전향적 연구에 의한 경주지역 주민의 Helicobacter pylori 재감염률 및 관련요인

도준형(Joon Hyung Doh),강복수(Pock Soo Kang),황태윤(Tae Yoon Hwang),이경수(Kyeong Soo Lee),김석범(Seok Beom Kim),김상규(Sang Kyu Kim),김호각(Ho Gak Kim) 대한내과학회 2002 대한내과학회지 Vol.63 No.4

목적 : 지역사회 주민들에 감염된 H. pylori에 대한 성공적인 제균치료가 이루어진 이후의 1년 재감염률을 파악하고 재감염과 관련된 요인을 분석하기 위하여 본 연구를 수행하였다. 방법 : 1998년 3월 경상북도 경주시에 거주하는 30세 이상의 소화불량 증상이 있는 주민 중 내시경 검사를 통한 신속요소분해효소 검사에서 양성으로 판정된 사람에 대하여 H. pylori 제균치료를 위해 tripotassium dicitrato bismuthate 600 mg 1일 2회, amoxicillin 500 mg 1일 4회, metronidazole 250 mg 1일 4회로 구성된 삼제요법을 실시하고 1년 후 13C-요소호기 검사에서 음성으로 판정된 87명 중 추적이 가능하였던 86명을 대상으로 하였다. 대상자들을 1년간 추적 관찰한 후 재감염 여부를 판정하기 위한 13C-요소호기 검사와 재감염 관련 요인의 파악을 위한 설문조사를 실시하였다. 결과 : 13C-요소호기 검사에서 양성으로 판정 받은 대상자는 16명으로 H. pylori의 1년 재감염률은 18.6%였다. 연령별로 50세 미만군에서는 1년 재감염률이 4.5%이었으나, 50세 이상군에서는 1년 재감염률이 23.4%로 두 연령 군간에 통계적으로 유의한 차이가 있었다(p<0.05). 13C-요소호기검사에서 음성으로 판정 받은 후 1년 간 연구 대상자 본인이 느끼는 주관적 소화불량 증상 중 '식후 포만감'이 있는 경우와 '상복부 팽만감'이 있는 경우에 각각 재감염률이 40.0%와 27.9%로 아닌 경우에 비하여 통계학적으로 유의한 차이가 있었다(p<0.01, p<0.05). 소화불량의 증상인 식후 포만감, 상복부 팽만감, 역류 증상, 속쓰림 그리고 상복부 통증의 증상 각각에 1점씩의 점수를 부여하여 5점 만점으로 소화불량 증상을 점수화 했을 때, 점수가 4∼5점인 경우에 재감염률이 39.1%이었고, 2∼3점인 경우에는 12.5%, 1점 이하인 경우에는 10.3%로 점수가 높을수록 재감염률이 높아지는 양상이었으며 통계학적으로도 유의하였다(p<0.05). 재감염에 영향을 미칠 수 있는 요인을 예측하기 위한 다중 로지스틱 회귀분석 결과 최근 1년 동안의 소화불량 증상 점수가 4∼5점인 경우에 교차비가 4.5로 통계학적으로 재감염에 유의한 영향을 미치는 변수였다(p<0.05). 결론 : H. pylori 제균치료가 성공적으로 이루어진 지역사회 주민의 1년 재감염률은 18.6%였다. 개인의 주관적인 소화불량 증상 호소 정도는 지역사회에서 H. pylori 재감염을 시사하는 근거의 하나로 H. pylori 제균치료 후 추적검사에 활용될 수 있을 것이다. Background : High prevalence of Helicobacter pylori (H. pylori) in developing countries may result in high reinfection rate after eradication therapy, but there were few studies on H. pylori reinfection, especially in community population. The aim of this study was to investigate the one -year reinfection rate of H. pylori after successful eradication therapy and the factors related to the reinfection of H. pylori in community population. Methods : 86 persons who had been confirmed as H. pylori-negative by 13C-urea breath test were included. They were ones of 181 persons treated by eradication regimen one year ago because of H. pylori-positive in serologic H. pylori antibody test and rapid urease test. The reinfection rate of H. pylori and the factors related to the reinfection of H. pylori were investigated after one-year follow-up. The subjects were confirmed as H. pylori reinfection by repetitive 13C-urea breath test and asked to answer the questionnaire regarding demographic characteristics, dyspepsia symptoms, health-related behaviors and family history. Results : The one-year reinfection rate was 18.6% in this study. The one-year reinfection rate of the subjects who aged above 50 years was 23.4% (p<0.05). The symptom score (total 5) was positively related to H. pylori reinfection (p<0.05). In multivariate logistic regression analysis, the subjective symptom score was the significant factor in predicting H. pylori positivity by 13C-urea breath test (OR=4.5, p<0.05). Conclusion : During 1 year period after successful H. pylori eradication, the reinfection rate of H. pylori was 18.6%. The subjective symptom score survey by questionnaire may be useful predictor of H. pylori reinfection in community setting.(Korean J Med 63:357-368, 2002)

