정상 심기능을 보이는 노인 환자에서 정형외과 수술 전 NT-proBNP의 역할

고은정 ( Eun Jung Ko ),문재연 ( Jae Youn Moon ),임영민 ( Yeong Min Lim ),홍원정 ( Won Jung Hong ),신석표 ( Suk Pyo Shin ),김상훈 ( Sang Hoon Kim ),양우인 ( Woo In Yang ),성정훈 ( Jung Hoon Sung ),김인재 ( In Jai Kim ),임상욱 ( San 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Background/Aims: Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of postoperative cardiovascular complications. The present study investigated whether blood NT-proBNP values are suitable for predicting postoperative cardiovascular complications after non-cardiac surgery in elderly patients showing normal left ventricular (LV) function on preoperative echocardiograms. Methods: This study was performed by analyzing the medical records of elderly patients referred to the cardiology department for the purpose of assessing their cardiac function before orthopedic surgery. Of the patients who underwent echocardiography and NT- proBNP assessment simultaneously, 275 patients aged ≥ 70 years and with an LV ejection fraction of ≥ 55% were included in the study. Results: Major adverse cardiac and cerebrovascular events (MACCEs) occurred in 33 (12%) of the 275 patients, and the NT-proBNP concentration was higher in patients with complications than in those without complications (1,904.20 ± 2,300.23 vs. 530.58 ± 882.27 pg/mL, p < 0.01). The ROC area under the curve was 0.756 (95% confidence interval 0.701-0.805, p < 0.001) with an optimal cutoff of 416.3 pg/mL (69.7% sensitivity, 67.36% specificity). A multivariate analysis showed that a preoperative age of > 80 years (odds ratio, 2.313; p = 0.047) and an increased blood NT-proBNP concentration (odds ratio, 3.189; p = 0.009) were independent risk factors for the prediction of MACCEs. Conclusions: Although elderly patients scheduled to undergo non-cardiac surgery may show normal LV systolic function on echocardiography, measurement of their preoperative blood NT-proBNP concentration is useful for predicting MACCEs occurring after non-cardiac surgery. (Korean J Med 2014;87:302-310)

노인 급성관동맥증후군 환자들의 항혈전치료

심민정(Minjung Shim),문재연(Jae Youn Moon) 대한임상노인의학회 2019 대한임상노인의학회지 Vol.20 No.3

Ischemic heart disease is the leading cause of death in older people. In particular, more than one-third of myocardial infarction patients are aged 75 or older. Nonetheless, little attention has been given to the scientific assessment of antithrombotic treatment of acute coronary syndrome in older people. Despite the fact that older people with acute coronary syndrome increases, most randomized trials of antithrombotic treatment of acute coronary syndrome have been conducted excluding this population. For now, there is no establishment of scientific practice guideline of antithrombic treatment of acute coronary syndrome in older people. In clinical decision-making process, concerns of drastic hemorrhagic complications in older people often override the benefits of antithrombic treatment and lead to pursue more passive conservative treatment. The present article reviews various antithrombotic agents with an emphasis on older people with acute coronary syndrome by most recent updates derived from clinical trials and future perspectives.

증례 : 순화기; 중재시술과 부가적인 항응고요법으로 치료한 신동맥 근접 대동맥 폐색증

김건우 ( Gun Woo Kim ),문재연 ( Jae Youn Moon ),진선미 ( Sun Mi Jin ),문지혜 ( Jie Hye Moon ),김경호 ( Kyung Ho Kim ),김상훈 ( Sang Hoon Kim ),임상욱 ( Sang Wook Lim ) 대한내과학회 2013 대한내과학회지 Vol.85 No.3

