구연 / 제 4 회의장 / 간 9 : 각종 만성 간질환자들에서 B 형 간염 바이러스의 잠재성감염에 대한 관찰

정정명(Jung Myung Chung),최정식(Jung Sik Choi),김석주(Suk Ju Kim),이연재(Youn Jee Lee),장윤식(Yeun Sik Jang),이상혁(Sang Hyuk Lee),설상영(Sang Young Seoi),모혜경(Hye Kyung Mo),박영홍(Young Hong Park) 대한소화기학회 1999 대한소화기학회 추계학술대회 Vol.1999 No.-

한국인 B형 간염 바이러스 관련 간질환에서 HBV C 및 S 유전자 영역 돌연변이의 면역학적 중요성

정정명 ( Jung Myung Chung ),조환진 ( Hwan Jin Cho ),이연재 ( Yeon Jae Lee ),장윤식 ( Yeun Sik Jang ),박은택 ( Eun Taek Park ),최봉기 ( Bong Ki Choi ),모혜경 ( Hye Kyoung Mo ),박영홍 ( Yeong Hong Park ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

<목적> 본 연구의 목적은 HBV DNA의 C와 S 유전자 영역에서 돌연변이의 빈도를 관찰하고 면역 상태와 C와 S 유전자 영역의 돌연변이 사이에 상관관계를 알아보고자 한다. <방법> HBV 관련 간질환 소아와 성인 34명으로부터 추출한 혈청이나 생검 간조직으로부터 DNA을 추출하였다. 추출한 DNA로부터 HBV의 C와 S 유전자 영역을 증폭하고 클로닝하여 염기서열을 분석하였다. <결과> 34례의 adr type의 분석 결과 32례(94.1%)에서 co

조기에 발견된 점액분비성 간내담관암

조경임(Kyoung Im Cho),윤철(Cheol Yoon),이홍기(Hong Gi Lee),김석주(Seok Joo Kim),장윤식(Yeun Sik Jang),이연재(Youn Jae Lee),이상혁(Sang Hyuk Lee),설상영(Sang Young Seol),정정명(Jung Myung Chung),강미선(Mi Seon Kang) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Peripheral cholangiocarcinoma which was originated from the small bile ducts and generally presents an infiltrative growth, intraductal growth in the peripheral large duct tributaries, is very unusual. Mucin-producing cholangiocarcinoma showing intraductal spread has been reported previously, and it is difficult to diagnose this type of cholangiocarcinoma definitely in early stage in spite of jaundice due to mucin impaction in the common bile duct. We experienced a 49-year-old male patient who had hepatic mass observed incidentally without any specific symptom. This patient was diagnosed as having mucin-producing cholangiocarcinoma by abdominal ultrasonography, computed tomography scan and ERCP. He received hepatic resection successfully. It was diagnosed as mucin-producing cholangiocarcinoma, intrahepatic variant. He is expected to have long term survival. We report this case because the case of asymptomatic mucin-producing cholangiocarcinoma diagnosed at such an early stage is rare. (Kor J Gastroenterol 2000;36:431 - 436)

한국인에서의 IgA 신장병증과 조직적합성 항원과의 관계

신영신(Young Shin Shin),김영옥(Young Ok Kim),박철휘(Chul Whee Park),윤성노(Sung No Yoon),양철우(Chul Woo Yang),김용수(Yong Soo Kim),장윤식(Yeun Sik Jang),방병기(Byung Kee Bang),한훈(Hoon Han) 대한내과학회 1998 대한내과학회지 Vol.54 No.2

