한국형 출혈열 환자에서 분리한 한타 바이러스의 핵산 분석

조종태,윤성철,안규리,한진석,김성권,이정상 단국대학교 1998 論文集 Vol.33 No.-

Hemorrhagic fever with renal syndrome(HFRS)is an infectious disease showing diverse clinical manifestations according to different serotypes of hantavirus. On the assumption that the antigenicity, nucleotide and amino acid sequence diversity of hantaviruses, as well as immune response diversity of individual KHF patients may be present, this study was performed to analyse the genetic diversity of hantaviruses isolated from patients with KHF. In the 13 samples hantaviral RNAs were extracted, cDNAs of partial M segment were amplified by RT-PCR using genus-reactive primer, amplified cNNAs were analyzed by direct sequencing method, and then the nucleotide and deduced amino acid sequences were compared with previously known sequences of four serotypes of hantavirus isolated from rodent hosts and each other by the computer assistance. The results were as follows. The nucleotide and amino acid sequences of 11 samples among the 13 human isolates showed 90.3∼95.5%, 86.7∼97.9% the other 1 samples 82.7%, 71.9% homology respectively to those of Hantaan virus 76-118 strain, and another 1 sample showed 83.7%, 75.3% homology respectively to those of Seoul virus B1 strain isolated from rodent host. The nucleotide and amino acid sequences of 7 among 12 Hantaan samples showed differences within 5%, 10% respectively each other and high genetic similarities, but those of the oehr 5 among 12 Hantaan samples showed low genetic similarities each other. In conclusion, hantaviruese isolated from KHF patients showed genetic diversity compared with previously known hantaviruses isolated from rodent hosts.

지속성 외래 복막투석 환자에서 복막염의 발병 양상 단일 임상 기관 연구

안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),오윤규(Yoon Kyu Oh),김현리(Hyun Lee Kim),정우경(Woo Kyung Chung),오국환(Kwook Whan Oh),양재석(Jae Suk Yang),김세중(Se Jung Kim),이경이(Kyung Ey Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Peritonitis remains the leading cause of the patient dropout in CAPD in many developing countries. In Korea, 71% of CAPD patients dropout is caused by peritonitis. To elucidate an adequate guideline for treating peritonitis in our country, we analyzed clinical and bacteriologic profiles of peritonitis(1995. l. 1- 1999. 12 31). Two hundred and twenty eight episodes of peritonitis were developed in 127/247 patients. The incidence of peritonitis was 0.41/patient-year in general, which was decreased to 0.24/patient-year in 1999. The incidence of causative organisms were as follows: 82(36.0%) by Gram positive organisms, 38 (16.2%) by gram negative organisms, 16 cases(7.0%) by mixed organsisms, and 5 cases(2.2%) by fungus. During study period, the incidence of peritonitis by gram positive organsism was decreased while the incidence of peritonitis by gram negative organism was not changed. Recurrent infection/relapse was noted in 58 patients(45%). Peritonitis were eradicated only in 66% of the cases by initial antibiotics(cefazolin+aminoglycoside); and another 17% responded by second line antibiotics. Peritoneal catheters were removed in 38 episodes(16.7%). Patients with exit infection were more frequent in removal of catheter. Risk factor analysis was performed in 146 patients, who were newly started CAPD. There were 60 initial episodes of peritonitis(mean duration of follow up was 16.7 patient months). Sixty-five percent were free of peritonitis at the end of first year, 54% at the end of second year and 45% at the end of third year (Kaplan-Meier). Factors such as age, sex, underlying DM, were not risk factor for CAPD peritonitis. In conclusion, we observed that the incidence of peritonitis decreased every year. It was revealed however that only 66% of peritonitis can be successfully treated by first line antibiotics. Second line antibiotics such as ceftazidime may need to be introduced in early phase of CAPD peritonitis. Up to one third of patients had recurrent infection/relapse, which raised the incidence of peritonitis. Continuing education as well as better exit care is needed to improve technical survival of CAPD patients in Korea.

