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결핵성 흉수에서 IL-10, IL-12, IFN-$\gamma$, ADA 측정의 의의
전두수,윤상명,박삼석,이효진,김윤성,이민기,박순규,Jeon, Doo-Soo,Yun, Sang-Myung,Park, Sam-Seok,Lee, Hyo-Jin,Kim, Yun-Seong,Lee, Min-Ki,Park, Soon-Kew 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.2
Background: Cell mediated immune response mediated by interaction between CD4+ T lymphocytes and macrophagies is thought to play an important role in tuberculous pleurisy. This interaction is dependent on the interplay of various cytokines. The immunologic response of tuberculous pleurisy is thought to depend on the balance between helper T cell(Th1) cytokine Interleukin-12, Interferon gamma and Th2 cytokine IL-4, IL-10. To understand immunologic mechanism in tuberculous pleurisy and evaluate diagnostic value of these cytokines, the concentrations of Th1 cytokine IL-12, IFN -$\gamma$ and Th2 cytokine IL-10 were measured in tuberculous pleurisy and malignant pleural effusion group. Material and Methods: The concentrations of IL-10, IL-12 and IFN-$\gamma$ were measured by ELISA method in pleural fluids and serums of 20 patients with tuberculous pleurisy and 20 patients with malignant pleural effusion ADA activities were measured by spetrophotomery in pleural fluids of both groups. Results: In tuberculous pleurisy, the mean concentrations of IL-10, IL-12 and IFN-$\gamma$ of pleural fluids showed $121.3{\pm}83.7$ pg/mL, $571.4{\pm}472.7$ pg/mL and $420.4{\pm}285.9$ pg/mL. These were significantly higher than that of serum, $21.2{\pm}60.9$ pg/mL, 194.5 pg/mL, $30.1{\pm}18.3$ pg/mL respectively(p< 0.01). In malignant pleural effusion, the mean concentrations of IL-10, IL-12 and IFN-$\gamma$ of pleural fluids showed $88.4{\pm}40.4$ pg/mL, $306.5{\pm}271.1$ pg/mL and $30.5{\pm}54.8$ pg/mL respectively. Compared with that of serum ($43.4{\pm}67.2$ pg/mL, $206.8{\pm}160.6$ pg/mL, $14.6{\pm}3.3$ pg/mL), only IL-10 was significantly higher (p<0.001), but IL-12, IFN-$\gamma$ were not significant. In tuberculous pleural effusion compared with malignant pleural effusion, the concentration of IL-12, IFN-$\gamma$, ADA were significantly higher (p=value 0.046, <0.001, <0.001), but IL-10 was not significant. For differential diagnosis of tuberculous pleurisy from malignant pleural effusion, using cut-off value of