혈액투석 환자의 영양 상태와 혈장 아미노산

윤동진(Dong Jin Youn),김진국(Jin Kook Kim),최수정(Soo Jeong Choi),최태윤(Tae Youn Choi),황승덕(Seung Duk Hwang) 대한내과학회 2002 대한내과학회지 Vol.62 No.5

목적: 혈액투석 치료 중인 만성신부전 환자들은 여러 연구에서 아미노산 대사의 이상을 보여왔으나 우리나라에서 만성신부전 환자의 혈장 아미노산 변화에 대한 연구는 적은 편이며, 서양인과 동양인의 식사 내용이 다르기 때문에 서양인을 대상으로 한 연구 결과를 한국인에게도 그대로 적용하는 것은 적절하지 않다. 그러므로 본 연구의 목적은 혈액투석 중인 만성신부전 환자에서 혈장 아미노산의 분포를 정상인과 비교하여 영양상태를 파악하는데 있다. 방법: 순천향대학교 부천병원에서 혈액투석을 시행하고 있는 만성신부전 환자 20명과, 연령과 성별이 비슷한 정상대조군 20명을 대상으로 영양상태 평가, 인체계측 그리고 혈장 아미노산을 reverse phase HPLC 법으로 측정하여 비교하였다. 결과 : Triceps skinfold thickness와 midarm muscle circumference (MAMC)는 만성신부전 환자에게서 각각 12.32±5.6 mm, 18.2±3.5 cm로, 정상 대조군의 21.6±4.6 mm, 23.6± 4.7 cm 비해 유의하게 낮은 수치를 보였다. 혈청 총단백, 알부민, 총콜레스테롤, 중성지방 등은 차이가 없었으나 prealbumin과 transferrin은 만성신부전 환자에서 정상대조군에 비해 유의하게 낮았다. 아미노산 중 taurine, phosphoserine, cystine은 만성신부전 환자에서 더 높았으며, serine, alanine, valine, leucine, tyrosine은 만성신부전 환자에서 더 낮았고, glycine, threonine, aspargine, glutamine, proline, methionine, isoleucine, lysine, histidine은 만성신부전 환자와 정상 대조군 사이에 통계적으로 의미있는 차이는 없었다. 결론 : 만성신부전 환자는 정상대조군과 비교하여 영양상태가 불량하였으며 대부분의 아미노산이 감소되어 있음을 관찰할 수 있었다. 혈액투석 중인 만성신부전 환자들의 아미노산 이상과 질소 균형을 개선하기 위해서는 대사성 산증을 교정하고 serine을 고려한 식이요법이 중요하리라 생각되며, 아직 투석을 시행하고 있지 않은 만성신부전증 환자에서의 혈장 아미노산 변화에 대한 추가적인 연구가 필요하리라고 생각된다. Background: Many studies document the presence of abnormalities in amino acids metabolism in chronic uremia. These abnormalities have been attributed to low protein intake, deficiency of excretory and metabolic functions of the diseased kidneys, toxic effects of uremia on the intermediary metabolism of amino acids and in dialysis patients, loss of protein and amino acids by the dialytic procedure. Methods: This study was designed to compare anthropometric measurement, biochemical characteristics and plasma amino acid concentration between patients with end stage renal disease on maintenance hemodialysis (HD) and normal controls. A cross sectional study of overnight fasting plasma amino acids and plasma albumin, prealbumin, triglyceride (TG), cholesterol, transferrin concentration were performed on 20 hemodialysis patients and 20 normal controls, matched by age and sex. Results : The concentrations of prealbumin (25.60±7.05 mg/dL vs 35.08±8.11 mg/dL, p<0.005), transferrin (158.30±39.66 mg/dL vs 275.50±55.46 mg/dL, p<0.001) were found to be lower in HD patients. No differences in albumin, cholesterol and TG were observed between the two groups. Several amino acids (taurine, cystine, phosphoserine) were found to be higher in the HD patients, while the concentrations of other five amino acids (serine, alanine, valine, leucine, tyrosine) were lowered in HD patients. No differences in nine amino acids (asparagine, glutamine, proline, glycine, methionine, isoleucine, lysine, histidine, arginine) were observed between the two groups. Conclusion: Our results suggest that chronic renal failure patients have malnutrition and amino acids abnormalities. To correct the amino acids abnormalities and improve nitrogen utilization in hemodialysis patients, correction of acidosis and supplementation of the diet with serine should be considered.(Korean J Med 62:522-529, 2002)

일개 상급종합병원 완화의료 병동 말기 암 환자를 대상으로 Objective Prognostic Score의 타당도 조사

박희진(Hee Jin Park),최윤선(Youn Seon Choi),김선미(Seon Mee Kim),김정은(Jung Eun Kim),김은혜(Eun Hye Kim),김이연(E Yeon Kim),조윤정(Youn Jung Cho),김정원(Jeong Won Kim),오연희(Yeon Hee Oh),정지훈(Ji Hoon Jung),윤동진(Dong Jin Yoon) 대한임상노인의학회 2016 대한임상노인의학회지 Vol.17 No.2

