Helicobacter pylori cagE 유전자 다형성이 위상피세포주에서 Interleukin-8 유도능에 미치는 영향

이수민,이학성,이인석,조유경,한혜원,오정환,박재명,최명규,정인식,Lee Su-Min,Lee Hak-Sung,Lee In-Suk,Co Yu-Kyung,Han Hae-Won,Oh Jung-Hwan,Park Jae-Myung,Choi Myung-Gyu,Chung In-Sik 한국생명과학회 2004 생명과학회지 Vol.14 No.6

Helicobacter pylori infection is highly prevalent, as high as 2/3 of whole population infected, in Korea. H. pylori infection initiates inflammation by induction of interleukin-8 through type IV secretion of CagA. It was recently suggested that induction failure of IL-8 is not associated with defect in cag PAI but associated with cagE locus diversity. This study was designed to investigate ability of 11-8 in-duction according to sequence variation within the cagE gene, cagA TP motifs and vacA m-types in vitro study using AGS cell-line, and to evaluate its association with different clinical outcome. Seventy-four H. pylori stains were isolated from 23 patients with gastric cancer (Ca), 24 subjects with gastritis (G) and 27 patients with duodenal ulcer (Du) in Kangnam St. Mary's Hospital, Seoul, Korea. cagE gene diversity was confirmed by the PCR-RFLP methods with MboI/NlaIII and tyrosine phosphate motifs (TPMs) of cagA was determined TPM-A and C by using DdeI/Tsp5091 restriction enzyme and TPM-B was determend by Real time PCR the method of Owen et al. and IL-8 was measured by ELISA assay. IL-8 activity was positively detected in 59 among 74 strains $(79.7\%)$. IL-8 secretion was significantly increased in MboI A and MboI B type compared to MboI C type and in MboI/NlaIII A-C and B-C type than C-C type. 1L-8 activity was not associated with either the number or composition of cagA tyrosine phosphorylation motifs and vacA m-type. There was no significant difference in IL-8 activity among patient groups. cagE gene diversity is thought to be mainly associated with the induction of IL-8 in H. pylori infection. 한국에서 분리한 Helicobacter pylori 균주가 위암 세포주에서 IL-8를 유도하는 유도능을 관찰하고자 하였으며, 특히 4형 분비구조의 주요 구성체인 cagE 유전자의 다형성에 따라 IL-8 유도능의 차이 및 각 질환에서 분리한 균주에서의 차이가 있는지 검토하고자 하였다. 강남성모병원 내시경검사를 받은 환자들 중 H. pylori 감염 양성으로 확인된 위암 23명 $(31.0\%)$, 위염 24명$(32.6\%)$, 십이지장궤양27명$(36.4\%)$ 총 74명을 대상으로 하여 H. pylori를 분리한 후 PCR-RFLP방법을 이용하여 cagE 다형성을 확인하였으며, PCR 및 Real-time PCR을 이용하여 ragA TPMs를 결정하였다, 또한 분리된 균주를 위암세포주에 감염시켜 상등액을 취하여 ELISA방법으로 IL-8을 정량화 하였다. 전체 74개의 분리 균주 중 59개의 균주$(79.7\%)$에서 IL-8 유도능이 있는 것으로 확인되었으며, cagE 다형성 중에서 가장 높은 빈도로 관찰되는 형태는 MboI/NlaIII B-C, A-C 및 C-C 타입 이었으며, 이중 A-C와 B-C 형태가 C-C 형태에 비해 유의적으로 높은 IL-8 유도능을 나타냈다. 그러나 cagA TPMs의 분류 및 vacA m-아형 분류와 IL-8 유도능과는 연관성이 없었다. 비록 본 연구에서 cagE 다형성과 IL-8 유도능과 아주 밀접한 연관성이 나타나지는 않았지만 vacA m-아형이나 cagA TPMs 보다는 cagE 다형성이 IL-8 유도능과 연관성이 클 것으로 생각된다.