혈뇨의 진단적 접근

안규리 대한내과학회 1998 대한내과학회지 Vol.55 No.4

에리스로포에틴 치료에 대한 저항성

안규리 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.2

C1q nephropathy의 임상병리학적 소견

안신영 ( Shin Young Ahn ),박재윤 ( Jae Yoon Park ),이성우 ( Seong Woo Lee ),정종철 ( Jong Cheol Jeong ),정지용 ( Ji Yong Jung ),오국환 ( Kook Hwan Oh ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Su 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2

Purpose: C1q nephropathy (C1qN) is a rare glomerulonephritis characterized by mesangial deposits, predominantly C1q, without the evidence of systemic lupus erythematosus (SLE). It showed various clinical courses, however, the clinicopathologic features of C1qN have not been well defined as yet. Methods: We retrospectively reviewed the clinicopathologic features of 11 patients (0.8%) diagnosed as C1qN among 1,403 patients aged 18 years who had undergone renal biopsy due to primary glo ≥-merular disease from Jan. 2000 to Jan. 2009. Diagnostic criteria of C1qN were as follows; 1) the presence of dominant or co-dominant immunofluorescence staining for C1q in the mesangium, 2) corresponding mesangial dense deposit by electron microscopy, and 3) lack of clinical evidence of SLE. Results: The male-to-female ratio was 6:5 and their mean age was 41.1±22.6 yrs (range, 19-69 yrs). Eight patients presented with urinary abnormalities and three with nephrotic syndrome. At the time of biopsy, three patients had hypertension. The mean value of 24-hour urine protein was 4.4±5.5g/day (range, 0.5-18.5g/day). On light microscopy, normal glomerular architecture (4/11) and segmental sclerosis (7/11) were observed. Complete or partial remission was achieved in six of the seven patients treated with immunosuppressive agents (steroid and/or immunosuppressants). Among these patients, two using steroid monotherapy had relapsed. The mean follow-up duration was 14±11 months (range, 2-31 months) and renal function deterioration was observed in three patients. Conclusion: C1qN showed various clinical manifestations and prognosis. Therefore, additional studies are needed to fully define the clinicopathologic features.

전자 오더시스템을 이용한 N-acetylcystein (NAC)의 사용과 조영제 사용 CT촬영 이후의 조영제 유발 Acute Kidney Injury (AKI) 발생에 관한 단일 기관 자료

정종철 ( Jong Cheol Jeong ),안신영 ( Shin Young Ahn ),오국환 ( Kook Hwan Oh ),김연수 ( Yon Su Kim ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Suhng Gwon Kim ),주권욱 ( Kwon Wook Joo ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

복막투석 환자에서 항결핵제의 약물역동학

김기원(Ki Won Kim),안규리(Cu Rie Ahn),오국환(Kook Hwan Oh),이경이(Kyung Yi Lee),이중건(Jung Geon Lee),오명돈(Myung Don Oh),김연수(Yon Su Kim),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),장인진(In Jin Jang),신상구(Sa 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

N/A Background : Tuberculosis is more prevalent in dialysis patients than in the general population, and more difficult to make a diagnosis, and often leads to death, Moreover, extra-caution is needed in prescribing anti-tuberculosis medications as dose modification is frequently needed in patients with renal insufficiency. Several pharmacokinetic studies have been performed for antimycobacterial regimens in patients with renal insufficiency, including under hemodialysis. However, the anti-mycobacterial regimens of patients on peritoneal dialysis have been made based on empirical methods because of few pharmacokinetic studies. Methods : To elucidate the pharmacokinetic profiles of anti-mycobacterial regimens for peritoneal dialysis, we measured both plasma and peritosol concentrations of anti- tuberculous drugs including isoniazide, rifampin and pyrazinamide in 9 patients maintained on chronic ambulatory peritoneal dialysis(CAPD). Results : After a conventional oral dose of anti-tuberculosis medication, their plasma concentrations were in the therapeutic range, but the peritosol concentration of rifampin was below the therapeutic range. Conclusion : No dose adjustments are required for isoniazid, rifampin and pyrazinamide for the treatment of systemic or peritoneal tuberculosis in CAPD patients. On the contrary, oral rifampin is not expected to be effective in the treatment of tuberculous peritonitis, because of its low peritosol concentration. (Korean J Nephrol 2002; 21(1):67-73)

