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활동성폐결핵환자에서 말초혈액단핵구의 Th1 및 Th2 cytokine 분비양상
박성학(Sung Hak Park),이상학(Sang Hak Lee),이숙영(Sook Young Lee),문화식(Hwa Sik Moon),현대성(Dae Sung Hyun),신윤(Yoon Shin),최지현(Gee Hyun Choi),여동승(Dong Seung Yoe),김석찬(Suk Chan Kim),송정섭(Jeong Sup Song) 대한내과학회 1999 대한내과학회지 Vol.56 No.4
N/A T cell mediated immunity amlifies macrophage capacities to kill and digest the bacilli through production of interferon-γ (IFN-γ). The secreted cytokines of Th1 and Th2 cells can mutually regulate and inhibit each other's function. Therefore, the fine balance between the secreted cytokines is important for the resulting nature of tuberculosis. In this study, activation marker and cytokine production profiles were compared in patients with active tuberculosis and healthy control, and according to degree of radiographic extent and pleural involvement. Method:Forty-four patients with active pulmonary tuberculosis and 25 normal controls were recruited. We measuerd soluble interleukin-2 receptor(sIL-2R), IFN-r, IL-4 and IL-5 produced from blood mononuclear cells in vitro stimulation with phytohemagglutinin by ELISA. Results:The sIL-2R and IFN-γ from patients with active pulmonary tuberculosis were significantly lower than normal control, while IL-4 and IL-5 were not different between two group. The sIL-2R and IFN-r decreased in proportion to the extent of pulmonary involvement, and the sIL-2R and IFN-r from pulmonary tuberculosis with pleural effusion were significantly lower than those without pleural effusion. Conclusion:At the level of systemic T cells, development of tuberculosis is associated with diminished Th1 but not enhanced Th2 response.
IP-10에 의한 기도상피세포에서의 TNF-α 유도 MUC5AC발현 억제: 특발성폐섬유증 환자의 적은 객담과의 연관성
김승준 ( Seung Joon Kim ),강춘미 ( Chun Mi Kang ),유문빈 ( Moon Bin You ),윤형규 ( Hyung Kyu Yoon ),김영균 ( Young Kyoon Kim ),김관형 ( Kwan Hyoung Kim ),문화식 ( Hwa Sik Moon ),박성학 ( Sung Hak Park ),송정섭 ( Jeong Sup Song 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.5
연구배경: 특발성폐섬유증 환자의 전형적인 증상은 운동호흡곤란과 마른기침으로, 객담이 적은 원인에 대해서 아직까지 잘 알려져 있지 않다. Interferon-γ inducible protein-10 (IP-10)은 여러 호흡기질환과 관련되는데 폐 내로 염증을 유입시키는데 중요한 역할을 한다. 본 연구는 특발성폐섬유증 환자에서 객담이 적은 기전으로 IP-10이 연관성이 있는지에 대해 연구하였다. 방법: 특발성폐섬유증 환자를 대상으로 기관지폐포세척액에서 IP-10의 농도를 ELISA로 측정하였다. IP-10이 기도 점액소 발현에 미치는 영향을 간접적으로 알아보기 위해 NCI-H292 세포(점막표피모양 암종 세포주)에서 IP-10을 전처치한 이후 tumor necrosis factor-α (TNF-α)로 자극하여 발현정도를 측정하였다. 이때 점액소 발현과 관련되는 기전으로 epidermal growth factor receptor-mitogen activated protein kinase (EGFR-MAPK)의 신호전달 경로를 알아 보았다. 결과: IP-10의 기관지폐포세척액내 농도는 특발성폐섬유증 환자가 건강 대조군에 비해 유의하게 높았다. IP-10의 전처치는 NCI-H292 세포에서 TNF-α 유도 MUC5AC 점액소 발현을 감소시켰는데 이 때 EGFR-MAPK 신호전달 경로의 차단과 관련되었다. 결론: 특발성폐섬유증 환자의 적은 객담은 IP-10의 발현증가와 일부 관련 가능성이 있으며, 이때 IP-10의 작용은 MUC5AC 점액소 유전자 발현에 필요한 EGFR-MAPK 신호전달 경로의 차단과 관련될 것으로 생각한다. (Tuberc Respir Dis 2008;64:347-355) Background: IPF is characterized by chronic, fibrosing inflammatory lung disease of unknown etiology. Typical symptoms of IPF are exertional dyspnea with nonproductive cough. Why patients with typical IPF have dry cough rather than productive cough, is unknown. IP-10 plays an important regulatory role in leukocyte trafficking into the lung. The present study investigated the effect of IP-10 in the pathogenesis of dry cough rather than productive cough in IPF patients. Methods: IP-10 concentration was measured by ELISA from BALF of IPF patients. To evaluate the role of IP-10 in mucin expression, the expression of the MUC5AC mucin gene was measured in NCI-H292 cells, a human pulmonary mucoepidermoid carcinoma cell line, after stimulation by TNF-α with or without IP-10 pretreatment. EGFR-MAPK expression was also examined as a possible mechanism. Results: IP-10 levels were significantly higher in the BALF of IPF patients compared to healthy controls. IP-10 pretreatment reduced TNF-α induced MUC5AC mucin expression by inhibiting the EGFR-MAPK signal transduction pathway in NCI-H292 cells. Conclusion: These findings suggest that little mucus production in IPF patients might be attributable to IP-10 overproduction, which inhibits the EGFR-MAPK signal transduction pathway required for MUC5AC mucin gene expression.
