충주 지역 설사 환아의 Rotavirus G Serotype 분포에 관한 연구

심재건,권재봉,강신영,Sim, Jae-Geon,Kwon, Jae-Bong,Kang, Shien-Young 대한소아소화기영양학회 2000 Pediatric gastroenterology, hepatology & nutrition Vol.3 No.1

목 적: 설사 환아에서 rotavirus 장염의 빈도는 매우 높으며 rotavirs에 대한 예방 접종이 실용화되었으나 국내 rotavirus 혈청형 분포에 대한 체계적인 연구 결과는 매우 드물고, 혈청형의 정확한 분포비율도 아직까지는 알려져 있지 않다. Rotavirus 설사 환아의 G 혈청형 분포를 RT-PCR 기법을 이용하여 조사하였다. 대상 및 방법: 1998년 6월부터 1999년 5월까지 설사를 주소로 내원 또는 입원한 소아 202명을 대상으로 하였다. 설사 시작 후 3일 이내의 대변을 채취하여 영하 $20^{\circ}C$의 냉동고에 보존하였다. EIA(TestPack Rotavirus, Abbott Laboratories)법으로 rotavirus 양성인 검체를 선별하였으며, 양성 반응을 보인 검체를 대상으로하여 RT-PCR을 이용하여 rotavirus G serotype을 결정하였다. 결 과: 총 202 검체 중에서 rotavirus 양성은 95례였으며, 이 중 serotype 판정이 가능했던 것은 50례이었다. G serotype 1이 5례(10%), 2 (G2)가 5례(10%), 3 (G3)가 14례(28%), 4 (G4)가 13례(26%), 9(G9)이 10례(20%)였으며, G1과 G9이 함께 있는 것과, G2과 G9이 함께 있는 것, G4와 G9이 함께 있는 경우가 각 1례씩 있었다. G8은 발견되지 않았다. 결 론: 국내에 기존에는 알려지지 않았던 G9이 상당수 있으며, 일반적으로 제일 많다고 알려진 G1보다 G3, G4가 더 많은 비율을 차지하는 등 이번 연구 결과는 기존에 발표되었던 자료와는 많은 상이점을 보인다. 이는 지역적인 요인 및 시기 상의 일시적인 현상이라고 볼 수도 있으나, 보다 정확한 역학적인 자료를 얻기 위해서는 보다 광범위하고 장기적인 조사가 필요할 것으로 판단된다. Purpose: It is important to have the epidemiologic data of rotavirus serotypes for the application of polyvalent rotavirus vaccines. Epidemiological studies of rotavirus serotypes in Korea have been reported only in limited areas with small number of cases. Authors tried to investigate the distribution of rotavirus G serotypes in ChungJu area with RT-PCR. Method: Stool specimens were collected from 202 children with acute diarrheal symptoms, who admitted to or visited Kon-Kuk University Hospital in ChungJu from June 1998 to May 1999. Samples were screened for rotavirus with EIA method (TestPack Rotavirus, Abbott Laboratories) and rotavirus G Serotypes were determined by RT-PCR. Results: Rotavirus was positive in 46.6%. The incidence of G serotypes was as follows; G1 10%, G2 10%, G3 28%, G4 26%, and G9 20%. There were three cases of multiple serotypes; G1 with G9, G2 with G9, and G4 with G9. Serotype of G8 was not found. Conclusion: The proportion of G serotypes in ChungJu is much different from previous reports. Serotype of G9 was found which had not been reported in Korean children till now. Long term plans for the investigation of rotavirus serotypes must be needed in wide area.

Rotavirus 및 Adenovirus에 의한 급성 장염에 관한 비교 연구

권재봉,심재건,Kwon, Jae Bong,Sim, Jae Geon 대한소아감염학회 2000 Pediatric Infection and Vaccine Vol.7 No.1

