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패혈증에서의 TNF - α의 변화와 장기 손상의 상관관계와 상정호르몬의 치료효과
윤여규,이중의 대한외상학회 1996 大韓外傷學會誌 Vol.9 No.1
Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by the injury by oxygen radicals generated in the septic condition. As mediators of inflammatory reactions, oxidants and cytokines such as TNF- stimulates macrophages and neutrophils, and causes systemic inflammatory reactions. Recently, some reported that GH(growth hormone) has been clinically used in septic patients with beneficial therapeutic effects, but the mechanisms of these effects don,t have been explained exactly. This study is designed to evaluate the therapeutic effects of GH in sepsis. For this purpose, the suppresive effects of GH on hepatic and pulmonary injury in sepsis induced by zymosan were examined, and the relation of this effects with antioxidant mechanism and cytokines was investigated in this experiment. Methodologically, female Sprague-Dawley rats as experiment animal were injected intraperitoneally with zymosan to simulate experimental sepsis model, and then their liver and lung tissue were examined histopathologically, and malondialdehyde(MDA) level and catalase activity of the liver and lung tissue were measured biochemically. TNF level in the blood of the rats were measured with ELISA method to evaluate the mechanism of the therapeutic effect of GH on sepsis. The rats were devided into 3 groups, that is a control group, a zymosan-injected group(500 mg/kg intraperitoneal injection, mixed with mineral oil), and a zymosan & recombinant human GH-injected group(2.0 I.U./kg intramural injection). Each group except control group(8 rats) had 40 rats, and every 8 rats were sacrificed and sampled at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours after injection. The results are as follows. On pathological examination, liver tissue of the zymosan-injected group showed lymphocyte and neutrophil infiltration, fatty degeneration of hepatocyte, and destruction of liver lobular structure. Lung tissue of the same group showed lymphocyte and neutrophil infiltration and interstitial edema. There were lesser degree of lymphocyte and neutrophil infiltration and lesser structural injury in the liver and lung tissue of the zymosan & GH-injected group than the zymosan only-injected group. Plasma TNF- levels of the zymosan-injected group were markedly increased compared with the control group, and reached peak level between 24 hours and 48 hours after injection. Plasma TNF- levels were significantly suppressed in zymosan & GH-injected group. MDA levels of liver and lung tissue were remarkably increased in the zymosan-injected group, compared with the control group. The zymosan & GH-injected group had lower MDA levels than the zymosan-injected group. There were statistically significant differences in both liver and lung tissues. So far as catalase activity, lung had higher catalase activity than liver in the control group, and catalase activity was markedly reduced in the zymosan-injected group. In the zymosan & GH-injected group, there were statistically significant increases of catalase activity as compared with zymosan-injected group. Conclusively, CH had therapeutic effect on the organ failure induced by zymosan. GH was demonstrated to have suppressive effect on the lipid peroxidation, and this effect was supposed to be related to increase of catalase activity. And GH was found to have inhibitory effect on the production of TNF-a, a cytokine which mediates tissue injury in sepsis.
윤여규,윤효영,정연권 대한외상학회 1994 大韓外傷學會誌 Vol.7 No.1
To solve the problem of tertiary medical center emergency room, overcrowding and long hospital stay, it is very important to analyze the emergency patients who visited tertiary medical center and to accumulate data bases of various hospitals. For this purpose, we have reviewed 14,521 cases of pateints who visited the emergency room of Seoul National University Hospital, tertiary medical center, from,January 1 to December 31, 1992. The results were as follow: 1. Male to female ratio was l.4:1 and the most common age group was 6th decade. 2. The peak time of patient's enterance in emergency room was between 12:00 PM and 4:00 PM (26.7%), and second peak was between 08:00 AM and midday. 3. In a week, Monday was the most crowding day (mean 44 patients). 4. The most predominant monthly distribution of visit was March and September. 5. Of the patients, 71.7% were known to live in Seoul, 6. About half of the patients who visited emergency room needed internal medical care and 42% of them had gastrointestinal disease. 7. The admission rate was 29.5% and transfer rate was 3.9%. The number of the patients who could admit the ward was largest in Monday (mean 15.2 patients) and smallest in Sunday (mean 6.8 patient,s). The average duration from visit to admission was 51 hours. 8. About 1% (144 patients) of patients expired during the treatment in the emergency room and most of them(81.3%) were internal medical patients.