IgA 신병증 환자에서 발생한 크론병

염지연 ( Ji Youn Youm ),이오영 ( Oh Young Lee ),박문향 ( Moon Hyang Park ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),백유흠 ( Yoo Hum Baek ),박송리 ( Song Ree Park ),이항락 ( Hang Lack Lee ),윤병철 ( Byoung Chul Yoon ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.4

치료 불응성 루푸스 신염 환자에 대한 Rituximab 치료

염지연 ( Ji Youn Youm ),성윤경 ( Yoon Kyoung Sung ),엄완식 ( Wan Sik Uhm ),전재범 ( Jae Bum Jun ),유대현 ( Dae Hyun Yoo ),배상철 ( Sang Cheol Bae ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4

Objective: To determine preliminary evidence for the safety and efficacy of B lymphocyte depletion therapy in refractory systemic lupus erythematosus (SLE). Methods: Four female lupus nephritis patients who had been refractory to steroid and one or more immunosuppressive therapy were treated on an open-label basis. During a 4-week period, each patient received two 500-mg infusions of rituximab and two 750-mg infusions of cyclophosphamide. Results: Patient 1, 2, and 3 were responded with rituximab treatment with improvements in SLEDAI and laboratory parameters such as C3/C4 and 24 hour urine protein. However, patient 4 had not improved with rituximab. The variation in the level of anti-double-stranded DNA antibody was different in individual patients. No significant adverse events were observed during follow-up. Conclusion: This study provides an evidence for the safety and possible efficacy of B lymphocyte depletion therapy in refractory lupus nephritis. However a further randomized trial is needed to confirm the efficacy and durability of remission.

신장 ; 혈액투석에서 투석액 칼슘농도와 칼시트리올이 골대사에 미치는 영향

염지연 ( Ji Youn Youm ),김현철 ( Hyun Chul Kim ),이영철 ( Young Chul Lee ),최종욱 ( Jong Wook Choi ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