만성 폐쇄성 복부 대동맥 질환 중에서 폐쇄가 점차 근위부로 진행하여 신동맥 기시부까지 파급된 질환을 신동맥 근접 대동맥 폐색증(juxtarenal aortic occlusion)으로 부른다. 신동맥 근접 대동맥 폐색증의 경우 단순한 복부대동맥 폐쇄질환보다 수술적 치료가 난해하며 수술과 관련된 이병률 및 사망률이 높은 것으로 알려져 있다. 대동맥 폐쇄성 질환의 치료로는 주로 대동맥양측대퇴동맥 우회로술 또는 동맥내막절제술과 같은 외과적인 수술에 의한 치료에 의존하고 있으나 최근 혈관 중재시술의 발달 및 스텐트 삽입술이 발달하면서 중재적 치료로 치료하는 경우가 늘고 있는 상황이다. 하지만 신동맥 근접 대동맥 폐색증의 경우 중재시술 과정 중 신동맥 폐색 등의 합병증이 생길 위험이 높아 현재까지도 중재적 치료의 경험이 많지 않은 상태이다. 이에 저자들은 신동맥 근접 대동맥 폐색증 환자에서 스텐트를 이용한중재술과 부가적인 항응고요법을 이용하여 합병증 없이 치료한 사례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Chronic atherosclerotic occlusion of the abdominal aorta is a rare disease in clinical practice. In this disease, juxtarenal aortic occlusion is defined as the condition extended, adjacent to the renal arteries. The treatment of juxtarenal aortic occlusion is more difficult than a ``simple`` abdominal aortic occlusion. Vascular surgery of a juxtarenal aortic occlusion-specifically aortic endarterectomy and bypass grafting-is a challenging procedure that almost invariably requires aortic cross-clamping above the level of the renal arteries, and may be associated with significant morbidity and mortality. With the advent of endovascular treatment, percutaneous transluminal angioplasty and stent implantation have been used increasingly as an alternative to conventional surgery in the management of patients with aortoiliac disease. However, endovascular treatment for juxtarenal aortic occlusion is not common and, also, special attention is needed with regard to possible renal complications. Here, we report the successful revascularization of a case of chronic juxtarenal aortic occlusion with endovascular treatment and adjunctive anticoagulation. (Korean J Med 2013;85:302-307)

Reversible Posterior Leukoencephalopathy Syndrome과 동반된 전신성 홍반성 루푸스

박민찬 ( Min Chan Park ),박용범 ( Yong Beom Park ),문재연 ( Jae Youn Moon ),김형종 ( Hyung Jong Kim ),이수곤 ( Soo Kon Lee ),허경 ( Kyoung Heo ),박선영 ( Sun Young Park ),김동익 ( Dong Ik Kim ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinico-radiologic syndrome, first described by Hinchey, et al in 1996, which was reported to be associated with several medical conditions, including hypertensive encephalopathy, chronic renal insufficiency, blood transfusion and eclampsia. RPLS is also reported to be developed during treatment with immuno-suppressive drugs such as cisplatin, cyclosporin A, tacrolimus, and interferon-α, the acute phase of autoimmune disease, and post-transplantation state. Clinical manifestations of RPLS are headache, nausea, vomiting, altered mental status, seizures, cortical blindness, other visual disturbances, and motor deficits. Neuroimaging shows bilateral subcortical and cortical edema with a predominant posterior distribution. The association of RPLS and systemic lupus erythematosus has been rarely reported in the literature, but not yet in Korea. Recently we experienced a patient with SLE, who had RPLS during her disease flare.

류코트리엔 조절제를 사용중인 기관지천식 환자에서 경구 부신피질 호르몬 감량후 발병한 Churg - Strauss 증후군 1 례

김철우(Cheol Woo Kim),홍천수(Chein Soo Hong),배상운(Sang Woon Bae),조재희(Jae Hee Cho),김현진(Hyun Jin Kim),문재연(Jae Youn Moon),장승민(Seung Min Jang),김형종(Hyung Jong Kim),선우일남(Il Nam Sunwoo),조상호(Sang Ho Cho) 대한천식알레르기학회 2002 천식 및 알레르기 Vol.22 No.2

N/A

급성 ST 분절 비상승 심근경색증의 경색 관련 동맥 완전 폐색 예측인자

정대호 ( Dae Ho Jung ),정명호 ( Myung Ho Jeong ),김계훈 ( Kye Hun Kim ),이우석 ( Woo Seok Lee ),이기홍 ( Ki Hong Lee ),윤현주 ( Hyun Joo Yoon ),윤남식 ( Nam Sik Yoon ),문재연 ( Jae Youn Moon ),홍영준 ( Young Joon Hong ),박형욱 ( H 대한내과학회 2008 대한내과학회지 Vol.74 No.3

