원발성 간세포암의 발생원인에 대한 임상적 연구 - 2 . 간경변증 및 간세포암 환자들에서의 혈청 Selenium 치에 대한 비교 관찰 -

구자영(Ja Young Koo),박병채(Byung Chae Park),한병훈(Byung Hoon Han),이상욱(Sang Ook Lee),서승연(Sung Yun Suh),정인철(In Chul Chung),조무연(Moo Yun Cho) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

N/A Whether or not serum selenium concentrations were changed was evaluated in patients with liver cirrhosis and hepatocellular carcinoma. Serum selenium levels among the patients with liver cirrhosis (10.08±1.99 ug/dl) and hepatocellular carcinoma (9.76±1.51 ug/dl) were significantly lower (p<0.05, p<0.005) as compared to the controls (11.49±1.77 pg/dl). These data suggest that a low serum selenium concnetrations observed in patients with liver cirrhosis may be one of risk factors in the development of hepatocellular carcinoma.

B형 간염 바이러스에 의한 간경변증과 간세포암에서 pre-S 영역의 돌연변이에 대한 연구

박영홍,이상혁,정정명,이상욱,설상영,이연재,장윤식 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.1

Background/Aims : According to the recent research, mutations in the HBV pre-S region may have an impact on the progression of hepatitis B virus(HBV)-related liver disease. The aim of this study was to clarify the frequency and location of naturally occurring mutations in the pre-S region of HBV, and their possible effects on the clinical course of HBV-associated chronic liver diseases. Methods : HBV DNA was extracted from the sera of 15 patients (8 with liver cirrhosis and 7 with hepatocellular carcinoma). The pre-S sequence was amplified via polymerase chain reaction, subcloning and sequenced. Results : All patients had point mutations in the pre-S region. Nine of 10 mutation sites (90%) in the pre-S1 region, and 4 of 5 mutation sites (80%) in the pre-S2 region were identical in both liver cirrhosis and hepatocellular carcinoma. Deletions were detected in seven patients (4 with liver cirrhosis and 3 with hepatocellular carcinoma). Among the 4 patients with liver cirrhosis, three had deletion in 5'-end of the pre-S2 region and one spanning the 3'-end of the pre-S1 to 5'-end of the pre-S2 region. All 3 patients with hepatocellular carcinoma had deletions in 5'-end of the pre-S1 region, and two patients had simultaneous deletion spanning the 3'-end of the pre-S1 to the 5'-end of the pre-S2. Conclusion : The pre-S mutants were frequently detected in HBV-associated liver cirrhosis or hepatocellular carcinoma and the point mutations or deletions in the pre-S gene were clustered in specific regions. (Korean J Hepatol 2000;6:91-101)

상부위장관 용종성 병변 265예의 내시경 및 병리조직 소견에 대한 연구

설상영,장윤식,윤상조,주남영,김민기,이상욱 인제대학교 1998 仁濟醫學 Vol.19 No.2

저자는 1988년 7월부터 1997년 12월까지 부산백병원에서 내시경 검사를 통해 상부 위장관의 용종성 병변이 확인된 265명 환자의 274 용종성 병변에서 용종을 올가미법, 박리 생검술, "O" ring 결찰술을 이용하여 절제술을 시행하였으며, 이들을 대상으로 임상적 및 조직학적 소견을 분석하였다. The gastrointestinal polyp is a premalignant lesion in varying degree. Polyps in the gastrointestinal tract can be removed by surgical excision, electrosurgical method, cryotherapy, regional radiotherapy and laser therapy with some limitations. Advance in fibroptic endoscopy have improved diagnostic capabilities and management in patients with gastrointestinal polyps and endoscopic polypectomy is the most simple and safe method in removal of these polyps. We have underwent endoscopic snare polypectomy, strip biopsy and "O"ring ligation on upper gastrointestinal tract polyps in 274 lesions of 265 patients who visited in Pusan Paik hospital from July 1988 to December 1997, and the clinical characteristics including histopathology has been evaluated. The results obtained were as follows : 1) The age distribution of patients were from 28-year old to 78-year old. The ratio of male to female was 1:1.45. 2) The common clinical symptoms presented were epigastric discomfort (38.4%), epigastric pain (28.1%) and indigestion (19.6%). 3) The number of patient wish single gastric polyp was 225(85%), and that of multiple gastric polyps was 40(15%). 4) The most common location of gastric polyps was antrum(47.2%) and followed by body(37.5%) and fungus(9.1%). 5) The removed polyps were mostly 0.5∼1cm(44.8%) in size and in the gross findings by Yamada classifications type II(41.9%) was most common. 6) Histological examinations of gastric polypoid lesions revealed that 63.1% of removed polyps were hyperplastic polyps and 24% of 7hose were adenomatous polyps. 7) Almost all cases showed no significant complication, but there were postpolypectomy abdominal pain in 20 cases(7.5%) and minor bleeding in 8 cases(3.0%). Finally, we concluded that endoscopic polypectomy is a safe and relatively simple procedure and postpolypectomy complication can be considerably reduced by conservative antiulcer therapy, So. most of polypoid lesions of upper gastrointestinal tract should be removed and meticulous pathological review is mandatory.

