지속성 외래 복막투석 환자에서 고용량(10,000 IU) Epoetin alfa의 효과에 대한 교차 연구

도정호 ( Jung Ho Do ),김대중 ( Dae Joong Kim ),최소연 ( So Yeon Choi ),도연실 ( Yeon Sil Do ),장은희 ( Eun Hee Jang ),백현정 ( Hyun Jeong Baek ),김정인 ( Jung In Kim ),여호명 ( Ho Myoung Yeo ),최성철 ( Sung Chul Choi ),이정은 ( Ju 대한내과학회 2006 대한내과학회지 Vol.71 No.5

목적: 유전자 재조합 인 에리스로포이에틴(rHuEPO)은 신성빈혈 치료에 필수 불가결한 약제이다. rHuEPO는 당화 폴리펩타이드로 피하 또는 정맥 내로 투여하여야 하며 이에 따른 불편함을 개선하기 위하여 최근에는 darbepoetin 또는 고용량의 epoetin beta로 투여 간격을 늘리는 방법이 소개되고 있다. 본 연구는 대상 환자간의 변이를 최소화 할 수 있는 교차 연구를 통하여 고용량 epoetin alfa 피하 투여의 빈혈 교정 효과를 볼 수 있는지 확인하고자 하였다. 방법: RHuEPO를 투여 중인 지속성 외래 복막투석환자 24명을 고용량-기존용량(n=12) 또는 기존용량-고용량(n=12) 피하투여군으로 무작위 분류하여 처음 6개월간은 총 10회 방문(스크리닝 1회, 이후 9회) 치료하였고(Period I), 이후 6개월간은 두 군을 교차시켜 4회 방문 치료(Period II)하였다. 고용량은 10,000 IU, 기존용량은 4,000 IU로 투여하였고, 헤마토크릿이 30~39% 범위를 유지하도록 투여 간격을 이전 투여 간격의 50% 이하 범위에서 조절하였다. 결과: 24명의 대상 환자 중 교차 연구를 완결한 환자는 고용량-기존용량군 8명, 기존용량-고용량군 7명이었고, 이들에 대하여 최종분석을 실시하였다. 투여 전, 12주, 24주, 36주, 48주에 혈색소는 고용량-기존용량군에서 10.8±1.1 (이하 평균±표준편차), 11.5±0.9, 11.5±1.5, 11.4±1.5, 11.5±0.8 g/dL이었으며, 기존용량-고용량군에서 11.2±0.8, 11.4±1.2, 11.2±0.9, 11.2±1.4, 11.4±0.9 g/dL로 차이가 없었다. 투여 전, 12주, 24주, 36주, 48주의 epoetin alfa의 평균 투여량은 고용량-기존용량군에서 83.6±38.1, 87.1±35.8, 89.4±34.2, 60.1±25.1, 62.8±30.7 IU/kg/week이었으며 기존용량-고용량군에서 69.8±31.6, 64.9±12.2, 69.9±46.1, 78.8±29.3, 75.9±16.4 IU/kg/week로 고용량 투여시 다소 많은 양상이었으나 유의한 차이는 없었다. 투여간격은 Period I, Period II에서 고용량-기존용량군은 13.3±5.3, 8.2±4.3일, 기존용량-고용량군은 7.0±2.5, 13.4±4.0일이었고, 고용량 투여시와 기존용량 투여시의 투여간격은 13.3±4.8, 7.5±3.4일로 유의한 차이를 보였다. 관찰 기간동안 양 군 모두 혈압의 변화와 요소 청소율(Kt/V)에는 차이가 없었고, 주사 부위 통증은 경미하였다. 결론: 지속성 외래 복막투석 환자에서 epoetin alfa 10,000 IU를 일시에 투여할 경우 4,000 IU 투여에 비하여 거의 비슷한 평균 용량으로 투여 횟수를 감소시킬 수 있었고, 부작용은 경미하였다. Background: Recombinant human erythropoietin (rHuEPO) is an essential and well-established treatment for renal anemia. Rcently, clinicians have moved toward administration of high dose rHuEPO to reduce the inconvenience and time efficient. We aimed to determine whether high dose subcutaneous (SC) epoetin alfa is as efficient and safe as the usual dose for treating anemia in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Twenty-four