Background: OPS (Objective Prognostic Score) have been developed to predict the 3-week survival of terminally ill cancer patients from six training hospitals in Korea based on an integrated model using symptoms, performance status, and routine blood tests for inpatients in 2007. The purpose of this study is to validate OPS for terminally ill cancer patients in a tertiary hospital of Korea. Methods: 163 terminally ill cancer patients hospitalized at hospice palliative care unit of a university hospital in Korea from January 2012 to December 2013 were retrospectively analyzed. The OPS was calculated from the sum of partial scores obtained from following seven significant predictors: anorexia, dyspnea, the Eastern Cooperative Oncology Group (ECOG) performance status scale, white blood cell (WBC) count, total bilirubin, creatinine and lactate dehydrogenase (LDH). The accuracy of the OPS was evaluated. Results: The median survival was 15 days (95% confidence interval 12∼18 days). The predictors that validated significant by the multivariate analysis were low performance status (HR=1.62; P=0.0295), leukocytosis (HR=1.46; P=0.0265), elevated serum bilirubin (HR=1.57; P=0.0164), elevated serum creatinine (HR=1.71; P=0.0258), and elevated serum LDH (HR=1.49; P=0.0320). The cutoff point for the prediction of survival time shorter than 3 weeks was set at 3.0 (sensitivity 82.1%, specificity 52.6%). Conclusion: OPS has been validated in this population and was useful to predict the 3-week survival of terminally ill cancer patients in a tertiary hospital of Korea. It may help in making decisions about hospice care for patients and their families.

마약성 진통제 사용과 Cortisol 및 DHEAS와의 관계

정지훈,최윤선,김선미,이준영,김은혜,김정은,김이연,박희진,윤동진,Jung, Ji Hoon,Choi, Youn Seon,Kim, Seon Mee,Lee, June Young,Kim, Eun Hye,Kim, Jung Eun,Kim, E Yeon,Park, Hee Jin,Yoon, Dong Jin 한국호스피스완화의료학회 2015 한국호스피스.완화의료학회지 Vol.18 No.2

목 적: 치료 불가능한 암환자에서는 암으로 인한 전신적 쇠약 이외에 피로와 에너지 상실, 무력감, 식욕부진 및 통증 등이 공통적으로 나타나는 주요 증상으로 알려져 있으며 이러한 증상은 부신 기능 부전이 있을 때 나타나는 증상과 유사한 점이 많다. 또한 말기암환자의 통증은 중등도 이상이기 때문에 대부분 마약성 진통제로 조절하고 있는 경우가 많다. 본 연구에서는 마약성 진통제와 부신 기능 부전에 대한 관계를 알아보고자 한다. 방법: 2013년 11월부터 2014년 6월까지 7개월 동안, 만 18세 이상의 말기암환자 55명을 대상으로 혈장 cortisol, DHEAS 등을 측정하였다. 또한 환자의 마약성 진통제의 사용 기간 및 용량도 함께 조사하였고 마약성 진통제의 사용 기간 및 용량과 부신 기능을 대표할 수 있는 혈장 cortisol, DHEAS의 농도를 각각 비교하였다. 결과: Cortisol의 평균값은 $20.24{\mu}g/dL$, DHEAS의 평균값은 $44.41{\mu}g/dL$였으며, 상관 분석 결과 DHEAS와 마약성 진통제의 사용 기간 및 용량과의 관계는 통계적으로 유의한 수준의 관련성이 없었고, Cortisol의 경우 마약성 진통제의 사용 기간과는 유의한 관련성이 없었으나, 진통제의 사용 용량이 많을수록 Cortisol의 수치가 유의하게(P-value 0.0322) 상승되었다. 결론: 마약성 진통제의 사용 기간 및 용량에 따른 부신 기능의 저하는 통계적으로 유의한 연관성을 보이지 않았으나 진통제를 사용하고 있는 말기암환자들의 부신 기능을 대표할 수 있는 지표인 DHEAS 값은 대부분 정상 이하로 낮아져 있는 모습을 보였다. Purpose: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. Methods: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. Results: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). Conclusion: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

슬관절 전치환술 1,000예 분석

조우신(Woo-Shin Cho),정용갑(Yong-Gab Jeong),박종희(Jong-Hi Park),김기용(Ki-Yong Kim),윤동진(Dong-Jin Youn),신재명(Jae-Myoung Shin) 대한정형외과학회 2001 대한정형외과학회지 Vol.36 No.5