섭식장애 환자에서 전도 이상 및 관련 요인

배상빈,도준형,김율리,Bae, Sang-Bin,Doh, Joon-Hyung,Kim, Youl-Ri 대한생물정신의학회 2012 생물정신의학 Vol.19 No.1

Objectives : QT interval prolongation and dispersion known as indicators of an increased risk for ventricular arrhythmias and sudden death have been reported to be prolonged in patients with anorexia nervosa. The aims of this study were to compare conduction abnormalities in Korean patients with anorexia nervosa and bulimia nervosa, and to examine its relation with clinical and laboratory factors. Methods : We retrospectively examined 45 women with anorexia nervosa and 75 women with bulimia nervosa who were assessed by 12-lead electrocardiogram at baseline. QT interval and corrected QT interval, QT dispersion of the difference between the longest and shortest QT intervals, and abnormal U wave were measured for conduction abnormalities. Results : QT interval was significantly longer in patients with anorexia nervosa compared with those with bulimia nervosa. There were no differences in QTc (Corrected QT), QTd (QT dispersion) and abnormal U wave between patients with anorexia nervosa and those with bulimia nervosa. QTd was significantly correlated with the lowest ever lifetime body mass index ($kg/m^2$) as well as the serum amylase level in patients with anorexia nervosa. Conclusions : These results suggest some conduction abnormalities reported in patients with anorexia nervosa are also found in patients with bulimia nervosa. It appears that severity of weight loss and purging behavior could affect the cardiac arrhythmia in patients with eating disorders. Appropriate attention should be paid to cardiac involvement in patients with eating disorders.

증례 : 순환기 ; 대동맥 수술 후 발생한 전이성 진균 가성동맥류 1예

최윤호 ( Yun Ho Choi ),도준형 ( Joon Hyung Doh ),장우익 ( Woo Ik Chang ),주미 ( Mee Joo ),권성욱 ( Sung Uk Kwon ),남궁준 ( June Namgung ),이성윤 ( Sung Yun Lee ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1S

64절편 다검출기 CT 관상동맥 조영술을 이용한 관상동맥 질환 진단의 정확도

남궁준 ( June Namgung ),최현민 ( Hyun Min Choe ),권성욱 ( Sung Uk Kwon ),도준형 ( Joon Hyung Doh ),이성윤 ( Sung Yun Lee ),허감 ( Gham Hur ),이원로 ( Won Ro Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1