5'-Untranslated Region에 존재하는 Iron Responsive Element에 의한 Ferritin 합성조절

정인식,이중림,김해영,Chung, In-Sik,Lee, Jung-Lim,Kim, Hae-Yeong 한국응용생명화학회 1998 Applied Biological Chemistry (Appl Biol Chem) Vol.33 No.2

철의 대사과정에 관여하는 ferritin 단백질의 발현은 ferritin transcript의 5'-untranslated region에 위치한 iron-responsive element (IRE)와 철 농도 조절 단백질의 결합에 의해 조절된다. 이러한 ferritin의 생성에 관여하는 구조적인 요소를 밝히기 위해, RNA 이차구조인 IRE의 bulge 부분을 다른 염기로 변환시켜 철 농도 조절단백질에 의한 RNA 결합력과 ferritin 단백질의 생성의 저해정도를 비교 측정하였다. 측정된 결과로부터 IRE의 bulge 부분의 시토신 염기배열만이 RNA 이차구조의 형성에 중요한 작용을 하여 ferritin 합성을 조절할 수 있는 것을 보였다. The expression of ferritin involved in iron metabolism is regulated at the translational level by the interaction of iron regulatory protein with iron-responsive element(IRE) in the 5'-untranslated region of ferritin transcript. To identify the role of structural element utilized for translational regulation of ferritin, we studied the effects of mutations in the ferritin IRE by measuring IRP binding activity and translational activity. Our data suggest that the cytosine at bulged position of IRE within ferritin is important for the formation of RNA secondary structure involved in translational regulation.

한국인에서 Helicobacter pylori 감염의 진단에 있어 Genedia™ H . pylori ELISA 검사의 진단 정확도

정인식(In Sik Chung),김상우(Sang Woo Kim),고재성(Jae Sung Go),김나영(Na Young Kim),김재규(Jae Gyu Kim),김진호(Jin Ho Kim),김학양(Hak Yang Kim),김재준(Jae Jun Kim),노임환(Im Hwan Roe),심재건(Jae Geon Sim),안형식(Hyeong Sik Ahn),윤병철(By 대한내과학회 2001 대한내과학회지 Vol.61 No.1

N/A Background: Genedia™ H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of Genedia™ H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. Methods Genedia : H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with Genedia™ H. pylori ELISA. H, pylori infection was determined by rapid urease test, histology, culture or (13)C-urea breath test in adults. In children, the subject was considered to he H. pylori positive if (13)C-urea breath test was positive. Results: In adults, the sensitivity and specificity of Genedia™ H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of Genedia™ H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of Genedia™ H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%, p<0.005 and 92.5% vs 71.4%, p<0.005, respectively). Conclusion : Genedia™ H pylori ELISA is a relatively accurate method for the serodiagnosis of H pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of Genedia™ H. pylori ELISA for epidemiological studies of H. pylori infection in Korea. (Korean J Med 61:17-23, 2001)

위 악성종양 900예의 임상 분석

선희식(Hee Sik Sun),정인식(In Sik Chung),이재학(Jai Hak Lee),주상용(Sang Yong Choo),이종서(Jong Seo Lee),장석균(Suk Kyun Chang),최상근(Sang Geun Choe),안창준(Chang Jun Ahn) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

