비세균성 신염환자에서 신장내 67Ga - Citrate 흡수에 관한 연구

김삼용(Sam Yong Kim),노흥규(Heung Kyu Ro),신영태(Young Tai Shin),이강욱(Kang Wook Lee),정민수(Min Soo Jeong),이순구(Sunn Kgoo Rhee) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2

N/A Ga-67 citrate scan has been requested for detection or follow-up of inflammatory or neoplastic disease. Visualization of Ga-67 citrate in the kidneys at 48 and 72 hr post injection is usually interpreted as evidence of renal pathology. But precise mechanisms of abnormal Ga-67 uptake in kidneys were unknown. We undertook a study to determine the clinical value of Ga-67 citrate imaging of the kidneys in 68 patients with primary or secondary nephropathy confirmed by renal biopsy and 66 control patients without renal disease. Renal uptake in 48 to 72 hr images was graded as follows: Grade 0=background activity;1=faint uptake greater than background; 2= definite uptake, but less than lumbar vertebrae;3 same uptake as lumbar vertebrae, but less than liver; 4=same or higher uptake than liver. The results were as follows. 1) 42 of 68(62%) patients with noninfectious nephritis showed grade 2 or higher Ga-67 renal uptake but only 10 percent of control patients showed similar uptake. 2) In 14 patients with systemic lupus erythematosus, 8 of 9 (89%) patients with lupus nephritis exhibited marked renal uptake. 3) 36 of 41 patients (88%) with combined nephrotic syndrome showed Grade 2 or higher renal uptake. 4) Renal Ga-67 uptake was correlated with clinical severity of nephrotic syndrome determined by serum albumin level, 24 hr urine protein excretion and serum lipid levels. 5) After complete remission of nephrotic syndrome, renal uptake in all 8 patients who were initially Grade 3 or 4, decreased to Grade 1 or 0. In conclusion, we think that the mechanism of renal Ga-67 uptake in nephrotic syndrome might be related to the pathogenesis of nephrotic syndrome. In systemic lupus erythematosus, Ga-67 citrate scan is useful in predicting renal involvement.

두부외상후 만성 기질성 정신장애 환자에서 Tc-99m HMPAO Brain SPECT 분석

이강욱,이종진,송민호,강민희,지익성,신영태,노흥규 ( Kang Wook Lee,Jong Jin Lee,Min Ho Shong,Min Hee Kang,Ick Sung Ghi,Young Tai Shin,Heung Kyu Ro ) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3

It is well known that Tc-99m HMPAO brain SPECT can reflect the functional lesions better than X-ray computerized tomography(CT) and magnetic resonance imaging(MRI) in the cerebral disorders. In order to evaluate the clinical utilities of Tc-99m HMPAO brain SPECT in patients with post-traumatic chronic organic mental disorder(OMD). We included 28 patients diagnosed as OMD in department of psychiatry after traumatic head injury. And we compared the results of Tc-99m HMPAO SPECT with those of MRI, EEG and MINI mental status examination(MMSE). The results were as follows 1) All patients diagnosed as OMD showed diffuse or focal decreased cerebral perfusion on Tc-99m HMPAO SPECT. 2) Most frequent lession on brain Tc-99m HMPAO SPECT was decreased perfusion on both frontal lobe. And most frequent lesion on brain Tc-99m HMPAO SPECT was decreased perfusion on both frontal lobe. And most frequent lesion on brain Tc-99m HMPAO SPECT showing normal brain MRI result was also decreased both frontal perfusion. 3) Eight of 28 patients showed focal brain MRI lesions(4 small frontal hygroma, 3small cerebral infarction and 1 cerebellar encephalomalacia) which were not detected in brain Tc-99m HMPAO SPECT. 4) The patients showing less than 20 points on MMSE disclosed abnormal results of EEG more frequently than those disclosing more than 20points. In conclusion, we think that Tc-99m HMPAO brain SPECT is sensitive method to detect functional lesions of the brains in patients with chronic post-traumatic organic mental disoder.

전신성 홍반성 루푸스 환자에서 Ga - 67 - Citrate 스캔의 임상적 의의

이순구(Sunn Kgoo Rhee),김성숙(Seong Suk Kim),정민수(Min Soo Jeong),이강욱(Kang Wook Lee),신영태(Young Tai Shin),노흥규(Heung Kyu Ro) 대한내과학회 1994 대한내과학회지 Vol.46 No.3

