결핵성 및 비결핵성 흉막삼출액에서 TNF-$\alpha$ 농도의 진단적 의의

나현주,박석채,강광원,박형관,김영철,최인선,박경옥,Na, Hyun-Joo,Park, Seog-Chea,Kang, Kwang-Won,Park, Hyeong-Kwan,Kim, Young-Chul,Choi, In-Seon,Park, Kyung-Ok 대한결핵및호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.3

연구배경 : 결핵성 흉막염의 감별 진단 목적으로 널리 이용되고 있는 검사는 adenosine deaminase와 INF-$\gamma$를 세포성 면역에 또다른 중요한 매개체로 알려진 TNF-$\alpha$의 진단적 의의를 조사하고, 현재 임상에서 유용한 지표로 사용되고 있는 adenosine deaminase와의 감별력을 비교하고자 본 연구를 시행하였다. 방 법 : 삼출성 흉막염 80예(결핵성 : 39예, 암성 : 31예, 부폐렴흉막염 : 10예)를 대상으로 흉수의 기본적인 세포조성, 화학 검사와 더불어 ADA와 TNF-$\alpha$(Medgenix IRMA kit)를 측정하였다. 결 과 : 흉수내 ADA농도는 결핵성 흉막염에서 $48.7{\pm}32.7U/L$로 비결핵성 흉막염 $26.0{\pm}41.3U/L$에 비해 유의한 차이로 높았고(p < 0.05), TNF-$\alpha$치 또한 결핵성 흉막염에서 $184.1{\pm}214.2pg/mL$로 비결핵성 흉막삼출액 $44.1{\pm}114.2pg/mL$에 비해 유의하게 높았다(p < 0.01). ROC 곡선을 이용하여 ADA와 TNF-$\alpha$의 감별력을 가장 높일 수 있는 기준치를 정하였을 때, ADA는 30U/ml, TNF-$\alpha$는 15pg/ml로 측정되었고, 각각의 기준치를 이용하여 감수성과 특이도를 구하였을때, ADA는 감수성 66.7%, 특이도 85.0%, TNF-$\alpha$는 감수성 69.2% 특이도 87.1%를 보였다. 두 검사의 민감도와 특이도를 비교하기 위한 ROC 곡선에서, ROC 곡선아래의 면적(area under curve)은 ADA와 TNF-$\alpha$사이에 유의한 차이가 없었다(ADA 0.83, TNF-$\alpha$ 0.82). 다중회귀분석(multiple stepwise regression)에서 ADA가 가장 유용한 지표로 계산되었으나 TNF-$\alpha$의 추가가 분별력에 더 이상의 기여함은 없었다. 결 론 : 결핵성 흉막염과 비결핵성 흉막염을 감별 진단하는데 ADA와 함께 TNF-$\alpha$도 유용한 지표로 이용될 수 있으나 두가지 검사를 함께 시행함에 따른 진단에 있어서의 잇점은 없었다. Objectives : The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various eytokines including Inteferon-$\gamma$, tumor necrosis factor alpha(TNF-$\alpha$) are considered as useful diagnostic tools in differentiating exudative pleural effusion. The author would like to demonstrate the diagnostic usefulness of TNF-$\alpha$ in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-$\alpha$ with ADA. Methods : Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-$\alpha$. Results : Tuberculous pleural fluid showed higher levels of ADA and TNF-$\alpha$, $48.7{\pm}32.7U/L$ and $184.1{\pm}214.2pg/mL$ than that of non-tuberculous effusion $26.0{\pm}41.3U/L$ and $44.1{\pm}114.2pg/mL$, respectively (ADA, TNF-$\alpha$, p < 0.05, p < 0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-$\alpha$ and the best cut-off value for adenosine deaminase and TNF-$\alpha$were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-$\alpha$. Conclusion : For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-$\alpha$ as well as ADA was considered as useful diagnostic method. However adding TNF-$\alpha$ to ADA has no further diagnotic benefit than ADA alone.

메타콜린 유발검사 때 폐 천명과 flow volume loop 검사의 가치

최인선(In Seon Choi),강광원(Kwang Won Kang),임호(Ho Lim) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.5