만성 폐쇄성 폐질환 환자에서 Tiotropium 1일 1회, 1회 18㎍ 요법과 Ipratropium 1일 4회, 1회 40㎍ 요법의 치료효과 및 안전성 비교
김승준 ( Seung Joon Kim ),김명숙 ( Myung Sook Kim ),이상학 ( Sang Haak Lee ),김영균 ( Young Kyoon Kim ),문화식 ( Hwa Sik Moon ),박성학 ( Sung Hak Park ),이상엽 ( Sang Yeub Lee ),인광호 ( Kwang Ho In ),이창률 ( Chang Youl Lee ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.5
소세포 폐암환자에서의 치료에 따른 뇌하수체 - 부신피질계의 변화
박석준(Suk Joon Park),이승헌(Seung Hun Lee),김양리(Yang Ree Kim),김영균(Young Kyoon Kim),송정섭(Jeong Sup Song),이광우(Kwang Woo Lee),박성학(Sung Hak Park) 대한내과학회 1992 대한내과학회지 Vol.43 No.3
N/A Background. Small cell carcinoma of the lung can produce many ectopic hormones, and most frequently ectopic ACTH. The change of the pituitary-adrenal axis is shown more frequently than the ectopic ACTH production, and its squential check reveals some prognostic significance. Methods. We evaluated the 13 patients with small cell carcinoma of the lung, who treated with combined chemotherapy and radiotherapy. The basal ACTH and cortisol, mid-night cortisol, and cortisol after ACTH stimulation were measured at each admission by RIA during 6-kur of chemotherapy. Results. 1) There were 5patients who lost the diurnal variation of serum cortisol. They were all responded to the scheduled treatment, partially or completely. At the same time they recovered from the loss of diurnal variation simultaneously with the therapeutic responses. 2) Non-responders to the ACTH stimulation were 6patients. 2patients among them showed abnormal response initially, but returned to normal response to the ACTH stimulation simultaneously with the response during treatment. Other 4patients showed normal response to the ACTH stimulation initially, but beacame to no response during treatment and finally turned out to normal Cortisol response. Conclusions. Thre are more changes in the pituitaryadrenal axis despite of normal ACTH and cortisol level, and these changes become normalized in almost all of the therapeutic responders.
A Case of T-cell Primary Pulmonary Lymphoma Diagnosed by $TCR{\gamma}$ gene rearrangement
최영미,김승준,권순석,김영균,김관형,문화식,박성학,송정섭,Choi, Young Mee,Kim, Seung Joan,Kwon, Soon Seog,Kim, Young Kyoon,Kim, Kwan Hyoung,Moon, Hwa Sik,Park, Sung Hak,Song, Jeong Sup The Korean Academy of Tuberculosis and Respiratory 1996 Tuberculosis and Respiratory Diseases Vol.43 No.6
반복되는 흉막염 및 폐렴을 주소로 내원한 30세 남자환자에서 경기관지 폐생검과 흉수내 림프구에 대한 유세포 분석 및 T세포 수용체 유전자 재배열 분석을 실시하였다. 경기관지 폐생검 조직의 연역조직화학 염색상 대부분의 림프구가 T세포 표식자인 UCHLl 에 대해 강하게 염색되었고, B세포 표식자인 L26에 대해서는 거의 염색되지 않았다. 흉수에서 추출한 림프구의 유세포 분석상 CD3양성 CD2양성인 T림프구가 대부분이었고, 이들 림프구에 대해 중합효소연쇄반응을 이용한 T세포 수용체 유전자 재배열 분석을 하였더니 $TCR{\gamma}$ 유전자 재배열과 클론성을 관찰할 수 있었다. T세포 원발성 폐림프종으로 진단하였고, 문헌고찰과 함께 보고하는 바이다.
만성 C형 간염 환자에서 Interferon-${\alpha}$를 투여중 발생한 간질성 폐렴 1예
윤종구,안중현,고승현,이현승,권순석,김영균,문화식,박성학,송정섭,Yoon, Jong Goo,Ahn, Joong Hyun,Ko, Seung Hyeon,Lee, Hyun Seoung,Kwon, Soon Seog,Kim, Young Kyoon,Moon, Hwa Sik,Park, Sung Hak,Song, Jeong Sup 대한결핵및호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.4
만성 C형 간염환자에서 IFN으로 치료중에 발생된 간질성 폐렴은 매우 드물고 아직까지국내에는 보고된 바 없었다. 저자들은 만성 C형 간염환자가 IFN-${\alpha}$를 투여받던 중에 기침과 호흡곤란을 주소로 내원하여 간질성 폐렴으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Interstitial pneumonitis associated with interferon alpha therapy for chronic hepatitis C was first describe6 in 1994 by Kazoo et al In Japan. The mechanism of interstitial pneumonitis developed by interferon alpha was still unknown but immunologic, allergic of direct lung toxicity were suggested. We experienced a case of interstitial pneumonitis developed during interferon alpha therapy for chronic hepatitis C in a 52-year-old male patient. He was treated with 6 million units of interferon alpha intramuscularly 3 times per week for 4 weeks and noted progressive dyspnea and cough. These symptoms were subsided after 6 weeks' discontinuation of interferon alpha therapy. And so, he was retreated with 3 million units of interferon alpha 3 times per week for 8 weeks and felt dyspnea again. He was admitted to our hospital for further evaluation of progressive dyspnea. Arterial blood gas(ABG) values were $PaO_2$ 90.7 mmHg and $PaCO_2$ 31.9 mmHg, and antinuclear antibody(ANA) was negative. A chest X-ray film revealed diffuse reticulo-nodular shadows in bilateral lung fields, suggesting a diagnosis of interstitial pneumonitis. A marked increase in lymphocyte count and suppressor T cell were observed in bronchoalveolar lavage(BAL) fluid. Lymphocyte stimulation test with interferon alpha was positive. Interstitial pneumonitis was confirmed by transbronchial lung biopsy. After discontinuation of interferon alpha, we gave oral steroid in the condition that clinical symptoms were being improved gradually.