상염색체 우성 다낭신에서의 신낭종 경화요법

김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Shung Gwon Kim),이정상(Jung Sang Lee),이중건(Jung Geon Lee),윤성철(Sung Chul Yoon),박종훈(Jong Hoon Park),송은경(Eun Kyong Song),황대연(Dae Yeon Hwang),박정환(Jung Hwan 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

배 경 : 상염색체 우성 다낭신(ADPKD)은 성인에서 가장 흔한 유전성 신질환의 하나로서 낭종의 팽창으로 인한 복부 팽만이나 통증을 흔히 호소한다. 이의 치료를 위해 에탄올을 이용한 경화요법이나 복강경을 이용한 치료, 수술적 감압술 등이 사용되어지고 있다. 본 연구에서는 한국인 ADPKD 환자에서의 경화요법 후의 임상경과를 분석하고, 새로운 경화제인 n-butyl cyanoacrylate(NBCA)의 유용성을 검토하였다. 방 법: 저자들은 한국인 ADPKD 환자 24명을 대상으로 에탄올경화요법(n=9) 및 NBCALipiodol 혼합액을 이용한 경화요법(n=18)(3예는 두가지 치료법 병행 )을 시술하고 이들의 임상 경과를 추적 관찰하였다. 결 과: 대상 환자의 남녀비는 8 : 16이었고 치료 시 평균연령은 50±13세였다. 경화요법의 적응증으로는 동통이 14예, 복부 팽만이 7예였으며, 흡인된 낭종의 직경은 5 내지 16 ㎝으로 다양하였다. 동통이나 복부팽만은 2명을 제외한 전원에서 주관적인 개선을 보였다. 시술 전후의 평균동맥압은 시술 전 112±11.1, 시술 후 1개월 96±9.6, 시술 후 6개월에 98±9.7 ㎜Hg로 유의한 저하를 보였으나(p<0.05), 이러한 효과는 12개월째에 소실되었다. 혈중요소질소 농도는 기저치와 시술 후 6개월 측정치 사이에 유의한 차이가 없었다[24±12.1 대 22±14.6(㎎/dL)]. 출혈이나 감염과 같은 주요 합병증은 발생하지 않았으며, 시술과 관련된 사망례도 없었다. 에탄올과 NBCA 사용군 사이에 치료효과나 합병증에서 차이는 관찰되지 않았다. 결 론: ADPKD 환자에서의 신낭종 경화요법은 대부분에서 증상의 완화를 보였고, 일시적인 혈압강하 효과를 보였으며, NBCA는 신낭종 치료에 새롭게 사용된 경화제로서 단기관찰 결과 유용하고 안전한 것으로 생각된다. Background : Autosomal dominant polycystic kidney disease(ADPKD) is the most common hereditary renal disease in adults, and its major complaints include pain and abdominal fullness due to cyst expansion. So far, for the control of these symptoms, cyst ablation with ethanol or tetracycline, laparoscopic manipulations and surgical marsupialization have been used. Methods : We used conventional ethanol(n=9) or n-butyl cyanoacrylate(NBCA) plus lipiodol solution (n=18) or both(n=3) for separate cysts as the sclerosing agent in 24 adult Korean ADPKD patients. And their clinical courses after treatment were evaluated. Results : The male to female ratio was 8 : 16 and the mean age at the treatment was 50 yrs(S.D. 13.1). Causes for aspiration were pain in 14 and abdominal fullness in 7 patients and the range for the cyst diameters aspirated were 5-16 cm. Flank pain or discomfort were decreased subjectively in most cases except two. Mean arterial pressures(S.D.) (㎜Hg) before and after procedure were as follows 112(11.1)(basal), 96(9.6)(1 month) and 98(9.7)(6 month)(p<0.05, paired-t test). Blood urea nitrogen levels(㎎/dL) were not changed 6 month later[24 (12.1) vs. 22(14.6)]. There was no major complication such as bleeding or infection and no death and associated with procedure. There was no difference of therapeutic effect according to sclerosing agent. Conclusion : NBCA was as effective as conventional ethanol for sclerotherapy in ADPKD and cyst ablation therapy showed a BP-lowering effect in short-term period.