N/A Objectives: We studied to evaluate the relationship between disease activity of lupus nephritis and renal uptake of Ga-67 citrate Methods: Nineteen cases of SLE were evaluated to test a relationship between the renal accumulation of Ga-67 citrate and pathological or clinical parameters. Results: 1) On the 19 patients, 12 (63%) patients had lupus nephritis, among them 7 (58%) patients had renal uptake above Grade 3. And 7 (37%) patients without lupus nephritis had renal uptake below Grade 2. 2) The BUN value of the patients with renal uptake above Grade 3 (group B, 44.0±43.6 mg/dl) were higher than that of the patients with renal uptake below Grade 2 (group A, 12.1±5.9 mg/dl) significantly (p<0.01), 3) The systolic blood pressure was 144±35 mmHg in group B and 115±22mmHg in group A, which was significantly different (p<0.01). And the diastolic blood pressure was 88±23mmHg in group E and 74±12 mmHg in group A, which was significantly different (p<0.01). 4) The degree of renal Ga-67 citrate uptake showed inverse correlation with the degree of serum albumin level (r=-0.64, p<0.01) and correlation to the degree of 24-hours urine protein amount (r=0.54, p<0.05). 5) The serum C3 level was 29.0±18.0 mg/dl in group B and 41.2±26.7 mg/dl in group A, which was significantly different (p<0.01). The serum C4 level was 8.7±3.2 mg/dl in group B and 23.9±16.3mg/dl in group A, which was significantly different (p<0.05). 6) Renal disease activity was 7.3±1.5 in group B and 2.3±1.5 in group A, which was significantly different (p<0.01). 7) In group B, renal biopsy findings were membranous lupus GN in 3 cases, diffuse proliferative lupus GN in 2 cases, and focal and segmental lupus GN in 2 cases. 8) Among the patients with renal uptake above Grade 3, six patients were evaluated after immunosuppressive therapy. Ga-67 citrate were accumulated with the Grade below 2. Serum C3 and albumin values increased and BUN and serum creatinine values were normalized. And renal and extrarenal disease activities were improved, significantly. Conclusion: We could have suggested that Ga-67 citrate scan is useful to diagnose and to estimate the activity of lupus nephritis.

관상동맥질환에서 Tc-99m Methoxyisobutyl Isonitrile (MIBI) Myocardial SPECT의 이용 : Dipyridamole 심근부하 SPECT와 관상동맥조영술과의 비교 A Comparison between Coronary Angiography and Tc-99m-MIBI Myocardial SPECT

이강욱,전은석,박종훈,신영태,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

In order to evaluate clinical utilities of Tc-99m MIBI dipyridamole stress myocardial SPECT in patients with coronary artery disease (CAD), we compaired tomographic and polar map images of Tc-99m MIBI myocardial SPECT with the results of coronary angiography in 25 patients with CAD (myocardial infarction 13,angina pectoris 12) in Chungnam National University Hospital from Oct. 1991 to Oct 1993. Percutaneous transcoronary angioplasty (PTCA) was done in three patients of 25 CAD patients and follow up SPECT studies were done in same three patients within 2 months after PTCA. The results were as follows : 1. Mean age of patients was 57.4 years. Man was 2.7 times more than woman. 2. Sensitivity and specificity of Tc-99m MIBI myocardial SPECT for the detection of coronary artery stenosis in patients with myocardial infarction were 92.7 % anf 85 %, respectively. 3. Sensitivity and specificity of Tc-99m MIBI myocardial SPECT for the detection of coronary artery stenosis in patients with angina pectoris were 100 % and 67 %, respectively. 4. After PTCA size of perfusion defects in stress SPELT images was decreased in all three patients . With the results above,we thought that Tc-99m MIBI myocardial SPECT is useful noninvasive method to detect stenosed coronary artery in patients with CAD and it can be used as a method to evaluate the result of PTCA.

혈액투석중인 만성신부전 환자에서 골대사 지표로써의 Osteocalcin치

송치운,이진홍,안미애,윤환중,윤상임,성기양,이강현,송민호,이강욱,신영태,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Background : Serum osteocalcin is synthesized by osteoblast and has been shown to be sensitive indicator of bone turnover inpatients with various metabolic bone disease. In renal osteodystrophy, serum osteocalcin is elevated due to decreased renal clearance and elevated level of PTH. This study was done to evaluate the usefulness of serum osteocalcin as a marker of bone metabolism and the correlation with other biochemical markers of bone metabolism. Methods : We measured serum osteocalcin, calcium, phosphorus, ALP(alkaline phosphatase) and PTH(parathyroid hormone) in 37 patients with end stage renal disease on hemodialysis. Osteocalcin was determined by radioimmunoassay and PTH was determined by radioimmunometric assay. Results : 1) The mean level of serum osteocalcin in ESRD patients was 233.8± 218.2ng/ml which was significantly higher than that of controls(p<0.0001). 2) The mean level of serum PTH in ESRD patients was 40.5± 43.8pg/ml was significantly higher than that of controls(p<0.005). 3) There was a significant positive correlation between the level of serum PTH, ALP and the level of serum osteocalcin in ESRD patients. 4) By using multiple regression, PTH is most reliable factor that affect to elevated level of serum osteocalcin ( beta coefficient = 0.687, Sig T<0.05). Conclusion : Serum osteocalcin as a marker of bone metabolism in ESRD patients is more useful than other biochemical marker such as serum calcium, phosphorus, ALP and PTH is a most reliable factor that affect to elevated level of serum osteocalin.