N/A Stomach cancer is the most common malignant tumor in Korea. This study includes 900 stomach cancer cases which were collected at the Departrnent of Surgery, St. Marys Hospital, Catholic University medical College over the period from 1980 to 1991. The patients are divided into two groups: Those treated during the period between 1980 and 1986 - first group and the period between 1987 and 1991 - second group. We followed each patient and then analysed each patient's record using guidelines from the Stomach Cancer Study Group of Korean Surgical Society. There were 889 adenocarcinomas (98.8%), 5 malignant lymphomas (0.5%), 5 leiomyosarcomas (0.5%) and 1 leiomyoblastoma (0.1%). There were 378 patients in the first group and 522 in the second group. The number of second group patients was 1.4 times as many as compared to the first group. Peak age incidence was 6th decade (32%) and male to fema]e ratio was 1.8:1. The difference about age and sex between groups was insignificant. The number of patient under 35 years old was 87 cases (9.7%), Tumor locations were antrum (62.8%), body (27.4%), cardia (5.3%) and whole stomach (3.7%). The tumor location of the second group is more proximal portion of stomach than first group. Operation procedures performed were subtotal gastrectomy (69.1%), total gastrectomy (18.7%), bypass gastrojejunostomy (4.6%), exploratory surgery (6.3%) and proximal gastrectomy (0.8%) and so gastric resection rate was 88.6%. Total gastrectomy of the second group has increased compared to first group, while exploratory surgery has decreased. Regional lymph node metastasis was seen in 60.8% of all cases. Rate of regional lymph node metastasis according to tumor depth were as follows; 16% in T1, 48.4% in T2, 77.3% in T3 and 92.5% in T4, There were 162 cases of early gastric cancer (EGC 18%): 14% in the first group, 20% in the second group. The rate of EGC has significantly increased every year (p<0.05). Overall 5-year-cummulative survival rate was 55.8%. Overall 5-year-cummulative survival rates according to stage were as follows: 98.6% in stage I a, 89.6% in I b, 67% in II, 58.4% in llIa. 29.4% lIlb and 14% in stage IV. overall 5-year-cummulative survival rates according to depth were as follow: 93.9% in Tl, 85% in T2, 48.8% in T3 and 12.4% in T4. Hospital death rate was 1.5%.

HBe 항원 양성 만성활동성간염에서 베타 인터페론의 효과

정규원(Kyu Won Chung),정환국(Whan Kook Chung),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),안병민(Byung Min Ahn),김재광(Jae Kwang Kim) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

N/A The lack of an effective drug against chronic type B virus infection has led to trials of variety of antiviral drugs. Among these drugs interferon has shown more encouraging results. In all studies, greater HBeAg to anti-HBe seroconversion rates occurred in treated patients than in control. The reason for the use of interferon in this disease is the effectiveness as an antiviral activity. More recently its activity has heen extended as an immunomodulating drug in the immune response. The purpose of this study was to elucidate the effect of human fibroblast interferon (β-interferon) in Korean HBsAg positive chronic active hepatitis. We has conducted therapeutic trial with total l02 X1000000 IU of beta-interferon for 28 days in fifteen cases with needle aspiration biopsy proven chronic activc heaptitis. 1) Six patients (40.0%) lost HBeAg in the serum and four of these patients (26.7%) were seroconverted to anti-HBe after β-interferon therapy. And two patients expressed anti-HBe without loss of HBeAg. However, none of the patients lost HBsAg during the study peroid. 2) The serun ALT began to increased significantly (p<0.05) from the 7th day of interferon therapy and reached its maxinauin level on 10th day of therapy, and then continued to decrease to the level below the pretreatment level in 2nd week after treatment of interferon. 3) Pre-tretament ALT showed higher levels in group of changed viral rnarkers (n=6) than in unchanged (n=8), but there was no statistical significance. 4) Peripheral blood leukocytes and granulocytes showed significant reduction in number from the 3rd day of interferon treatment (p<0.05), and recovered within one week after withdrawal, 5) There was no significant changes in serum protein, bilirubin and prothrombin time. 6) All the treated patients experienced an initial flu-like illness consisting of fever, chills, malaise, myalgia, anorexia, headache and dizzeness. Tachyphylaxis developed gradually during the treatment. The above results suggest that β-interferon therapy may be effective and safe in the treatment of patients ivith tvpe B chronic activc hepatitis.

