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Angiotensin II 수용체 길항제 투여가 Cyclosporine 신독성에 의한 염증반응에 미치는 영향
송준창,신미정,전연주,우성용,형복진,윤혜은,우현영,최범순,양철우,김용수,장윤식,방병기 대한내과학회 2004 대한내과학회지 Vol.67 No.6
Background : Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the anti-inflammatory effect of angiotensin II blockades using losartan (LSRT) in a rat model of chronic CsA nephropathy. Methods : Male Sprague-Dawley rats, initially weighing 225 to 250 g, were used. After 1 week of a low-salt diet (0.05% sodium), the rats were randomized into four groups and treated for 4 weeks. The Vehicle (VH) group was treated with olive oil. The VH+LSRT group was treated with olive oil and LSRT. The CsA group received CsA. The CsA+LSRT group was simultaneously treated with CsA and LSRT. The anti-inflammatory effect of LSRT was evaluated with C-reactive protein (CRP) expression, osteopontin (OPN) mRNA and protein expression, and ED-1 infiltration Results : The CsA treatment caused an increase in serum creatinine and a decrease in creatinine clearance compared with that of the VH group. Intrarenal CRP positive cells were significantly decreased in the CsA+LSRT group compared with the CsA group (38.0±2.1 vs. 65.0±5.1, p<0.01). In the CsA group, the degree of OPN mRNA expression was increased compared with that of the VH group. But, OPN mRNA expression was decreased in the CsA+LSRT group (387.5±46.6% vs. 719.8±58.5%, p<0.05). In the degree of ED-1 infiltration, we had a similar results such as CRP and OPN mRNA expression (CsA group 30.5±8.0 vs. CsA+LSRT 86.0±11.0, p<0.01). Conclusion : We concluded that the anti-inflammatory effects of angiotensin II blockade has a potential protective effect against CsA-induced renal injury. 목적 : 신장 이식시 투여되는 cyclosporine (CsA)은 우수한 면역 억제제이지만 장기간 투여로 세뇨관 간질 섬유화와 염증반응을 유발한다. 만성 CsA 신독성 병태생리는 다양하게 제시되고 있으며 이중 레닌-안지오텐신계의 활성화가 중요한 역할을 하는 것으로 보고 되고 있다. 이에 본 연구에서는 안지오텐신 Ⅱ 수용체 길항제인 losartan (LSRT) 투여가 CsA에 의한 신장내 염증반응을 억제하는지 세뇨관 간질 섬유화와 대식세포 침윤의 지표인 ED-1, 염증반응의 지표인 C-reactive protein (CRP), osteopontin (OPN) mRNA 발현을 통해 연구하였다. 대상 및 방법 : 몸무게 225 g에서 250 g까지 나가는 수컷 흰쥐에 0.05% 나트륨의 저염식이를 1주일간 투여한 뒤 4개의 군으로 나누어 실험을 실시했다. 대조군(Vehicle, VH)은 올리브유를 매일 1 mg/kg로 4주간 피하로 주사하였다. CsA군은 CsA를 15 mg/kg로 매일 4주간 피하주사 하였다. 그리고 LSRT는 100 mg/L를 경구로 VH군과 CsA군에 각각 병합투여 하였다. 만성 CsA 신독성 발생 유무는 신기능과 신조직의 섬유화 정도로 확인하였다. LSRT의 항염증 효과는 신장 조직내 CRP 양성 세포수, OPN mRNA 및 단백 발현정도, ED-1에 양성인 대식세포 침윤정도로 측정하였다. 결과 : 1. CsA군에서는 VH군에 비해 신기능이 감소(혈중 크레아티닌의 증가와 크레아티닌 제거율의 감소)하였으며 세뇨관 간질 섬유화도 증가하였다. 2. 신장 조직내 CRP 양성 세포수는 CsA군이 VH군에 비해 현저히 증가하였으나 CsA+LSRT군에서는 유의하게 감소하였다(CsA+LSRT 38.0±2.1 vs. CsA 65.0±5.1, p<0.01). 3. OPN mRNA 발현정도는 CsA군이 VH군에 비해 증가하였으나 CsA+LSRT군에서는 유의하게 낮았다(CsA+ LSRT 387.5±46.6% vs. CsA 719.8±58.5%, p<0.05). 4. ED-1 양성 세포 수는 CsA군이 VH군에 비해 증가하였으나 CsA+LSRT군에서는 유의하게 낮았다(CsA+ LSRT 30.5±8.0 vs. CsA 86.0±11.0, p<0.01). 결론 : 안지오텐신 Ⅱ 수용체 길항제인 LSRT은 CsA로 인한 염증반응을 억제하여 신독성을 감소시키는 것으로 이해된다.
