Henoch-$Sch{\ddot{o}}nlein$(HS) 신염에서 장기 스테로이드와 Azathioprine의 병합치료 효과

문경상,진소영,김은미,Moon, Kyoung-Sang,Jin, So-Young,Kim, Eun-Mi 대한소아신장학회 1998 Childhood kidney diseases Vol.2 No.2

목 적 : HS 신염은 확정된 특별한 치료지침이 없으며, 신염의 정도가 심한 경우 단일 스테로이드 요법으로 치료 효과가 좋지 않으므로 장기간 스테로이드 투여 및 azathioprine의 병합에 의한 치료 효과를 관찰하기 위해 본 연구를 시행하였다. 대상 및 방법 : Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP)로 진단 받은 후 심한 단백뇨(40 mg/hr/$m^2$ 이상)를 보인 HS 신염 환아 5례(남자 2례, 여자 3례)를 대상으로 신장 생검을 실시하여 ISKDC grade III 이상을 보인 환아를 대상으로 하였고 치료방법은 1)스테로이드 pulse치료를 격일로 6회 정주한 다음, 2) 경구로 스테로이드를 2mg/kg/day(최대 80mg/day) 1개월 투여한 후 1 mg/kg/day으로 1 개월 투여하고 2년간 격일로 1mg/kg/day경구 투여하였다. 3)스테로이드 pulse치료 시행 뒤 azathioprine(2 mg/kg/day)을 2년간 병합하여 경구 투여하였다. 단백뇨 및 미세 혈뇨를 추적 검사하여 임상적 관해 여부를 조사하였고 추적 신장조직 검사를 시행하였다. 결 과 :발병 평균 연령은 $10.5{\pm}3.4$년이었으며 HSP에서 신염으로의 발병 기간은 2주에서 5개월로 평균 $7.4{\pm}7.4$주이었다. 24시간 뇨단백은 평균 $4857.8{\pm}2046.1$ mg/day이었다. 임상적 관해는 5례 중 4례($80\%$)로 단백뇨 소실의 평균기간은 $5{\pm}2.4$개월, 미세혈뇨의 소실 기간은 평균 $13.3{\pm}2.9$개월이었다. 병리학적 소견은 ISKDC 분류로 Crade IIIb가 3례, Grade VI가 2례로 추적 신장 조직 검사를 시행한 4례 중 3례에서 조직학적으로 호전된 양상을 보였다. 결 론 : 아직까지 HS 신염에 대한 확정된 치료 지침이 없는 상황에서 본 연구의 장기간 스테로이드 경구 투여 및 azathioprine의 병합 요법이 임상적, 조직학적으로 효과가 있는 것으로 생각되며 앞으로 더 많은 환아에서 추적 관찰이 필요하다. Purpose : There is no specific treatment guidelines for Henoch-$Sch{\ddot{o}}nlein$(HS) nephritis. Therefore we performed this study to observe the effect of long term steroid therapy combined with azathioprine Methods : Treatment protocols; 1) Steroid pulse therapy: methylprednisolon 30 mg/kg/dose, maximum 1 gm, intravenolisly 6 times for alternate day. 2) Oral steroid was given 2 mg/kg/day for 1 month, 1 mg/kg/day for following 1 month and alternate day oral steroid combined with azathioprine 2 mg/kg/day for 2 years. Results : Time period from HSP to onset of HS nephritis was between 2 weeks to 5 months with mean $7.4{\pm}7.4$ weeks. Clinical remission were seen in 4 cases out of 5 ($80\%$). Mean time period with disappearance of proteinuria and microscopic hematuria were $5{\pm}2.4$ month and $13.3{\pm}2.9$ month respectively. On pathologic findings by ISKDC, 3 cases were grade IIIb, 2 cases were grade IV in first kidney biopsies and showed pathologic improvement in follow up tidneybiopsiesafterlyearstreatment. Conclusion : As there is no definitive treatment for HS nephritis so far, our study of long term oral steroid therapy with azathioprine was effective in clinical and histologic aspect. Therefore further study in HS nephritis with in a large group will be needed in the future.