간장 및 담도 : 삼출성 복수증의 감별진단과 복강경 검사

정규원(Kyu Won Chung),차상복(Sang Bok Cha),선희식(Hee Sik Sun),김부성(Boo Sung Kim),정인식(In Sik Chung),안병민(Byung Min Ahn),김재광(Jae Kwang Kim),김태룡(Tae Ryong Kim),최규용(Gyu Yong Choi) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1

N/A Exudative ascites should initiate an evaluation for peritoneal processes, most importantly infection and tumor. And the pathological diagnosis is required for a approapriate treatment in most cases. To assess the diagnostic accuracy and complication rates of diagnostic laparoscopy in patients with exudative ascites we studied in 73 patients with exudative ascites retrospectively. Thirty three patients had malgnancy related ascites, and peritoneal carcinomatosis was confirmed in thirty one patients. Twenty seven patients had tuberculous peritonitis, and thirteen patients had miscellaneous causes, among them eight patients had underlying liver cirrhosis and clinically spontaneous bacterial peritonitis were suspected in three patients in whom bacteria were cultivated in ascites. Pancreatic pseudocyst and leakage into peritoneal cavity was confirmed by endoscopic retrograde pancreatography in one case, but the remained four cases had not known the diagnosis. The most common primary cancer was gastric carcinoma which was diagnosed in fourteen patients, and then ovarian cancer in five patients, colon cancer in four patients, pancreatic cancer in three patients, mesothelioma in one patient and unknown origin in four patients. Cytology evaluation of the ascitic fluid was positive for tumor cells in 62% of patients with peritoneal carcinomatosis. Blind Cope needle biopsy yielded positive diagnosis of neoplastic or tuberculous in 65.4 per cent of rases. The major and minor complication rates of laparoscopy were 0% and 26.4%, respectively, with no fatalities. These findings compare favorably with general experience. We conclude that laparascopy is relatively safe and accurate diagnostic method of choice in exudative ascites, especially in cases when other non-invasive methods were failed.

만성적인 후두증상을 주소로한 환자에서의 식도내압검사 및 24 시간 보행성 pH 검사소견

방춘상(Choon Sang Bhang),노대근(Dae Keun Lo),박수헌(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeul Han),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),김부성(Boo Sung Kim),조승호(Seung Ho Ch 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: The exact causes of nonspecific chronic laryngitis or laryngeal symptoms are unknown, but many cases of this disease are associated with gastroesophageal reflux or motility disorders of esophagus. We suppose that because Korean people have less gastroesaphageal reflux diseases and the life style including food is different from those of western people, the causes of chronic laryngeal symptoms nre different, So we studied the patients who complained the chronic laryngeal symptoms for evaluation of the role of esophageal motility disorders and gastroesophageal reflux. Methods: 19 patients(male 3, female 16, mean age 40(26-66)) with hoarseness, globus sensation, sorethroat of chronic nature(greater than 3-month duration), not response to conventional therapy of otolaryngologist in St. Mary's Hospital were referred to department of internal medicine. A group of normal, 15 healthy subjects(male 7, female 8, mean age39(24-57)) who had no esophageal or laryngeal symptoms was studied as a control group. All patients and normal controls had manometric studies and 24 hour ambulatory pH monitoring. abnormal findings required pathologic reflux or results greater than the mean plus 2 SDs of normal controls. Results: 1) The chronic laryngeal symptoms were hoarseness in 15 patients(79%), globus sensation in 14 patients(74%), sorethroat in 6 patients(32%), pulmonary symptoms in 3 patients(16%), dysphagia in 2 patients(11%) and heartburn in 1 patient(5%). 2) The lower esophageal sphincter pressure by the rapid pull through tecnique(mean±SD, 27,9± 6.9mmHg) in patients was not different compared with normal controls(31,1±11.0nmHg), 3 patients (16%) had esophageal body dysmotility and all of these were non specific motility disorder. 3) The upper esophageal sphincter pressure(mean±SD, 53.2±23.8mmHg) in patients was not different compared with normal controls(40.9±20.8mmHg), but 2 patients(10.5%) had high upper esophageal sphincter pressures(>82,5mmHg), The postrelaxation pressure of upper esophageal sphincter(mean±SD,98.3±32.1mmHg) was not different compared with normal controls(79,8±30.6mmHg), but 2 patients(10.5%) had high postrelaxation pressures of upper esophageal sphincter(>141mmHg). 4) The time(mean±SD, 321±193msec) between lowest point of upper esophageal sphincter relaxation and onset of pharyngeal contraction was not different compared with normal controls(273.5±179,8msec). 5) The percentage of time of pH less than 4 was 2.4±4.7% in total periods, 2.5±2.3% in upright position and 2.4±9.7% in supine position. Two patients (10.5%) had pathologic reflux(more than 4% of percentage of time pH less than 4 in total periods) and one patient with 2.5% of persentage of time pH less than 4 had high symptom index(66.7%(4/6)). 6) According to above results either of abnormal esophageal pressure or dysmotility was seen in 6 patients(32%) and either of more than 4% of persentage time pH less than 4 in total periods or positive symptom index was seen in 3 patients(16%), Positive results in either of two tests were seen in 7 patients(37%). Conclusion We suggest that some patients who complain the chronic laryngeal symptoms in Korean may have abnormal esophageal motility or gastroesophageal reflux.