IL-12, IFN-$\gamma$, ADA as 300 pg/mL. 100 pg/mL, 45 U/L, the sensitivity/specificity were 60%/70%, 90%/87.5%, 85%/90% respectively. Conclusion: In tuberculous pleurisy, IL-10, IL-12 and IFN-$\gamma$ were selectively concentrated highly in pleural space than serum. Compared with malignant pleural effusion, IL-12 and IFN-$\gamma$ were significantly higher, but IL-10 were not in tuberculous pleural effusion. The results suggest that Th1 pathway contributes to immune resistant mechanism in tuberculous pleurisy. IFN-$\gamma$ and ADA revealed useful methods of differential diagnosis in tuberculous pleurisy from malignant pleural effusion. 연구배경: 결핵성 흉막염은 면학적으로 흉강내에 국소적으로 활성화된 CD4+ T림프구와 대식세포가 관여하는 세포매개면역이 중요한 역할을 하며 이들의 상호작용은 다양한 사이토카인에 의해 좌우된다고 알려져 있다. 특히 helper T cell type 1 (Th1) 사이토카인인 IL-12 및 IFN-$\gamma$와 Th2 사이토카인인 IL-4 및 IL-10간의 균형이 세포매개반응의 정도를 결정한다고 생각되고 있다. 본 연구는 세포매개면역반응의 지표로서 Th1 사이토카인인 IL-12, IFN-$\gamma$와 이들과 길항적으로 작용한다고 알려져있는 Th2 사이토카인 중 IL-10이 결핵성 흉수내에 어떻게 표현되는지를 검사하여 대조군인 악성 흉수와 비교함으로써 결핵성 흉막염의 변역학적 기전을 이해하는데 도움이 되고자 하였으며 아울러 사이토카인의 진단적 유용성을 알아보고자 하였다. 방 법: 각 20명의 결핵성 흉막염과 악성 흉막염 환자를 대상으로 흉수와 혈장에서 IL-10, IL-12, IFN-$\gamma$를 측정하고 흉수에서의 ADA를 측정하여 비교하였다. 사이토카인은 대상환자의 혈액과 흉수를 원심분리하여 얻은 상층액을 ELISA 방법으로 측정하였고 ADA 활성도는 비색법으로 측정하였다. 결 과: 결핵성 흉막염 환자에서 흉수의 IL-10, IL-12, IFN-$\gamma$의 농도는 $121.3{\pm}83.7$ pg/mL, $571.4{\pm}472.7$ pg/mL, $420.4{\pm}285.9$ pg/mL로 혈장의 $21.2{\pm}60.9$ pg/mL, $194.5{\pm}67.6$ pg/mL, $30.1{\pm}18.3$ pg/mL 보다 모두 유의하게 높았다 (p<0.01). 악성 흉막염 환자에서 흉수의 IL-10, IL-12, IFN-$\gamma$의 농도는 $88.4{\pm}40.4$ pg/mL, $306.5{\pm}271.1$ pg/mL, $30.5{\pm}54.8$ pg/mL로 혈장의 $43.4 {\pm}67.2$ pg/mL, $206.8{\pm}160.6$ pg/mL, $14.6{\pm}3.3$ pg/mL와 비교하였을때 IL-10 만이 유의하게 높았고 (p<0.001) IL12, IFN-$\gamma$에선 유의한 차이가 없었다. 결핵성 흉막염과 악성 흉막염 환자의 흉수에서의 농도를 비교하였을 때 IL-12, IFN-$\gamma$, ADA는 결핵성 흉막염에서 유의하게 높았으나 (p=0.046, <0.001, <0.001) IL-10은 유의한 차이가 없었다. 결핵성 흉수염을 악성 흉수염과 감별하는데 있어 IL-12, IFN-$\gamma$, ADA의 기준을 각각 300 pg/mL, 100 pg/mL, 45 U/L으로 하였을때 민감도/특이도는 IL-12에서 60%/70%, IFN-$\gamma$에서 90%/85%, ADA 에서 85%/90%였다. 결 론: 결핵성 흉수에서 흉강내에 Th1 사이토카인인 IL-12, IFN-$\gamma$와 함께 IL-10이 증가되어 있었고 악성흉수와 비교했을때 IL-12, IFN-$\gamma$는 유의하게 증가되어 있었으나 IL-10은 의의가 없었다. 따라서 결핵성 흉막염의 면역기전에 Th1 경로의 세포매개변역반응이 주로 관여함을 확인할 수 있었고 국소적인 IL-10 증가의 임상적 의의는 추후의 연구가 필요할 것으로 생각된다. 또한 IFN-$\gamma$와 ADA는 결핵성 흉수와 악성 흉수와의 감별에 유용한 진단법으로 생각된다.