patients on CAPD were randomly assigned to a high-usual dose group (n=12) and an usual-high dose group (n=12) with a variable interval for 48 weeks. Patients received 10 times treatments by scheduled visiting during Period I lasting 24 weeks and received 4 times treatments by scheduled visiting in Period II lasting 24 weeks by cross-over. The high dose was 10,000 IU and the usual dose was 4,000 IU epoetin alfa regimen. If hematocrit was out of the targeted range, 30~39%, the interval of epoetin alfa was changed within 50% of the previous interval. Results: Fifteen patients, out of 24, completed the study (8 patients in the high-usual dose group; 7 patients in the usual-high dose group). Mean hemoglobin levels at randomization and after 12, 24, 36 and 48 weeks were 10.8±1.1, 11.5±0.9, 11.5±1.5, 11.4±1.5, 11.5±0.8 g/dL, respectively, in high-usual dose group compared with 11.2±0.8, 11.4±1.2, 11.2±0.9, 11.2±1.4, 11.4±0.9 g/dL, respectively, in usual-high dose group. The mean weekly epoetin alfa dosages at randomization and after 12, 24, 36 and 48 weeks were 83.6±38.1, 87.1±35.8, 89.4±34.2, 60.1±25.1, 62.8±30.7 IU/kg/week, respectively, in high-usual dose group compared with 69.8±31.6, 64.9±12.2, 69.9±46.1, 78.8±29.3, 75.9±16.4 IU/kg/week, respectively, in usual-high dose group. No statistically significant differences between the two groups were apparent for hemoglobin levels or mean weekly epoetin alfa dosages. Treatment interval at Period I and Period II were 13.3±5.3, 8.2±4.3 days in high-usual dose group compared with 7.0±2.5, 13.4±4.0 days in usual-high dose group with statistically significant differences. Treatment interval in high dose was about two times as longer as usual dose. Adverse events were generally mild and transient, and pain on injection site following subcutaneous administration was rarely reported. Conclusions: This study demonstrates that epoetin alfa 10,000 IU is as efficient and safe as 4,000 IU with a similar weekly dose in CAPD patients. Epoetin alfa 10,000 IU administration can reduce frequency of injections by about one half.(Korean J Med 71:527-534, 2006)