Helicobacter pylori 제균요법 적용의 실태 분석: 단일 기관 연구

정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),백창렬 ( Chang Nyol Paik ),이정록 ( Jeong Rok Lee ),정성훈 ( Sung Hoon Jung ),김진동 ( Jin Dong Kim ),한석원 ( Sok Won Han ),정인식 ( In Sik Chung ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.4

목적: 현재 H. pylori 제균치료는 소화성 궤양 환자에서만 인정을 받고, 위암이나 위염 환자를 대상으로 적용 범위를 확대 적용하는 것에는 아직 논란의 여지가 있다. 최근 들어 표준 삼제요법의 제균율이 점차 감소하는 경향을 보이며, 이는 항생제 내성의 증가 및 환자의 순응도 감소와 가장 큰 연관이 있으나, 다른 여러 요인들도 제균율에 영향을 미치는 것으로 알려져 있다. 저자들은 진료과에 따른 제균율의 차이가 있는지 알아보기 위해 진료과별 제균치료 현황과 제균율, 그리고 내시경적인 궤양에 대한 적용 빈도를 조사하였다. 대상 및 방법: 2003년 1월부터 2007년 6월까지 가톨릭대학교 성빈센트병원에서 H. pylori 제균요법을 시행했던 환자를 대상으로 소화기내과, 일반내과, 가정의학과별로 제균율의 차이를 후향 조사하였다. 대상 환자는 2,050명으로 의료영상 저장 전송 체계(PACS)를 이용하여 3명의 내시경전문의가 각각의 내시경 소견을 다시 판독하여 내시경적인 미란과 궤양을 구분하였다. 결과: 일차 삼제요법에 대한 제균율은 82.5%였고, 이차 사제요법에 대한 제균율은 71.2%였다. 일차 진료를 담당하는 가정의학과와 내과 일반에서 소화기내과에 비해 내시경적인 미란에 대해 제균요법을 시행하는 빈도가 의미 있게 높았고, 전체 제균율과 내시경적인 궤양에 대한 제균율은 유의하게 낮았다. 결론: 일차 진료과에서 적용한 H. pylori 제균요법은 미란 등 부적절한 제균대상이 많았다. 전체적인 제균율이나 내시경적인 궤양에 대한 제균율은 소화기내과가 일차 진료과에 비해 의미 있게 높았고, 이것은 여러 가지 복합적인 요인이 작용하고 있을 것이며, 그 중에서도 복약에 대한 환자의 순응도가 중요한 역할을 할 것으로 본다. Background/Aims: Eradication rates of Helicobacter pylori (H. pylori) tend to decrease over the last few years. Apart from the antibiotic resistance and patient`s compliance, various factors have an influence on the efficacy of eradication therapy. We analyzed the inter-departmental differences in the eradication therapy for H. pylori infection. Methods: Between January 2003 and June 2007, total 3,072 eradication regimens were prescribed to patients. Eradication rates according to departments-gastroenterology (GE), general internal medicine (IM) and family medicine (FM)-were analyzed retrospectively. Results: The overall eradication rate of first-line triple therapy was 82.5% and second-line quadruple therapy was 71.2%. In the department of IM and FM, the eradication therapy was applied more frequently to the patients with erosion only, not ulcer. Overall eradication rates according to the departments were 87.0% in GE, 81.1% in IM and 77.2% in FM (p=0.02 GE vs. IM and p<0.01 GE vs. FM, respectively). Eradication rate in patients with peptic ulcer was also significantly higher in GE compared with IM or FM. Conclusions: In primary clinic (IM and FM), the eradication therapy was frequently applied to erosion. The eradication rates of H. pylori in GE department were significantly higher than those of IM or FM. Inter-departmental differences of the eradication rate might be caused by patients` compliance to prescribed medication. (Korean J Gastroenterol 2009;53:221-227)

