급성호흡곤란증후군 환자에 있어서 B-type Natriuretic Peptide의 유용성

이진국 ( Chin Kook Rhee ),주영빈 ( Young Bin Joo ),김석찬 ( Seok Chan Kim ),박성학 ( Sung Hak Park ),이숙영 ( Sook Young Lee ),고윤석 ( Yoon Seok Koh ),김영균 ( Young Kyoon Kim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5

연구배경: B-type natriuretic peptide(BNP)는 심인성 및 다른 쇼크 상태를 포함하는 심혈관 질환에서 사망을 예측하는 좋은 인자 중의 하나로 알려져 있다. 그러나, 급성호흡곤란증후군환자에서 이런 관계가 잘 알려져 있지 않는 바, 저자들은 BNP가 급성호흡곤란증후군 환자에서 사망을 예측할 수 있는 지를 연구하였다. 방법: 본 연구는 전향적 관찰로 시행되었다. 급성호흡곤란증후군으로 진단된 환자들에게 심초음파 검사를 시행한 후, 좌심실 구획률이 50% 미만이거나 확장성 심부전 양상을 보인 환자들을 제외하였다. 2003년 12월부터 2006년 2월까지 총 47명의 환자가 채택되었다. 등록된 환자들은 24시간 내로 BNP를 포함한 여러 검사실 수치를 얻었으며, APACHE (Acute Physiology and Chronic Health Evaluation) II 점수를 구하였다. 결과: BNP와 APACHE II 점수 평균값은 생존자군과 사망자군에서 유의한 차의를 보였다(BNP: 219.5±57.7 pg/mL vs 492.3±88.8 pg/mL; p=0.013, APACHE II 점수: 17.4±1.6 vs 23.1±1.3, p=0.009). BNP는 혈중 크레아티닌 수치와 양의 상관관계를 보였으나(r=0.374, p=0.01), 좌심실 구획률과는 유의한 관계가 없었다. Receiver operating characteristic 곡선상, BNP 수치를 585 pg/mL로 잡았을 때 사망을 예측하는데 있어서 94%의 특이도를 보였으며, APACHE II 점수의 경우에는 15.5를 기준으로 하였을 때 87%의 민감도를 보였다. 이 두 요소를 결합하여 ``아파치II 점수+11×logBNP`` 수치를 계산하여 기준점을 46.14로 했을 경우, 사망 예측에 있어서 민감도 63%, 특이도 82%의 결과를 얻을 수 있었다. 결론: 좌심실 기능 부전을 보이지 않는 급성호흡곤란증후군 환자에서 BNP 수치는 생존자군과 사망자군에서 유의한 차이를 보였으며 사망을 예측할 수 있었다. 향후 급성호흡곤란증후군 환자에 있어서 BNP와 관련된 연구가 더 필요하다고 생각된다. (Tuberc Respir Dis 2007; 62: 389-397) Background: B-type natriuretic peptide (BNP) has been shown to be strong mortality predictors in a wide variety of cardiovascular syndromes. Little is known about BNP in patients with acute respiratory distress syndrome (ARDS). We studied whether BNP can predict mortality in patients with ARDS. Method: Echocardiographic study was done to all patients with ARDS, and we excluded patient with low ejection fraction (less than 50%) or showing any features of diastolic dysfunction. 47 patients were enrolled between December, 2003 and February, 2006. Parameters including BNP were obtained within 24h hours at the time of enrollment. Result: Mean BNP concentrations and APACHE II scores differed between the survivors and nonsurvivors (BNP, 219.5 ± 57.7 pg/mL vs 492.3± 88.8 pg/mL; p=0.013, APACHE II score, 17.4 ± 1.6 vs 23.1 ± 1.3, p=0.009, respectively). With the use of the threshold value for BNP of 585 pg/mL, the specificity for the prediction of mortality was 94%. The threshold value for APACHE II of 15.5 showed sensitivity of 87%. ``APACHE II + 11×logBNP`` showed sensitivity 63%, and specificity 82%, using threshold value for 46.14. Conclusion: BNP concentrations and APCHE II scores were more elevated in nonsurvivors than survivors in patients with ARDS who have normal ejection fraction. BNP can predict mortality. Further study should be done.

