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제생 불량성 빈혈과 신증후군이 동반된 전신성 홍반성 낭창 환자에서 plasma filtration 과 synchronized cyclophosphamide 치료 1예
남동기,김현수,박해심,김희연,남동호,김효철,박지원,최소연 대한내과학회 1999 대한내과학회지 Vol.56 No.1
Systemic lupus erythematosus(SLE) is a multisystemic autoimmune disease. In rare case, aplastic anemia can develop as a complication of SLE. We report a case of SLE patient with aplastic anemia and nephrotic syndrome. A 33-year-old woman was admitted because of gum bleeding. After laboratory work up including bone marrow biopsy study, she was diagnosed as SLE with aplastic anemia and nephrotic syndrome. The patient was initially treated with high dose steroid pulse therapy. However the patient did not responded to high dose steroid treatment. We treated the patient with plasma filtration and synchronized cyclophosphamide thrapy followed by monthly intravenous cyclophosphamide treatment. Complete clinical remission of hematologic and renal complications was achieved in this patient. We suggest that plasma filtration and synchronized cyclophosphamide therapy might be one of efffectie treatment modality in the management of severe SLE patient.
환삼덩굴 ( Humulus Japonicus ) 화분에 대한 피부 반응도 및 특이 IgE 의 측정에 관한 연구
남동기(Dong Ki Nam),박해심(Hae Sim Park),오승헌(Seung hun Oh),홍천수(Chein Soo Hong) 대한내과학회 1988 대한내과학회지 Vol.35 No.2
N/A To assess the clinical contribution of Humulus japonicus pollen which is thought to be an important causative pollen of the pollinosis in Autumn as are ragweed and sagebrush in Korea, a total of 340 patients with allergic respiratory disease visiting the allergy clinic in Severance Hospital, Yonsei University College of Medicine from March 1986 to February 1987 were studied. These patients (bronchial asthma 108, allergic rhinitis 97, bronchial asthma with allergic rhinitis 41 and other 94 cases) were tested for their skin reactivity to the extracts of Korean and Torii`s Humulus japonicus pollen, Dermatophagoides farinae, sagebrush, and rag- weed. Micro-ELISA was used to determine the Humulus japonicus-specific IgE level in 120 sera from patients who showed a positive skin test (more than 2+) to the Torii`s Humulus japonicus. The following results were obtained: 1) The global results of the skin prick test to the extract of Korean pollen of Humulus japonicus were negative in 64.0%, 1+ in 22.1%, 2+ in 11.8%, 3+ in 1.8%, and 4+ in 0.3% of 340 cases. The positive skin test rate (more than 2+) among the disease entities for the Korean and Toriis extracts of Humulus japonicus pollens respectively were 14.9% and 8.4/o in bronchial asthma; 17.5% and 21.6% in allergic rhinitis; 17.1% and 26.9% in bronchial asthma with allergic rhinitis; and 7. 7% and 6.3% in the others 2) The positive skin test rate for Korean Humulus japonicus in those patients who showed a positive skin test to Torii`s Humulus japonicus was 42.6% and the positive skin test rate of for Torii`s Humulus japonicus in those patients who showed a psotive skin test to Korean Humulus japonicus was 42.6% also. The correlation between the skin test results of the extracts of Korean and Torii`s Humulus japonicus pollen was very weak (r=0.41, p<0.05). 3) The positive skin test rates for Korean Humulus japonicus in patients who showed positive (more than 2+) and negative (less than 1+) skin tests to D. fariae, sagebrush and ragweed were 23.5%, 6.3% and 33.3%, 9.6% and 46.4%, 9.4% respectively (p<0.01). 4) The cut-off value of optical density (OD) in ELISA for Humulus japonicus-specific IgE was calculated from 30 negative control sera by computing its mean and standard deviation (Mean+2.S.D.=0.012) and forty-five (37.5%) of 120 patients' sera were ELISA positive. And the correlation between wheal size resulting from the skin prick test and the OD value of ELISA for the specific IgE of Humulus japonicus pollen was very weak (r=0.23 with Korean; r=0.12 with Torii`s). 5) The ELISA positive rates in patients who showed a positive skin test (more than 2+) to Korean and Torii s Humulus japonicus respectively were 46.2% and 50.0 %; and the ELISA positive rate in the negative skin test group was 40.3% and 32.5%. 6) The ELISA inhibition test with sera from 4 patients with high OD value (more than 0.1) showed that 2 patients were definitely inhibited upon the addition of the extract of Korean Humulus japonicus pollen extract, demonstrating Humulus japonicus specific-IgE in the patients sera. 7) The correlation between total serum IgE level and the OD value of ELISA was very weak (r=0.17), showing little effect of a high total IgE level on the results of ELISA. The ELISA positive rate was 41.7% in 12 sera with total serum IgE level of more than 500 IU/ml and 40.0% in 75 sera with a level of less than 500 IU/ml. The author could conclude that both skin test reactivity and OD value using micro-ELISA with the extract of the Korean pollen of Humulus japonicus were relatively low and consequently the allergenicity of it was minimal with the above data. The ultimate outcome in the evaluation of the skin test result with OD value in micro-HLISA to determine the specific IgE level must await further exhaustive research using a more highly purified extract of Humulus japonicus pollen.