슬개대퇴간 동통 증후군 환자의 방사선학적 분석

이창원(Chang-Won Lee),김종민(Jong-Min Kim),박재형(Jai-Hyung Park),손현철(Hyun-Chul Shon),윤동진(Dong-Jin Youn),빈성일(Seong-Il Bin) 대한정형외과학회 2001 대한정형외과학회지 Vol.36 No.3

상완 신경총 신경염

이기원(Ki-Won Lee),최영준(Young-Joon Choi),안형선(Hyung-Sun Ahn),김정환(Chung-Hwan Kim),황재광(Jae-Kwang Hwang),윤동진(Dong Jin Youn),김유진(Eugene Kim),하정기(Jung-Ki Ha) 대한견주관절의학회 2006 대한견주관절학회지 Vol.9 No.2

역류성 식도염 환자에서 증상 발현의 의미

한찬희(Chan Hee Han),이준성(Joon Seong Lee),임희혁(Hee Hyuk Lim),오영수(Young Soo Oh),윤영근(Young Keun Yoon),김상균(Sang Gyune Kim),김명수(Myung Soo Kim),류은상(Eun Sang Ryoo),윤동진(Dong Jin Youn),정인섭(In Seop Jung),고봉민(Bong M 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

N/A Background/Aims : The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. Methods : Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. Result : Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score >14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p <0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. Conclusion : It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.

만성 B형 간염환자에서 인터페론 치료 후 간 조직검사 소견의 변화와 Tumor Necrosis Factor의 임상적 의의

김홍수,윤동진,김은주,정일권,박상흠,이문호,김선주 순천향의학연구소 2000 Journal of Soonchunhyang Medical Science Vol.6 No.2

Background: Interferon has been widely used in the treatment of chronic hepatitis B, but its effectiveness is debatable. The clinical indices as the loss of HBeAg, HBV DNA, and improvement of liver function are applicated to identify the effectiveness of interferon therapy, but the mechanism of hepatohistological change is not well known. We investigated the changes of histologic finding and plasma tumor necrosis factor(TNF) in the patients with chronic hepatitis B after treatment with interferon-alpha. Methods: 11 patients with chronic hepatitis B who had treated by interferon-alpha were enrolled for this study. Liver biopsy was done before and after treatment of interferon and plasma TNF was evaluated at the same time. A semiquantitative study using a histologic scoring system was applied on pre and post liver biopsy specimens and the changes of HBeAg and HBV DNA were also evaluated. Results: Among subjects, the response group, recurrence group, and non-response group based on serologic response with clearance of HbeAg were6, 3, and 2 patients, respectively. The changes of serum ALT level and HBV DNA titer on pre and post therapy decreased significantly in the response group. The change of mean plasma TNF level in the response group decreased insignificantly to 19.4 from 19.9. The histological improvements of grading and staging were shown 4 patients in the response group. Conclusions: Serologic response with clearance of HBeAg was associated with histolofical improvement. The loss of HBsAg in the serum was significant indicator of reduction in the amount of HBV core antigen and HBV surface antigen in the hepatocytes. Plasma TNF level was not associated with response of interferon-alpha therapy and histologic activity.

진행성 신부전증 환자에서 소분자 물질 청소율의 감소가 영양 상태에 미치는 영향

김진국,이은아,윤동진,전성희,나명희,한동철,박민선,황승덕,이희발 대한신장학회 2000 대한신장학회잡지 Vol.19 No.4

점막하종양양 벽외성 압박의 진단에 있어서 내시경적 초음파차단층촬영술

조주영,김진오,한찬희,이문성,심찬섭,윤동진,김명수,이준성 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6

Background/Aims: When a submucosal lesion is discovered through an upper gastrointestinal endoscopy, it may be often difficult to differentiate an extra-gastric compression from a true submucosa1 tumor (SMT). An endoscopic ultrasonography (EUS) provides information about the relationship between a lesion and the gastric or esophageal wall. Furthermore, EUS helps in identifying the compression caused by surrounding organs. The diagnostic usefulness of EUS for extralumina1 compressed lesion was assessed. Methods: The 261 patients who received an endoscopic diagnosis of submucosal tumors had EUS examinations performed. The results of EUS to additional diagnostic procedures such as UGI, USG, CT scan or tissue biopsy were then compared. Results: Of 261 patients who received endoseopic diagnosis as SMT, extraluminal compression existed in 46 (17.6%) cases and true intramural lesion were found in 215 (82.4%) cases on EUS. The causes of extraluminal compression are lymph nodes (2 case.), the gallbladder (12 cases), the pancreas (9 cases), the spleen (6 cases), a pancreatic pseudocyst (5 cases), pancreatic cancer (2 cases), a hepatic cyst (2 cases), the left lobe of the liver (4 cases), hepatoma (1 case), a mesenteric tumor (2 caws) and a splenic vein (1 case). Conclusions: EUS is considered to be a useful diagnostic method not only for differential diagnosis of extraluminal compression from true SWT, but also for clarifying the cause of extraluminal compressed lesions.