공여자가 동일한 사체신이식에서 Mycophenolate Mofetil(MMF)과 Azathioprine(AZA)의 비교 연구

도정호 ( Do Jeong Ho ),허우성 ( Heo U Seong ),김정아 ( Kim Jeong A ),이효락 ( Lee Hyo Lag ),최성철 ( Choe Seong Cheol ),한혁준 ( Han Hyeog Jun ),김대중 ( Kim Dae Jung ),김윤구 ( Kim Yun Gu ),오하영 ( O Ha Yeong ),이광웅 ( Lee Gwan 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6

목 적: 뇌사 공여자로부터 적출된 두개의 신장을 하나는 MMF(연구군)에 다른 하나는 AZA(대조군)에게 이식하여 공여자 차이로 인한 영향을 최소화 하여 두 약제가 신이식 후 초기 급성거부반응과 이식신 생존율에 미치는 영향을 비교 분석하고자 하였다. 방 법 : 1998년 4월부터 2000년 1월까지 성균관의대 삼성서울병원에서 시행된 신장이식 중 공여자의 양측 신장(34쌍)이 제공된 68예의 사체 신이식을 대상으로 각 쌍을 MMF군(34예)과AZA군(34예)으로 무작위 배정을 하였고 면역억제제는 3제요법을 시행하여, MMF군은 Cyclosporine,MMF, Prednisolone을 AZA군은 Cyclosporine, AZA, Prednisolone을 투여 하였다. 두 군간의 6개월 이내의 급성 거부반응의 발생률과 CMV 감염 발생률 그리고 1년 이식신의 생존율 등을 전향적인 방법에 의해 비교하였다. 결 과: MMF군과 AZA군 간에 성별, HLA 부적합, 냉무혈시간, 몸무게 등의 유의한 차이는 없었다. 급성 거부반응 발생 또는 치료실패는 각각 12예(35.3%)와 11예(32.4%)로 두 군간에 유의한 차이가 없었고(p>0.05), 1년 이식신의 생존율은 각각 91.2%, 97.1%였고 CMV 감염은 각각 1예와 3예로 차이를 보였으나 통계적 의미는 없었다. 결 론: MMF와 AZA, 두 신이식 군에서 약제로 인한 급성 거부반응 발생률의 차이와 이식신 생존율의 차이는 없었다. 이는 기존의 보고들과는 다른 결과로 사체신이식일 경우 공여자의요인이 신장이식의 결과에 많은 영향을 미친다는 것을 의미한다. 그러므로 사체신이식을 통한 비교 임상 시험을 시행할 때는 기존의 연구들에서 제시한 공여자 인자 외 다른 공여자 인자들에 대한 충분한 고려가 있어야 하겠다. Objective : In order to evaluate how immunosuppressive agents such as MMF and AZA would influence on the outcome of the graft kidney, we analyzed the incidence of acute rejection episodes and one year graft survival rate after minimizing influences of donor factors by grafting the same cadaveric donor kidney. Methods : From April, 1998 to January, 2000, sixty eight patients grafted by 34 cadaver donors were enrolled in our study. From the same donor, one was randomly assigned to the MMF group(n=34) who were treated with cyclosporine, MMF, prednisolone while the other kidney was assigned to the AZA group(n=34) with cyclosporine, AZA, prednisolone. We analyzed the incidence of acute rejection episodes and CMV infection within the first 6 months of renal transplantation and one year graft survival rate was studied prospectively. Results : There were no significant differences in sex, HLA mismatch, cold ischemic time, and patients` weight between two group. Acute rejection or treatment failure occurred in 35.3% in the MMF group by 6 months after transplant, compared with 32.4% in the AZA group without statistic significance(12/34 vs. 11/34, p>0.05). One year graft survival rate was 91.2% and 97.1%, respectively, and CMV infection was documented in 4 patients(1/34 vs. 3/34, p>0.05). Conclusion : There were no significant differences in the incidence of acute rejection episodes and one year graft survival rate between two groups. In contrast, previous studies showed that MMF could have lowered the incidence of acute rejection episodes and improved graft survival rate. This discrepancy in results might be explained that donor factors were important to cadaveric renal transplantation. Thus, we suggest that the influences of donor factors should be considered in further clinical study of cadaveric renal trans-plantation.

혈역학적으로 안정된 혈액투석환자에서 심장 질환 지표로서 B-type Natriuretic Peptide (BNP), N-terminal pro-BNP Cardiac Troponin T 측정

백현정 ( Hyun Jeong Baek ),김정아 ( Jung Ah Kim ),최소연 ( So Yeon Choi ),도연실 ( Yeon Sil Do ),장은희 ( Eun Hee Jang ),김정인 ( Jung In Kim ),도정호 ( Jung Ho Do ),최성철 ( Sung Chul Choi ),이정은 ( Jung Eun Lee ),허우성 ( Woo S 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

