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급성 신기능 손상을 동반한 A형 간염의 임상상과 예후 인자
이진희 ( Jin Hee Lee ),최문석 ( Moon Seok Choi ),곽금연 ( Geum Yeon Gwak ),이준혁 ( Joon Hyoek Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Background/Aims: We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA. Methods: We reviewed medical record of 391 patients with AHA admitted at our institution since 2000. Results: AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7±8.7 years vs. 31.3±7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI. Conclusions: AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect. (Korean J Gastroenterol 2010;56:359-364)
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라미부딘과 아데포비어에 순차 내성을 보인 만성 B형 간염 환자에서 라미부딘/아데포비어 병합요법의 항바이러스 효과
서현주 ( Hyun Joo Suh ),박문경 ( Moon Kyung Park ),이향이 ( Hyang Ie Lee ),곽금연 ( Geum Yeon Gwak ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ),이준혁 ( Joon Hyeok Lee ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5
목적: LMV과 ADV의 단독치료에 순차내성을 보인 만성 B형 간염 환자에서 LMV과 ADV의 병합투여 후 항바이러스 효과를 알아보고자 하였다. 대상 및 방법: 1997년부터 2007년 사이 LMV와 ADV에 순차적으로 바이러스 돌파현상을 보였던 만성 B형 간염 환자들을 대상으로 하였고, 이들 중 LMV과 ADV 병합치료를 받은 18명의 환자들을 후향 분석하였다. 결과: LMV-ADV 병합치료 시행 후 추적관찰 기간의 중앙값은 17개월(범위, 6-27)이었다. 병합치료 0, 3, 6, 12, 24개월의 평균 DNA역가는 6.08±0.95, 4.05±1.66, 3.17±1.58, 3.18±2.16, 2.35±1.52 log10 IU/mL였고 전체 18예 중 16예(88.9%)에서 HBV DNA의 역가가 20,000 IU/mL 미만으로 감소하였다. HBeAg의 혈청전환은 단 1예(7.1%)에서만 관찰되었고 12예(66.7%)에서 혈청 ALT가 정상화되었다. 병합치료 12개월과 14개월째 바이러스 반등이 있었던 환자가 2예 있었다. 혈청 ALT는 12예(66.7%)에서 정상으로 감소하였다. 일차치료 실패를 보인 경우는 2예(11.1%)가 있었다. 결론: 이번 연구에서 LMV과 ADV에 순차적으로 내성을 보인 환자들에게 LMV-ADV 병합치료를 시행하고 단기간 추적관찰하였을 때 88.9%에서 효과가 있었다. 이는 다른 항바이러스제의 사용이 여의치 않을 때 LMV-ADV의 병합치료가 도움이 될 수 있음을 보여준다. Background/Aims: The aim of this study was to elucidate the antiviral efficacy of lamivudine (LMV)-adefovir (ADV) combination therapy in chronic hepatitis B patients who showed resistance to LMV and ADV consecutively. Methods: A retrospective review was performed in eighteen patients with chronic hepatitis B who developed virologic breakthroughs during LMV-ADV sequential mono-therapy and treated with LMV-ADV combination therapy. Results: The median duration of follow up was 17 months (range, 6-27) after the start of LMV-ADV combination therapy. Mean HBV DNA level in log10 IU/mL was 6.08±0.95, 4.05±1.66, 3.17±1.58, 3.18±2.16, and 2.35±1.52 at 0, 3, 6, 12, and 24 months, respectively. Sixteen patients (88.9%) showed HBV DNA reduction below detection limit (<20,000 IU/mL). HBeAg seroconversion was observed in one patient (7.1%) after 8 months of combination therapy. Virologic breakthrough occurred in only one patient after 21 months of combination therapy. Viral rebound occurred in two patients at 12 months and 14 months of combination therapy. Normalization of serum ALT was achieved in twelve patients (66.7%). Primary non-response was observed in two cases (11.1%). Conclusions: LMV-ADV combination treatment was effective in 88.9% of patients with resistance to LMV and ADV in a short-term follow up. It may be applied as a bridge therapy until another effective antiviral regimen becomes available. (Korean J Gastroenterol 2009;53:305-310)
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