위궤양환자에서 Rebamipide의 자유산소유리기제거에 의한 궤양치료효과

박수헌(Soo Heon Park),정운태(Woon Tae Jung),서정한(Jung Han Suh),정명희(Myung Hee Chung),정인식(In Sik Chung),이용찬(Yong Chan Lee),박인서(In Suh Park),송근암(Guen Am Song),양웅석(Ung Suk Yang),유종선(Jong Sun Rew),윤종만(Chong Mann 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

N/A Background/Aims: Helicobacter pylori has been shown to be an important pathogen of gastric disorder including gastritis and gastric ulcer. One of the potential toxic factors involving gastric mucosal cell injury is reactive oxidants, which are released from activated neutrophils. Rebamipide had been reported to promote mucus synthesis, mucosal prostaglandin content, and rapid ulcer healing, It has recently been reported to inhibit the production of oxygen derived free radicals from stimulated neutrophils. We conducted this study to evaluate the effects of rebamipide on gastric ulcer healing and reactive oxygen metabolite production. Methods: In this multicenter study conducted in Korea, combination treatment of rebamipide and ranitidine was compared with ranitidine alone in 108 patients with gastric ulcer patients. Pre- and post-treatment endoscopic findings and concentration of reactive oxygen metabolite produced were used to evaluate efficacy. The efficacy of rebamipide and ranitidine versus ranitidine was evaluated using endoscopy results, and tissue lipid peroxides by thiobarbituric acid and myeloperoxide concentration. Results: The percentage of ulcer size reduction was significantly higher with rebamipide and ranitidine group than with placebo and ranitidine group(size reduction: 71.5% vs 58.3% P=0.04556). The myeloperoxidase activities at ulcer margin in rebamipide and ranitidine group patients were 96.7+-13.4 unit/mg protein in baseline and 53.8+9.9 unit/mg protein in follow up (P=0.0065). The myeloperoxidase activities at ulcer margin in placebo and ranitidine group patients were 90.2+9.1 unit/mg protein in baseline and 63.1+6.7 unit/mg protein in follow up (P=0.0668). The thiobarbituric acid activities at ulcer margin in rebamipide and ranitidine group patients were 34.7+5.3 nmol of MDA/mg protein in baseline and 24.1W3.1 nmol of MDA/mg protein in follow up. The thiobarbituric acid activities at ulcer margin in placebo and ranitidine group patients were 14.8+1.5 nmol of MDA/mg protein in baseline and 24.3+2.7 nmol of MDA/mg protein in follow up (P=0.0059). The thiobarbituric acid activities at ulcer margin in H. pylori positive and negative patients were 28.1+2.1 nmol of MDA/mg protein and 25.3+4.7 nmol of MDA/mg protein, respectively. The myeloperoxidase activities at ulcer margin in H. pylori positive and negative patients were 79.9+5.3 unit/mg protein and 40.4+25.3 unit/mg protein, respectively (P=0.0001). The cumulative relapse rate was examined starting at 24 week after ulcer treatment. The rate was lower in rebamipide and ranitidine group patients, but insignificantly(19.2% vs 27.3%, P=0.0857). Conclusions: These results suggest that rebamipide promote gastric ulcer healing by decreasing reactive oxygen metabolite production in patients with gastric ulcer. (Korean J Gastroenterol 1997;29:569-578)

역류식도염 환자에서 Helicobacter pylori 감염과 Gastrin, Pepsinogen의 관계 -역류식도염과 H. pylori 감염, 위축위염의 관계-