목적: 만성 신질환 환자들은 일반인에 비해서 관상 동맥질환과 좌심실 비대가 동반되는 경우가 많다. 일반인에서 Btype Natriuretic Peptide (BNP), N-terminal pro-BNP (NT-proBNP), Cardiac Troponin T (cTnT)가 심질환 진단과 예후 인자로 유용하게 사용되고 있다. 투석 환자에서도 표지자를 이용하여 심질환을 예측할 수 있는지 알아보고자 하였다. 방법: 2004년 9월부터 9개월간 삼성서울병원에서 6개월 이상 투석을 받고 있는 환자 중 급성 심혈관계 질환이 없는 27명을 대상으로 하였다. 같은 날 채혈과 심장초음파 검사를 시행하였다. 결과: BNP, NT-proBNP, cTnT 중앙값 (pg/mL)은 각각 433, 10,598, 0.021이었다. NT-proBNP는 BNP (r= 0.940, p=0.000), cTnT (r=0.504, p=0.009)와 뚜렷한 양의 상관관계를 보였다. BNP, NT-proBNP는 심박출 계수와는 음의 상관관계를 (각각 r=-0.502, p=0.008 vs. r=-0.556, p=0.003), 좌심실 질량 지수와는 양의 상관관계를 보였다 (각각 r=0.619, p=0.001 vs. r=0.718, p=0.000). cTnT는 심박출 계수와 음의 상관관계를 보였으나 (r=-0.513, p=0.007), 좌심실 질량 지수와는 상관관계를 보이지 않았다 (r=0.369, p=0.063). 심박출 계수에 독립적으로 영향을 미치는 인자는 albumin, cholesterol, LDL-cholesterol, NT-proBNP이었고 (R2=0.80), 좌심실 질량 지수에 영향을 미치는 인자는 나이, body mass index, LDL-cholesterol, NT-proBNP, cTnT이었다 (R2=0.78). 결론: 혈액투석을 받고 있는 환자에서도 표지자 측정이 심질환을 예측하는데 도움이 될 것으로 사료된다. Purpose: The prevalence of coronary artery disease and left ventricular hypertrophy (LVH) is higher in patients with chronic kidney disease (CKD) than in the general population. In the general population, BNP, NT-proBNP, and cTnT are useful markers of cardiac disease. Recently, studies on biomarkers in patients with CKD have been reported. However, the effect of renal disease on these markers is still uncertain particularly in hemodialysis patients. We investigated the potential of BNP, NT-proBNP, and cTnT as biomarkers of cardiac disease in hemodialysis patients. Methods: We prospectively studied 27 hemodialysis patients without cardiovascular event within the last 6 months. We performed an echocardiography and blood samples for plasma BNP, NT-proBNP and cTnT. Results: Median BNP, NT-proBNP, and cTnT level (pg/mL) were 433, 10,598, and 0.021, respectively. NT-proBNP was correlated with BNP (r=0.940, p=0.000) and cTnT (r=0.504, p=0.009). There was a negative correlation between BNP and left ventricular ejection fraction (LVEF) (r=-0.502, p=0.008), between NT-proBNP and LVEF (r=-0.556, p=0.003), and between cTnT and LVEF (r=-0.513, p=0.007). There was a positive correlation between BNP and LV mass index (LVMI) (g/m2) (r=0.619, p=0.001). Also, a positive correlation between NT-proBNP and LVMI was shown (r=0.718, p=0.000). There was an insignificant positive correlation between cTnT and LVMI (r=0.369, p=0.063). Albumin, cholesterol, LDL-cholesterol, and NT-proBNP had an independent effect on LVEF (R2=0.80). Age, body mass index, LDL-cholesterol, NT-proBNP, and cTnT had an independent effect on LVMI (R2=0.78). Conclusion: BNP, NT-proBNP, and cTnT may be as a noninvasive diagnostic or prognostic marker of cardiac disease in stable hemodialysis patients.

대추幼木의 生長과 無機成分含量에 미치는 黑色 폴리에틸렌 필름 및 볏짚의 土壤被覆 效果

卞在均(Byun Jae-Kyun),都正鎬(Do Jeong-Ho),張璟浩(Chang Kyung-Ho) 한국원예학회 1991 Horticulture, Environment, and Biotechnology Vol.32 No.1

성인에서 장기간 Furosemide 오용과 연관된 신수질 석회화

최성철 ( Choe Seong Cheol ),김윤구 ( Kim Yun Gu ),김정아 ( Kim Jeong A ),도정호 ( Do Jeong Ho ),한혁준 ( Han Hyeog Jun ),이현희 ( Lee Hyeon Hui ),윤수진 ( Yun Su Jin ),이영기 ( Lee Yeong Gi ),허우성 ( Heo U Seong ),김대중 ( Kim Da 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6