N/A designed to evaluate the pattern of histocompatibility antigens(HLA) and its association with poor prognostic factors in patients with IgAN. Methods : Study population comprised the 69 patients with IgAN which was diagnosed by clinical and pathological findings, and control groups were 202 healthy Korean people. We evaluated the HLA class I serologic typing by standard microlymphocytotoxic technique and the HLA class II genotypes by the two-step polymerase chain reaction. Results : 1. HLA-A was not associated with IgAN. 2. The phenotype frequency of HLA-B55 was 6.1% in patient group and 1.7% in normal control group. HLA- B55 was associated with IRAN(relative risk 3.47, P<0.05). 3. HLA-DQB1*04 was also associated with IgAN (relative risk 3.57, P<0.05). 4. There was no significant difference in the distribution of HLA in IgAN patients according to histologic grading, blood pressure, renal function and proteinuria. Conclusions : Frequencies of HLA-B55, HLA-DQB1*04 are higher in Korean patients with IgAN compared to general population. But we could not observe the significant relationships between HLA type and poor prognostic factors. Further study using larger population with IgAN may be necessary to identify the association of HLA locus with poor prognostic factors and progress decline in renal function in patients with IgAN.

급성 A 형 간염에 의한 급성 췌장염 1 예

조환진(Hwan Jin Cho),김성목(Sung Mok Kim),조경임(Kyoung Im Cho),이상봉(Sang Bong Lee),설상훈(Sang Hoon Seol),강석우(Seok Woo Kang),최봉기(Bong Ki Choi),박은택(Eun Taek Park),장윤식(Yeun Sik Jang),이연재(Youn Jae Lee),이상혁(Sang Hyuk 대한소화기학회 2002 대한소화기학회지 Vol.39 No.6

N/A

식도 정맥류 출혈에 대한 내시경적 결찰요법의 치료효과

송진호,장윤식,이옥주,정준용,이연재,이상혁,설상영,정정명 인제대학교 1996 仁濟醫學 Vol.17 No.4

식도 정맥류 출혈은 사망율이 높은 치명적인 질환으로 현재까지 확실한 치료법은 없는 실정이다. 최근 식도 정맥류 출혈에 비교적 지혈률이 높고 부작용이 적은 방법으로 식도 정맥류 결찰술이 보고되었다. 1993년 2월부터 1995년 12월까지 급성 식도 정맥류 출혈로 인제대학 부속 부산백병원에 입원한 환자 중에 내시경적 결찰요법을 72예에서 시행하여 그 결과를 분석해 본 결과 부작용이 적고 지혈효과가 비교적 우수한 치료법이라고 판단되어 이를 보고하는 바이다. Endoscopic injection sclerotherapy(EIS) has been an effective method of treatment for bleeding esophageal varices. However, it is associated with some undesirable complications. Endoscopic variceal ligation(EVL) is a recently developed technique that eradicates esophageal varices and controls active bleeding with similar efficacy and less complication rates than EIS. We have performed EVL in 72 patients who bled from esophageal varices. Total 350 variceal lagations were performed during 104 separate sessions. Control rate of acute bleeding was 93.1% (67 of 72 patients) and five patients died after EVL due to failure of bleeding control. Rebleeding following initiation of EVL occurred in eight patients. Among them, bleeding was successfully controlled by EVL in five, and two patients died of uncontrollable bleeding. In one patient, bleeding was controlled but varices were not completely eradicated. Varices were eradicated or reduced to Grade I in 36 (53.7%) of 67patients by 1-9 ligations (mean 4.9) in 1-4 EVL sessions(mean 1.4). After EVL, there were several minor complications; mild substernal discomfort in seven patients, mild dysphagia in three and fever in two. These results suggest that EVL is a safe and effective method of treatment for bleeding esophageal varices, and eradication of esophageal varices can be obtained with less complications.

원발성 담즙성 간경변증 1례

김호철,장윤식,이연재,이상혁,설상영,정정명,최하진,양영일 인제대학교 1996 仁濟醫學 Vol.17 No.2

원발성 담즙성 간경변증은 원인 미상의 담즙정체 질환으로 만성적인 간내 담관의 염증을 보이면서 간경변증으로 진행하는 드문 질환이다. 저자들은 황달과 소양증을 주소로 내원한 55세의 여자 환자에서 원발성 담즙성 간경변증 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Primary biliary cirrhosis is rare and a disease of unknown origin. It is a chronic cholestatic liver disease characterized by the presence of chronic inflammation, necrosis of hepatic bile duct and progression to liver crirhosis. We experienced a 55 year- old woman complained of jaundice and itching for 3 years. Her clinical symptoms, biochemistry, liver function test and liver biopsy were compatible with primary biliary cirrhosis. Thus we report a case of primary biliary cirrhosis with literature review.

