기관지 천식환자에서 단기간 Prednisolone 경규투여후 나타난 기관지 과반응성 및 면역학적 지표의 변화

나문준(Moon Jun Na),이선우(Sun Woo Lee),신인철(In Cheol Shin),김영준(Young Jun Kim),박인원(In Won Park),최병휘(Byung Whui Choi),허성호(Sung Ho Hue) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

N/A Recent studies have suggested that inflammation may play an important role in the characteristic bronchial hyperresponsivenees (BHR) and symptoms of bronchial asthma. The corticosteroid is widely used in bronchial asthmatics with antiinflammatory action, and improves the late response or bronchial hyperreactivity by the effect on the airway smooth muscle. Also, corticosteroid alters the immunologic properties by the mechanism which effects on the blood cells and their chemical mediators. In order to assess the effect of oral short-term prednisolone therapy on BHR in mild bronchial asthmatics, we measured nonspecific-BHR with methacholine bronchial provocation test [Meth-PC20 (mg/ml)], including IgE and eosinopohil count in peripheral blood in 2S bronchial asthmatic patients before and after treatment. Thery were divided into two groups; the control group (n=14) was treated with ordinary bronchodilator and antihistamine, and the steroid group (n=14) was treated with above regimen plus oral prednisolone (total 12wks; 30-40 mg/day for 1-2wks and tapering for 10-11wks). The results were as follows 1) Baseline FEV1 demonstrated no significant difference in both groups as 2340.00±500.56ml, 2296.43±514.29ml in control group, and 2387.14±683.48ml, 2474.29±660.74ml in steroid group before and after treatment. 2) Meth-PC20 was 8.92×/÷0.37 mg/ml before treatment and 12.29×/÷0.47 mg/ml after treatment in control group, which was not significantly changed. But after steroid therapy, Meth-PC showed significant change as 7.81 0.49 mg/ml vs 18.11×/÷0.51 mg/ml (p<0.05). 3) Peripheral eosinophil count was 272.25×/÷0.39/mm' before treatment and 254.38×/÷0.34/mm' after treatment in control group (p>0,05). In steroid group, it was 485. 83×/÷0.23/mm before treatment and 300.25×/÷0,40/mm after treatment (p0.05). 4) Total serum IgE measured as 147.38×/÷0.54 U/ml before treatment and 88.25×/÷0.43 U/ml after treatment in control group (p>0. 05). In steroid group, it was 563. 50×/÷0.64 U/ml before treatment and 302.92×/÷0.58U/ml after treatment (p<0.05). In conclusion, the oral corticosteroid therapy may reduce BHR in bronchial asthmatics with decrement of recruitment of activation of inflammatory cell, and inhibition of IgE production by the antiinflammatory effects.

폐결핵 진단에서 유도객담과 기관지경 검사의 유용성 비교

나문준(Moon Jun Na) 대한내과학회 1998 대한내과학회지 Vol.55 No.1

N/A Objective: Expectorated sputum examination applied first in all patients with suspected pulmonary tuberculosis is low sensitivity. Bronchoscopy is applied next in patients with smear negative sputum. In some instances, bronchoscopy can not be available in patients because of poor conditions or cooperations. The aim of this study was to determine whether sputum induction is more simple and more convenient method than bronchoscopy or not to diagnose pulmonary tubereulosis in AFB smear-negative patients. Methods : The objects of this study were 47 patients whose smear results of expectorated sputum were negative or could not produce expectorated sputum, Consecutive patients underwent sputum induction with 3% hypertonic saline delivered by ultrasonic nebulizer at least Z4 hour before bronchial washing by fiber-optic bronchoscopy. All specimens were examined for acid-fast bacilli with Ziehl-Neelsen stain and cultured for mycobacteria. Results : 1) Sensitivity of AFB smear were 36% (17/47) in induced sputum, 53%(25/47) in bronchoscopy, but statistically not significant(p>0.05). 2) Sensitivity of mycobacterial culture were 53%(25/47) in induced sputum, 68%(32/47) in bronchoscopy, statistically not significant(p>0,05), 3) Positive AFB smear in endobronchial tuberculosis(n=9) were 5 in induced sputum, and 9 in bronchoscopy. 4) In 10 patients who were not obtainable sputum initially, AFB smear were positive in 7 in induced sputum and 9 in bronchoscopy 5) In ll patients who cultured in expectorated sputum later, positive culture were 10 patients both in induced sputum and bronchoscpy. 6) All 5 patients who didn't undergo bronchoscopy were positive AFB smear in induced sputum Conclusion : 1n suspected active pulmonary tuberculosis patients with negative AFB smear of expectorated sputum, induced sputum does not replace bronchoscopy to diagnose active pulmonary tuberculosis. But, sputum induction is useful diagnostic method to detect mycobacteria before or in not available bronchoscopy.