지방간의 병리학적 소견과 초음파검사의 연관성에 관한 연구

조성환,박이천,박남영,노지훈,윤병철,한병훈,이상욱 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

BACKGROUND Fatty liver is a common disease characterized by diffuse accumulation of neutral fat(triglycerides) more than 5 percent in liver. Ultrasonography has used to be a diagnostic tool for fatty liver, because of cost-effective and non-invasive study. But the sensitivity and specificity of ultrasonography for diagnosis of fatty liver are variable. Thus, we conducted a retrospective study to investigate correlation between histology and sonographic findings of fatty change in liver. METHODS We collected data from 47 patients who were diagnosed as fatty liver by liver biopsy and ultrasonography from January, 1994 to December, 1997. We compared a sonographic finding with the histologic grade of fatty liver and analysed the data retrospectively by SAS program. RESULTS Major cause of fatty liver is alcohol. The mean consumption of alcohol during 1 day is 64.1 gram, and the mean duration of alcohol drinking is 16.5 years. Degree of fatty infiltration in ultrasonography was significantly correlated with degree of fatty accumulation of liver(p=0.001). But, though it was diagnosed as normal by ultrasonography, 19.1% of total patients was fatty liver by needle biopsy. CONCLUSION We think that liver biopsy is needed for further management and follow-up, if liver function test is abnormal, though the finding of ultrasonography is normal.

B형 만성 간질환 환자들의 간조직내 HBV precore 돌연변이종에 관한 관찰

정정명,이상욱,김석주,하희근,김민기,박영홍 인제대학교 1998 仁濟醫學 Vol.19 No.1

HBV의 C 유전자 영역에는 두 개의 개시 codon이 있는데 앞쪽 개시 codon에서 HBeAg이 합성되고 뒤쪽 개시 codon으로부터 HBcAg가 합성된다. 그리고 이 두 개의 개시 codon 사이를 precore 유전자 영역이라 명명하는데 이 부위에서 HBeAg의 합성과 분비를 나타낸다. 따라서 이 precore 유전자 영역에 변이종이 발생되면 이 영역이 비활성화되고 결과적으로 HBV의 증식은 지속되나 HBeAg의 생산이나 표현은 되지 않을 가능성이 있다. 그리고 이러한 사실은 실제 anti-HBe가 양성인데도, 혈중에 HBV DNA가 고농도로 존재하며, 비전형적인 간염을 나타낸 환자들에서 precore 영역의 염기서열을 분석한 결과 이 유전자 부위에 변이가 있음이 증명되고 있다. HBV precore 변이증에 대한 연구는 현재 세계적으로 진행되고 있으나 아직도 질병과의 관계는 확실히 알려져 있지 않다. 따라서. 저자들은 우리나라의 HBV precore 변이종의 양상과 질병과의 관계를 파악하기 위하여 본 연구를 시행하였다. 그 결과 우리나라의 경우 HBV precore 변이종의 양상은 첫째, 염기서열 1896의 G가 A로 치환된 변이종이 주종을 나타내고 있으며. 둘째, 이 1896변이종은 precore의 다른 유전자 부위에 변이를 동반하는 경향이 높으며, 셋째, HBV precore 변이종은 모든 B형 만성 간질환에서 발생될 수 있을 것으로 사료되나. 간세포암이나 간경변증과 같은 중한 간질환과의 관계에 대해서는 향후 계속적인 연구가 필요할 것으로 사료된다. Aims : In order to determine the relationship between the HBV precore mutant and the severity of liver disease in Korea, we performed liver biopsies in patients with HBV associat ed chronic liver disease and compared the types of HBV precore mutation and histologic findings in the same limier tissue. Method : HBV DNA in liver tissues was amplified by polymerase chain reaction(PCR). The precore mutants were detected by the direct sequencing for them. Results : 1.Total of 59 cases (43 males, 16 females) were studied and the age ranged from 19 to 72 years with a mean age of 36.3 years. The subjects were composed of 26 cases with chronic active hepatitis, 8 with chronic persistent hepatitis, 3 wish chronic lobular hepatitis, 9 with minimal changes, 5 with cirrhosis and 8 with hepatocellular carcinoma. 2.The HBV precore mutants were found in 27 cases(45.8%) and all mutations were G to A changes at nucleotide 1896, creating a stop codon at codon 28. However, 15 cases among 27 mutants of 1896 also had mutation at different precore regions ; one case at 1937, 3 cases at 1840, 6 cases at 1846, 2 cases at 1856 and 3 cases at 1899. respectively. Also, all HBV precore mutants were combined with wild type HBV sequence. 3.The relationship between HBV precore mutants and HBeAg status revealed that 9 cases from 31 HBeAg positive (29.0%), and 18 from 28 HBeAg negative or anti-HBe positive (64.3%) were mutants. More frequent mutations were observed in HBeAg negative cases. 4.In analysis of the types of mutants and histopathological findings of liver disease, 16 among 26 chronic active hepatitis (46.2%), 1 among 8 chronic persistent hepatitis (12.5%), 1 among 3 chronic lobular hepatitis (33.3%), 5 among 9 minimal changes (55.6%), 2 among 5 liver cirrhosis (40.0%) and 6 among 8 hepatocellular carcinoma (75.0%) showed precore mutations. Conclusion : The patterns of HBV precore mutants in Korea could be summarized as follows. Firstly, mast of the mutations were composed of G to A change at nucleotide 1896. Secondly. most of the mutants at nucleotide 1896 are associated with simultaneous mutations at another precore regions. Thirdly, although precore mutations can happen in any histologic status of chronic liver diseases, its possible relationships with serious conditions, such as cirrhosis and hepatocellular carcinoma, need further investigation.