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- 저자 : ( Chan Ran You ) (검색결과 82 건)
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The Relationship between NAFLD and the Risk of Obstructive Sleep Apnea
( Chan Ran You ),( Jung Hwan Oh ),( Si Hyun Bae ),( Jong Young Choi ),( Seung Kew Yoon ),( Sang Wook Choi ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: In several studies using animal models, chronic intermittent hypoxia was associated with severe liver damage in diet-induced fatty liver. Intermittent hypoxia induced by obstructive sleep apnea (OSA) is a potential risk factor of nonalcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the relationship between OSA and NAFLD in non-obese patients. Methods: We assessed the OSA risk using Berlin questionnaire (BQ) in 1612 patients who visited health promotion center in our hospital. We excluded subjects with any other liver disease including HBV or HCV hepatitis, a history of malignancy, disorders of biliary tree, alcohol intake ≥20g/day and missing biochemical and radiologic data. We also excluded subjects with BMI ≥28 kg/m2. The total number of eligible subjects for this study was 207. The severity of fatty liver was measured with liver/renal echogenicity ratio (hepatorenal index). Steatosis combined with ALT level more than 30 IU/L was defined nonalcoholic fatty liver damage, while steatosis combined with ALT level less than 30 IU/L was defined simple steatosis. Results: Steatosis with hepatorenal index more than 1.49 was observed in 49 patients (23.8%). Of patients with steatosis, 25 (52.0%) had simple steatosis and 24 (48%) had nonalcoholic fatty liver damage. Of all 207 subjects, 134 patients (64.7%) were classified as low risk of OSA and 73 patients (35.3%) were classified as high risk of OSA through the BQ. Serum ALT level was significantly higher in subjects with high risk of OSA compared to low risk of OSA (mean ALT±SD, 31.25±20.06 IU/L vs. 22.55±14.48 IU/L, P<0.001). Also, hepatorenal index was higher in patients with high risk of OSA compared to low risk of OSA (mean±SD, 1.45±0.44 vs. 1.20±0.36, P<0.001). The number of patients with steatosis by hepatorenal index was 32 (43.8%) in high risk of OSA group and 17 (26.1%) in low risk of OSA group (P<0.001). The rate of patients with steatosis and elevated ALT level was significantly higher in high risk of OSA group compared to low risk of OSA group (14.7% vs. 4.5%, P<0.001). BMI was higher in patients with high risk of OSA than in patients with low risk of OSA (24.57±2.18 vs. 23.19±1.96, P<0.001). High risk of OSA remained correlated with the severity of steatosis (OR 1.92; 95% CI, 1.179 to 3.127; P=0.003) after adjusting for BMI. Conclusions: In patients with BMI < 28 kg/m2, a proportion of steatosis is more frequent in subjects with high risk of OSA. NAFLD is associated with high risk of OSA regardless of BMI in non-obese patients.
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A Case of Acquired Hemochromatosis Due to Oral Iron Supplementation
( Chan Ran You ),( Yeong Ji Yu ),( Sang Wook Choi ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Hereditary hemochromatosis, a very rare genetic disorder in Korea, is characterized by increased iron accumulation in tissues and organs, resulting from a mutation in the HFE gene. Iron overload may also occur due to chronic transfusion or parenteral iron supplementation. We present a case of acquired hemochromatosis that developed hepatic iron overload after chronic oral iron supplementation. Results: A 53 years old woman was referred to our clinic due to elevated liver enzyme. Four years ago, she visited hematologic center for evaluation of cause of anemia. According to anemia study and bone marrow biopsy, the cause of anemia was determined to chronic inflammatory disease. She had been treated with nontuberculous mycobacteria infection in lung for a long time. Her pulmonology physician has supplied her oral iron during 3 years because her anemia did not recover. At the time of visit to our clinic, she had elevated liver enzyme (AST 110 IU/L, ALT 157 IU/L). Abdominal CT showed diffusely increased attenuation of liver on precontrast scan. Laboratory data revealed hemoglobin of 10.7 g/dL, serum iron of 242 μg/dL (40-162), serum TIBC of 249 μg/dL (246-396) and serum ferritin of > 1500 ng/mL (11-306.8). Transferrin saturation was 97.2%. Liver biopsy documented increased iron content in hepatocytes and Kupffer cells. She did not carry the mutation of HFE gene. The iron supplements were discontinued. We are going to treat her with iron chelator deferasirox. Conclusions: To avoid secondary hemochromatosis caused by iatrogenic measures, we have to monitor serum ferritin level and transferrin saturation during iron therapy.