송준창,민보영,김진욱,김종엽,김여명,신철민,이상협,황진혁,정숙향,김나영,이동호 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.4
Background/Aims: Decay of hepatitis B surface antigen (HBsAg) titers has previously been shown to be predictive of a virologic response (VR), especially during peginterferon-alpha therapy. However, the role of HBsAg levels in predicting a VR to nucleos(t)ide analog therapy has not yet been established. In this study we sought to determine whether the VR can be predicted from HBsAg titers in nucleos(t)ide-naïve chronic hepatitis B (CHB) patients treated with entecavir. Methods: CHB patients who started entecavir as an initial antiviral therapy were enrolled in this study. Serum hepatitis B virus (HBV) DNA, HBsAg, and alanine aminotransferase levels were measured every 3 months during treatment. A VR was defined as undetectable serum HBV DNA titer by real-time PCR assay (<60 IU/mL). Results: Fifty-two patients were enrolled, and the median duration of treatment was 26 months (range 7-35 months). Forty-five patients achieved a VR; the cumulative VR rates at 3, 6, 12, and 24 months were 40%, 71.2%, 81.5%, and 88%, respectively. Baseline HBV DNA levels were significantly lower in patients with VR, whereas the HBsAg levels did not differ significantly between patients with or without VR. In a univariate analysis the cumulative VR rate was significantly higher in HBeAg negative patients and patients with an HBsAg/HBV DNA ratio above 0.56. However, in a multivariate analysis only an HBsAg/HBV DNA ratio above 0.56 was an independent predictor of VR (P=0.003). The area under the receiver operating characteristic curve was larger for the HBsAg/HBV DNA ratio than for either HBV DNA or HBsAg. Conclusions: Pretreatment HBsAg/HBV DNA ratio can predict a long-term VR to entecavir therapy in nucleos(t)ide-naïve CHB patients.
발열과 요통을 동반한 혈액투석 환자에서 발견된 경막의 농양
송준창 ( Joon Chang Song ),김미경 ( Mee Kyoung Kim ),김윤정 ( Youn Jeong Kim ),김성용 ( Sung Yong Kim ),김영수 ( Young Soo Kim ),유혜영 ( Hye Young You ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ),방병기 ( Byung Kee Bang 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2
Epidural abscess in hemodialysis patient is uncommon diseases, but it causes severe neruological complication if diagnois is delayed. In the clinical practice, because it is difficult to differentiate epidural abscess with simple back pain. Therefore, it is important to make early diagnosis and treatment of epidural abscess to prevent nuurological sequellae. We here report a case of epidural abscess with early diagnosis and successful treatment. A 54-year-old male patient was admitted to back pain and fever. Under the presumptive diagnosis of epidural abscess, MRI was perofrmed, and it revealed epidural abscess. Intravenous antibiotic treatment was started and drain of abscess was subsequently performed since back pain was persisted. He discharged without neurologic sequellae. Our case strongly suggests that epidural abscess should be considered in patients and early radiologic evaluation and treatment are mandatory to prevent neurological complication.
송준창 ( Joon Chang Song ),황현석 ( Hyeon Seok Hwang ),형복진 ( Bok Jin Hyoung ),이소영 ( So Young Lee ),전연주 ( Yeon Joo Jeon ),장세나 ( Se Na Chang ),윤혜은 ( Hye Eun Yoon ),최범순 ( Bum Soon Choi ),김용수 ( Yong Soo Kim ),양 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1
After renal transplantation, we are more likely to encounter hyperkalemia rather than hypokalemia. We report a case of kidney transplantation recipient with hypokalemia and hypertension secondary to primary aldosteronism. A 48 year-old woman was presented with fatigue and weight loss that had lasted for 3 months. She was diagnosed as autosomal dominant polycystic kidney disease that ultimately progressed to end-stage renal disease. She was operated for renal transplantation before 6 months. She had hypokalemia and hypertension at that time. The ratio of plasma aldosterone over plasma renin activity was 851.7. The computed tomography (CT) revealed 2.4×1.7 cm sized adrenal mass on the right side. The pre-transplantation CT also showed that there had been adrenal mass in the same location even before the transplantation. Right adrenalectomy was performed. After she got discharged, she was again presented with nausea and vomiting. She developed hyperkalemia and was diagnosed as hyporeninemic hypoaldosteronism. She was prescribed with fludrocortisones and recovered from the disease, and resumed the state of normokalemia and normotension.
Angiotensin 2 수용체 길항제 투여가 Cyclosporine 신독성에 의한 염증반응에 미치는 영향
송준창 ( Joon Chang Song ),신미정 ( Mi Jung Shin ),전연주 ( Yeon Joo Jun ),우성용 ( Seong Yong Woo ),형복진 ( Bok Jin Hyoung ),윤혜은 ( Hye Eun Yoon ),우현영 ( Hyun Young Woo ),최범순 ( Beum Soon Choi ),양철우 ( Chul Woo Yang ) 대한내과학회 2004 대한내과학회지 Vol.67 No.6
목적 : 신장 이식시 투여되는 cyclosporine (CsA)은 우수한 면역 억제제이지만 장기간 투여로 세뇨관 간질 섬유화와 염증반응을 유발한다. 만성 CsA 신독성 병태생리는 다양하게 제시되고 있으며 이중 레닌-안지오텐신계의 활성화가 중요한 역할을 하는 것으로 보고 되고 있다. 이에 본 연구에서는 안지오텐신 Ⅱ 수용체 길항제인 losartan (LSRT) 투여가 CsA에 의한 신장내 염증반응을 억제하는지 세뇨관 간질 섬유화와 대식세포 침윤의 지표인 Background : Long-term treatment of immunosuppresant CsA causes interstitial inflammation and fibrosis in the kidney. Renin-angiotensin system (RAS) plays the most important role in the pathogenesis CsA-induced renal injury. Accordingly we evaluated the a