목 적 : Rotavirus와 adenovirus는 영유아에서 급성장염을 유발하는 주요 원인인데 한국에서 adenovirus에 관한 연구 논문이 적어 저자들은 최근에 발생한 adenovirus와 rotavirus 장염의 분포를 조사하여 향후 질병 예방 및 발생 정보에 도움을 얻고자 연구 분석하였다. 방 법 : 1998년 3월에서 1999년 6월까지 대상으로 건국의대 부속병원에 급성 위장관염으로 입원 또는 통원 치료를 한 143명을 대상으로 하였다. 결 과 : 전체 환아 143명중 rotavirus 양성은 53명으로 37%의 양성률을 보였으며 1999년 1월에서 3월 사이의 초봄에 가장 많이 발생하였으며 2세 이하에서 가장 많이 발생함을 보였고 2~4세 사이에서도 16%의 양성률을 보였으며 9월에 전체 24례중 6례로 가장 많이 검출되었고 2개월에서 2세 사이에 많은 발생을 보였다. Adenovirus와 rotavirus에 동시 검출된 경우는 7명(5%)이였다. 결 론 : Rotavirus 장염은 1월부터 3월에 가장 많은 발생 빈도를 보여서 겨울 및 초봄에 유행시기를 보였으며 adenovirus는 9월에 가장 많이 검출 되었다. Rotavirus와 adenovirus의 발생의 중간 나이 분포는 각각 1세 4개월, 1세 3개월의 분포를 보였다. Purpose : Acute diarrhea in one of the most important diseases in children with high morbidity and mortality worldwide. Most of acute diarrhea is induced by viruses. Rotavirus and adenovirus are leading causes of severe gastroenteritis among infants and young children worldwide. Studies for adenovirus gastroenteritis in Korea are limited. We studied the prevalence of rotavirus and adenovirus gastroenteritis from March 1998 to June 1999 in Chungju area. Methods : Stool samples were collected from 143 children with acute diarrhea. Specimens were tested for group A rotavirus antigen and for adenovirus type 40 and 41 by using available commercial kits. Results : Among 143 samples, 37% were positive for rotavirus and 16% were positive for adenovirus. Rotavirus was most prevalent from January to March, 1999 and adenovirus was prevalent during September 1999. The greatest number of rotavirus infections occurred under 24 months of age, followed by 2~4 years of age. Adenovirus was most common in 2~24 months of age. Conclusion : Rotavirus was most prevalent in winter and early spring. In our study, rotavirus was prevalent in early spring and adenovirus was in autumn.

한국인 영아에서의 Acid Steatocrit 표준치에 관한 연구

김교순,박지혜,심재건,Kim, Kyo-Sun,Park, Ji-He,Sim, Jae-Geon 대한소아소화기영양학회 2001 Pediatric gastroenterology, hepatology & nutrition Vol.4 No.1

목 적: 지방흡수장애를 진단하는 데 있어서 가장 간편하고 손쉬운 검사로 최근 알려지기 시작한 acid steatocrit법을 국내에 도입하고 또한 특히 지방 흡수장애가 중요한 임상 문제의 하나인 3개월 이내의 영아에서 우리 나라 정상치를 확립하고자 한다. 방 법: 1998년 5월부터 2000년 4월까지 건국대학교 의료원 민중병원 신생아실에 입원한 소화기질환이 없는 만삭아 79명 미숙아 21명, 모유영양아 27명, 인공영양아 73명을 대상으로 acid steatocrit치를 측정하였고 출생 후 1~7일(31명), 8~14일(21명), 15~21일(16명), 22~28일(11명), 1~2개월(12명), 생후 2~3개월(3명)에 acid steatocrit치를 측정하여 분석하였다. 결 과: 1) 신생아의 평균 acid steatocrit치는 $94.41{\pm}1.35%$이었고 생후 1~7일은 $94.63{\pm}1.41%$, 8~14일은 $94.88{\pm}0.96%$, 15~21일은 $93.79{\pm}1.47%$, 22~28일은 $93.82{\pm}1.24%$이었다. 생후 1개월에서 2개월의 평균 acid steatocrit치는 $92.29{\pm}3.31%$, 생후2개월에서 3개월은 $89.29{\pm}6.56%$로 생후 1개월 이후 acid steatocrit치가 서서히 떨어짐을 알 수 있었으나(p=0.0248) 생후 3개월까지도 대변내의 지방이 많음을 알 수 있었다. 2) 만삭아의 평균 acid steatocrit치는 $94.41{\pm}1.35%$로 미숙아의 평균 acid steatocrit치 $94.92{\pm}1.57%$와 유의한 차이를 보이지 않았다(p=0.1605). 3) 인공수유아의 평균 acid steatocrit치는 $94.78{\pm}1.28%$로 모유수유아의 평균 acid steatocrit치 $93.82{\pm}1.46%$와 유의한 차이를 보였다(p=0.0018). 결 론: 만삭아와 미숙아의 acid steatocrit 측정치, 연령에 따른 acid steatocrit 측정치와 수유방법에 따른 acid steatocrit 측정치를 근거로 우리 나라 정상 신생아의 acid steatocrit 정상치를 확립하였고 향후 담즙정체성 간질환 환자, 만성설사 환자 등 영양장애를 가지는 환자에서 지방흡수장애 평가의 표준자료로 이용될 수 있을 것으로 사료된다. Purpose: The fecal acid steatocrit is an improved steatocrit method for the evaluation of fecal fat. The present study was set up in order to define the normal range of acid steatocrit values during the first 3 months of life. Methods: Fecal acid steatocrit values were determined in 78 healthy full term and in 21 healthy prematurely born infants between May 1998 and April 2000. The acid steatocrit method was performed in these babies during the first 3 months of life. Results: Steatorrhea occurs during the first month and then decreases, as shown by the fall in the acid steatocrit curve from 1st to 3rd month in our subject. Very high acid steatocrit results (above 90%) were found in all full term and premature infants during the first month of age. Acid steatocrit results of human milk-fed infants were significantly lower than those of formula-fed infants (p=0.0018). Conclusion: We conclude that high acid steatocrit results during the first 1 month of age can be due to physiologic steatorrhea. The acid steatocrit micromethod can be used for the evaluation of milk fat absorption in infants and monitoring steatorrhea instead of other more cumbersome methods.