항경련제가 갑상선기능에 미치는 영향

서은숙,이동환,문경상 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Object: Many studies on the effect of long-term treatment with anticonvulsant on thyroid function in children have been reported. Because the mechanism and metabolism of each drugs are different, the effect of anticonvulsants on thyroid function is controversial. And it has been reported that competitive binding with serum protein, increased intrahepatic excretion and more recently effects on hypothalamus and pituitary gland make changes in thyroid hormones. Therefore, we checked T₃, T₄, TSH levels of the patients who have been taking anticonvulsants for more than 1 years, in order to the influence of carbamazepine and valproic acid on thyroid function. Method: 38 patients (male 18, female 18) who have been diagnosed as epilepsy during the period of Jan 1996 to Dec 1996 at SoonChunHyang University Hospital, and being treated with anticonvulsant, the serum levels of triiodothyronine(T₃) thyroxine(T₄) and TSH were measured were measured by RIA. Result: Of these 38 patients, 18 were males and 18 were females. The mean age of the patients was 9.46 ±3.86(2 to 17 years old) years old. In 10 cases were treated with valproic acid, in 7 cases received carbamazepine and in 11 cases were treated with combined therapy. In valproic acid treated group, T₃, T₄, TSH levels were 145.05±25.34ng/dl, 8.86±2.17㎍/dl, 2.73±0.86 μU/ml respectively. In Carbamazepine treated group. T₃, T₄, TSH levels were group, T₃, T₄, TSH levels were 162.06 ±26.78ng/dl, 9.66 ±4.18㎍/dl 2.01 ±0.78 μU/ml respectively. Although the levels of T₃, T₄, TSH were within normal range, they were relatively decreased compared to the control group. The carbamazepine treated group was revield lower T₃, T₄ levels compared to those treated with valproic acid, but we couldn't find out statistical significance. Conclusion: In our study we found out long-term treatment with anticonvulsants including carbamzepine and valproic acid had effects on thyroid function and follow-up test with larger group of patients should be proceeded.

인지적 도덕발달이론의 단계이행과정에 대한 분석

문경상,나귀옥 순천향대학교 1994 논문집 Vol.17 No.1

The purpose of this study is to re-examine the differences between traditional modes of Kohlberg's moral developmental theory and the assumption of Kim Sang-yun. Kim's moral developmental theory is that stage 2 and P are of cognitive features whereas stage 3 and 4 are noncognitive, and there are differences between boys and girls in moral development. The hypotheses set up in this study are as follows. In the stage of morality related to cognitive characteristics Hy.1-1 Morality of stage 2 will reveal differences with increasing age. Hy.1-2 Morality of stage P will reveal differences with increasing age. In the stage of morality related to noncognitive characheristics Hy.2-1 Morality of stage 3 will reveal no differences with increasing age. Hy.2-2 Morality of stage 4 will reveal no differences with increasing age. In the trend of moral development between the sexes Hy.3-1 There will be no sex differences in morality of stage 2 and stage P. Hy.3-2 There will be sex differences in morality of stage 3 and stage 4. This study covered the period from February 8 to 13, 1993. The object of this study sampled at random are 6th graders of a primary school. 2nd graders of a middle school, and 1st graders of a high school in Sosan in Chunguam. The number of whole sampling was 412. The 186 samples were meaningless and without consistency. At last 226 samples were used on this study. This study used Rest's DIT translated by Kim and Park. The average score of the groups was analyzed by One-Way ANOVA and the differences between the groups by Tukey test. The result of this study is that there was a meaningful difference in the average score between the age groups in stage 2 and 3, and that there was a trend in which the score gets lower with increasing age. On the other hand, moral development of stage 4 didn't reveal any meaningful difference in the average score between the age groups. And morality of stage P reveals the meaningful difference of the average score in the different age groups and the average score increased with age. In moral development, there is no sex difference in stage 2, 3, and 4, but the girls are different from the boys in stage 4. This corresponds with Kim's study. The following conclusions are derived from the result. First, Kim suggests like this : morality contains both cognitive and noncognitive characterstics, and in the developmental trend related to cognitive characteristics, stage 2 and P can be replaced, whereas stage 3 and stage 4 related to noncognitive characteristics are adopted at the very early age and last without regard to age. But Kim's assumption can not be proved validity. Second, Kim's assumption that the developmental trend in stage 2 and P reflecting cognitive charcteristics will reveal sex differences has no validity. The cognitive theory of moral development that the sex differences have no influence on moral development can be more valid.

