항헬리코박터 IgY 항체의 위염(위궤양) 치료효과에 관한 연구

배만종(Man-Jung Bae),김수정(Soo-Jung Kim),김병기(Byung-Ki Kim),박창호(Chang-Ho Park),서정일(Jung-Ill Suh),김욱년(Wook-Nyeon Kim),장태정(Tae-Jung Jang),권상호(Sang-Ho Kweon) 한국식품영양과학회 2003 한국식품영양과학회지 Vol.32 No.8

면역물질인 IgY가 함유된 다기능성 계란 섭취로 인체에서 H. pylori 제균 치료에 어떠한 효과를 나타내는지 알아보고자 H. pylori 양성인 위염 환자 63명을 대상으로 임의로 IgY 함유 계란 투여군(17명), 항생제 투여군(17명) 및 항생제와 IgY 함유 계란 병합투여군(16명)으로 나누고 2주간 치료하였고 IgY 정제투여군(13명)은 1개월간 치료하였다. 치료후 H. pylori 박멸률, ¹³CO₂ 변화율(Δ¹³CO₂) 및 updated sydney system에 따른 H. pylori 균체 밀도, 급만성 염증 활성도, 장상피화생을 비롯한 위축도 등의 조직학적 변화에 대한 시험결과는 다음과 같다. IgY 함유 계란 투여군, 항생제 투여군, 항생제와 IgY 함유 계란 병합투여군 및 IgY 정제 투여군에서 H. pylori 박멸률은 각각 0%, 88%, 94% 및 0%로 IgY 함유 계란을 항생제와 병합투여했을 때 항생제만 투여할 때보다 H. pylori 박멸률이 높게 나타났지만 유의성은 없었다. IgY 함유 계란 투여군 17명중 1명이 Δ¹³CO₂이 감소하는 경향을 보였지만 나머지는 변함이 없었다. 항생제와 IgY 함유계란 병합투여군 16명중 15명에서 치료 1주째 Δ¹³CO₂이 모두 4이하로 치료전보다 유의하게 감소하였으며(p<0.05), 나머지 1명도 치료 1주와 2주째 Δ¹³CO₂이 치료전에 비해 감소하는 경향을 보였다. IgY 함유 계란 투여군과 IgY 정제 투여군에서 위전정부의 급성 염증 활성도가 유의하게 감소하였다 (p<0.01). IgY 함유 계란 투여군과 IgY 정제 투여군에서 위전정부의 H. pylori 균체 밀도가 유의하게 감소하였다 (p<0.05). IgY 정제 투여군에서 위체부의 만성 염증 활성도가 감소하는 경향을 보였다. IgY 함유 계란 투여군에서 위전정부 및 위체부의 장상피화생과 위축도는 치료전후 변화가 없었다. IgY 정제 투여군의 1예에서만 치료전 위전정부에 경도의 장상피화생이 관찰되었으며 치료후 정상으로 호전되었다. 위점막 위축은 대상환자 모두에서 치료전후 변화가 없었다. This study was conducted to investigate the effect of chiken egg containing IgY againt H. pylori in patients with gastritis. Sixty three H. pylori-infected volunteers (20~43 year, Male : Female=49 : 14) were randomized into four groups which were treated with one chiken egg containing IgY b.i.d. (IgY group; n=17) or omeprazole 20 mg b.i.d., amoxicillin 1.0 g b.i.d. and clarithromycin 500 mg b.i.d. (OAC group; n=17) or omeprazole 20 mg b.i.d., amoxicillin 1.0 g b.i.d., clarithromycin 500 mg b.i.d. and one chicken egg containing IgY b.i.d. (OAC with IgY group; n=16) for 2 weeks or lyophilized IgY 1 g b.i.d (lyophilized IgY group) for 1 month. Δ¹³CO₂ before and after treatment, the eradication rate of H. pylori and histologic change including H. pylori density, acute and chronic inflammation activity, intestinal metaplasia and glandular atrophy by updated sydney system were evaluated. Eradication rate of OAC with IgY group (94%) was higher than IgY group (0%), lyophilized IgY group (0%) and OAC group (88%). Δ¹³CO₂ at 2 weeks after treatment in one patient of IgY group was decreased. But that was not changed in the other patients. Δ¹³CO₂ at 1 week after treatment in 15 patients of OAC with IgY group was significantly lower than pretreatment level (p<0.05), and Δ13CO2 at 1 week and 2 week after treatment was decreased in the other patient. Acute inflammation activity at antrum was significantly decreased after treatment in IgY and lyophilized IgY group (p<0.01). H. pylori density at antrum was significantly decreased after treatment in IgY and lyophilized IgY group (p<0.05). Chronic inflammation activity at body was decreased after treatment in lyophilized IgY group. Intestinal metaplasia and grandular atrophy at antrum and body were not changed after treatment in IgY group. Mild intestinal metaplasia in one patient of lyophilized IgY group changed to normal after 1 month treatment. Gandular atrophy at antrum and body were not changed after treatment in lyophilized IgY group.