의식 변화와 구토를 주소로 내원한 Grayanotoxin Intoxication 1예

김규리,김동순,이희우,안영민,엄지현,Kim, Cu-Rie,Kim, Dong-Soon,Lee, Hee-Woo,Ahn, Young-Min,Uhm, Ji-Hyun 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.2

Grayanotoxin에 의한 중독은 대부분 보존적 치료만으로도 완전히 회복되는 경우가 많기 때문에 이를 감별하는 것이 중요하다. 저자들은 산에서 철쭉꽃을 10송이 넘게 섭취 후 의식저하를 주소로 응급실에 내원한 9세 남자 환자를 진단하고 치료하였기에 문헌고찰과 함께 보고하는 바이다. Rhododendron species is one of the largest and most diverse genera in the plant kingdom, comprising over 800 species and existing all over the globe. Grayanotoxin intoxication is caused by ingestion of honey and flowers. Grayanotoxin exists in honey, flowers, pollen, and nectar of the Rhododendron species. Grayanotoxin-intoxicated patients may present with nausea, vomiting, dizziness, weakness, hypotension, bradycardia, and syncope for several hours. We report a case of grayanotoxin intoxication associated with mental changes. A 9-year-old male presented with impaired consciousness and delirium 26 hours after eating about 10 rhododendron sclippenbachii flowers. A brain MRI and EEG were normal. Parenteral fluids were administered and these symptoms resolved completely in 17 hours.

성인의 원발성 초점성 분절성 사구체 경화증 ( FSGS ) 의 예후 및 예후 인자

김연수(Yon Su Kim),안규리(Cu Rie Ahn),한진석(Jin Suk Han),김성권(Shung Gwon Kim),이정상(Jung Sang Lee),김성균(Seong Gyun Kim),김현리(Hyun Lee Kim),황영환(Young Hwan Hwang),이상구(Sang Goo Lee),이정은(Jung Eun Lee),오윤규(Yun Kyu Oh) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4

배 경: 성인에서 FSGS는 그 발생율이 증가하고 지속적인 스테로이드 치료로 예후가 향상됨이 제시되면서 질병에 대한 관심이 높아지고 있다. 그러나 우리나라 성인 FSGS의 임상상과 예후에 대한 보고는 많지 않다. 본 연구에서는 성인 FSGS의 임상상을 살펴보고 예후에 관계하는 임상 인자를 밝히고자 하였다. 방 법 : 1985년부터 1999년까지 서울대학교병원에서 조직검사로 확진된 성인 환자를 대상으로 연구를 진행하였고 이차적 원인이 있는 경우는 제외하였다. 조직검사 당시의 임상상을 분석하였고, 10주 이상 추적 관찰된 환자를 대상으로 신기능 악화여부를 후향적으로 분석하였다. 결 과: 대상 환자는 총 92명이였으며, 이 중 47명(51%)이 신증후군(NS) 범주에 속하였다. 남녀비는 1.7 : 1이였으며 조직검사시 신기능 저하가 51%에서 관찰되었고 고혈압은 45%에서 나타났다. NS군과 신증후군 이하의 단백뇨군(non-NS)간에 고혈압유무, 신기능 저하 등의 초기 임상상의 차이는 없었다. 이들 중, 10주 이상 추적 관찰된 환자는 88명이였고, 관찰 기간은 37.1개월(2.5-185)이였다. 관찰 기간동안 14명에서 신기능이 악화되었다. 신기능 악화군과 유지군간에 조직 진단시 임상상의 차이는 없었으며, 신기능 악화 여부에 대한 독립적 예후 인자는 단백 뇨량의 정도와 조직 검사시의 신기능, 스테로이드 치료 여부였다. 전체적으로 5년 신기능 유지율은 80%로 나타났다. NS군에서 스테로이드 치료를 한 환자는 77%(34/44명)이였으며 그 중 1명(3%)에서 신기능 악화소견을 보였다. NS군에서 스테로이드 치료를 하지 않은 10명 중 6명(60%)의 신기능이 악화되었다. 결 론 : 위의 결과에서 밝혀진 성인 FSGS 환자의 예후 인자에 대한 적극적인 조절이 필요하며 향후 스테로이드 치료법의 유용성을 확인하기 위한 전향적인 연구가 필요하다. N/A