당뇨병환자에서 게이트심장혈액풀신티그라피를 이용한 심기능 평가

윤상임,송치운,이진홍,안미애,성기양,송민호,이강욱,신영태,김영건,노흥규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Major cardiovascular complications of diabetes are coronary atherosclerosis, diabetic dilated cardiomyopathy, autonomic neuropathy and those are major causes of morbidity and mortality in diabetic patients. Gated blood pool heart scan is noninvasive and useful method for evaluation of functional status of heart in diabetics. We evaluated 52 patients with diabetes and divided 3 groups. Group 1 were 11 patients without proteinuria or with proteinuria less than 550mng during 24 hours. Group 2 were 9 patients with proteinuria more than 550mg during 24 hours and group 3 were 32 patients with endstage renal diasese due to diabetes. We performed 99mTc-HSA cardiac gated blood pool scan and used left ventricular ejection fraction(LVEF), peak ejection rate(PEF) to indices of LV systolic function and peak filling rate(PER) to index of LV diastolic function. The results were follows : 1) LVEF, PER were significantly lower in diabetics with ESRD than diabetics without ESRD, but there were no significant difference between normal controls and diabetics without ESRD 2) PFR was significantly lower in diabetics than normal controls, but there were no significant differences in diabetics with or without nephropathy. 3) There were negative correlation between PER, PFR and duration of diabetes. On the basis of results, PFR is a LV functional index of GBPS which can disclose early change of LV dysfunction in patients with diabetes.

Thyrotropin은 STAT1(Signal Transducers and Activation of Transcription 1) 의 활성을 저해하여 Interferon-r에 의한 유전자 발현을 억제한다

이강욱,김영건,노흥규,송민호,김호,박은신,유순희,한희정,주원찬,원진호,임규,권오유 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.4

Background: The proinflammatory cytokine, IFN-y has been shown to exert pleiotropic effects in a variety of pathophysiologic conditions in autoimmune thyroid disease. The thyrocyte response to IFN-y is mediated two distinct classes of proteins, Janus kinases(Jakl and Jak2) and Signal Transducers and Activation of Transcription(STATl). The activation of STAT 1 is involved in the regulation of many interferon stimulated genes, such as MHC class II, intercellular adhesion molecules-1(ICAM-1) and MHC class II transactivator(CIITA) after the binding to the GASgFN- pactivated site) of the gene promoters. Recently we found TSH/forskolin inhibits IFN-y stimulated maximal expression of ICAM-1 in FRTL-5 cell. IFN-y action is localized between -175 bp and -97 bp from the start of translation of ICAM-1 gene which contains regulatory elements known to be involved in IFN-y action in other eukaryotic cells, palindromic IFN-y activated site(GAS)(5-TTTCCGGGAAA-3) which could bind STAT1, STAT3, STAT5, STAT6. Furthermore, the addition of TSH and forskolin causes a decrease in ICAM-1 promoter activity and its action was localized in GAS. These findings suggested TSH/cAMP signaling pathways downregulate IFN-y activated Janus kinase-STAT signaling path. We wanted to explore the possible involvement of elevated cAMP in the negative regulation of IFN-y induced STAT1 activation in thyroid cells. Method: We made several 5-deletion constructs of rat ICAM-1 promoter and analyzed the promoter activities by measuring the luciferase activity after tranfection into FRTL-5 cells. The protein/DNA complex was measured by electrophoretic mobility shift analysis using labeled oligonucleotide. We checked the level of total and phosphorylated STATl protein by immunoblot analysis using specific antibodies. Results: Stimulation of IFN-y in FRTL-5 cells resulted in rapid activation of STATl/DNA binding activity, which was apparent after several minute of stimulation, maintains its activity until 48 h. Incubation of cells with TSH result in suppression of IFN-p mediated STAT1/DNA binding activity throughout the time course of activation by IFN-y. Addition of TSH into 5H maintained FRTL-5 cells did not change the total amount of latent STAT1 amount and also not affect IFN-y mediated production of total STAT1 until 4 h. IFN-y(100 U/mL) rapidly induced phosphorylation of STAT1 within 30 min. and maintained its level without significant change until 48 hours. Cells treated with TSH dramatically lowered the level of IFN-y induced production and phosphorylation of STAT1 after 12 h, 24 h, 36 h, and 48 h but TSH had no effect on the level of phosphorylated STATl within 4 h after IFN-y stimulation. The proteasome inhibitor, MG132 and phosphatase inhibitor, sodium orthovanadate did not block the TSH or forskolin mediated downregulation of phosphorylated STAT1. Conclusion: These results indicate a regulatory mechanism which TSH signaling can modulate the prolonged activation of Jak/Stat by IFN-y. We identified one of mechanisms related to TSH mediated negative suppression of the ICAM-1 gene; TSH/cAMP signaling pathways downregulate the cytokine activated Janus kinase-STAT signaling path (J Kor Soc Endocrinol 13:536-553, 1998).

