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급성 심근경색 환자에서 예후 예측인자로 혈청 감마-글루타밀 트랜스퍼라제가 유용한가?
이장훈 ( Jang Hoon Lee ),채성철 ( Shung Chull Chae ),이현상 ( Hyun Sang Lee ),박용휘 ( Yong Whi Park ),류현민 ( Hyeon Min Ryu ),이순학 ( Soon Hak Lee ),배명환 ( Myung Hwan Bae ),양동헌 ( Dong Heon Yang ),박헌식 ( Hun Sik Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3
목적: 혈청 감마-글루타밀 트랜스퍼라제(GGT)는 관상동맥 죽상경화반 내의 저밀도 지단백(LDL)의 산화과정을 촉매 하여 관상동맥 질환의 진행에 관여하며, 관상동맥 질환의 과거력이 있는 환자에서 심장사와 재경색의 독립적인 예후 예측인자로 알려져 있다. 저자는 관상동맥 질환의 과거력이 없는 급성 관상동맥 증후군 환자에서 예후 예측인자로서의 혈청 GGT의 효용성을 연구하였다. 방법: 흉통을 주소로 응급실을 방문하여 급성 심근경색으로 진단받은 환자의 혈청 GGT 값을 측정하여 응급실 방문당시 혈청 GGT 값이 정상범위(남자: 8-61 U/L; 여자: 5-31 U/L)에 있었던 192명(남/여=143/49, 평균 연령: 60.8±11.8세)의 환자를 대상으로 하여, 추적기간(16.5±10.8개월) 내 심장사건이 재발한 환자에서의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교 하였다. 결과: 급성 심근경색 환자 192명중 추적 기간 내 17명의 환자에서 심장사와 재경색이 있었으며, 23명의 환자에서 불안정협심증이 있었다. 이 환자들의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교하였을 때 통계적으로 유의한 차이를 보였다(29.5±10.0 U/L 대 25.0±11.2 U/L p=0.024). 그러나 다변량 분석에서 혈청 GGT에 영향을 줄 수 있는 혼란변수들과 알려진 심혈관계 질환의 위험인자로 보정하였을 경우 독립적인 예후 예측인자가 되지 못했다. 결론: 심질환의 과거력이 없는 심근경색 환자의 예후 예측인자로 심근경색의 급성기에 측정한 혈청 GGT 값은 통계적으로 유의한 차이는 있으나, 독립적인 예후 예측인자가 되지 못했다. Background: Serum gamma-glutamyl transferase activity (GGT) is able to catalyse low-density lipoprotein oxidation in coronary atherosclerotic plaques and has a role in the pathogenesis of atherosclerosis. GGT has been shown to be an independent risk factor for cardiac mortality in patients with a previous myocardial infarction. The purpose of this study is to determine the prognostic value of GGT within its normal range at an acute stage in patients with acute myocardial infarction. Methods: In a retrospective study, GGT and other cardiac risk factors were evaluated in 192 patients (M/F=143/49; mean age: 60.8±11.8 years) who were diagnosed with an acute myocardial infarction at the emergency room. We compared the serum GGT values for each patient with or without a cardiac event, including cardiac death, non-fetal myocardial infarction and unstable angina, after an acute myocardial infarction for a mean follow-up of 16.5±10.8 months. Results: During the follow-up period, 17 patients underwent cardiac death and experienced an acute myocardial infarction and 23 patients had unstable angina. Although the mean GGT values were significantly different from patients with cardiac events (29.5±10.0 U/L vs 25.0±11.2 U/L, p=0.024), serum GGT was not an independent cardiac risk factor for a cardiac event based on multivariate analysis adjusted for age, sex, alcohol and known cardiovascular risk factors. Conclusions: Serum GGT within its normal range at an acute stage in patients that experienced an acute myocardial infarction is not an independent prognostic marker. (Korean J Med 72:281-289, 2007)
박보은,양동헌,김현정,박윤정,Hong Nyun Kim,Se Yong Jang,Bae Myung Hwan,이장훈,Hun Sik Park,Yongkeun Cho,Shung Chull Chae 대한의학회 2020 Journal of Korean medical science Vol.35 No.42
Background: The association of N-terminal pro-B type natriuretic peptide (NT-proBNP) and plasma renin activity (PRA) for the prognosis of the patients with acute heart failure (HF) has not been fully investigated. This study aimed to determine the association between NT-proBNP and PRA and to investigate the incremental value of PRA to NT-proBNP for predicting long term prognosis in patients with acute HF. Methods: Three hundred and ninety-six patients (mean age, 64.7 ± 15.9 years; 46.5% female) presenting with acute HF were enrolled between December 2004 and July 2013. Patients with newly diagnosed HF as well as patients with acute exacerbated chronic HF were included. The prognosis was assessed with the composite event of all-cause mortality and readmission for HF during a 2-year follow-up period. Results: The etiology of HF was ischemic in 116 (29.3%) patients. In a Cox proportional hazards model, log-transformed PRA (hazard ratio [HR], 1.205; P = 0.007) was an independent predictor of the composite outcome of all-cause mortality and readmission for HF in addition to age (HR, 1.032; P = 0.001), white blood cell (WBC) count (HR, 1.103; P < 0.001), and left ventricular ejection fraction (LVEF) (HR, 0.978; P = 0.013). Adding PRA to age, sex, LVEF, and NT-proBNP significantly improved the prediction for the composite outcome of all-cause mortality and readmission for HF, as shown by the net reclassification improvement (0.47; P < 0.001) and integrated discrimination improvement (0.10; P < 0.001). Conclusion: PRA could provide incremental predictive value to NT-proBNP for predicting long term prognosis in patients with acute HF.