N/A Background: In methacholine bronchoprovocation test, lung function is traditionally measured by using forced vital capacity maneuver which depends on patient's effort. And insufficient breath may result in a false positive test. Objective : To evaluate the additional indices of airflow obstruction in the interpretation of methacholine bronchoprovocation test. Method: FEV1/FVC, canfiguration index of flow-volume loop(Slope-Ratio), modified Borg dyspnea score, and wheezing in addition to FEV1 were measured before and after methacholine challenge. Results : The changes of the measurements after methacholine challenge were significantly greater in patients with airway hyperresponsiveness(AHR). However, only 9 out of 29(31.0%) patients with AHR developed all of indices and 6.9/o did not show any evidence of obstruction except dyspnea. On the contrary, 40% of patients without AHR showed positive in two or more indices and 2 of them were hyperresponsive to histamine. Among patients with AHR, those without dyspnea and wheezing on challenge showed significantly lower baseline Borg score. FEV1, FEV1/FVC, and PC20, and were older than those with them(p<0.05). Conclusion Methacholine-induced △FEV1 is related to, but not concordant with other indices of airflow obstruction. Development of dyspnea and wheezing depends on age, etc. For an accurate interpretation of methacholine bronchoprovocation test, it maybe necessary to consider these variables. (J Asthma Allergy Clin Immunol 20: 717-724, 200G)

근적외선 분광분석법을 이용한 판상엽 화학성분 평가

한영림,한정호,이호근,제병권,강광원,이기열,어성제,Han, Young-Rim,Han, Jungho,Lee, Ho-Geon,Jeh, Byong-Kwon,Kang, Kwang-Won,Lee, Ki-Yaul,Eo, Seong-Je 한국연초학회 2013 한국연초학회지 Vol.35 No.1

Near InfraRed Spectroscopy(NIRS) is a quick and accurate analytical method to measure multiple components in tobacco manufacturing process. This study was carried out to develop calibration equation of near infrared spectroscopy for the prediction of the amount of chemical components and hot water solubles(HWS) of reconstituted tobacco leaf. Calibration samples of reconstituted tobacco leaf were collected from every lot produced during one year. The calibration equation was formulated as modified partial least square regression method (MPLS) by analyzing laboratory actual values and mathematically pre-treated spectra. The accuracy of the acquired equation was confirmed with the standard error of prediction(SEP) of chemical components in reconstituted tobacco leaf samples, indicated as coefficient of determination($R^2$) and prediction error of sample unacquainted, followed by the verification of model equation of laboratory actual values and these predicted results. As a result of monitoring, the standard error of prediction(SEP) were 0.25 % for total sugar, 0.03 % for nicotine, 0.03 % for chlorine, 0.16 % for nitrate, and 0.38 % for hot water solubles. The coefficient of determination($R^2$) were 0.98 for total sugar, 0.97 for nicotine, 0.96 for chlorine, 0.98 for nitrate and 0.92 for hot water solubles. Therefore, the NIRS calibration equation can be applicable and reliable for determination of chemical components of reconstituted tobacco leaf, and NIRS analytical method could be used as a rapid and accurate quality control method.

천식 의심 환자들의 메타콜린 상부기도 과민성

최인선(In Seon Choi),강광원(Kwang Won Kang),고영일(Young Il Koh),홍서나(Seo Na Hong) 대한천식알레르기학회 2002 천식 및 알레르기 Vol.22 No.3

N/A N/A

결핵성 및 비결핵성 흉막삼출액에서 TBF-α 농도의 진단적 의의

나현주 ( Hyun Joo Na ),박석채 ( Seog Chea Park ),강광원 ( Kwang Won Kang ),박형관 ( Hyeong Kwan Park ),김영철 ( Young Chul Kim ),최인선 ( In Seon Choi ),박경옥 ( Kyung Ok Park ) 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.3

조기 및 후기 발생 노인천식의 임상적 특성 비교

최인선(Inseon S . Choi),명보현(Bo Hyun Myung),강광원(Kwang Won Kang) 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The asthma mortality has risen during last decades, especially in the elderly. This study was performed to investigate whether newly-developed asthma in the elderly has any difference in clinical features relating to asthma severity compared to early-onset asthma (EOA).Methods: Thirty-three asthma patients (≥60 years-old) hospitalized due to severe attack were classified to late-onset (LOA) when their asthma developed after the age of 60 and the remaining to EOA. Data obtained from their medical records were analyzed retrospectively. Results: Ten out of the 33 patients (30.3%) were LOA. Duration of asthma was significantly longer in EOA (21.6±14.8 years vs. 2.9±2.4 years, p<0.001). There were no significant differences between both groups in age, sex, atopy history (personal and familial), sinusitis, and peripheral blood eosinophils. However, EOA showed more smoking history and frequent exacerbations following URI-like symptoms (p<0.05, respectively), and higher serum total IgE level (geographic mean: 228 vs. 20 IU/mL, p<0.001). Life-threatening asthma attack was developed more frequently (89.5% vs. 40%, p<0.05), and the lung function measurements obtained just before discharge were significantly lower (FEV1/FVC: 54.8±10.1% vs. 64.6±11.7%, p<0.05) in EOA. Severity of chronic asthma was significantly more severe in EOA (moderate to severe persistent asthma: 95.6% vs. 60.0%, p<0.05). Conclusion: Many elderly asthmatics develop asthma newly in their old age. EOA is more related to atopic allergy, and seems to have more severe and long-standing asthma leading to chronic persistent airflow obstruction.(Korean J Med 61:616-622, 2001)