전두수(Doo Soo Jeon),정해억(Hae Uk Chung),승기배(Ki Bae Seung),강동헌(Dong Hun Kang),김상우(Sang Wo Kim),김용주(Young Ju Kim),채장성(Jang Sung Chae),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1996 대한내과학회지 Vol.50 No.6
N/A Objectives: Cardiogenic shock resulting from acute myocardial infarction is a serious complication with high mortality. The early identification of patients at high risk of developing post-infarction cardiogenic shock might allow early intervention in an attempt to prevent cardiogenic shock and to reduce the mortality due to cardiogenic shock. The aim of the present study was to examine the risk factors of inhospital development of cardiogenic shock among patients with acute myocardial infarction. Methods: We studied 152patients with acute myocardial infarction who were admitted to Kang-Nam St. Mary's hospital within 24hours after the onset of chest pain and did not have cardiogenic shack on admission between March 1991 and May 1994. Clinical data of these patients were analyzed. Results: Of 152patients, 17(11.1%) developed cardiogenic shock during their hospital stay. Cardiogenic shock developed in 53% of cases more than 24hours after admission. 82.4% of patients with cardiogenic shock died whereas a 6.7% in-hospital mortality was found among patients without cardiogenic shock. Multivariate regression analysis that controlled for variables affecting incidence of postinfarction cardiogenic shock showed that independent risk factors for in-hospital cardiogenic shock were history of myocardial infarction (adjusted relative odds[RO]=5.294, 95% confidence interval[CI]=2.149 to 13.041); heart failure on admission (RO=3.344, 95% CI=1.738 to 6.432); hyperglycemia (>180mg/dl) in non-diabetic patients (RO=3.270, 95% CI=1,590 to 6.727); age over 70 year old (RO=2.912, 95% CI= 1.816 to 4.668); ST deviation over 4mm (RO=2.417, 95% CI=1.225 to 4.767); peak LDH level greater than 1600U/ml (RO=1.154, 95% CI=1.080 to 1.233). Patients with one independent risk factor had an estimated probability of 10.5% for developing inhospital cardiogenic shock; patients with two independent risk factors, 48.5%, patients with three risk factors, 65.0% patients with four risk factors, 65.7% patients with five risk factors, 67.2%. Conclusion: Of post-infarction cardiogenic shock during admission, 53% developed more than 24hours after admission. The more independent risk factors on admission for inhospital cardiogenic shock patients with acute myocardial infarction had, the more likely in-hospital cardiogenic shock developed.
일개 결핵병원에서 다제내성결핵과 광범위내성결핵의 추이, 2001~2005
전두수 ( Doo Soo Jeon ),신동옥 ( Dong Ok Shin ),강형석 ( Hyung Seok Kang ),성낙문 ( Nack Moon Sung ),권경순 ( Kyung Soon Kweon ),신은 ( Eun Shin ),김경순 ( Kyung Soon Kim ),이명희 ( Myung Hee Lee ),박승규 ( Seung Kyu Park ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3
연구배경: 다제내성결핵과 광범위내성결핵은 전세계적으로 결핵 치료에 큰 위협으로 등장하고 있지만 이에 대한 국내의 정확한 실태 및 추이는 잘 알려져 있지 않다. 일개 결핵병원에서 다제내성결핵과 광범위내성결핵의 빈도 및 추이를 살펴봄으로써 국내 실태를 간접적으로 파악하고자 하였다. 방법: 2001년부터 2005년 사이에 국립마산병원에 입원하여 배양양성 결핵으로 진단된 환자를 대상으로 약제 감수성검사 결과와 의무기록을 후향적으로 분석하였다. 결과: 2001년부터 2005년 사이에, 다제내성결핵은 신환자에서 9.2%, 13.8%, 16.9%, 23%, 27.0%로 의미있게 증가하였고(p<0.001 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다 (p=0.002 for trend). 광범위내성결핵은 신환자에서 0%, 2.3%, 3.1%, 2.5%, 6.3%로 의미있게 증가하였고(p=0.005 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다(p<0.001 for trend). 결론: 다제내성결핵과 광범위내성결핵은 신환자와 재치료환자 모두에서 증가하는 추이를 보였다. 