COPD 코호트 자료에서의 Machine Learning 방법론 비교

정현명,박헌진,이진국,이종민,Jeong, Hyeon-Myeong,Park, Heon-Jin,Rhee, Chin-Kook,Lee, Jong-min 한국빅데이터학회 2017 한국빅데이터학회 학회지 Vol.2 No.2

최근 머신러닝 방법은 높은 예측력과 함께 널리 이용되지만 머신러닝을 제대로 활용하기 위해서 데이터가 가진 한계를 통계적 기법으로 해결한다면 기존보다 더 높은 예측력을 이끌어 낼 수 있다. 본 연구에서는 Longitudinal and Imbalanced Data에서 SMOTE 방법을 활용하여 불균형 문제를 해결한 결과 예측력이 증가하는 것을 확인할 수 있었다. 추가적으로 만성폐쇄성폐질환 급성악화 관련 연구가 활발히 이루어지고 있지만 급성악화와 관련 있는 요인을 찾는 연구만 이루어지고 있어 여러 요인들에 대한 복합적인 관철과 예측모형을 통한 급성악화 예측 연구는 이루어지지 않는다. 본 연구에서는 여러 요인을 같이 살펴봤을 때 어떤 요인들이 만성폐쇄성폐질환 급성악화와 관련이 있는지 확인하고 개인 맞춤형 특정 질환 예측 모형을 구축하였다. Recently, Machine Learning Methods are widely used with high prediction performance. But if the limit of the data is solved by the statistical technique, It can, lead to higher prediction performance than the existing one. In this study, the SMOTE method is used to solve the imbalance problem in the longitudinal and imbalanced data. As a result, It, was confirmed that the prediction performance increases. Additionally, Although, studies on COPD have been actively conducted, only studies that are related to acute exacerbation have been conducted. So there are no studies on the prediction of acute exacerbation through multiple perspectives and predictive models for various factors. In this study, We examined the factors related to acute exacerbation of COPD and constructed a personalized specific disease prediction model.

진성 적혈구증다증 환자에서 발현한 Erdheim-Chester Disease

김지은 ( Ji Eun Kim ),이현정 ( Hyun Jeong Lee ),이진국 ( Chin Kook Rhee ),윤형규 ( Hyung Kyu Yoon ),송정섭 ( Jeong Sup Song ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3

Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan`s cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD. (Tuberc Respir Dis 2008;64:224-229)

군병원 중환자실 병원 감염률 추이분석과 민간병원 병원감염률 및 항생제 민감성 비교

송주희 ( Ju-hee Song ),이희경 ( Hee-kyung Lee ),윤선영 ( Sun-young Yoon ),남은혜 ( Eun-hye Nam ),오유리 ( Yu-ri Oh ),이진국 ( Chin-kook Rhee ) 국군의무사령부 2011 대한군진의학학술지 Vol.42 No.1

BACKGROUND: The purpose of this study was to exam the nosocomial infection rate of intensive care unit (ICU) in military hospital and to compare with civilian hospitals and past rate in military hospital. METHODS: We retrospectively surveyed the nosocomial infection rate of ICU in Armed Forces Capital Hospital (AFCH) between 2005 to 2010. We compared infection rate with the data of Korean Nosocomial Infections Surveillance System (KONIS) and AFCH in 2000. RESULT: Total 47 cases of nosocomial infections were detected during the study period. Among them, 15 cases were pneumonia, 9 were blood stream infection, and 17 were urinary tract infection. The infection rate (2.12) was significantly lower than AFCH in 2000 (15.48, P < 0.0001) and KONIS (8.40, P < 0.0001). The rate of imipenem resistant Acinetobacter was also significantly lower than KONIS (33.3% vs 82.5%, AFCH vs KONIS; P = 0.012). CONCLUSION: The nosocomial infection rate in ICU of AFCH is significantly lower than KONIS and AFCH in 2000. Further study about the nosocomial infection rate of military hospital is needed.