랜덤상태의 E-유리 단섬유 강화 불포화 폴리에스터 기반 수지 복합재료의 물성 - E-유리 단섬유의 길이와 함량 및 적층수의 영향 -
박진명,박영광,이영희,서대경,이장훈,김한도,Park, Jin-Myung,Park, Young-Gwang,Lee, Young-Hee,Seo, Dae-Kyung,Lee, Jang-Hun,Kim, Han-Do 한국염색가공학회 2015 韓國染色加工學會誌 Vol.27 No.3
To develop automobile parts, the unsaturated polyester based matrix resin(PR)/reinforcement(randomly oriented chopped E-glass fiber, GF) composites were prepared using sheet molding compound(SMC) compression molding. The effects of GF length(0.5, 1.0 1.5 and 2.0inch)/content (15, 20, 25, 30wt%) and number of ply(3, 4 and 5) on the specific gravity and mechanical properties of PR/GF composites were investigated in this study. The optimum length of GF was found to be about 1.0inch for achieving improved mechanical properties(tensile strength and initial modulus). The tensile strength and initial modulus of composites increased with increasing GF content up to 30wt%, which is favorable content range for SMC. The specific gravity, tensile strength/initial modulus, compressive strength/modulus, flexural strength/modulus and shear strength increased with increasing the number of ply up to 5, which is the maximum number of ply range for SMC. The effectiveness of ply number increased in the flexural strength > shear strength > compressive strength > tensile strength.
Flecainide 독성과 관련된 치명적인 심실상빈맥의 1예
천상수 ( Sang Soo Cheon ),송준혁 ( Joon Hyuk Song ),배명환 ( Myung Hwan Bae ),이장훈 ( Jang Hoon Lee ),양동헌 ( Dong Heon Yang ),박헌식 ( Hun Sik Park ),채성철 ( Shung Chull Chae ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1
평소 말기 신부전으로 혈액투석을 받고 있는 72세 여자 환자가 폐렴에 의한 심부전의 악화로 입원하였으며 발작성 심방세동의 치료를 위해 flecainide 50 mg 하루 세 번이 투여 되었다. 폐렴 및 심부전의 치료 후 회복되어 퇴원을 고려하던중 flecainide 독성으로 인해 wide QRS complex 형태의 빈맥이 발생하였으며 불응성 심인성 쇼크로 진행하였다. 승압제 등 일반적인 치료로 심인성 쇼크 회복되지 않아 bicarbonate 정주하며 체외막 산소공급 및 혈액 관류 실시하였으며 환자는 합병증 없이 성공적으로 회복되어 퇴원하였다. 저자들은 말기신부전 환자에서 flecainide 독성으로 발생한 불응성 심인성 쇼크를 체외막 산소공급 및 혈액관류로 성공적으로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Flecainide acetate is a potent class Ic anti-arrhythmic drug with a major sodium channel-blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse, particularly in patients with renal failure. Electrical and hemodynamic deterioration during flecainide toxicity may not respond to conventional treatments. We report the successful management of flecainide toxicity using extracorporeal membrane oxygenation (ECMO), hemoperfusion, and bicarbonate administration maintaining alkalinity. (Korean J Med 2014;87:72-76)