B형 만성 간질환 환자에서 HBV core promoter 변이에 대한 고찰

김호철,이연재,장윤식,이상혁,설상영,박영흥,정정명 인제대학교 2000 仁濟醫學 Vol.21 No.1

Objectives: Chronic hepatitis B virus(HBV) infection may cause various kinds of liver disease. The pathophysiologic mechanisms of such clinical manifestations are still not clearly understood. According to the recent reports, mutations in the HBV core promoter may have an impact on the progression of HBV-related liver disease. The aim of this study was to clarify the frequency and location of naturally occurring mutations in the core promoter region of HBV, and their possible effects on the clinical course of HBV -associated chronic liver diseases. Methods: and Materials: HBV DNA was extracted from the sera of 31 patients who had been HBsAg positive for more than 6 months. The core promoter/precore sequence was amplified via polymerase chain reaction, and direct sequenced. And in this study. 31 patients were divided into 3 groups according to the histopathological severity of liver disease i.e. Group 1 as minimal change and chronic persistent hepatitis, Group 2 as chronic active and lobular hepatitis, Group 3 as liver cirrhosis and hepatocellular carcinoma, respectively. Results: 1.Frequent mutated nucleotides(nt) were 1764(77.4%), 1762(58.1%) and 1753 (25.8%). 2.A double-nucleotide mutation at nt1762 and nt1764 (M1) was observed in 18 cases of 31 patients(58.1%), a single-nucleotide mutation at nt1764(M2) in 5 cases. But a single-nucleotide mutation at nt1753 or nt1762 were not observed at all. 3.M1 had nothing to do with the severity of hepatitis. In case of M2. there was association with severity of hepatitis only in comparisons among Group 2 vs. Group 3(p<0.05) 4.The frequency of mutation in core promoter region had little association with the status of HBeAg/Anti-HBe. 5.The frequency of mutation at nt1896(G→A) in precore region was related with status of HBeAg/Anti-HBe(p<0.01) rather than the severity of disease. Conclusion: We could not find the definite relationship between core promoter mutation and the histopathologic severity of HBV associated liver disease. Further investigations are needed with larger number of patients.