권정현 ( Jung Hyun Kwon ),정인식 ( In Sik Chung ),손혜숙 ( Hye Suk Son ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ),이인석 ( In Seok Lee ),김상우 ( Sang Woo Kim ),최명규 ( Myung Gyu Choi ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.3

목적: H. pylori 감염은 위축 위염의 중요한 원인이 되며, 혈청 gastrin과 pepsinogen (PG) 분비에도 영향을 미친다. 위식도역류질환 환자에서 H. pylori의 빈도가 낮다는 보고들이 있으나 위식도역류질환의 발생과 H. pylori 감염의 관계는 아직도 분명치 않다. 이번 연구에서는 미란 식도염(erosive reflux esophagitis, ERD)의 원인인자인 위산 분비와 관련이 있는 H. pylori 감염과 gastrin, PG I, II 및 I/II 비와의 관계를 알아보고자 하였다. 대상 및 방법: 환자 2006년 3월부터 10월까지 강남성모병원에서 한 명의 내시경 전문의가 상부위 장관 내시경 검사로 ERD로 진단한 환자를 대상으로 하였고 나이와 성을 대응시켜 대조군을 선정하였다. 두 군 모두 내시경 검사에서 궤양 등의 다른 위장관 질환이 있거나 제균 치료를 받은 자는 제외하였다. 음주와 흡연 유무, 신체질량 지수(BMI)를 조사하였고 H. pylori 감염, 혈청 PG I, II (라텍 스응집면역비탁법)와 gastrin (방사면역측정법)을 검사하였다. 결과 총 45명의 ERD 환자군과 66명의 대조군을 비교하였다. H. pylori 감염은 ERD군에서 대조군보다 낮았다(11.1%vs. 43.9%, p<0.05). PG I/II 비는 ERD군에서 대조군보다 높았다(7.0±3.1 vs. 5.3±2.6, p<0.05). PG II와 gastrin은 ERD군에서 대조군 보다 낮았다(p<0.05), BMI는 ERD군이 대조군보다 높았다(24.46 kg/m2 vs. 23.08 kg/m2, p<0.05). 결론: 한 국인에서 ERD 환자군은 대조군보다 H. pylori 감염률이 낮고, PG I/II 비가 증가되어 있어 역류식도염은 위점막의 위축이 더 적은 환자에서 잘 생기는 것으로 생각한다. PG I/II비는 H. pylori 감염 검사와 함께, ERD 환자군에서 동반되어 있는 위축 위염의 형태나 정도, 위산 분비 정도를 예측해 볼수 있는 인자로서 유용성이 있다고 생각한다. Background/Aims: Helicobacter pylori (H. pylori) infection is known as a major cause of atrophic gastritis and is associated with serum gastrin, pepsinogen, and gastric acid secretion. There is still a controversial association between gastroesophageal reflux disease and H. pylori infection. This study was designed to investigate the relationship among serum gastrin, pepsinogen, and H. pylori infection in the erosive reflux esophagitis (ERD) patients. Methods: Patients who were diagnosed as ERD by one gastroenterologist at the Kangnam St. Mary`s hospital were prospectively enrolled. The persons without ERD in the control group were matched for age and sex. We examined the gastrin, pepsinogen I (PG I), PG II, PG I/II ratio, and H. pylori infection. Results: Forty five patients were enrolled in ERD group and 66 persons in control group. The H. pylori infection rate in ERD group was lower than that in the control group (11.1% vs. 43.9%, p<0.001). PG I/II ratio in ERD group was higher than that in the control group (7.0±3.1 vs. 5.3±2.6, p=0.003). The PG II (p=0.016) and gastrin (p=0.029) in ERD group were lower than those in the control group. BMI in ERD group was higher than that in the control group (24.5 vs. 23.1 kg/m2, p=0.013). Conclusions: The H. pylori infection rate in ERD group was lower and PG I/II ratio was higher than that in the control group. Reflux esophagitis is thought to be reversely associated with the atrophy of gastric mucosa. (Korean J Gastroenterol 2008;51:159-166)