인슐린 비의존성 당뇨병에 의한 말기 신부전증 환자에서 iPTH치 및 골밀도에 관한 연구

이강욱,김종학,황평주,송민호,김영건,노흥규,신영태 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

The patients with diabetic ESRD have been reported to be suffered from more serious morbidity and mortality than other ESRD patients. In order to define if there are certain differences in the clinical parematers including bone metabolism, such as bone mineral density (BMD), serum iPTH level and Tc-99m MDP whole body bone scan between diabetic and nondiabetic ESRD, we evaluated 52 patients with ESRD (20 diabetic ESRD and 32 non-diabetic ESRD) beginning first hemodialysis or peritoneal dialysis at the Department of Internal Medicine in Chungnam National University Hospital, from January to December, 1998. The results were as follows : 1. Twenty patients with diabetic ESRD have been suffered from non-insulin dependent diabetes mellius and diabetic nephropathy. The causes of ESRD of 32 non-diabetic ESRD patients were hypertension (56%), chronic glomerular nephritis (26%), chronic interstitial nephritis (3%), and others (15%), respectively. 2. Serum creatinine, albumin, and phosphorus levels of diabetic ESRD patients were significantly lower than those of non-diabetic ESRD patients(all p<0.05), and creatinine clearance was also significantly higher in diabetic ERSD patients than non-diabetic ESRD patients (p<0.05) at the beginning of renal replacement therapy. 3. There was no significant difference in BMD, serum calcium, iPTH, alkaline phosphatase, 24 hours urine protein excretion, hemoglobin, and Tc-99m MDP whole body bone scan score between diabetic and non-diabetic ESRD patients (all p>0.05). 4. On the multivariable linear regression analysis, there was no statistically significant influence of patient's age, presence or absence of diabetes, iPTH, calcium, phosphorus, ALP, albumin, creatinine and ferritin levels on t-score of bone densitometry. In conclusion, we speculate that diabetic ESRD patients begin renal replacement therapy earlier than other ESRD patients although there was no significant difference in bone metabolism parameters, such as iPTH and bone mineral density.

만성부전증에서 Tc-99m HSA Cardiac Gated Blood Pool Scan을 이용한 심기능 평가

이강욱,정민수,신영태,노흥규 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

Congestive heart filure is a common and serious problem in patients with chronic renal failure (CRF) of any causes, and many cardiovascular death of this individuals has been attributed to myocardeal dysfunction. To evaluate left ventricular function in patients with CRF, we performed 99mTc-HSA cardiac gated blood pool scan in 37 patients with CRF not being managed by dialysis, admitted to CNUH for arteriovenous shunt surgery and 12 patients with CRF being managed by routine hemodialysis(HD). We compared various LV function indices of GBPS with clinical parameters of patients with CRF. The results were as follows. 1. Left ventricular ejection fraction(LVEF), peak ejection rate(PER), peak filling rate(PER) were significantly lower in patients with CRF not being managed by dialysis than normal controls.(P<0.01, P<0.01, P<0.001, respectively) 2. Fourty nine percent of patients with CRF not being managed by HD disclosed LVEF lower than normal controls, and fifty seven percent of them showed PER less than normal controls. seventy five percent of patients with CRF not being managed by HD disclosed PER lower than normal controls. 3. Seven patients(19%) of 37 patients with CRF not being managed by HD disclosed only abnormally lower PER than M±1 SD of normal controls. LVEF and PER of them were within normal limit. 4. It patients with CRF being managed by hemodialysis, PER was significantly lower than those of normal controls. However, there was no significant difference in LVEF and PER between normal controls and patients with CRF being managed by hemodialysis. 5. There was no significant difference in LVEF, PER and PER between patients with diabetes induced CRF and other causes induced CRF. 6. There was no significant difference in blood pressue, hemoglobin, serum creatinine, calcium and phosphorus levels between the group of patients who disclosed normal LVEF, PER, PER and patients who showed lowe LVEF, PER and PER than those of normal controls. As the results above, we think that PFR is a LV functional index of GBPS which can disclose early change of LV function in patients with CRF evenif another indices of LV systolic function is within normal limit.