폐암 치료 후 발생한 기관지 침범 Mycobacterium intracellulare 감염 1예

조형준 ( Hyeong Jun Cho ),이종민 ( Jongmin Lee ),이진국 ( Chin Kook Rhee ),김승준 ( Seung Joon Kim ),김석찬 ( Seok Chan Kim ),김영균 ( Young Kyoon Kim ),강지영 ( Ji Young Kang ) 대한내과학회 2022 대한내과학회지 Vol.97 No.6

The incidence of nontuberculous mycobacterial pulmonary disease is increasing, and Mycobacterium avium complex (MAC) is the most common causal species. Patients with underlying structural lung disease or an immunosuppressive condition are at increased risk for MAC infections. Endobronchial lesions caused by MAC infection are extremely rare, especially in immunocompetent hosts. Here, we describe a case of a 58-year-old woman with pulmonary infiltration and endobronchial involvement caused by MAC. The patient had shortness of breath and a productive cough. She had undergone surgery and chemoradiotherapy for lung cancer 10 years prior. Radiological findings revealed small centrilobular nodules with consolidation in the right lung and mild stenosis at the right main bronchus. Bronchoscopy revealed yellowish-white caseous necrosis in the right main bronchus. Mycobacterium intracellulare was identified in bronchial washing fluid. She was treated with antimicrobial medications. After 6 months of treatment, bronchial lesions, radiological findings, and symptoms had improved remarkably and she showed culture conversion. (Korean J Med 2022;97:375-380)

증례 : 만성 신부전으로 발현된 Erdheim-Chester disease 1예

황현석 ( Hyun Suk Hwang ),지병수 ( Byoung Su Ji ),이진국 ( Chin Kook Lee ),김진영 ( Jin Young Kim ),최범순 ( Bum Soon Choi ),양철우 ( Chul Woo Yang ),김용수 ( Yong Soo Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2

Erdheim-Chester disease는 포말 대식세포에 의한 전신 염증 반응을 일으키는 드문 질환이다. 본 증례는 만성신부전으로 발현하여 원인을 찾는 과정에서 Erdheim-Chester disease를 진단하게 되었다. 만성신부전의 원인으로 Erdheim-Chester disease는 드문 질환이나 원인미상의 후복막섬유화증이 있는 경우 Erdheim-Chester disease에 대한 가능성을 고려하는 것이 중요하다고 판단된다. Erdheim-Chester disease is a rare non-langerhans cell histiocytic disorder of an unknown cause that may associate with multisystem, rapidly fatal, infiltrative disease. We report here on a case of Erdheim-Chester disease in a 45-year-old man who presented with chronic renal failure. The patient visited a local clinic due to renal failure that was accidentally diagnosed on a routine health examination. At that time, abdominal computed tomography revealed retroperitoneal fibrosis and bilateral hydronephrosis. However, he did not visit hospital for further evaluation. After 1 year, he visited our clinic due to exertional dyspnea that had developed several months previously. The chest and abdominal CT showed interstitial pneumonitis and pleural effusion and there was progressed hydronephrosis and perirenal fibrosis. He was diagnosed with Erdheim-Chester disease based on the characteristic findings of pleural biopsy (interstitial fibrosis, infiltration of macrophge, CD68-positive but S-100 negative). The patient was treated with insertion of a double J catheter and immunesuppression with prednisolone and azathioprine. Erdheim-Chester disease is a rare disease, but it should be considered in those patients displaying chronic renal failure with retroperitoneal fibrosis.(Korean J Med 73:216-222, 2007)