경주지역에서 식물제제에 의한 급성 간손상 환자의 임상적 고찰

천우정(Woo Jung Chun),윤병구(Byung Gu Yoon),김남일(Nam Il Kim),이구(Goo Lee),양창헌(Chang Heon Yang),이창우(Chang Woo Lee),서정일(Jeong Ill Suh) 대한내과학회 2002 대한내과학회지 Vol.63 No.2

배경: B형 간염 백신의 도입 이후 우리나라에서는 바이러스에 의한 급성 간손상은 감소하는 추세에 있는 반면에 식물제제나 건강식품에 의한 약인성 간손상이 증가하고 있는 추세이나, 급성 간손상에 대한 일치된 진단방법과 원인평가의 기준이 없는 실정이다. 이에 저자들은 경주 인근지역의 급성 간손상의 분포와 특성, 식물제제에 의한 급성 간손상의 빈도와 원인물질, 임상양상 등을 알아보고, 원인평가기준으로 제시된 CIOMS 진단점수표와 Maria & Victorino 진단점수표를 비교, 분석하였다. 대상 및 방법: 1997년 4월부터 2001년 3월까지 급성 간손상으로 동국대 경주병원에 입원한 150예의 환자 중에서 이전 간질환의 병력이나 상습적인 음주력, 대사성 간질환 및 간담도 질환, 바이러스성 간염과 자가면역성 간염을 제외한 78예를 대상으로 하였으며, 명확한 약제의 복용력이 있으면서 ALT, ALP, Total bilirubin 중 한 가지 이상이 정상범위 상한의 2배(2N) 이상이며, 약제복용 중단후 특별한 치료없이 간검사가 정상으로 회복된 경우만을 대상으로 선택하였으며, 각각의 예에 대해 복용약제, 간손상의 양상, 약제 중단 후 회복기간, 음주력, 다른 간담도질환의 존재 여부, 의심되는 약제의 재투여 여부, 바이러스성 간염 표지자, AST, ALT, TB, ALP 등을 후향적으로 조사하였고, 각 예를 식물제제에 의한 군과 양약제에 의한 군으로 구분하여 두 군간의 특성을 비교하였다. 또한 CIOMS 진단 점수표와 M&V 진단 점수표의 유용성과 일치성을 비교하였다. 결과: 4년 동안 급성 간손상으로 입원한 환자는 150예였고, 그 중 약인성 간손상이 78예(52.0%)로 가장 높은 빈도를 보였다. 원인약제로는 양약이 39예(50.0%)였으며, 식물제제와 건강식품 또한 39예(50.0%)였다. 그 중 한약제가 23예(58.9%)였고, 환약 5예(12.8%), 인진쑥 3예(7.7%), 사슴 액기스 3예(7.7%), 키토산이 2예(5.1%), 호박소주, 잉어, 풀뿌리 등이 각 1예(2.6%)였다. 간손상의 양상은 간세포성 간손상이 48예(61.5%)로 가장 많았고 두 군간에 유의한 차이는 없었다(p>0.1). CIOMS와 M&V 진단점수표 간에 등급이 일치하는 경우는 2예(2.6%)에 불과하여 kappa값을 이용한 카이제곱 검정으로 계산이 되지 않을 만큼 매우 낮은 일치율을 보였다. 결론: 급성 간손상으로 입원한 환자들에게서 약인성 간손상의 빈도가 증가하고 있고, 그 중 식물제제에 의한 간손상의 비중이 높음을 확인할 수 있었으며, 간손상의 가능성이 있는 양약제 및 식물제제의 무분별한 남용에 대해 사회적 경각심을 고취시켜야 할 것으로 생각된다. 또한 식물제제에 의한 간손상의 빈도가 높은 한국적 특성에 맞는 새로운 진단 점수표가 필요할 것으로 생각된다. Background: The prevalence of acute viral liver injury is decreasing, but drug induced liver injury by herbal medicine and health foods is on an increasing trend after introduction of vaccination. Nevertheless, there is no consensus of diagnostic method and causality assessment for acute liver injury. Therefore, the cause, clinical features, prevalence and pattern of acute liver injury caused by herbal medicine and health foods in Gyeongju area were analyzed. Moreover, Council for International Organization of Medical Science (CIOMS) scale and Maria and Victorino (M&V) scale, clinical scales for causality assessment in hepatotoxicity were compared. Methods: 78 patients in whom there was definite evidence of taking medicine and there was one more increase of over 2N (upper limit of the normal range) in alanine aminotransferase (ALT) or total bilirubin (TB) or alkaline phosphatase (ALP) and self-remitted after drug stop were selected excluding patients with previous liver disease history and history of alcohol, metabolic liver disease and hapatobiliary disease and viral, autoimmune, unknown origin hepatitis among 150 patients of admission due to acute liver injury, from April 1997 to March 2001. Each case was investigated retrospectively about taken medicine, the pattern of liver injury, recovery period after drug stop, history of alcohol, other hepatobiliary disease, pregnancy, recent hypotension, rechallenge and viral markers of hepatitis, aspartate aminotransferase (AST), ALT, TB, ALP. Also, herbal medicine and western medicine groups were compared and consistency with CIOMS scale and M&V scale were investigated. Results: For four years, among 150 cases, drug-induced liver injury were 78 cases (52.0%), occurred the highest prevalence. In taken medicine, western medicine were 39 cases (50.0%), herbal medicine and health foods were 39 cases (50.0%), too. Among those cases, herbal medication were 23 cases (58.9%), pellet 5 cases (12.8%), In-jin-ssuk 3 cases (7.7%), deer extract 3 cases (7.7%), kitosan 2 cases (5%) and pumpkin extract, carp, plant roots was 1 case (2.5%) respectively. In the pattern of liver injury, hepatocellular liver injury were 48 cases (61.5%), occurred the highest prevalence. Between CIOMS and M&V scale, best correlation were only 2 cases (2.6%), therefore, their agreement was very low. Conclusion: The prevalence of drug induced liver injury is on an increasing trend in Gyeongju area and acute liver injury caused by herbal medicine and health foods had very high incidence was ascertained. Therefore, we should attend to indiscreet use of herbal medicine and health foods and should give a warning to our society. And a new clinical scale suitable for characteristic of our country that had high prevalence of liver injury caused by herbal medicine and health food is needed. (Korean J Med 63:141-150, 2002)