목 적: Furosemide 장기간 사용은 신생아에서 신수질 석회화(medullary nephrocalcinosis)발생의 주 위험 인자로 알려져 있다. 비록 furosemide가 성인에서도 여러 임상적 상황들에서 사용되지만 성인에서 신수질 석회화와 연관성은 확실하지 않다. 저자들은 성인에서 furosemide 장기간 사용과 신수질 석회화 사이에 연관성이 있는지를 알아보기 위하여 본 연구를 시행하였다. 방 법 : 오랜 기간(복용기간 범위 3-25년) 부종이나 체중 조절을 목적으로 습관적으로 furosemide를 복용한 18명(남 : 녀=1 : 17, 연령범위 21-59세)을 대상으로 하였다. 신수질 석회화는신초음파나 컴퓨터 단층 촬영, 또는 신생검을 통해 확인하였고 대상환자들을 신수질 석회화(+)군과 신수질 석회하(-)군으로 분류하여 임상적 특성들을 비교하였다. 결 과 : 신장 초음파와 컴퓨터 단층 촬영상 신수질 석회화는 양측 신장 수질부 추체(pyramid)들에서 18명 중 15명(83.3%)에서 관찰되었다. Furosemide 오용기간은 신수질 석회화(+)군과 신수질 석회화(-)군에서 차이가 없었지만(10.1±1.7년 대 15.3±0.9, p>0.05), furosemide 하루복용 용량은 신수질 석회화(+)군이 신수질 석회화(-)보다 더 많았다(538±174 대 67±13 mg/일, p<0.01). 두 군간 하루 요 칼슘배설양과 혈청 칼슘, 크레아티닌 청소율치의 차이는 없었다.대상 환자 중 3명에서 시행한 신생검 병리소견에서 국소적인 세뇨관 간질 위축과 섬유화가 관찰되었고 석회화는 외부 수질 세뇨관 간질에서 관찰되었다.결 론: 저자들은 성인에서 furosemide 장기 복용이 신수질 석회화를 유발할 수 있으며 신수질 석회화 발생의 위험성은 furosemide 복용 용량과 관련이 있다는 것을 알 수 있었다. 저자들은 성인에서 우연히 신장 초음파나 컴퓨터 단층 촬영상 신수질 석회화 소견이 관찰되면 furosemide 장기 오용 여부를 반드시 감별진단 해야 한다고 제안한다. Background : The use of furosemide is well recognized as a predisposing factor to nephrocalcinosis (NC) in infants. Although furosemide is widely used for various clinical settings in adults, the association of furosemide use and nephrocalcinosis in adults is not well established. Methods : We studied 18 consecutive adult patients( male : female=1 : 17, age range 21-59 years) who took furosemide habitually to control their weights or edema for a long-term period(range 3-25 years). NC was evaluated using renal ultrasonography(US), computed tomography(CT) and/or kidney biopsies. Patients were categorized into NC(+) and NC(-) groups while the difference in clinical features were investigated. Results : Renal US and CT revealed nephrocalcinosis in the bilateral medullary pyramids in 15(83.3 %) out of 18 patients. The duration of furosemide abuse was not different between NC(+) and NC(-) groups(10.1±1.7 years vs. 15.3±0.9, p>0.05). The daily dose of furosemide was higher in NC(+) group than the NC(-) group(538±174 vs. 67±13 mg/day, p<0.01), however. All patients showed a variable degree of renal insufficiency and there was no difference in creatinine clearance between two groups(p>0.05). The kidney biopsies performed in three patients showed focal tubulointerstitial fibrosis and atrophy and calcifications were observed at outer medullary tubulointerstitium. Conclusion : Long-term furosemide abuse could cause medullary nephrocalcinosis in adults and the risk of developing of nephrocalcinosis is correlated with the daily dose of furosemide. We suggest that long-term furosemide abuse should be suspected in adult patients when medullary nephrocalcinosis is incidentally detected by US and/or CT.

복수가 동반된 간경변증을 가진 말기 신부전 환자에서 복막투석의 안정성

김정인 ( Jung In Kim ),이정은 ( Jung Eun Lee ),백현정 ( Hyun Jeong Baek ),최성철 ( Sung Chul Choi ),도정호 ( Jung Ho Do ),허우성 ( Woo Seong Huh ),김윤구 ( Yoon Goo Kim ),김대중 ( Dae Joong Kim ),오하영 ( Ha Young Oh ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.3

Purpose : When liver cirrhosis patients accompanying ascites need renal replacement therapy because of chronic renal failure (CRF), peritoneal dialysis (PD) can allow direct removal of ascites and prevent anticoagulants use. However, since PD might aggravate hypoalbuminemia and increase chances of peritonitis, clinicians tend to hesitate to apply it to those patients. The aim of the present study is to assess the outcome and stability of PD for the treatment of CRF patient with cirrhosis accompanying ascites. Methods : A retrospective study based on the clinical records was performed in cirrhotic patients with ascites in whom PD was performed for the treatment of CRF and who were followed up at Samsung Medical Center unit, between January 1995 and July 2005. Results : In our study, 15 patients were enrolled. Child-pugh class was worse in non-survival group than survival group (p<0.01). One-year patient survival was 40% in Class C and 75% in Class B, and patient survival differed between Class C and Class B (p=0.0014). Causes of death were terminal liver failure (n=6) and sepsis due to pneumonia (n=1). Total 27 episodes of peritonitis occurred, and the peritonitis rates were 0.91 episodes/patients-year. Conclusion : Although the peritonitis rates turned out somewhat high, the use of PD for the treatment of CRF in patients with liver cirrhosis accompanying ascites seems to be safe and effective. Main cause of death in our study seems to be related to liver disease.

