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만성신장질환 5단계 환자에서 발생한 폐렴 및 무기폐의 임상상
김민영 ( Min Young Kim ),백나나 ( Na Na Baek ),장혜련 ( Hye Ryoun Jang ),이정은 ( Jung Eun Lee ),이진아 ( Chin A Yi ),허우성 ( Seong Huh Woo ),김윤구 ( Yoon Goo Kim ),오하영 ( Ha Young Oh ),김대중 ( Dae Joong Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
목적: 만성신장질환 환자들에서 폐렴은 높은 이환율 사망률과 관련되어 있다. 그러나 만성신장질환 환자의 폐렴의 특성에 대해서 연구된 바가 많지 않으며 특히 이 환자들에서 높은 빈도로 발생하는 무기폐의 의미에 대하여서는 연구된 바가 없다. 이에 저자들은 폐렴이 발생한 만성신장질환 환자에서 폐렴의 특성 및 무기폐의 임상적 의의에 대해 다음과 같이 알아보았다. 방법: 만성신장질환 5단계인 환자들 중에서 폐렴으로 입원치료를 받은 25명의 환자를 조사하였다. 환자들의 임상적 특징, 검사 결과 및 방사선학적 특징에 대해 조사하였고 무기폐의 정도에 따라 임상 경과의 차이가 있는지 비교하였다. 결과: 환자들의 평균 나이는 71세이었고 15명의 (60%)의 환자가 당뇨병이 있었다. 중증 폐렴은 40%, 사망은 16%의 환자에서 발생하였다 흉부 전산화단층촬영술에서 폐엽 침범은 75%, 무기폐는 64%, 흉수는 56%의 빈도로 보였다. 중증 폐렴 및 사망은 무기폐의 정도에 따라 발생의 빈도가 증가하는 경향을 보였으나 통계적으로는 차이가 없었다. 하지만 무기페가 없는 환자와 비교할 때 무기폐가 심한 환자에서 폐렴 재발이 통계적으로 유의하게 높은 빈도로 발생하였다. 결론: 폐렴이 발생한 만성신장질환 5단계 환자에서 무기폐의 정도가 심해질수록 중증 폐렴과 사망의 빈도는 증가하는 경향을 보였다. 그리고 무기폐가 없는 환자보다 심한 무기폐를 동반한 환자에서 폐렴의 재발 빈도가 의미 있게 높았다. Purpose: Pneumonia is a common condition in patients with chronic renal insufficiency, and the condition is closely associated with high mortality and hospitalization rate in such patients. However, limited information is available about the clinical course of pneumonia in these patients, particularly in those with coexistent pulmonary atelectasis. We studied the characteristics of pneumonia as well as the clinical significance of pulmonary atelectasis in patients with chronic renal insufficiency. Methods: We retrospectively reviewed the medical records of 25 patients with chronic renal insufficiency that were diagnosed as having pneumonia with atelectasis. The clinical, laboratory and radiological findings in these patients were examined. We also assessed the severity of atelectasis in these patients and compared the clinical courses of patients with different grades of atelectasis. Results: The mean age of the patients was 71 years, and 15 of the 25 patients (60%) had diabetes. On chest computed tomography, the incidence of lobar infiltration, atelectasis, and pleural effusion was 75%, 64%, and 56%, respectively. The incidences of severe pneumonia and death tended to increase with the severity of atelectasis; however the increase was not statistically significant. The incidence of recurrence of pneumonia was significantly higher in patients with severe atelectasis than that in those without atelectasis. Conclusion: The incidence of severe pneumonia and the mortality rate tended to be higher in patients with severe atelectasis than in those without atelectasis. In addition, severe atelectasis was associated with the recurrence of pneumonia in patients with chronic renal insufficiency.
보중익기탕(補中益氣湯) 복용 후 재발생한 미만성 간질성 폐렴
김승구 ( Seung Gu Kim ),강건희 ( Gun Hi Kang ),김준재 ( Jun Jae Kim ),박현 ( Hyun Park ),백나나 ( Na Na Baek ),이현경 ( Hyun Kyung Lee ),신은아 ( Eun Ah Shin ),이영민 ( Young Min Lee ),이혁표 ( Hyuk Pyo Lee ),정훈 ( Hoon Jeung ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to). (Tuberc Respir Dis 2008;65:416-420)
Tacrolimus를 근간으로 한 면역억제제를 복용하는 장이식 환자에서 이식 후 새로 발생한 당뇨병의 위험인자
허우성 ( Woo Seong Huh ),최유경 ( Yu Kyong Choi ),김예지 ( Ye Jee Kim ),최남경 ( Nam Kyong Choi ),김민영 ( Min Young Kim ),백나나 ( Na Na Baek ),염지연 ( Ji Youn Youm ),이정은 ( Jung Eun Lee ),김대중 ( Dae Joong Kim ),김윤구 ( Yoo 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: This study was conducted to identify risk factors for new onset diabetes after transplantation (NODAT) among renal transplant recipients treated with tacrolimus-based immunosuppressant. Methods: We selected renal transplant recipients who underwent surgery at Samsung Seoul Hospital between May 2001 and July 2009. Exclusion criteria were as follows: recipients <18 years old, history of diabetes mellitus (DM) or impaired glucose tolerance. Analysis of possible risk factors for NODAT included age, gender, body mass index, co-morbid diseases, family history of DM, infection of hepatitis B or polyomavirus, type of donors (cadaver or living) and acute rejection. Overall incidence and median value of NODAT onset day were analyzed with Kaplan-Meier curve. We calculated crude incidence rate and relative risk (RR) and 95% confidence interval (CI) for independent risk factors of NODAT using Cox proportional hazard analysis. Results: A total of 278 patients were included and the incidence of NODAT was 13.3% (5.6/100 person-year) and the median duration of NODAT onset was 28 days. In Cox analysis, risk factors for NODAT were age (45-59 years: RR=1.41, 95% CI 1.09-1.83, 60> years: RR=4.36, 95% CI 2.00-9.49), family history of DM (RR=1.62, 95% CI 1.12-2.34) and polyomavirus infection (RR=1.40, 95% CI 1.08-1.81). Conclusion: The risk factors for NODAT among renal transplant recipients treated with tacrolimus- based regimen were age (>45 years old), family history of DM and polyomavirus infection.
전신성 홍반성 루프스 환자에서 발생한 자가 면역성 간염 1례
김준재,백나나,김현정,전태주,서동대,오태훈,최원충 인제대학교 2008 仁濟醫學 Vol.29 No.-
SLE 환자에서 간 효소 수치의 상승은 여러 가지 원인에 의하여 드물지 않게 관찰될 수 있다. 이 중 자가 면역 기전에 의해 발생되는 질환으로 자가 면역성 간염과 SLE에 동반된 간염이 있으며, 두 가지 질환의 감별은 환자의 예후 및 치료에 중요하다. 따라서 간 조직 검사를 포함한 정확한 진단 기준으로 조기에 진단하여야 하며, 이에 따른 적절한 치료를 통해서 간 부전 및 비가역적 간경변증으로 진행을 방지할 수 있을 것으로 사료된다. Patients with systemic lupus erythematosus (SLE) have a 25-50% chance of developing abnormal liver tests in their lifetime and various causes are related to elevation of liver enzyme, such as hepatic involvement of lupus, hepatotoxic drug, viral infection, autoimmune hepatitis and so on. Discrimination of autoimmune hepatitis from SLE-associated hepatitis is important because complications and therapy are quite different, although both are autoimmune syndromes. Here we are presenting a case of SLE patient with type I autoimmune hepatitis proved with liver biopsy.