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소아 만성 B형 간염의 Interferon Alfa 치료 후 혈청학적, 조직학적 소견의 변화
고재성,정주영,장자준,서정기,Ko, Jae-Sung,Chung, Ju-Young,Jang, Ja-Joon,Seo, Jeong-Kee 대한소아소화기영양학회 2000 Pediatric gastroenterology, hepatology & nutrition Vol.3 No.1
목 적: 만성 B형 간염 환자의 치료에 interferon alfa는 효과가 있는 것으로 알려지고 있지만 연구자에 따라 차이가 있으며 소아에서의 치료 후의 조직학적 변화에 대한 연구는 거의 없는 실정이다. 저자들은 소아 만성 B형 간염에서 interferon alfa의 치료 효과와 추적 생검이 가능했던 환자에서의 조직학적 변화에 대해 알아보고자 하였다. 대상 및 방법: 1995년 3월부터 1997년 8월까지 서울대학교병원 소아과에서 6개월 이상 HBsAg과 HBeAg 및 HBV DNA가 양성이었으며 간 조직검사상 만성 간염으로 확진된 환자 35명을 대상으로 recombinant interferon alfa 3~6 MU(평균 $3.4\;MU/m^2$)를 주 3회씩 6개월간 피하주사 하였다. 치료 시작 12개월 이상 혈청학적 변화를 추적 관찰하였다. interferon에 반응이 있는 환자 중 18명에서 치료후 간생검을 실시하여 조직학적 변화를 분석하였다. 결 과: 1) 치료 환자 35명 중 17명(49%)에서 인터페론 치료 시작 6개월에 HBV DNA의 감소가 있었고, 12개월째에 22명(63%)에서 HBeAg 및 HBV DNA의 음전이 생겼으며 18개월까지는 25명(71%)에서 관찰되었다. 반응군에서 혈청 ALT치는 모두 정상화되었고, HBsAg의 음전은 1명에서 관찰되었다. 2) 어머니가 HBsAg 보유자가 아닌 수평감염, 치료전 ALT가 정상의 2배 이상, 간조직의 심한 괴사와 염증이 interferon에 대한 반응이 좋은 예측인자이었다. 3) 치료 후 반응군의 간조직 소견에서 간맥주위괴사, 소엽내 활성도, 간맥내 염증, 간섬유화, total HAI가 유의하게 감소하였다. 결 론: 소아 만성 B형 간염에서 interferon alfa 치료 후 63%에서 반응을 보였으며, 혈청학적 변화는 조직학적 소견의 호전과 연관이 있다. 소아 만성B형 간염 환아에서 interferon 치료는 혈청학적, 생화학적, 조직학적 관해를 유도하는 효과적이고 안전한 치료방법이다. Purpose: The aim of this study was to evaluate the efficacy and histologic changes of interferon-alfa therapy on chronic hepatitis B virus infection in children. Patients and Methods: Thirty five children aged 3~16 years who were seropositive for HBV DNA, HBsAg and HBeAg were enrolled. Interferon-alfa 2a ($3.4\;MU/m^2$) were given for 6 months. Serologic markers of viral replication was evaluated 1 year after therapy. Post treatment liver biopsy was performed in 18 patients who showed serologic response. Results: Serum HBeAg and viral DNA became negative in 22 (63%) of treated children at 12 months after therapy. Serum aminotransferase levels normalized in all of the responders and HBsAg became negative in one responder. Horizontal transmission, serum aminotransferase levels more than twice normal, and active inflammation on liver biopsy were predictive factors for response to interferon therapy. Periportal piecemeal necrosis, lobular activity, portal inflammation, fibrosis, and total histologic activity index were reduced in responders. Conclusion: In children with chronic hepatitis B, interferon alfa promotes loss of viral replication and improves aminotransferase. Serologic response is associated with improvement in hepatic histology.
유선질환에서 Secretory Component와 Carcinoembryonic Antigen 출현도에 관한 관찰
이윤덕,장자준,송계용,유재형 중앙대학교 의과대학 의과학연구소 1987 中央醫大誌 Vol.12 No.1
To observe the reaction and relationship between the secretory component(SC) and the carcinoembryonic antigen(CEA) in the mammary diseaes, immounohistochemical studies were carried out. The studies consisted of 15 cases of infiltrating ductal carcinoma,5 cases of infiltrating colloid carcinoma, 10 cases of fibroadenoma and 15 cases of mammary dysplasia. The results were as follows: 1. Moderately or strongly positive reaction of CEA and weakly poaitive reaction of SC were observed in infiltrating ductal carcinoma. 2. Weakly poitive reactions of CEA and SC were observed in infiltrating colloid carcinoma. 3. Weakly poitive reactions of CEA and moderately positive reaction of SC were observed in infibroadenoma. 4. Weakly poitive reactions of CEA and moderately positive reaction of SC were observed in mammary dysplasia. 5. Therefore, reactivities of CEA were more increased in the carcinoma than benign condition of the breast in comtrasr with those of the SC which were more dominant in reactive or benign tumorous condition than in carconoma, suggesting dedifferentiation to the embryonal stage of carcinoma cells.
유방암에서 Carcinoembryonic Antigen 출현도에 관한 면역조직화학적 관찰
이광수,유재형,장자준,송계용 중앙대학교 의과대학 의과학연구소 1986 中央醫大誌 Vol.11 No.3
To observe the carcinoembryonic antigen with their morphologic differentiation in the mammary carcinoma immunohistochemical studios were carried out with 38 cases of carcinoma and 20 cases of benign diseases. The studies consisted of 28 cases of the infiltrating ductal carcinoma, 5 cases of infiltrating colloid carcinoma, 5 cases of infiltrating papillary carcinoma, 10 cases of fibroadenoma and 10 cases of mammary dysplasia. The results were as follows: 1. Infiltrating ductal carcinoma showed mild to moderate intracellular positive reaction of CEA of poorly differentiated tumor cells. CEA of the well differentiated neoplastic ducts was more positive reaction in the centriluminal area than that of the intracellular area. 2. CEA was positive in surface and intracellular area of tumor ce11s of the infiltrating colloid carcinoma without positive reaction in mucin pool. 3. CEA positive reaction of the infiltrating papillary carcinoma showed basically identical findings in contrast to that of the infiltrating ductal carcinoma. 4. CEA was weakly positive in the ductal epithelia of the fibroadenoma and mammary dysplasia focally.