백서 기관지 천식 모텔에서 난황에 의한 기도염증과 기도반응

나문준 ( Moon Jun Na ),이병훈 ( Byoung Hoon Lee ),안창혁 ( Chang Hyeok An ),김재열 ( Jae Yeol Kim ),박인원 ( In Won Park ),최병휘 ( Byung Whui Choi ),허성호 ( Sung Ho Hue ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.1

호흡기 ; 만성 폐쇄성폐질환의 폐기능 검사와 운동 검사의 비교

나운태 ( Woon Tae Na ),박주호 ( Joo Ho Park ),이고은 ( Go Eun Lee ),권선중 ( Sun Jung Kwon ),손지웅 ( Ji Woong Son ),나문준 ( Moon Jun Na ),최유진 ( Eu Gene Choi ) 대한내과학회 2009 대한내과학회지 Vol.76 No.5

목적: 일반폐기능 검사만으로는 COPD 환자가 실생활에서 겪는 장애정도와 운동 내성의 한계를 예측하는 데는 한계가 있어, 일반폐기능 검사와 운동부하심폐기능 검사를 이용하여 COPD 환자를 중증도별로 하여 각각 분류하고 그 결과를 비교하여, 운동부하폐기능 검사의 유용성을 알아보고자 하였다. 방법: COPD 환자 105명을 대상으로 안정 시 폐기능 검사와 운동부하심폐기능 검사를 시행하였고, 결과는 표준 의학중증도 분류에 의해 categorical statistical comparison으로 분석하였다. 결과: 두 검사에서 COPD 환자 105명 중 오직 44명(42%)의 환자가 일치된 결과를 보였다. 나머지 환자들 중 21명(20%)은 일반폐기능 검사보다 운동부하심폐기능 검사에서 경한 판정을 받았고, 40명(38%)은 운동부하심폐기능 검사에서 더 심한 판정을 받았다. 운동부하심폐기능 검사에서 더 심한 판정을 받은 환자들은 운동부하 검사 심혈관계 지표들이 보다 감소되어 있었다. 결론: COPD 환자의 운동능력은 일반폐기능 검사만으로는 예측하는 데는 한계가 있으며, 전신질환으로서의 COPD 질환을 이해하고 예측하는데 있어 운동부하폐기능 검사도 일부 도움을 주리라 생각되나, 앞으로 좀 더 많은 연구가 필요하리라 사료된다. Background/Aims: Chronic obstructive pulmonary disease (COPD) is characterized by an incompletely reversible airflow limitation. Pulmonary function test (PFT) has been considered the gold standard test for diagnosis and severity evaluation in COPD. However, PFT by spirometry does not provide information about exercise performance in COPD patients. Therefore, the present study was performed to compare pulmonary function determined by spirometry with exercise function determined by cardiopulmonary exercise test (CPET) for grading of COPD. Methods: A total of 105 patients with airway obstruction were examined. The patients` mean age was 65 years, and the mean smoking history was 27 pack-years. The patients underwent spirometry and CPET. The results were analyzed by categorical statistical comparison, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and American Thoracic Society guidelines. Results: The two methods agreed on the classification of only 44 patients (42%). Of the remaining patients, 21 (20%) were found to be less severe according to CPET than according to PFT, whereas 40 (38%) were more severe. Those who were more severe according to CPET had significantly low maximal minute ventilation, low anaerobic threshold, low oxygen pulse, and high breathing reserve. Conclusions: The present study revealed the large disagreement between the results of resting and exercise pulmonary function tests, and therefore suggests the need for a novel approach or guideline. Additional cardiological evaluation may be needed in patients classified as more severe according to CPET, who are assumed to have a greater degree of impairment of cardiovascular function. (Korean J Med 76:571-577, 2009)

기관지천식 환자의 혈중 eosinophil cationic protein 치와 기관지과민성과의 관계

유지훈,최재선,안창혁,이병훈,나문준,김재열,박인원,최병휘,허성호 ( Ji Hoon Yoo,Jae Sun Choi,Chang Hyuk Ahn,Byung Hoon Lee,Moon Jun Na,Jae Yul Kim,In Won Park,Byung Whui Choi,Sung Ho Hue ) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.3