목적: 관상동맥 질환의 진단에 있어서 현재까지 가장 정확한 방법은 고식적 관상동맥 조영술(conventional coronary angiography)이었다. 다검출기 CT (multidetector computed tomography, MDCT) 관상동맥 조영술은 1999년에 처음 등장한 이래로 빠른 기술적 진보를 보여 최근에 임상에 도입된 64절편 MDCT는 공간 및 시간해상도를 더욱 향상시켜 비관혈적으로 관상동맥 영상을 보다 정확히 규명하기에 이르렀다. 이에 본 연구에서는 64절편 MDCT를 사용하여 MDCT 관상동맥 조영술의 진단 정확도를 확인하여 기존의 관혈적 관상동맥 조영술을 대치할 수 있는지 판정하였다. 방법: 고식적 관상동맥 조영술이 예정된 101명(남자 63명, 여자 38명; 평균연령 63.7±10.5세)을 대상으로 MDCT와 고식적 관상동맥 조영술을 7일 이내에 시행하였다. 관상동맥 각 분절의 유의한 협착은 관상동맥 내경의 50% 이상 협착으로 정의하여 고식적 관상동맥 조영술의 영상과 비교하여 MDCT의 진단적 정확도를 측정하였다. 관상동맥의 유의한 협착정도를 각각 관상동맥의 분절별, 혈관별, 환자별로 구분하여 판정하였다. 결과: 총 1,440개의 관상동맥분절 중 1,348개의 분절(94%)이 MDCT로 분석 가능한 영상을 얻을 수 있었고 이중 고식적 관상동맥 조영술에서 209개의 관상동맥 분절의 유의한 협착이 있었다. MDCT의 진단정확도는 민감도, 특이도 양성예측도, 음성예측도가 분절별 평가에서 각각 96%, 97%, 85%, 99%, 혈관별 평가에서 각각 99%, 95%, 88%, 99%, 환자별 평가에서 각각 100%, 94%, 97%, 100%였다. 위양성이 37분절에서 있었고 관상동맥 석회화(26분절)가 위양성의 주요 원인이었다. 결론: 본 연구에서 64절편 MDCT 관상동맥 조영술은 높은 진단정확도를 보였다. 따라서 선택적인 환자에서 불필요한 관혈적 관상동맥 조영술의 시행을 줄이고 이를 대치할 수 있는 유용한 검사로 판단된다. Background/Aims: Invasive coronary angiography remains the gold standard in the diagnosis of coronary artery disease. However, multidetector CT (MDCT) coronary angiography is an emerging technique that is available for the non-invasive detection of coronary artery stenoses. While the diagnostic accuracy of first generation MDCT is limited, recently released 64-slice MDCT has yielded promising results due to increased temporal and spatial resolution. The objective of this study was to investigate the diagnostic accuracy of non-invasive 64-slice MDCT for coronary artery disease. Methods: One hundred one patients (63 males and 38 females; mean age, 63.7±10.5 years) undergoing conventional coronary angiography were included in this study. All coronary arteries, including the distal segments and side branches, were analyzed for the presence of significant stenosis (≥50% diameter stenosis) and compared with of the quantitative coronary angiographic findings. Results: Of the 1,440 coronary artery segments studied, 1,348 segments were assessed quantitatively by both MDCT and conventional coronary angiography (94%). Two hundred nine significant stenoses were detected by conventional coronary angiography. On a segment-based analysis, the senisitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. On a vessel-based analysis, the sensitivity, specificity, and positive and negative predictive values of 64-slice MDCT were 96, 97, 85, and 99%, respectively. The corresponding values obtained on a patient-based analysis were 100, 94, 97, and 100%, respectively. Coronary calcification was the major cause of false-positive findings. Conclusions: This study demonstrated that 64-slice MDCT coronary angiography is of similar accuracy as conventional coronary angiography for the detection of coronary artery disease. In selected groups of patients, 64-slice MDCT may replace the more invasive coronary angiography. (Korean J Med 75:42-53, 2008)

전신성 홍반성 루푸스에 동반된 Hemophagocytic syndrome

오동호 ( Dong Ho Oh ),송용호 ( Yong Ho Song ),김창수 ( Chang Soo Kim ),김재훈 ( Jea Hoon Kim ),도준형 ( Joon Hyung Doh ),최병렬 ( Byung Reul Choi ),김상경 ( Sang Gyung Kim ),장성국 ( Sung Guk Chang ),최정윤 ( Jung Yoon Choe ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