포스터 전시 : 위장관 ; 장중첩증으로 발견된 소장 임파종 1예

정희철 ( Hee Chul Jung ),김남일 ( Nam Il Kim ),김성자 ( Sung Ja Kim ),이구 ( Goo Lee ),양창헌 ( Chang Heon Yang ),이창우 ( Chang Woo Lee ),정기훈 ( Gee Hoon Jung ),김정란 ( Jung Ran Kim ),서정일 ( Jeung Ill Suh ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

<증례> 33세 남자가 내원 1개월 전부터 간헐적인 상복부와 제대주위 통증이 있어 타병원에서 두 차례 상부위장관내시경검사를 시행하여 위염 진단 하에 치료 하던 중 증상호전이 없어 내원하였다. 내원당시 체중감소는 없었으며 이학적소견상 상복부와 제대주위에 경도의 압통이 있었지만 반발통은 없었고 덩어리나 임파선은 촉지되지 않았다. 검사실소견상 백혈구 8,460/㎣, 헤모글로빈 14.9g/㎗, 혈소판 281,000/㎣이였으며 말초혈액도말검사, 간기능검사, 혈청

포스터 전시 : 간 ; Fusobacterium nucleatum에 의한 간농양 1예

정소연 ( So Yean Jung ),정희철 ( Hee Chul Jung ),이창화 ( Chang Hwaa Lee ),천우정 ( Woo Jung Chun ),김남일 ( Nam Il Kim ),김성자 ( Sung Ja Kim ),이구 ( Goo Lee ),서정일 ( Jeung Ill Suh ),이창우 ( Chang Woo Lee ),하경임 ( Gyoung Y 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