Background: Serum eosinophil cationic protein(ECP) level has been proposed as a indirect marker of eosinophilic inflammation of the airway in bronchial asthma. Objective'. To evaluate serum ECP against indirect clinical markers of disease, we compared bronchial obstruction, bronchial hyperresponsiveness and peripheral blood eosinophil counts, total IgE with serum ECP levels in patients with bronchial asthma and normal controls. Method: Fourty-two patients with bronchial asthma and twenty-six normal controls were enrolled. Measurement were made by spirometry, inhalation challenge with methacholine, peripheral blood eosinophil counts, total IgE and FEIA(fluoroenzymatic immunoassay) of serum ECP Result. Serum ECP levels were significantly higher in asthmatic patients than normal controls(p<0.0,5). Serum ECP levels were correlated with peripheral blood eosinophil counts(p<0.01, r=0.544) and bronchial hyperresponsiveness(PC,)(p<0.01, r=-0.456) in patients with bronchial asthma. Serum ECP levels were correlated with degree of bronchial obstruction(FEV, % to predicted value, FEV1/FVC%) in total subjects, but not in asthmatic patients. Conchcsion.' Serum ECP level may be used as indicator of disease activity in bronchial asthma and be helpful in differentiation between normal person and asthmatic patients on simple serological method. Further studies on the changes of serum ECP levels according to disease course and therapeutic responses are needed.

결핵성 흉막염 환자에 있어서 천자회수와 천자 후 발생되는 합병증과의 관계에 대한 연구

신인철 ( Sin In Cheol ),나문준 ( Na Mun Jun ),이선우 ( Lee Seon U ),김영준 ( Kim Yeong Jun ),박인원 ( Park In Won ),최병휘 ( Choe Byeong Hwi ),허성호 ( Heo Seong Ho ) 대한내과학회 1992 대한내과학회지 Vol.42 No.3

결핵성 흉막염의 치료에서 천자회수와 천자후 발생되는 합병증 및 후유증과의 관련성을 알아보기 위하여 1984년 6월부터 1989년 8월까지 중앙대학교 부속 의료원에서 진단된 결핵성 흉막염 환자 중 흉막삼출액의 천자를 1회 시행한 단수천자군과 2회 이상 시행한 다수천자군을 대상으로 연구하여 다음과 같은 결과를 얻었다. 1) 천자후 평균 발열기간은 단수천자군에서 3.82일 이었고 다수천자군에서 4.74일 이었으며 기흉의 발생빈도는 각각 13.0%와 18.2%로서 통계적으로는 유의한 차이는 없었으나 다수천자군에서 발열기간이나 기흉의 발생빈도가 높은 경향을 보였다. 2) 흉막유착의 빈도는 단수천자군에서 51.9%이었고 다수천자군에서 57.6%를 보여 다수천자군에서 흉막유착이 많이 발생하였지만 통계적으로는 유의한 차이가 없었다. 또한 흉막유착 정도와의 관계를 보면 단수천자군에서 중등도의 흉막유착이 많았고 다수천자군에서 경증의 유착이 많았다. 3) 흉막 삼출액내의 단백질 농도와 흉막유착 발생빈도는 유의한 관련성이 없었다. 4) 천자전 흉막삼출액의 중증도(severity)와 흉막유착 발생빈도는 유의한 관련성이 없었다. 천자후 남은 흉막삼출액 양이 많을수록 흉막유착이 많은 경향을 보였다. 이상의 결과로서 경핵성 흉막염에서 천자후 상당히 많은 예에서 흉막유착이 발생되는데 그 정도는 단수천자군에서 중등도유착이 많았고 다수천자군에서 경증의 유착이 많았으나 다수천자를 한다해도 유착 및 기흉의 발생 빈도를 줄 일 수 없으므로 흉막삼출액의 천자는 단수천자가 좋을 것으로 사료된다. Tuberculous pleurisy is a most common form of extrapulmonary tuberculosis. Thoracentesis can relief the symptom of pleurisy but complcations such as pleural adhesion and pnemothorax may develop after thoracentesis. To evaluate the relationship between number of thoracentesis and complication after thoracentesis in tuberculous pleurisy, we analyzed 87 patients of tuberculous pleurisy who were treated at the department of Internal Medicine, Chung-Ang University Hospital from June, 1984 to August, 1989. The obtained results were as follows. 1) The mean duration of febrile illness was 3.82 days in patients of the single-tap group and 4.74 days in patients of multiple-tap group after thoracentesls. Pneumothorax was developed in 13.0% of single-tap goup and 18.2% of multiple-tap group after thoracentesis (p>0.05). 2) Pleural adhesion after thoracentesis was develped in 51.9% of single-tap group and 57.6% of multiple-tap group (p>0.05). 3) Moderate abhesion was common in single-tap group and mild adhesion was common in multiple-tap group (p<0.05). 4) The relationship between concentration of protein of pleural fluid and incidence of pleural adhesion showed no significant difference. 5) Between severity of effusion before and after thoracentesis and incidence of pleural adhesion, no statistical significance was observed and pleural adhesion was common in case who had more residual voume within the pleural space after throracentesis without significant difference. These results suggested that the pleural adhesion may occur in relatively large number of patients with tuberculous pleurisy after thoracentesis and the incidence of pleural adhesion was not decreased in the multiple-tap group.