목적: 현재 혈액투석에 사용 중인 투석액 칼슘 농도는 1.25mmol/L, 1.5 mmol/L, 1.75 mmol/L로 구분된다. 고칼슘 투석액은 부갑상선호르몬의 분비를 억제시키는 효과가 있으나 고칼슘혈증 위험을 증가시키고, 저칼슘 투석액은 adynamic bone disease을 개선시키는 효과가 있으나 칼슘 평형을 악화시킬 우려가 있으므로 투석액 칼슘 농도의 적절한 선택은 쉽지 않다. 저자들은 표준칼슘 농도인 1.5 mmol/L 투석액을 사용하였을 때 칼시트리올 용량 변화와 아울러 요독성 골질환에 미치는 효과를 평가하고자 하였다. 방법: 투석액 칼슘 농도 1.75 mmol/L로 1년 이상 혈액투석 중인 환자 36명에서 투석액 칼슘 농도를 1.5 mmol/L로 전환 후 1년간 경과를 추적하였다. 투석액 칼슘 농도를 낮추기3개월 전에 측정한 혈청 iPTH 농도에 따라 환자를 1군(iPTH< 150 pg/mL, n=21), 2군(iPTH 150-300 pg/mL, n=7), 3군(iPTH>300 pg/mL, n=8)으로 구분하여 혈청 칼슘, 인, 알칼리포스파타제, iPTH 농도를 3개월 간격으로 측정하였고, 인결합제 및 칼시트리올 용량 변화를 조사하였다. 결과: 투석액 칼슘 농도 1.75 mmol/L 사용 중 1군, 2군 및 3군의 iPTH 농도는 각각 57±48 pg/mL, 191±46 pg/mL, 589±200 pg/mL로 유의한 차이가 있었다(p<0.001). 투석액칼슘 농도를 1.5 mmol/L로 전환 후 1군에서 혈청 iPTH가 12개월에 걸쳐 유의하게 증가하였다(p=0.01). 3개월째부터 증가가 현저하여(57±48 vs. 287±266 pg/mL, p<0.01) 이후증가세를 유지하였다. 그러나 2군에서는 유의한 변화가 없었고, 3군의 혈청 iPTH는 12개월에 걸쳐 유의하게 감소하였는데(p=0.02) 특히 9개월째 감소가 기저치에 비해 낮았다(589±200 vs. 242±246 pg/mL, p<0.01). 혈청 알칼리포스파타제도 혈청 iPTH와 유사한 변화 양상을 보였다. 투석액칼슘 농도를 1.5 mmol/L로 전환한 후 1군과 2군에서 인결합제와 칼시트리올 투여 용량의 유의한 변화는 없었으나, 3군에서 칼시트리올 용량이 6개월째부터 유의하게 증가하였고 (4.4±5.1 vs. 9.6±2.9 μg/month, p<0.05) 나머지 기간 동안증가 추세를 유지하였다. 결론: 혈액투석액 칼슘 농도를 1.75 mmol/L에서 1.5 mmol/L으로 전환한 후 적절한 인결합제와 칼시트리올 투여 용량을 조정하면서 adynamic bone disease와 이차성 부갑상선항진증환자에서 혈청 iPTH 측정치가 호전되는 경향을 보였다. 신성골형성장애가 있는 혈액투석 환자에서 투석액 칼슘 농도 1.5 mmol/L를 선택하는 것이 효과적일 수 있다. Background/Aims: Whereas higher dialysate calcium (Ca) levels may pose a risk of hypercalcemia, lower levels may induce a negative Ca balance. We evaluated the effect of lowering dialysate Ca levels from 1.75 to 1.5 mmol/L and explored the appropriate use of calcitriol to regulate bone metabolism in hemodialysis patients. Methods: The dialysate Ca levels of 36 patients were reduced from 1.75 to 1.5 mmol/L. They were divided into three groups according to basal intact parathyroid hormone (iPTH) level (group 1, iPTH<150 pg/mL, n=21; group 2, iPTH 150-300 pg/mL, n=7; group 3, iPTH>300 pg/mL, n=8). Data were collected at 3-month intervals for 1 year. Results: Throughout the study period, no significant difference in phosphate binders, serum Ca, phosphorus (P), or Ca × P products was observed among groups. However, iPTH, alkaline phosphatase (AP), and calcitriol dosage patterns differed among groups. In group 1, iPTH and AP increased significantly over 12 months (p=0.01). In group 2, iPTH and AP showed no significant changes. In group 3, iPTH and AP declined significantly over 12 months (p=0.02). Calcitriol dosage did not change in groups 1 and 2, but increased significantly in group 3 (p=0.001). Conclusions: After converting hemodialysate Ca levels from 1.75 to 1.5 mmol/L, the initially different iPTH concentrations converged to a modestly elevated level. The use of 1.5 mmol/L hemodialysate Ca may thus be appropriate for both high- and low-turnover bone disease if phosphate binders and calcitriol are combined appropriately. (Korean J Med 2011;81:751-758)

국내 강직성척추염 환자를 대상으로 한 Infliximab 치료

백유흠 ( Yoo Hum Baek ),염지연 ( Ji Youn Youm ),이학현 ( Hak Hyun Lee ),김태종 ( Tae Jong Kim ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Objective: Infliximab, a monoclonal antibody to tumor necrosis factor-α, is effective in patients with ankylosing spondylitis (AS), who have not responded to conventional therapy. There were no data on the efficacy and side effect of infliximab in patients with AS in Korea. The objective of this study is to observe the efficacy and adverse effect of infliximab retrospectively in Korean patients with AS. Methods: We reviewed the medical records of thirty-three AS patients. The patients were enrolled to fulfill the modified New York criteria of AS and be in active disease state and resist to conventional therapy. Patients were given 3~5 mg/kg of infliximab infusions at weeks 0, 2, 8 and 16. Information on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) test was collected at each infusion. The paired t-test was used for comparison between the visits. Results: There were 29 male and 4 female patients. The mean age at first infliximab treatment was 34.6±9.8 years. All patients were HLA-B27 positive. ESR and CRP decreased significantly from baseline to 16 weeks after treatment (p<0.001, respectively). The mean ESR was 76.1±36.5 mm/h at baseline and 21.3±31.6 mm/h at 16 weeks. The mean CRP was 6.4±4.8mg/dL at baseline and 1.3±2.1 mg/dL at 16 weeks. Only 1 out of 33 patients got worse. All patients were tested negative for ANA at baseline. After 16 weeks of therapy, the induction of ANA was observed in 8 patients, but no patients have lupus-like symptoms. Conclusion: Infliximab is an effective therapy with non-specific adverse effect in AS non-responsive to conventional therapy in Korea.

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.