서울 지하철 근무자의 천식양 증상과 알레르기성 비염 유병현황

천은미 ( Eun Mi Chun ),조영주 ( Young Joo Cho ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.1

Background: Occupational asthma has become the most common form of occupational lung diseases. The subway is the transport vehicle that many people use daily, but subway pollution is more severe than road vehicle traffic pollution. There have been few reports concerning the prevalence and risk factors of bronchial asthma and allergic rhinitis in subway workers in Seoul, Korea. Objective: A cross-sectional survey was performed from October 2004 to December 2004 to evaluate prevalence and risk factors of work-related asthma-like symptoms such as work-related wheezing, postexercise dyspnea, and nocturnal cough and allergic rhinitis in subway workers in Seoul, Korea. Method: A total of 1,477 subway workers filled in questionnaires about asthma and rhinitis based on the GINA guidelines. They also underwent skin prick tests for two common house dust mites and pulmonary function tests. Result: The prevalence of asthma-like symptoms (most common symptom: wheezing in the chest) and allergic rhinitis, based on the skin prick tests with rhinitis symptoms, were 9.1% and 9.5%, respectively. Based on the questionnaire survey, asthma was higher in obese persons (P<0.05), [OR=1.06 (95% CI: 1.01∼1.12)], current smokers (P<0.01), [OR=2.61 (95% CI: 1.67∼4.07)] and allergic rhinitis (P<0.05), [OR=2.99 (95% CI: 1.07∼8.34)], but age and the length of their service in the subway were not risk factors of developing asthma-like symptoms and allergic rhinitis. Conclusion: The prevalence of asthma-like symptoms in subway workers was higher in obese persons, current smokers, and allergic rhinitis, but age and the length of their service in the subway were not risk factors. The length of their service and smoking state were not related to the development of allergic rhinitis in subway workers in Seoul, Korea. (Korean J Asthma Allergy Clin Immunol 2007;27:43-49)

중증 기관지천식 환자의 말초단핵구에서 자연살해세포의 비율과 자연살해세포에서 interferon gamma 의 생산

천은미(Eun Mi Chun),김미선(Mi Sun Kim),장윤혜(Yoon Hae Chang),박성숙(Sung Sook Park),조영주(Young Joo Cho) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.3

N/A Background: and objective: The natural killer (NK) cells which play an important role in defense immune system are supposed to be involved in the pathogenesis of bronchial asthma. The goal of this study is to analyze the role of NK cells in the pathogenesis of bronchial asthma by examining the proportion of NK cells in peripheral blood mononucler cells (PBMCs) and production of interferon gamma (IFN-γ) in NK cells between normal group and asthmatic group. Methods: Ten patients with moderate to severe persistent asthma sensitive to house dust mite were enrolled as asthmatic group. PBMCs were activated by 12-0-tetracanoylphorbol-13- acetate (TPA) and calcium inonophore for 18 hours. Surface CD3 and CD56 antigens with intracytoplasmic IFN-γ staining were performed simultaneously and the results were analyzed by three color fiow cytometer. Results : The percentage of CD56+ positive NK cells in PBMCs from asthma group was lower compared to control group (15.4±3.9% vs 19.8±4.5%). However, There was no signficant difference of IFN-γ production in CD56+ NK cells between two groups (30.3±3.9% vs 25.9±5.8%. P>0.05). IFN-γ producing CD3+ T cells were significantly higher in asthma group compared with normal control group (36.3±1.8% vs 28.4±5.7%, p<0.05). The ratio of TNK cells expressing both CD56 and CD3 was not different between asthma group and control group (4.7±1.4 % vs 5.9±1.8%, p<0.05). Conclusion : The results suggest that aggravation of asthma symptoms in severe asthma may be caused partly by decrease in NK cells. The increased production of IFN-γ in asthma patients suggest that IFN-γ may function as inflammatory cytokine.

의학강좌 : 일차 진료의를 위한 효과적인 금연 치료법

천은미 ( Eun Mi Chun ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Smoking leads to nicotine addiction and serious health problems and smoking cessation can reduce the risk of developing smoking-related diseases and premature death. Smoking is a chronic disease that requires repeated interventions, including counseling and pharmacotherapy. These are both effective for smoking cessation, but combined intervention is more effective than using either alone. Several first-line medications are effective and recommended for use, such as nicotine-replacement therapy (patch, gum, inhaler, lozenge, and nasal spray), bupropion SR, and varenicline. Special populations such as adolescent smokers, pregnant women, and smokers with mental illness can be treated with both counselling and medication. Physicians should recommend effective counselling and pharmacotherapy strategies to all smokers at every clinic visit. Insurance coverage for counselling and medications for quitting smoking are essential to reduce the smoking rate, especially in a primary care setting. (Korean J Med 2014;87:296-301)

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)

진행성 비소세포폐암 환자에서 Gefitinib와 Erlotinib의 비교

이진화 ( Jin Hwa Lee ),이경은 ( Kyoung Eun Lee ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),장중현 ( Jung Hyun Chang ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.4