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( Chan Ran You ),( Myeong Jun Song ),( Chan Kwon Jung ),( Sung Woo Hong ),( Won Hee Hur ),( Sang Wook Choi ),( Si Hyun Bae ),( Jong Young Choi ),( Seung Kew Yoon ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Ribosomal proteins (RP) involve in the regulation of apoptosis and carcinogenesis. In recent studies of RP in hepatocellular carcinoma (HCC), the overexpression of ribosomal protein L12, L27, L30 and L36 was found. We aimed to investigate the expression of ribosomal protein S23 (RPS23) and its effect on prognosis in postoperative HCC patients. Methods: Liver tissues were obtained 63 patients who had undergone curative resection for HCC. We enrolled the patients with early tumor stage (≤ UICC stage III) and good liver function (≤ Child Pugh score 6). The expressions of RPS23 in tumor tissue and non-tumor tissue were examined by immunohistochemical staining. Analyses for survival and recurrence were done between tumor RPS23 (t-RPS23) expression group and non-expression group. Results: RPS23 was expressed in 34 patients (54.0%) on tumor tissue and 8 patients (13.1%) in Non-tumor tissues (P=0.016). The patients were grouped according to the expression of RPS26 in tumor tissue. Basal characteristics were not different between t-RPS23 positive and negative group. The three years and five years survival rate was higher in t-RPS23 positive group (90.2% vs. 65.8% of 3 year survival rate, P=0.007, 86.1% vs. 55.7% of 5 year survival rate, P=0.010). On multivariate analysis, t-RPS23 expression (HR 10.95, P=0.004) and tumor number (HR 9.71, P=0.001) were independent prognostic factors for 3 year and 5 year survival. Tumor recurrence during one year after resection was relatively low in t-RPS23 positive group, but not statistically significant (17.8% vs. 36.0%, P=0.084). However, on multivariate analysis, t-RPS23 expression (HR 4.18, P=0.021) and serosa invasion (HR 4.15, P=0.019) were independent factors for 1 year tumor recurrence. Conclusions: The RPS23 expression of HCC patients was higher in tumor tissue than in non- tumor tissues. The RPS23 expression in tumor tissue was good prognostic marker for resected HCC. RPS23 may be associated with good oncogene to have paradoxical function in HCC.
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( Chan Ran You ),( Su Hyung Park ),( Sung Won Jeong ),( Hyun Young Woo ),( Si Hyun Bae ),( Jong Young Choi ),( Young Chul Sung ),( Seung Kew Yoon ) 대한간학회 2011 Gut and Liver Vol.5 No.4
Background/Aims: Interferon-γ-inducible protein 10 (IP-10) plays important roles in the pathogenesis of hepatitis C virus (HCV) infection. We investigated the association between serum IP-10 levels and liver pathology in patients with chronic HCV infection. Methods: The serum IP-10 concentration was assessed in 85 patients with chronic HCV infection using a solid phase sandwich enzyme-linked immunosorbent assay, and a liver biopsy specimen was obtained. The pathology was scored using the Knodell histologic activity index (HAI). Results: Of the 85 patients, 58 had genotype 1 HCV infection, 21 had genotype non-1, and 6 were undetermined. The serum IP-10 levels did not differ between patients infected with genotype 1 and genotype non-1 (p=0.472). In patients with genotype 1 infection, the total HAI score and the stage of fi brosis were highly correlated with the serum IP-10 level (r=0.555, r=0.578, p<0.001). Furthermore, the serum IP-10 concentrations of patients with severe fi brosis (stages 3, 4) were higher than those of patients with mild fi brosis (stages 0 to 2; 214.4 vs. 72.3 pg/mL, p=0.002) among patients with genotype 1 infection. However, in patients without genotype 1 infection, the histopathology was not associated with the serum IP-10 level. A multivariate analysis showed that serum IP-10 was an independent predictor of fi brosis (stages 3, 4) in patients with genotype 1 infection (odds ratio, 1.034; 95% confi dence interval, 1.006 to 1.064; p=0.018). Conclusions: Serum IP-10 concentration was signifi cantly correlated with the severity of liver histology in genotype 1 HCV infection. (Gut Liver 2011;5:506-512)
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You, Chan Ran,Park, Su-Hyung,Jeong, Sung Won,Woo, Hyun Young,Bae, Si Hyun,Choi, Jong Young,Sung, Young Chul,Yoon, Seung Kew The Korean Society of Gastroenterology; the Korean 2011 Gut and Liver Vol.5 No.4
<P><B>Background/Aims</B></P><P>Interferon-γ-inducible protein 10 (IP-10) plays important roles in the pathogenesis of hepatitis C virus (HCV) infection. We investigated the association between serum IP-10 levels and liver pathology in patients with chronic HCV infection.</P><P><B>Methods</B></P><P>The serum IP-10 concentration was assessed in 85 patients with chronic HCV infection using a solid phase sandwich enzyme-linked immunosorbent assay, and a liver biopsy specimen was obtained. The pathology was scored using the Knodell histologic activity index (HAI).</P><P><B>Results</B></P><P>Of the 85 patients, 58 had genotype 1 HCV infection, 21 had genotype non-1, and 6 were undetermined. The serum IP-10 levels did not differ between patients infected with genotype 1 and genotype non-1 (p=0.472). In patients with genotype 1 infection, the total HAI score and the stage of fibrosis were highly correlated with the serum IP-10 level (r=0.555, r=0.578, p<0.001). Furthermore, the serum IP-10 concentrations of patients with severe fibrosis (stages 3, 4) were higher than those of patients with mild fibrosis (stages 0 to 2; 214.4 vs. 72.3 pg/mL, p=0.002) among patients with genotype 1 infection. However, in patients without genotype 1 infection, the histopathology was not associated with the serum IP-10 level. A multivariate analysis showed that serum IP-10 was an independent predictor of fibrosis (stages 3, 4) in patients with genotype 1 infection (odds ratio, 1.034; 95% confidence interval, 1.006 to 1.064; p=0.018).</P><P><B>Conclusions</B></P><P>Serum IP-10 concentration was significantly correlated with the severity of liver histology in genotype 1 HCV infection.</P>
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( Chan Ran You ),( Jung Hwan Oh ),( Min Ji Seo ),( Hye Yeon Lee ),( Hyon Soo Joo ),( Sung Hoon Jung ),( Sang Haak Lee ),( Myung Gyu Choi ) 대한소화기기능성질환·운동학회 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.2
Background/AimsObstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigatedthe prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using theBerlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients. MethodsWe enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive refluxdisease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used toevaluate obstructive sleep apnea. ResultsMore patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P =0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients witherosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factorfor obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ≥ 55 years (OR, 1.83; P < 0.001) and a high body massindex (≥ 25 kg/m2) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk forOSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients. ConclusionsHigh risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ≥ 55, and a high BMIare associated with high risk for OSA.