상부우장관 증사이 없는 한국인에서 Helicobacter pylori 감염의 혈청학적 유병률에 관한 전국적 역학조사

김나영(Na Young Kim),김재규(Jae Gyu Kim),김진호(Jin Ho Kim),김학양(Hak Yang Kim),김상우(Sang Woo Kim),김재준(Jae Jun Kim),노임환(Im Hwan Roe),심재건(Jae Geon Sim),안형식(Hyeong Sik Ahn),윤병철(Byung Chul Yoon),이상우(Sang Woo Lee),이용 대한내과학회 2000 대한내과학회지 Vol.59 No.4

Background : Helicobacter pylori infection occurs throughout the world and causes various gastroduodenal diseases in all age groups. The prevalence of H. pylori infection varies among countries and races. The aim of this study was to evaluate the seroprevalence of H. pylori infection in healthy people in Korea. Methods : From March 1998 to October 1998, 5,732 asymptomatic subjects responded to the self-assessment questionnaires from 54 hospitals were enrolled. Serum level of anti-H. pylori IgG was measured by ELISA test. Results : The overall prevalence of H. pylori infection was 46.6% and showed no significant difference between male (47.2%) and female (45.9%). According to the geographic areas, the highly prevalent provinces were Kangwon (53.4%), Cheju (52.9%) and Jeonra provinces (50.6%), while Seoul (41.9%) was the lowest prevalent area. The seroprevalence increased with age and was the highest at 40's (78.5%). The characteristic feature of this study was that the infection rate increased steeply in three age groups (10-12, 16-19 years old and 30's). In Seoul, there was no different prevalence rate among the districts studied.Conclusion : The nation-wide seroprevalence of H. pylori infection in Korea is higher than that of the developed countries. We hope that this study provides the landmark for the study of H. pylori infection in Korea.(Korean J Med 59:388-397, 2000)

무증상 한국인에서 Helicobacter Pylori 감염의 위험인자

김나영(Na Young Kim),김재규(Jae Gyu Kim),김진호(Jin Ho Kim),김학양(Hak Yang Kim),김상우(Sang Woo Kim),김재준(Jae Jun Kim),노임환(Im Hwan Roe),심재건(Jae Geon Sim),안형식(Hyeong Sik Ahn),윤병철(Byung Chul Yoon),이상우(Sang Woo Lee),이용 대한내과학회 2000 대한내과학회지 Vol.59 No.4

Background : The prevalence of Helicobacter pylori (H. pylori) infection varies between countries and between social classes. The aim of this study was to identify risk factors for with Helicobacter pylori infection in asymptomatic Korean population. Methods : Sera were collected from 2,687 females and 3,049 males (mean age, 29.1 y; range, 1 m-79 y) in Korea from Mar 1998 through Oct 1998. All asymptomatic subjects completed assessment questionnaires. An enzyme-linked immunosorbent assay was performed to detect IgG antibody to H. pylori.Results : The overall seroprevalence observed was 46.6% and showed no statistical diffrerence between female (45.9%) and male (47.2%). The seroprevalences in children (neonate-15 y) and adult (16-79 y) were 17.2% and 66.9%, respectively. According to multivariate analysis, variables such as sex, age, geographic area, crowding (number of person per room) in childhood, economic status in childhood, and types of housing in childhood were significantly and independently associated with H. pylori seroprevalence of adults. In children, age, geographic area, income, mother's education, and drinking water source were significant risk factors of H. pylori infection. Conclusion : Socioeconomic condition and close person to person contact in childhood are the significant determinants for H. pylori infection in adult. Drinking water source is an another important risk factor for H. pylori infection in children, suggesting the fecal to oral transmission in Korea.(Korean J Med 59:376-387, 2000)

한국인에서 Helicobacter pylori 감염의 진단에 있어 Genedia™ H . pylori ELISA 검사의 진단 정확도

정인식(In Sik Chung),김상우(Sang Woo Kim),고재성(Jae Sung Go),김나영(Na Young Kim),김재규(Jae Gyu Kim),김진호(Jin Ho Kim),김학양(Hak Yang Kim),김재준(Jae Jun Kim),노임환(Im Hwan Roe),심재건(Jae Geon Sim),안형식(Hyeong Sik Ahn),윤병철(By 대한내과학회 2001 대한내과학회지 Vol.61 No.1