국내의 정확한 실태 파악을 위하여 공공 및 민간의료기관을 포괄하는 통합적인 약제내성실태 조사가 필요할 것으로 사료된다. Background: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) are serious threats to worldwide tuberculosis control, but the national burden and the trends of infectious spread are largely unknown. Methods: We retrospectively reviewed the results of drug sensitivity tests and medical records of patients that were diagnosed with culture-confirmed pulmonary tuberculosis and were admitted to the National Masan Tuberculosis Hospital between 2001 and 2005. Results: From 2001 to 2005, the proportion of MDR-TB among new cases was 9.2%, 13.8%, 16.9%, 23% and 27.0% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of MDR-TB among previously treated cases was 58.5%, 60.2%, 62.7%, 61.7% and 71.3% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for MDR-TB among both new and previously treated cases (p<0.001, p=0.002 for trend, respectively). The proportion of XDR-TB among new cases was 0%, 2.3%, 3.1%, 2.5% and 6.3% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of XDR-TB among previously treated cases was 9.1%, 15.7%, 17.3%, 19.9% and 19.1% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for XDR-TB among both new and previously treated cases (p=0.005, p<0.001 for trend, respectively). Conclusion: Both MDR-B and XDR-TB were gradually increased among both new and previously treated cases. Integrated national surveillance, including the public and private sectors, will be needed to estimate the exact status of antituberculous drug resistance. (Tuberc Respir Dis 2008;64:187-193)
폐결핵 환자에서 Interleukin-1β와 Interleukin-1 Receptor Antagonist 유전자의 다형성
전두수 ( Doo Soo Jeon ),이재형 ( Jae Hyung Lee ),이수진 ( Su Jin Lee ),조우현 ( Woo Hyun Jo ),정경식 ( Kyung Sik Jeong ),김기욱 ( Ki Wook Kim ),김윤성 ( Yun Seong Kim ),이민기 ( Min Ki Lee ),김영대 ( Young Dae Kim ),최영민 ( Young 대한내과학회 2005 대한내과학회지 Vol.68 No.3
조영 경식도 심초음파에 의한 난원공개존 유병율 및 임상적 의의
이만영(Man Young Lee),전두수(Doo Soo Jeon),전승석(Seung Suk Cheon),이길환(Gil Hwan Lee),강동헌(Dong Heon Gang),김철민(Chul Min Kim),채장성(Jang Seong Chae),박인수(In Soo Park),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1994 대한내과학회지 Vol.47 No.2
N/A Objectives: Most of patients with patent formen ovale have normal intracardiac pressure and no other abnormality during their life. But because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may occur. Although this is a rare complication, the result can be devastating. Previously, contrast transthoracic echocardiography was used to demonstrate patent foramen ovale but the prevalence rate was less than the expected one based on autopsy in general population. These low detection rates have discouraged the use of contrast transthoracic echocardiography to diagnose patent foramen ovale. But transesophageal echocardiography provides larger tomographic field and more clear views around the interatrial septum than transthoracic echocardiography, We tried this study to evaluate the incidence of patent foramen ovale and its role as a possible cause of paradoxical embolism in cerebral infarction patients. Methods: Contrast transesophageal echocardiographic examinations with indocyanine green were performed in 426 patients including 32 patients with cerebral infarction. The prescence of the patent forancen ovale was confirmed by demonstrating echogenic contrast crossing the interatrial septum. Result: 1) Contrast transesophageal echocardiography is a useful technique to evalute right to left shunt, 2) Patent foramen ovale was demonstrated in 73 of 426 patients and 6 of 32 two patients with cerebral infarction showed pakent formen ovale. But patent formen ovale was thought to be a cause of paradoxical embolism only in 3 patients without accompanying cardiovascular disease or risk factors. 3) The prevalence of patent foramen ovale increased progressively with increasing age. 4) There are no serious complications during and after contrast transesophageal echocardiography. Conclussion: Contrast transesophageal echocardiography is a safe, and reliable technique for evaluating interatrial shunt provoked with cough or Valsalva maneuver. This technique should be considered in cerebrovascualr disease patients without known risk factors to evaluate the possible paradoxical embolism.