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( Chan Ran You ),( Jeong Won Jang ),( Jae Ki Choi ),( Si Hyun Bae ),( Seung Kew Yoon ),( Chul Seung Kay ),( Jong Young Choi ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.2
Reactivation of hepatitis B virus (HBV) replication is a frequent phenomenon in patients receiving immunosuppressants or chemotherapy. It was recently reported that regional therapy, such as transarterial chemotherapy (TAC) or radiotherapy, can also induce HBV reactivation in patients with hepatocellular carcinoma (HCC), and this can be prevented by preemptive lamivudine treatment. We report an unusual case of fatal hepatitis caused by reactivation of the tyrosine-methionine-aspartate-aspartate (YMDD) lamivudine-resistant strain in a 51-year-old male patient with HCC who was receiving preemptive lamivudine therapy. This patient received combined helical tomotherapy and TAC for the treatment of HCC with pulmonary metastasis. HBV reactivation and hepatitis exacerbation occurred after 2 months of therapy, but preemptive antiviral therapy was continued. Laboratory tests showed that the serum HBV DNA level had increased by more than 10,000-fold and a severe elevation of the aminotransferase level to 1,060 U/L. Although adefovir was added to lamivudine immediately after detecting the YMDD mutants, the patient eventually died of hepatic failure. Our experience suggests that for preemptive therapy, the use of potent antiviral drugs with a low risk of drug resistance as well as close viral monitoring are important for chronic HBV carriers undergoing intensive anticancer therapy. (Gut Liver 2010;4:262-265)
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Experience with Ledipasvir/Sofosbuvir-Based Treatment for the Treatment of HCV Genotype 1a in Korea
( Chan Ran You ),( Sang Wook Choi ),( Sun Hong Yoo ),( Jung Hyun Kwon ),( Soon Woo Nam ),( Se Hyun Cho ),( Joon-Yeol Han ),( Do Seon Song ),( U Im Chang ),( Jin Mo Yang ),( Sung Won Lee ),( Hae Lim Le 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: In this multicenter retrospective cohort study, we aimed to evaluate the effectiveness of IFN-free direct acting anti-viral agents (DAA) for patients with HCV genotype 1a in a real life setting in Korea. Methods: We analyzed clinical data of all consecutive DAA-treated patients for chronic HCV genotype 1a infection from eight clinical centers in Korea. Between May 2016 to April 2017, 35 patients were included in this study. The primary efficacy endpoint was end of treatment response (ETOR) and sustained virological response 12 weeks (SVR12). Adverse events (AEs) and laboratory data were also collected for analysis. Results: A total of 35 patients with genotype 1a HCV infection, 8 patients (22.9%) had compensated liver cirrhosis and 14 patients (40%) were treatment-experienced. Ledipasvir/sofosbuvir (LDV/SOF) with ribavirin were administered to six of seven treatment-experienced patients with cirrhosis. Thirteen patients were over 65 years old (37.1%) and female patients were dominant (65.7%, 23/35 patients). The Child-Pugh scores of all patients were 5 or 6. The rate of SVR12 was 94.7% (18/19 patients) and the rate of ETOR was 96.6% (28/29 patients). SVR12 and ETOR were obtained in all patients completed treatment for 12 weeks. Five of 33 patients (15.2%) had detectable HCV RNA at week 4 of therapy, but all of them achieved SVR12. LDV/SOF without ribavirin was tolerated well. The dose of ribavirin was reduced in two patients because they complained fatigue and general weakness after the treatment of LDV/SOF with ribavirin. Conclusions: In patients with HCV genotype 1a infection, LDV/SOF based regimen was very effective and well tolerated.
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