스테로이드에 둔감한 천식 환자의 임상적 특징

정세웅,최인선,강광원 全南大醫大 2003 전남의대학술지 Vol.39 No.4

알레르기 진단에 있어서 morphine 피부단자시험의 임상적 가치

박석채,강광원,최인선 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.3

Background: Few studies have demonstrated an enhanced skin responsiveness to opiates in atopic subjects. Objective: To determine whether the skin response to morphine is increased in atopics and to assess the clinical usefulness of morphine skin prick test in diagnosis of allergic diseases. Method: Allergy skin prick tests were performed using 55 common allergens, histamine, and morphine in 158 patients with allergic diseases. Results: Wheal and flare sizes for morphine (1mg/mL) were significantly related to and smaller than those for histamine (1mg/mL). Although the proportion of subjects with allergic rhinitis and the level of serum total IgE were not different between responders (wheal >- 2mm) and nonresponders to morphine, the positive response rate to allergens was significantly lower in nonresponders. The flare sizes for morphine were significantly higher in positive allergen test group (A/H ratio >- 0.5). Among positive allergen test group, the subjects with atopy score >- 5 showed a larger flare size for morphine than those with atopy score < 5 while the sizes for histamine were not different. Conclusion: Morphine skin prick test is helpful for detecting false negative responses to allergens, and morphine skin test responses are increased in highly atopic patients probably due to enhanced mast cell releasability.

간폐증후군 1 예

김영철,박경옥,이정훈,박종춘,강광원,김준우,황준화,장일권,박형관,박창환 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Hepatopulmonary syndrome consists of a triad of liver dysfunction, intrapulmonary vascular dilatation, and hypoxemia. This is one of the main causes of arterial hypoxemia in patients with chronic liver disease. The vascular abnormalities are precapillary dilatation, direct arterial-venous communication, and dilated pleural vessels. In this article, we report a case of hepatopulmonary syndrome in a 62-year-old woman who had complained progressively worsening dyspnea, platypnea, and orthodeoxia. She had huge splenomegaly, clubbing fingers and cyanosis of lip and fingers. Arterial blood gas analysis showed refractory arterial hypoxemia and orthodeoxia suggesting right-to-left $quot;shunting$quot;. Chest X-ray showed increased interstitial markings on the lower part of right lung, In ^(99m)Tc-labeled macroaggregated albumin (MAA) lung perfusion scan, there was no perfusion defect in the lung, but labeled radionuclide were taken up in the intraabdominal organs, kidney, liver and spleen. The amount of shunted radionuclide were about 58 percent. In contrast echocardiography, microbubbles which were injected via cephalic vein were visualized in the left atrium at 4 cardiac cycles after leaving the right ventricle indicating intrapulmonary right-to-left $quot;shunting$quot; rather than intracardiac shunt. Pulmonary angiographic finding revealed diffuse blotchy arterial dilatation on both lung fields, especially lower lobes of both lungs. Current modalities of treatment of hepatopulmonary syndrome are the therapeutic embolization of direct arterial-venous communication for focal vascular dilatations, and TIPSS (Transjugular intrahepatic porto-systemic shunt) or liver transplantation for diffuse intrapulmonary vascular dilatations. Despite our recommendation of TIPSS, she refused the procedure and is under home oxygen therapy.

중증 천식 환자의 호흡곤란 인지도 저하

최인선,임호,장안수,박석채,강광원,장안수 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.2

Background: Blunted perception of dyspnea, which may be related to the increased mortality, has been demonstrated in patients with a history of near-fatal asthma and in the elderly. Objective: The purpose of this study was to evaluate the relationship between the perception of dyspnea and the severity of asthma. Methods: Baseline spirometry and Borg score change(A Borg score) during breathing through an inspiratory muscle trainer were measured in 27 consecutive asthma patients and 11 normal subjects. Results: The baseline Borg score was negatively related to FEV₁△Borg score was significantly lower in asthmatics than in controls at high level of loads. △Borg score was lower in severe asthma than in mild asthma. △Borg score was positively related to the baseline FEV₁. Seventy-five percent of severe asthma, 62.5% of moderate one, and 9.1% of mild one showed impaired dyspnea perception. Dyspnea perception was related to age(r_5= -0.49, p$lt;0.001). Conclusion: Three quarters of patients with severe asthma showed impaired dyspnea perception to inspiratory resistive load. Dyspnea perception was related to asthma severity and age.