Icodextrin 복막투석시 혈당 과다 측정으로 진단이 지연된 저혈당성 경련

최성철 ( Sung Chul Choi ),김대중 ( Dae Joong Kim ),백현정 ( Hyun Jeong Baek ),김정인 ( Jung In Kim ),도정호 ( Jung Ho Do ),이정은 ( Jung Eun Lee ),김윤구 ( Yoon Goo Kim ),오하영 ( Ha Young Oh ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.3

오스테나이트계 Fe-25Mn-Al-0.5C 강의 피로성질에 미치는 Al 첨가의 영향

도정호,권숙인,전채홍 한국열처리공학회 1998 熱處理工學會誌 Vol.11 No.4

The effect of Al addition on the fatigue properties of austenitic Fe-25Mn-Al-0.5C steels was studied. When Al was not added to the Fe-25Mn 0.5C steel. the strain induced ε martensites, deformation twins and slip bands were formed during fatigue deformation. When 2wt% of Al was added to the steel, the deformation twins and slip bands were formed during fatigue deformation. When 5wt% of Al was added, only slip bands were formed. In low cycle fatigue test, the alloys containing 0wt% and 2wt%Al showed the cyclic hardening due to ε martensites and deformation twins, resulting in shorter fatigue lives than the alloy containing 5wt%Al. In fatigue crack propagation test, the alloy without Al showed the highest crack propagation rate. The fracture surface of the alloy without Al was flat, whereas that of the alloy with 2% or 5%Al was rough. The ΔK_(th), values of the alloys with 0%, 2% and 5%Al were 16, 17.5, and 20.5 MPam^(1/2), respectively.

만성 정신분열증 환자의 Clozapine 및 Haloperidol 투여 후 눈깜박임에 대한 효과

이홍식,도정호,이희상 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.1

Objectives : It has been suggested that spontaneous eye blink rates might be, in part , determined by central dopamine activity. The purpose of our study was to investigate wether schizophrenics had higher eye blinking rate than normal controls and to compare eye blink rates of a group of schizophrenics receiving clozapine with a group of schizophrenics receiving haloperidol. Methods : We investigated the blink rate of normal controls(N=30) and chronic schizophrenics(N=42), who were assigned to clozapine(N=22) or haloperido(N=20) for eight weeks. In the chronic schizophrenics, blink rate and over all clinical states were assessed every two weeks until the end 8th week using the push-button counter and Brief Psychiatric Rating Scale (BPRS). Results : The chronic schizophrenics had a blink rate significantly higher than the normal controls and the blink rates were significantly decreased in the schizophrenics who were treated with colzpaine or haloperidol. But, there was no significant difference between the clozapine group and the haloperidol group and no significant correlation between blink rate change and change of BPRS scores. Conclusions : Our results suggest that the eye blinking is related to other neurotransmitters as well as dopamine in the central nervous system.

Clozapine에 의한 무과립구증

이홍식,김지현,이희상,도정호,김찬형,유계준 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.1

The authors reported one case of agranulocytosis that occurred in the clozapine treatment in a 34-year-old male patient with chronic schizophrenia. Agranulocytosis, a WBC count of 2700 with 4% neutrophils, developed on Day 25 of clozapine treatment, when clozapine was stopped. On day 26, he became febrile with temperature of 38℃ and he was treated with antibiotics, Claforan for 4 days, and received carefully daily blood monitering and observation. Six days after stopping the administration of clozapine, his WBC exhibited the normal range with increasing numbers of neutrophils(WBC, 6000/mm³; neutrophils, 43%) and he began to improve clinically. Also, we described the recent review of incidence, the natural history and implicated possible mechanisms for clozapine-induced agranulocytosis.