A 45-year-old woman was admitted to our hospital because of a high fever, dyspnea, and myalgia. At the time of admission, a diagnosis of systemic lupus erythematosus(SLE) was made by fulfilling four of the 1982 American College of Rheumatology criteria with increasing levels of anti-nuclear antibody titer(speckled pattern). Prednisolone given orally in an initial dosage of 30mg/day was not effective and she was expired by respiratory failure due to disseminated intravascular coagulation. A diagnosis of hemophagocytic syndrome was made because of the increased number of unusual hemophagocytic cells in the bone marrow. High levels of serum ferritin which are known to reflect macrophage activition, supported the diagnosis of hemophagocytic syndrome. Hemophagocytic syndrome is characterized by activated phagocytosis presumably induced by hypersecretion of cytokines. Malignant lymphoma and infection are the two representative diseases which may cause hemophagocytic syndrome. Recently several acute lupus hemophagocytic syndromes were reported in patients with SLE. Here we report a case of acute lupus hemophagocytic syndrome observed in a patient with SLE with brief review of literatures.

투석 중인 말기신부전 환자에서 관동맥 우회로술과 관동맥 중재술의 장기 성적 비교

선휘경 ( Hui Kyoung Sun ),김나경 ( Na Kyoung Kim ),조유정 ( Yu Jung Cho ),강승대 ( Seung Dae Kang ),김태완 ( Tae Wan Kim ),한금현 ( Kum Hyun Han ),도준형 ( Joon Hyung Doh ),이성윤 ( Sung Yun Lee ),김창영 ( Chang Young Kim ),장우익 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4

Purpose: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. Methods: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. Results: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. Conclusion: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.

패혈증 이후 발생한 스트레스성 심근병증 2례

김종훈,남궁준,박혜연,황철웅,박경일,도준형,이성윤,이원로 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy is a recently described novel cardiac syndrome. This syndrome is characterized by transient asynergy of the ventricular apex or mid-ventricle in the absence of obstructive epicardial coronay artery disease. This report concerns two types of morphologic difference about left ventricular apex and mid-ventricle. In this case, we report two types of stress-induced cardiomyopathy with review of literatures.

발열로 인해 발현된 부루가다 증후군 1례

박혜연,김종훈,박경일,황철웅,김태년,남궁준,도준형,이원로,이성윤 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Brugada syndrome is characterized by right bundle branch block morphology and ST segment elevation in the right precordial leads and a propensity to develop ventricular arrhythmias. Mutations in a cardiac sodium channel gene have been linked to this syndrome, and the ionic mechanisms responsible for the electrocardiographic phenotype are temperature-dependent. This case report describes a patient in whom a typical Brugada ECG pattern developed during fever and returned normal ECG after fever was subsided.

Phenylpropanolamine에 의해 유발된 심근손상 1예

윤원찬,여동근,김학준,박정기,도준형,류재근,최지용,장성국 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.3

파국성 원발성 항인지질 증후군 1예

김재훈,김용진,김창수,최정윤,오동호,김상경,김호각,도준형,현대성,류재근,최병렬 대한내과학회 1999 대한내과학회지 Vol.56 No.2

Catastrophic antiphospholipid syndrome is a rare clinical syndrome characterized by acute multi-organ failure occurring in patients with antiphospholipid antibodies. It is associated with involvement of several end-organs particularly kidneys, lungs, gastrointestinal tracts and adrenal glands and presents catastrophic clinical pictures such as acute renal failure with thrombotic microangiopathy, myocardial failure, adult respiratory distress syndrome, convulsion and disseminated intravascular coagulation. Conventional treatments(e.g. intravenous heparin, steroid, immunosuppressants) were not effective, while plasmapheresis seems to be a useful therapy. We experienced a case of catastrophic primary antiphospholipid syndrome in 41-year-old woman proved by renal biopsy and immuno-serological tests. She developed acute renal failure, multiple esophageal and oral ulcers, adult respiratory distress syndrome, abnormal elevation of hepatic and pancreatic enzymes and signs of disseminated intravascular coagulation. Evidences of any other connective tissue diseases were not found. Renal biopsy revealed features of thrombotic microangiopathic nephropathy and serum antiphospholipid antibody level was elevated(34GPL). In spite of steroid, cyclophosphamide and supportive therapies, her respiratory distress was not improved.