B형 만성 간 질환이 있는 소아와 성인에서 HBV core promoter, precore/core 유전자 부위의 돌연변이에 대한 고찰

정정명,박영홍,설상영,이상혁,장윤식,이연재,채창식 인제대학교 1998 仁濟醫學 Vol.19 No.2

B형 간염은 전세계적으로 수억의 인구가 감염되었을 뿐아니라 간경변증 및 간암의 중요한 원인으로 알려져 있다. 특히 우리나라는 B형 간염바이러스에 전 인구의 약 60%가 과거 HBV에 감염되었던 소견이 있다. 또한 만성 간질환 및 간암 환자의 약 60∼70%가 HBsAg 양성으로 우리나라에서는 HBV가 간질환의 가장 중요한 원인임을 알 수 있다. 그러나 현재까지 간염의 중증도에 어떤 요인이 작용하는지 밝혀져 있지 않다. 이런 점에서 저자들은 B형 간염 바이러스의 변이종과 간질환의 관계를 조사하였다. 변이는 성인에서 많은 경향을 나타내었는데 변이가 주로 발생하는 부위는 core promoter, precore/core 영역에 공히 존재하나 변이와 질환의 중증도와의 직접적인 관계는 관찰되지 않았다. Objectives: To clarify the frequency of mutations in core promoter, precore and core region of HBV(hepatitis B virus) and their possible effects on the clinical course of HBV associated chronic liver diseases. Methods and Materials: we performed PCR (polimerase chain reaction) and direct sequencing for the sera of 48 patients who had been HBsAg positive for more than 6 months (adult 31, children 17). And in this study, adult patients were divided into 3 groups according to the histopathological severity of liver disease i.e. Group 1 as minimal change and chronic persistent hepatitis. Group 2 as chronic active and lobular hepatitis, Group 3 as liver cirrhosis and hepatocellular carcinoma, respectively. Results: 1.The number of mutations at core promoter region did not show statistically significant difference between children and adults. In comparisons among Group 1 vs Group 2 and Group 1 vs Group 3, statistically significant differences were not seen either. About 53.3% of mutations occurred at nucleotide 1753, 1762 and 1764. 2.The number of mutations at precore region which were associated with amino acid changes did not show statistically significant differences between children and adults. And 63.3% of mutations were developed at codon 28(nucleotide 1896). In comparisons among Group 1 vs. Group 2 and Group 1 vs. Group 3, there were no differences in the numbers of mutations. The mutations at this region were more prevalent in Anti-HBe positive group rather than in HBeAg positive group (p= 0.013). 3.At the core region, total number of mutations which were associated with amino acid changes were more frequent in adults than in children. At CTL epitome (codon 18∼27), there were no significant differences of mutations between adults and children, In comparisons among Group 1 vs Group 2 and Group 1 vs Group 3, statistically significant differences were not seen either. CD4 epitope showed statistically significant differences between children and adults (p=0.025), but the histopathological severity was not related with the frequency of mutations. At the B cell epitome, there were significantly different rates of mutations between children and adults(p=0.038). Group 1 and 2 did not show differences, but Group 1 and 3 showed significance. Assuming that the hot spot as mutations over 10% of total cases, 5 spots were identified in children and 11 spots were identified in adults. The area of more frequent mutations in adults were codon 13∼27, 33∼49, 59∼63, 92∼97, 113∼117, which comprise 67.5% of all mutations. Conclusion: We could not find the definite relationships between the mutation in the core promoter, precore/core gene region of HBV and the histopathological severity of HBY associated liver diseases. Further investigations are needed with larger number of patients.

담관 낭종 23예에 대한 임상적 고찰

송진호,이상혁,정정명,이연재,장윤식,설상영,박은택 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.5

Background/Aims: Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. And it is an unusual entity that has increasingly been encountered by ultrasonography and computed tomography scan, even if the symptoms are variable. Methods: We reviewed 23 patients with choledochal cyst who were treated at the Department of Internal Medicine, Pusan Paik Hospital from April, 1986 to April 1995. Results: 1) Age ranged from 14 years to 73 years, and sex ratio was 1:1.4 in male vs female. 2) The durations of symptoms varied from 4 days to several years. 3) The major clinical symptoms were right upper quardrant pain in 19 cases, jaundice in 4 cases, abdominal mass in 2 cases. One case had all of above three symptoms. 4) The diagnostic tools were ultrasonography(USG) in l7 cases, ERCP in 11 cases, abdominal CT in 11 cases, PTC in 6 cases and oral GB in ~1 case. The eight cases(61.5%) were confirmed as anomalous junction of the pancreaticobiliary ductal system(AJPBS) among the 13 cases who had performed ERCP. 5) The choledochal cysts were classified into type I to V according to the classification of Todani; Fifteen cases were type I, six cases type IVa, one case was type II and one case was type V, respectively. 6) Excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was performed in 10 cases, and choledocho-jejunostomy in 4 cases, and Whipple's operation in 2 cases. 7) The associated diseases were CBD stone in 8 cases, cholecystitis in 6 cases, intrahepatic stone in 2 cases, GB cancer in 1 case, and colon cancer in 1 case. Conclusions: ERCP should be used when choledochal cyst is suspected by USG, aiming at demonstrating both AJPBS and enabling the morphologic classification. In addition, Surgical procedures including the excision of choledochal cyst and Roux-en-Y hepaticojejunostomy may be effective to reduce mortality and morbidity related to complication of choleclochal cyst.