흉막비후의 정도가 폐기능에 미치는 영향

이영경 ( Lee Yeong Gyeong ),나문준 ( Na Mun Jun ),윤보라 ( Yun Bo La ),이원영 ( Lee Won Yeong ) 대한결핵 및 호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.51 No.3

증례 : 위, 방광 및 폐에 병발한 삼중성 속발성 원발암 1예

윤현주 ( Hyun Ju Yoon ),최유진 ( Eu Gene Choi ),나문준 ( Moon Jun Na ),이원영 ( Won Young Lee ) 대한내과학회 2004 대한내과학회지 Vol.67 No.-

TGF-${\beta}1$으로 자극한 사람중피세포주에서 조직플라스미노겐 활성제가 미치는 영향

이정림,전수진,유영춘,김지혜,이유미,권선중,손지웅,최유진,나문준,Lee, Jung-Lim,Jeon, Soo-Jin,Yoo, Young-Choon,Kim, Ji-Hye,Lee, Yu-Mi,Kwon, Sun-Jung,Son, Ji-Woong,Choi, Eu-Gene,Na, Moon-Jun 대한결핵및호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.5

Background: In an effort to find alternative therapeutic agents to prevent excessive fibrosis as a sequela to complicated parapneumonic effusion or empyema, we examined the effect of tissue plasminogen activator (tPA) as a fibrinolytic agent combined with talc or transforming growth factor (TGF)-${\beta}1$ in a human pleural mesothelial cell line, MeT-5A. Methods: MeT-5A cells were stimulated with various doses of talc, doxycycline or TGF-${\beta}1$ for 24 h and then were treated with tPA for an additional 24 h. Cell viability was measured by MTT assay. The production of interleukin (IL)-8 and vascular endothelial growth factor (VEGF) in the culture supernatants was measured by ELISA. Real-time PCR was carried out for measurement of type I collagen mRNA. Results: MeT-5A cells treated with talc showed a dose-dependent increase in production of IL-8. Talc also increased production of type I collagen mRNA at low doses, but talc did not influence the induction of VEGF. Addition of tPA to talc-stimulated cells showed further increases in the production of IL-8, but tPA did not influence the production of VEGF or type I collagen mRNA. TGF-${\beta}1$ increased the production of both VEGF and collagen type I mRNA, both of which were effectively inhibited by additional tPA treatment in MeT-5A cells. Conclusion: TGF-${\beta}1$ is a potent inducer of collagen synthesis without induction of IL-8 in MeT-5A cells. Addition of tPA after TGF-${\beta}1$ stimulation inhibited further fibrosis by direct inhibition of collagen mRNA synthesis as well as by inhibition of VEGF production.

좌우 기관지 모두에서 발견된 생선등뼈로 인한 폐쇄성 폐렴

최유진 ( Choe Yu Jin ),황원민 ( Hwang Won Min ),나문준 ( Na Mun Jun ),이원영 ( Lee Won Yeong ) 대한내과학회 2003 대한내과학회지 증례 특집호 65-5 부록3 Vol.0 No.-

Foreign body aspiration occurs rarely in adults. Aspiration of foreign bodies into tracheobronchial tree commonly occurs by accident, and in most cases they get removed without delay. Sometimes, however, small foreign bodies that lodge in the peripheral a