연구배경: 표피성장인자수용체(epidermal growth factor receptor, EGFR) 티로신 활성효소 억제제(tyrosine kinase inhibitor, TKI)는 진행성 비소세포폐암의 새로운 치료제이다. 몇몇 연구 결과 gefitinib와 erlotinib에 대한 반응률과 반응 예측인자에 차이가 있을 가능성을 제시하였다. 저자들은 한국인 진행성 비소세포폐암에서 gefitinib와 erlotinib의 효과 및 독성을 비교하고 각 약제에 대해 서로 다른 반응 예측인자가 있는지 평가하였다. 방법: 2003년 7월부터 2009년 2월까지 이화여자대학교부속병원에서 진행성 비소세포폐암으로 gefitinib 또는 erlotinib로 치료 받은 환자들의 임상정보를 수집하였다. 중앙 생존기간은 Kaplan-Meier법으로 계산하였다. 결과: 대상 환자는 총 86명이었다(gefitinib군 52명 대 erlotinib군 34명). 나이의 중앙값은 64세였고 53명(62%)이 남자였다. 86명 중 83명에서 반응평가가 가능했으며, 83명 중 35명이 반응을 보였고 12명이 안정성 질환이었으며 36명이 진행성 질환으로, 치료 반응률이 42%였고 질병 조절률이 57%였다. 중앙 추적관찰기간 502일 동안, 진행까지의 중앙기간은 129일이었으며 중앙 생존기간은 259일이었다. 치료 반응률(gefitinib 44% 대 erlotinib 39%, p=0.678), 중앙 생존기간(gefitinib 301일 대 erlotinib 202일, p=0.151) 및 병의 진행까지 기간의 중앙값(gefitinib 136일 대 erlotinib 92일, p=0.672)은 두 군 사이에 차이가 없었다. 두 약제는 비슷한 독성을 보였다. Cox 회귀모형을 이용한 다변수분석에서 선암이 생존과 관련된 독립적인 예후인자였다(상대위험도: 0.487, 95% 신뢰구간: 0.292∼0.811, p=0.006). 아집단 분석 결과 두 약제에 대한 서로 다른 반응 예측인자는 없었다. 결론: Gefitinib와 erlotinib 사이에 반응률, 생존기간, 진행까지의 기간 및 독성에 차이는 없었다. 각 약제에 대한 특이적인 반응 예측인자도 없었다. Background: The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), became an attractive therapeutic option for advanced non-small-cell lung cancer (NSCLC). Several studies suggested that there might be some different efficacy or response predictors between gefitinib and erlotinib. We compared the efficacy and toxicity of gefitinib and erlotinib in Korean patients with advanced NSCLC and evaluated specific predictors of response for both gefitinib and erlotinib. Methods: We collected the clinical information on patients with advanced NSCLC, who were treated with gefitinib or erlotinib at the Ewha Womans University Hospital, between July 2003 and February 2009. Median survival times were calculated using the Kaplan-Meier method. Results: Eighty-six patients (52 gefitinib vs. 34 erlotinib) were enrolled. Patient median age was 64 years; 53 (62%) subjects were male. Out of the 86 patients treated, 83 received response evaluation. Of the 83 patients, 35 achieved a response and 12 experienced stable disease while 36 experienced progressive disease, resulting in a response rate of 42% and a disease control rate of 57%. After a median follow-up of 502 days, the median progression-free and overall survival time was 129 and 259 days, respectively. Comparing patients by treatment (gefitinib vs erlotinib), there were no significant differences in the overall response rate (44% vs. 39%, p=0.678), median survival time (301 days vs. 202 days, p=0.151), or time to progression (136 days vs. 92 days, p=0.672). Both EGFR-TKIs showed similar toxicity. In a multivariate analysis using Cox regression model, adenocarcinoma was an independent predictor of survival (p=0.006; hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.292-0.811). Analyses of subgroups did not show any difference in response predictors between gefitinib and erlotinib. Conclusion: Comparing gefitinib to erlotinib, there were no differences in the response rate, overall survival, progression-free survival, or toxicity. No specific predictor of response to each EGFR-TKI was identified.

만성활동성C형간염에 대한 인터페론 치료 후 사르코이드증의 악화

장혜정 ( Hye Jung Chang ),최은화 ( Eun Hwa Choi ),김인제 ( In Je Kim ),심윤수 ( Yun Su Sim ),이진화 ( Jin Hwa Lee ),김태헌 ( Tae Hun Kim ),문진욱 ( Jin Wook Moon ),천은미 ( Eun Mi Chun ),김유경 ( Yoo Kyung Kim ),성순희 ( Sun Hee S 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.3

Interferon alpha is an immunomodulator that is used as an antiviral agent to treat chronic active viral hepatitis C. However, interferon can induce or exacerbate sarcoidosis. We report a case of 42-year-old man with an exacerbation of pulmonary sarcoidosis after the cessation of interferon and ribavirin therapy for chronic hepatitis C. The patient`s sarcoidosis improved spontaneously and he continues to be monitored regularly without steroid therapy. (Tuberc Respir Dis 2006; 61: 285-288)

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)

폐선암과 병발한 비특이적간질성폐렴 1례

심윤수 ( Yun Su Sim ),이진화 ( Jin Hwa Lee ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),김유경 ( Yoo Kyung Kim ),성순희 ( Sun Hee Sung ),안재호 ( Jae Ho Ahn ),장중현 ( Jung Hyun Chang ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

Idiopathic pulmonary fibrosis (IPF) is strongly associated with lung cancer compared with the general population. However, other types of idiopathic interstitial pneumonia (IIP) are rarely associated with lung cancer. We describe a case of a primary lung cancer associated with IIP other than IPF, which was considered to be nonspecific interstitial pneumonia (NSIP), and NSIP disappeared spontaneously after treating the primary lung cancer. (Tuberc Respir Dis 2007; 63: 83-87)

만성폐쇄성폐질환의 급성악화로 입원했던 환자에서 장기간 사망의 예측인자

정해선 ( Hae Sun Jung ),이진화 ( Jin Hwa Lee ),천은미 ( Eun Mi Chun ),문진욱 ( Jin Wook Moon ),장중현 ( Jung Hyun Chang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.2

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.