<증례> 45세 여자가 2개월 전부터 발생한 간헐적인 발열 및 전신 쇠약감을 주소로 내원하였다. 환자는 2개월 전부터 발열 및 오한이 있어 개인 의원에서 상기도 감염 진단하에 약물치료를 받았으나 내원 전날까지 증상의 호전과 악화가 반복되어 내원하였다. 과거력상 2년전 고혈압을 진단 받고 치료중인 것 외에는 특이 사항이 없었다. 이학적 검사상 전신 상태는 양호하였고 복부 촉진에서 압통이 있는 부위는 없었으며 간이나 비장의 종괴는 만져지지 않았다. 검사실

위암절제후 절단부 암침윤례에 대한 임상병리학적 고찰

조용관(Yong Kwan Cho),장중근(Jung Keun Jang),홍기천(Kee Chun Hong),박흥길(Heung Gil Park),이찬영(Chan Young Lee),손진희(Jin Hee Sohn),서정일(Jung Ill Suh),박효숙(Hyo Sook Park) 대한외과학회 1990 Annals of Surgical Treatment and Research Vol.38 No.5

Helicobacter pylori 감염에서 CagA 및 VacA 발현과 위 상피세포 증식과의 관계

김남일(Nam Il Kim),이중현(Jung Hyun Lee),이영실(Yeoung Sil Lee),이재욱(Jae Uk Lee),이구(Goo Lee),서정일(Jeong Ill Suh),양창현(Chang Heon Yang),이창우(Chang Woo Lee),윤환중(Hwan Jung Yun),장태정(Tae Jung Jang),김정란(Jung Ran Kim),하경 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : Infection with Helicobacter pylori (H. pylori) has been associated with an increased risk for developing gastric cancer. This risk is further enhanced with CagA positive H. pylori strains. Increased epithelial cell proliferation is associated with an increased risk for gastric cancer. The aim of the study was to investigate whether the gastric epithelial cell proliferation was related to the expression of CagA and VacA in H. pylori infection. Methods : The subjects were 77 patients who had undergone diagnostic esophagogastroduodenoscopy with biopsy; 18 gastritis, 18 gastric ulcer, 17 duodenal ulcer and 24 gastric cancer. The expression of cytotoxic genes was determined indirectly by assaying serum IgG antibodies to specific antigens of H. pylori. Gastric epithelial cell proliferation was assessed using immunohistochemical method using Ki-67 monoclonal antibody. Acute and chronic inflammation, intestinal metaplasia and glandular atrophy were scored according to the updated Sydney system. Results : Ki-67 labeling index, acute and chronic inflammation were significantly higher in H. pylori infected persons (n=70, 90.9%) than in uninfected persons (n=7, 9.1%) (p<0.05), but the difference in intestinal metaplasia and glandular atrophy between the two groups was not statistically significant. Ki-67 labeling indices in persons infected with CagA positive strains (n=56, 80.0%) were significantly higher than in persons infected with CagA negative strains (n=14, 20%) (0.55±0.13 vs 0.37±0.17, p<0.05), but the differences in acute and chronic inflammation, intestinal metaplasia and glandular atrophy between the two groups were not statistically significant. No significant difference was found in Ki-67 labeling index, acute and chronic inflammation, intestinal metaplasia and glandular atrophy according to expression of VacA. Conclusion : Gastric mucosal cell proliferation, which might be closely involved in the pathogenesis of gastric carcinoma, was significantly higher in CagA positive H. pylori infected persons.(Korean J Med 58:516-525, 2000)

만성 B 형 간염에서 인터페론과 라미뷰딘의 단독치료와 병합치료의 효과 비교

장재식(Jae Sik Jang),김성욱(Sung Wook Kim),정소연(So Yeon Jung),김남일(Nam Il Kim),이구(Goo Lee),서정일(Jeong Ill Suh),양창헌(Chang Heon Yang),이창우(Chang Woo Lee),남경수(Kyung Soo Nam),김철호(Cheorl Ho Kim) 대한내과학회 2001 대한내과학회지 Vol.60 No.4

