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위장관 ; 혈괴가 부착된 소화성 궤양 출혈 환자에서 내시경 지혈 치료와 양성자 펌프 억제 약물치료의 효과 비교: 다기관 전향적 관찰상 코호트 연구
김시혜 ( Si Hye Kim ),정진태(교신저자) ( Jin Tae Jung ),권중구 ( Joong Goo Kwon ),김은영 ( Eun Young Kim ),이동욱 ( Dong Wook Lee ),전성우 ( Seong Woo Jeon ),박경식 ( Kyung Sik Park ),이시형 ( Si Hyung Lee ),박정배 ( Jeong Bae Park 대한소화기학회 2015 대한소화기학회지 Vol.66 No.2
목적: 출혈성 궤양의 내시경 소견은 Forrest 분류에 근거하여 재출혈 경향을 예측할 수 있는데 Forrest IIB 궤양의 경우 치료 여부에 대해 논란이 있는 실정이다. 소화성 궤양에 의한출혈 환자 중 Forrst IIB 궤양 병변을 대상으로 내시경 지혈술과 PPI 병합치료군 및 PPI 단독치료군의 임상결과를 비교하고재출혈 위험인자를 알아보기 위해 다기관 연구를 시행하였다. 대상 및 방법: 2011년 2월부터 2013년 12월까지 대구 경북,경남 지역의 8개 병원에 내원한 소화성 궤양 출혈 환자 중Forrest IIB 궤양 126명의 환자를 대상으로 전향적 관찰상 코호트 연구를 하였다. 내시경 지혈술 치료군과 PPI 단독치료군에서 성별, 나이, 궤양 과거력, 약제 복용력, 흡연력, 알코올섭취력, 활력징후, 임상 양상, 혈액검사 소견, 내시경 시행 시점, 내시경 소견, 헬리코박터 감염 여부 및 수혈량, 내시경 치료 내용, 재출혈 여부 및 내시경 치료 실패 시에 혈관색전술,수술 여부를 확인하였다. 결과: 전체 소화성 궤양 환자 1,101명 중 Forrest IIB 궤양환자는 126명(11.4%)을 차지했으며, 내시경 지혈술 치료군은 84명(66.7%), PPI 단독치료군은 42명(33.3%)이었다. 출혈 연관 사망은 내시경 치료군에서 1예(1.2%), 약물 치료군에서 3예(7.1%), 출혈 비연관 사망은 내시경 치료군에서 2예(2.4%),약물 치료군에서 3예(7.1%), 전체 사망은 내시경 치료군에서 3예(3.6%), 약물 치료군에서 6예(14.2%)로 약물 치료군에서 유의하게 높게 나타났다. 내시경 치료, 또는 약물 치료 후 기저질환이 악화된 경우는 각각 3예(3.6%), 5예(11.9%)로 두 군간의 유의한 차이는 없었다. 재출혈은 내시경 치료군에서 6예(7.1%), 약물 치료군에서 4예(9.5%)로 역시 유의한 차이는 없었다. 다변량 분석에서는 아스피린, 또는 비스테로이드성 소염제 복용력이 있는 경우만이 재출혈의 독립적인 예측인자로 나타났다. 결론: Forrest IIB 궤양 환자에서 내시경 지혈술은 출혈 연관사망률 및 전체사망률 감소와 연관이 있으며, 기저질환을 악화시키지 않는 것으로 나타났다. 재출혈 위험인자는 아스피린, 또는 비스테로이드성 소염제 복용력이 있는 경우이며, 이를 고려하여 효과적인 치료 계획 수립이 필요하다. Background/Aims: The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. Methods: Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. Results: Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs. 10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). Conclusions: In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID. (Korean J Gastroenterol 2015;66:98-105)
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류마티스관절염과 전신홍반루푸스 환자에서의 대유행 H1N1 인플루엔자 백신 접종 반응
김지헌 ( Ji Hun Kim ),최한나 ( Han Na Choi ),김시혜 ( Si Hye Kim ),이화정 ( Hwa Jeong Lee ),박성훈 ( Sung Hoon Park ),김성규 ( Seong Kyu Kim ),최정윤 ( Jung Yoon Choe ),권현희 ( Hyun Hee Kwon ),정희진 ( Hee Jin Cheong ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.2
Objective. We investigated the efficacy and safety of pandemic H1N1 vaccine in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients, and evaluated its correlation with serum cytokine level. Methods. A total of 43 RA patients and 31 SLE patients were enrolled in the study and were compared with age, sex-matched 40 healthy controls (HC). The blood samples drawn from selected patients before vaccination and in post-vaccination at week 4 were assayed in one session to measure the titers of antibodies against haemagglutinin specific for influenza virus strains: A/California/7/2009 NYMC X-179A (H1N1). Serum IL17 and CXCL13 levels were measured in the same session by enzyme-linked immunosorbent assay. The association of serum cytokine level with anti-influenza antibody titer and mean fold increase (MFI) was investigated. Each specific side effect after vaccination was monitored in both the patients and control groups. Results. The geometric mean antibody titer (GMT) for preand post-vaccination at week 4 was not significantly different between RA and HC, SLE and HC. The seroconversion rate in HC and RA was not significantly different, whereas the seroprotection rate is significantly higher in HC (82.5%) than RA (55.8%) (p<0.05). MFI in HC, RA, SLE were 19.65, 6.00 and 6.06, which were significantly higher in HC. Serum IL17 level was 6.28±2.89 pg/mL and 7.56±3.34 pg/mL in pre-, post-vaccination SLE patients, 33.85±15.62 pg/mL and 38.04±18.60 pg/mL in RA patients and was significantly lower in SLE patients. Serum CXCL13 level was 518.73± 720.29 pg/mL and 431.53±601.23 pg/mL in pre-, post-vaccination SLE patients, which was significantly higher than HC (149.64±248.81 pg/mL and 147.36±213.92 pg/mL in each pre-, post-vaccination) and was not significantly different with the level of RA patients. In SLE patients, significant correlations were detected between cytokine level and post-vaccination antibody titer (r=0.22 p=0.026 between IL 17 and GMT; r=0.44, p<0.05 between CXCL13 and GMT). Conclusion. The increase in post-vaccination antibody titer is weaker in both RA and SLE patients group than the HC group. Post-vaccination antibody titer was positively correlated with B lymphocyte chemoattractant and CXCL13 in SLE patients, but not in RA patients.
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조형호 ( Hyeong Ho Jo ),강선미 ( Sun Mi Kang ),김시혜 ( Si Hye Kim ),라모니 ( Moni Ra ),박병규 ( Byeong Kyu Park ),권중구 ( Joong Goo Kwon ),김은영 ( Eun Young Kim ),정진태 ( Jin Tae Jung ),김호각 ( Ho Gak Kim ),류헌모 ( Hun Mo Ry 대한소화기학회 2016 대한소화기학회지 Vol.68 No.1
In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy. (Korean J Gastroenterol 2016;68:40-44)
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