N/A Background: Genedia™ H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of Genedia™ H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. Methods Genedia : H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with Genedia™ H. pylori ELISA. H, pylori infection was determined by rapid urease test, histology, culture or (13)C-urea breath test in adults. In children, the subject was considered to he H. pylori positive if (13)C-urea breath test was positive. Results: In adults, the sensitivity and specificity of Genedia™ H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of Genedia™ H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of Genedia™ H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%, p<0.005 and 92.5% vs 71.4%, p<0.005, respectively). Conclusion : Genedia™ H pylori ELISA is a relatively accurate method for the serodiagnosis of H pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of Genedia™ H. pylori ELISA for epidemiological studies of H. pylori infection in Korea. (Korean J Med 61:17-23, 2001)

Clinical Significance of Duodenal Bile Acids in Differential Diagnosis for Infantile Jaundice : Duodenal Intubation in Infants with Cholestatic Jaundice

Sim, Jae Geon,Seo, Jeong Kee Seoul National University 1993 The seoul journal of medicine Vol.34 No.4

소아 H. pylori 위염의 혈청학적 진단 : 정상 학동기 아동과 위장관 증상 환아에서의 유병실태 및 혈청학적 진단의 정확도에 관한 연구 Seroepidemiology of H. pylori in Normal School Children and Diagnostic Accuracy of IgG GAP Test in Children with Gastrointestinal Symptoms

서정기,심재건,김의종 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.4

For the detection of Helicobeucter pylori infection, endoscopic biopsy related testa such as urease test, culture, and histology with special staining of bacteria are most widely used standard methods and most accurate. However, they are invasive, time consuming and dot easy to perform in asymptamatic children. Serologic test is non invasive and simple, and in adult, its diagnostic accuracy has been reported as comparable to that of the biopsy related tests. However, differencera in humoral response to Helicobacter pylori have beep noted between adults and children. The aims of this study are to measure the preylence of H.piori seropoaitivity in healthy Korean school children, and to evaluate the diagnotic accuracy of IgG GAP test in children for the detection of H.pylori infection. Serum samples were taken from 950 healthy Korean school children(age 6-14 years) and IgG GAP test(Bio-Rad) were done. Gastroscopic biopsy were performed from the gastric antrum in 310 children(1 mo-15 years) with gastrointestinal symptoms, and diagnostic accuracy of the IgG GAP test was compares with biopsy related tests(Urease, Culture, Giemsa stain). The prevalence of Helicobactar pylori seropositivity in 950 healthy Korean school children increased with age(8.1% in the age group 6-$lt;8 years, 12.4% in 8-$lt;10 years, 18.5% in 10-$lt;12 years, 21.9% in 12-$lt;14 years and 30.6% in 14-$lt;15 years). There was a significant difference in overall prevalence of H.pylori seropositivity between healthy Korean school children(16.5%) and children with gastrointestinal symptoms(28%). Serologic diagnosis by Helicobacter pylori specific IgG GAP test was very seaasitive(94.9%) and specific(92.4%) in comparison with CLO test, Culture and Giemsa stain of biopsy specimens by Gastroscopy. Children with Helicobacter pylori was treated for 4 weeks(Denol for 4 weeks and Amoxicillin for 2 weeks) and negative conversions at the completion of treatment were 85.7% by CLO test, 87.8% by Giemsa stain, 69.5% by culture and 30% by serologic test. Immediate evaluation of therapeutic response by antibody titer was not adequate. In children as reporteid in adults, serodiagnosis by Helicobacter pylori specific IgG antibody was very reliable and convenient for studying the prevalence in a large series of the population.

내시경적 검사 및 상부 위장관 조영술상 특징적인 소견을 보인 소아 전정부 격막 1예

윤혜선,심재건 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.3

Antral web (prepyloric mucosal diaphragm) is a rare gastric anomaly that disturbs the gastric outlet and has sometimes been a diagnostic problem to the radiologist and the endoscopist. It is composed of mucosa that enclose a membrane of submucosa and located at the antrum on variable distances from the pylorus. Web is congenital in origin but may be secondary to chronic peptic ulcer disease. Obstructive symptoms may not occur when diaphragmatic aperture is larger than 1 centimeter in diameter. The diagnosis of web relies on the history, barium study and gastroscopic findings but it may be noticed after laparotomy. We experienced an antral web which demonstrated characteristic endoscopic and radiologic findings in an eight-year-old girl. These typical distinguishable findings in endoscopic and barium study in this case can remind of the antral web in patients with gastric outlet obstruction symptoms. Antral web or pyloric web, although rare, should be considered in the differential diagnosis of upper gastrointestinal obstructive symptoms in patients of any age.