아토피피부염 환자의 발병과 치료에 대한 실태 조사

임정우 ( Jung Woo Rhim ),문경상 ( Kyoung Sang Moon ),공도연 ( Do Youn Kong ),편복양 ( Bok Yang Pyun ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2005 소아알레르기 및 호흡기학회지 Vol.15 No.1

아토피피부염 환자의 발병과 치료에 대한 실태 조사

임정우,공도연,편복양,문경상 대한 소아알레르기 호흡기학회 2005 Allergy Asthma & Respiratory Disease Vol.15 No.1

Purpose:Social concern about atopic dermatitis is increasing these days, and there is much informations from the mass media. However, we have difficulties to diagnose and treat atopic dermatitis because there is no general guideline. So these studies were done to help establish guidelines for proper diagnosis and treatment of atopic dermatitis. Methods:The authors made up a questionnaire consisting of symptoms, environment, birth, diet, family history, previous treatment and common knowledge about atopic dermatitis. We studied moderate to severe atopic dermatitis patients, from February to August, 2003, using a survey containing 40 questions. We tested serum total IgE, specific IgE(Pharmacia, uni CAP), skin culture, complete blood counts, AST/ALT, and IgA. Results:In our study results, the onset of atopic dermatitis, which was over moderate, was averaged 13 months after birth, and the earliest onset was 1 week after birth. The locations of skin lesion were lower extremities, face, buttocks, neck, and body, according to frequency. The most common type of housing was apartments. Many were getting breast milk feeding, had family members who smoke and most had no pets. Regardless of the severity of clinical manifestations, many patients did not have allergic tests and took just oriental medicine. Secondary infections were more common in patients who had fewer baths. Conclusion:Therefore the education of patients and their parents about etiology and progress of atopic dermatitis is needed. And for pediatricians, a general guideline of diagnosis and treatment needs to be established. 목 적 : 최근 아토피피부염에 대한 사회적 관심이 많아지면서 각종 매체를 통한 정보가 많지만 아토피피부염의 치료에 대한 공통된 지침이 없어서 진단과 치료에 어려움을 겪고 있는 현실이다. 따라서 환자들의 발병양상과 치료형태를 조사하여 적절한 진단과 치료 지침을 세우는데 도움을 주고자 이 연구를 시행하였다.방 법 : 2003년 2월부터 8월까지 순천향대학교병원 소아과 알레르기클리닉으로 전원된 중등도와 중증의 아토피피부염 환자를 대상으로 증상, 생활환경, 출생과 식생활, 가족력, 병원에 오기 전까지 치료하고 있는 상황, 알레르기 질환에 대한 일반 지식의 내용으로 구성된 총 40문항의 설문지로 설문 조사를 시행하고, 혈청 총 IgE, 특이 IgE, 피부 균 배양검사, 일반혈액검사, AST/ ALT, IgA 검사를 시행하였다.결 과 : 중등도 이상의 아토피피부염 환아의 발병 시기는 평균 생후 13개월이었으며 빠른 경우에는 생후 1주일부터 발병한 경우도 있었다. 피부병변이 심한 부위는 하지, 얼굴, 엉덩이, 목, 몸통 순이었는데, 연령에 따라 다소 차이가 있었다. 주거 형태는 대부분이 아파트나 연립주택과 같은 공동 주거 형태였으며 모유수유아가 많았고 가족 중 흡연하는 사람이 많았으며 애완동물은 기르지 않는 경우가 많았다. 임상증상의 중증도에 비해 알레르기에 대한 검사를 받지 않고 민간요법 등을 하는 예가 많았다. 목욕 횟수가 적을수록 2차 감염이 많았으며, 피부도말 배양검사에서 Staphylococcus aureus가 56명 중 30명(54%)에서 배양되었다. 결 론:환자와 보호자를 대상으로 아토피피부염의 원인과 경과에 대한 교육이 필요하며, 소아과 전문의들을 대상으로도 적극적인 진단과 치료에 대한 지침이 필요한 것으로 사료되었다.