N/A Background: Alpha-interferon achieves HBeAg seroconversion in about 30 to 40% of patients with chronic hepatitis B, and recently discovered lamivudine, an oral nucleoside analogue, inhibits hepatitis B virus replication and reduces hepatic necroinflammation in patients with chronic hepatitis B effectively. In this study, we compared the efficacy and safety of alpha-interferon, lamivudine and their combination regimen. Methods: Fourty chronic hepatitis B patients, who were diagnosed through HBV DNA, HbeAg positivity, alanine aminotransferase elevation, and liver biopsy were enrolled in this study. Twelve patients were treated with 500 MU of alpha-interferon subcutaneously 3 times a week for 6 months, 9 patients were treated with 150 mg of lamivudine and alpha-interferon, and 19 patients were treated with 150 lamivudine daily for 6 months. Results: After treatment, all of the three groups showed rapid decline in HBV DNA level, but lamivudine group showed more clearance of HBV DNA than interferon group (alpha-interferon: 75%, combination group: 89%, lamivudine group: 100%, respectively) (p=0.04). HBeAg seroconversion rate was 25% for interferon group, 11% for combination group, 26% for lamivudine group, showing no difference between three groups (p =0.705). Mean serum ALT level and rate of ALT normalization during therapy showed no differnece (83% for interferon group, 78% for combination group, 84% for lamivudine group). Conclusion: It is suggested that the efficacy of combination interferon/lamivudine therapy appears disappointing and further study should be done for appropriate combination or monotherapy of lamivudine for patients with chronic hepatitis B.(Korean J Med 60:342- 348, 2001)

간경변증 환자에서 간세포암 발생 위험 요인의 분석

이헌주(Heon Ju Lee),이재련(Jae Lyun Lee),이재춘(Jae Chun Lee),이은정(Eun Jung Lee),김기범(Ki Beom Kim),임상우(Sang Woo Lim),이동준(Dong Jun Lee),전경진(Kyeoung Jin Jeon),조영복(Young Bog Cho),도갑석(Gab Suk Doh),서정일(Jeong Ill Suh) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: 80-90% of the cases of hepatocellular carcinoma(HCC) are associated with cirrhosis. Hepatitis B virus(HBV) is known as a major etiologic factor of HCC and about 10% of Koreans are HBV carriers. And the prevalence of HCC is high in Korea. Early detection of HCC is important for the better treatment especially in the patients with cirrhosis who usually have the decreased functional hepatic reserve. Risk factors for the hepatocellular carcinoma in the korean patients with cirrhosis were evaluated. Methods: Risk factors for hepatocellular carcinogenisis such as age, sex, ascites, alcohol, HBsAg, anti-HCV, AFP, ICG R(15) and risk score were investigated among the 176 patients with cirrhosis and HCC(group I) and 72 patients with cirrhosis(group II) and compared between the two groups. Results: 1) No age difference was noted between group I and group II. 2) Male to female sex ratio were 5.7: 1 and 2.4: 1 for group I and II in each(p<0.01) and the frequency of HCC among cirrhosis was higher in male than female sex(p<0.01). 3) Both HBsAg and anti-HCV positivity were significantly higher in group I than in group II (p<0.01 and p<0.05 respectively). 4) The frequencies of Child-Pugh A, elevated AFP, elevated ICG R(15) and the frequency of super-high risk patient were higher in group I than in group II(p<0.01). 5) The frequency of alcoholic patients was significantly higher in group II than in group I (p<0.05) but no difference was noted between HBsAg positive group I and group II patients. 6) The frequency of abnormal AST with the level of below 100IU was not significantly different between group I and group II. 7) The frequency of the patients with ascites was higher in group II than in group I (p<0.01). Conclusion: Risk factors for hepatocellular carcinogenesis in korean patients with cirrhosis are male, Child-Pugh A, HBsAg positivity, anti-HCV positivity, absence of ascites, higher AFP, lower ICG R15 and higher platelet count.

기관지 유암종 2례

이관호,한승세,이동협,김성숙,이현우,이정철,최교원,정진홍,서정일 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.2

전형 중심성 기관지 유암종과 비전형 기관지유암종을 기관지내시경하 생검 및 전산화 단층촬영하 생검으로 확진했으며 근치적 치료로 폐절제술을 시행한 치험 2례를 문헌 고찰과 아울러 보고하는 바이다. Bronchial carcinoid tumor was a low grade malignant and it was regarded as predictable clinical course and good survivality after surgical resection. But despite of its low grade malignant potentiality, bronchial carcinoid tumor was clearly capable of metastasizing and causing death. We present 2 cases of bronchial carcinoid tumors. One of them was typical carcinoid tumor in 44 year-old female and another was atypical carcinoid tumor in 53 year-old male patient. Currative therapeutic procedure was performed by lobectomy and wedge resection.

기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.