 심장초음파를 이용한 심장 구조와 기능 평가

심윤수 ( Yun Su Sim ),이진화 ( Jin Hwa Lee ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),장중현 ( Jung Hyun Chang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2

목적: COPD 환자에서 우심실비대와 기능장애는 흔한 반면, 좌심실의 수축기능은 비교적 잘 보존되는 것으로 알려져 있다. 최근에 COPD 환자에서 좌심실이완기능장애가 흔하다는 보고가 있다. 저자들은 심장초음파를 이용하여 COPD 환자에서의 심장의 구조와 기능의 변화를 평가해 보고자 하였다. 방법: 심장질환을 진단받은 적이 없는 안정상태의 COPD 환자 69명과 정상폐활량을 가진 대조군 22명에서 심장초음파검사 결과를 비교하였고, Global initiative for chronic Obstructive Lung Disease (GOLD) 기준에 따른 COPD의 중증도에 따라 심장의 구조와 기능에 변화가 있는지 평가하였다. 결과: COPD 환자가 대조군보다 몸무게가 유의하게 작았고(p=0.001), 흡연량이 많았다(p=0.002). 심장초음파검사결과 COPD 환자의 좌심실이완기말지름(p<0.001), 좌심실수축기말지름(p=0.020), 좌심방지름(p=0.026)과 좌심실질량이 대조군보다 유의하게 작았다(p=0.003). 그러나 좌심실의 이완기능을 나타내는 여러 지표와 평균 우심실수축기압은 COPD 환자와 대조군 사이에 차이가 없었다. COPD의 중증도에 따라 몸무게(p<0.001), 체질량지수(p<0.001)와 좌심실질량이 유의한 차이를 보였고(p=0.011), 좌심실질량과(r=0.432)(p<0.001) 체질량지수는 FEV1% 예측치와 유의한 양의 상관관계를 보였다(r=0.600)(p<0.001). 결론: COPD 환자와 대조군 사이에 심박출계수는 차이가 없음에도 불구하고, COPD 환자에서 좌심실질량, 좌심방지름, 좌심실이완기말지름, 좌심실수축기말지름은 대조군보다 유의하게 작았다. 특히, 좌심실질량은 폐기능이 감소할수록 감소하였다. Background/Aims: In patients with chronic obstructive pulmonary disease (COPD), left ventricular (LV) systolic dysfunction and structural changes are rare, while right ventricular (RV) dysfunction and structural alteration and/or LV diastolic dysfunction are common. We evaluated the cardiac structure and function in patients with COPD using echocardiography. Methods: Echocardiography examinations were performed in 69 patients with clinically stable COPD and without a history of heart disease; 22 control subjects with normal lung function were enrolled for comparison. Echocardiography parameters of the COPD patients were compared with those of the controls, and assessed according to the COPD stage classified using the Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. Results: Patients with COPD had significantly lower body weight (p=0.001) and higher pack-years of smoking than did the controls (p=0.002). The echocardiogram showed that LV end diastolic diameter (p<0.001), LV end systolic diameter (p=0.020), left atrial (LA) diameter (p=0.026), and LV mass in the COPD patients were significantly decreased compared to the controls (p=0.003). However, there were no differences between the COPD patients and controls in the parameters reflecting LV diastolic function and mean RV systolic pressure (RVSP). According to the COPD stage, body weight (p<0.001), body mass index (BMI) (p<0.001), and LV mass were significantly different (p=0.011). In patients with COPD, LV mass (r=0.432) (p<0.001) and BMI were significantly correlated with FEV1% predicted (r=0.600) (p<0.001). Conclusions: Patients with COPD had lower LV mass and LA and LV diameters than did the controls, even though both groups had normal LV function. In particular, the LV mass appeared to correlate with the lung function in the patients with COPD.

궤양성 대장염에 병발된 비특이적 간질성 폐렴

노영욱 ( Young Wook Noh ),백은경 ( Eun Kyung Baik ),류연주 ( Yon Ju Ryu ),김성은 ( Seong Eun Kim ),이진화 ( Jin Hwa Lee ),심성신 ( Sung Shin Sim ),이신애 ( Shi Nae Lee ),천은미 ( Eun Mi Chun ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1

Pulmonary complications of ulcerative colitis are relatively uncommon and may present as a variety of disorders. Ulcerative colitis-related interstitial lung disease is extremely rare. There are a few case reports of nonspecific interstitial pneumonia in ulcerative colitis worldwide but none in Korea. We report a patient with ulcerative colitis related biopsy-proven nonspecific interstitial pneumonia, who responded to prednisolone (1mg/kg) and mesalazine therapy. (Tuberc Respir Dis 2007; 62: 56-61)