목적: 급성 ST 분절 비상승 심근경색증 환자들 중 일부분은 경색 관련 동맥의 완전 폐색이 동반될 수 있으므로 이를 선별하여 초기에 관혈적 치료방침을 시행하는 것이 임상적으로 중요할 것으로 생각된다. 본 연구의 목적은 ST 분절 비상승 심근경색 환자에서 관상동맥 조영술 전에 경색 관련 동맥의 완전 폐색을 예측할 수 있는 비 침습적 인자들에 대해 알아보는 것이다. 방법: 2005년 4월부터 2006년 12월까지 전남대학교병원 심장센터에 입원하여 관상동맥 조영술을 시행받은 연속적인 205명의 ST 분절 비상승 심근경색 환자(63.3±10.5세, 남자: 123명)들을 각각 I군(IRA의 완전 폐색군: 총 62명, 61.1±13.3세, 남자: 42명)과 II군(비폐색군: 총 143명, 64.2±11.3세, 남자: 81명)으로 대별하여 임상적, 생화학적, 심초음파도의 차이를 후향적으로 분석하였다. 결과: 관상동맥 조영술에서 총 62명(30.2%)이 경색 관련 동맥의 완전 폐색을 보였고, 완전 폐색을 가장 많이 보인 혈관은 좌회선지이었다. 다변량 분석 결과 경색 관련 동맥의 완전 폐색을 예측할 수 있는 인자로는 계속되는 흉통의 시간(OR:9.67, 95% CI:1.59~80.6, p=0.03), 높은 수치의 CK-MB(OR:5.35, 95% CI:1.31~90.0, p=0.035)와 fibrinogen(OR:6.73, 95% CI:1.48~50.2, p=0.043), 12-유도 심전도에서 ST 분절 하강이 보인 유도의 수(OR:4.78, 95% CI:1.22~41.9, p=0.048) 등이 있었다. 결론: ST 분절 비상승 심근경색증 환자에서 연속되는 흉통의 지속시간이 길고, CK-MB와 fibrinogen 수치가 높으면서, 내원 시에 심전도에서 여러 유도에서 ST 분절 하강을 보이는 경우에 IRA의 완전 폐색 가능성이 높음을 알 수 있었다. Background/Aims: Some patients with non-ST elevation myocardial infarction (NSTEMI) have total occlusion of the infarct related artery (IRA) and may benefit from early invasive treatments. The aim of this study was to investigate the predictors of total occlusion of the IRA in patients with NSTEMI before coronary angiography. Methods: A total of 205 consecutive patients with NSTEMI (63.3±10.5 years, 123 males) who were admitted and underwent coronary angiogram from April 2005 to December 2006 at Chonnam National University Hospital were divided into two groups: group I (total occlusion of IRA: n=62, 61.1±13.3 years, 42 males) and group II (patent IRA: n=143, 64.2±11.3 years, 81 males). Clinical, biochemical and echocardiographic parameters on admission were compared between the groups. Results: A total occlusion of the IRA in patients with NSTEMI was observed in 62 (30.2%) patients most frequently in the left circumflex coronary artery. The predictive factors for total occlusion, according to the multivariate analysis, were prolonged duration of continuous chest pain (OR:9.67, 95% CI:1.59~80.6, p=0.03), a higher level of the creatine kinase-MB fraction (CK-MB) (OR:5.35, 95% CI:1.31~90.0, p=0.035) and fibrinogen (OR:6.73, 95% CI:1.48~50.2, p=0.043), and multiple leads with ST depression on the ECG (OR:4.78, 95% CI:1.22~41.9, p=0.048). Conclusions: Total occlusion of the IRA in patients with acute NSEMI is associated with a long duration of chest pain, high levels of CK-MB and fibrinogen, and ST changes in multiple ECG leads. (Korean J Med 74:271-280, 2008)

관상동맥 중재술을 받은 급성 심근경색증 환자에서 체질량 지수의 영향

정선영 ( Seon Young Jeong ),이정애 ( Jung Ae Rhee ),정명호 ( Myung Ho Jeong ),황선호 ( Seon Ho Hwang ),윤남식 ( Nam Sik Yoon ),홍서나 ( Seo Na Hong ),이상록 ( Sang Rok Lee ),김계훈 ( Kye Hun Kim ),문재연 ( Jae Youn Moon ),홍영준 ( 대한내과학회 2007 대한내과학회지 Vol.73 No.6

목적: 비만은 관상동맥 질환의 위험인자로 알려져 있으나, 급성 심근경색증 환자에서 비만이 미치는 영향이나 관상동맥 중재술 후 장기 예후에 대한 영향은 잘 알려져 있지 않다. 본 연구를 통해 급성 심근경색증 환자에서 비만이 미치는 영향과 관상동맥 중재술 후 장기 예후에 미치는 영향을 알아보고자 하였다. 방법: 2002년 2월 1일부터 2006년 6월 30일까지 전남대학교 심장센터에서 급성 심근경색증으로 진단되어 관상동맥 중재술을 시행한 309예(60.5±11.3세, 남:여=243:66)를 대상으로 하였다. 체질량 지수가 25 kg/m2미만인 194예의 환자를 I 군(61.7±11.1세, 남:여=151:43), 체질량 지수가 25 kg/m2 이상인 115예의 환자를 II 군(58.6±11.5세, 남:여=92:23)으로 하여 두 군 간의 임상적 특성이나 위험인자들을 비교하였고, 6개월간 추적 경과관찰 동안 발생한 주요 심장 사건을 분석하였다. 결과: I 군에서 II 군에 비하여 나이가 많았고(61.7±11.1세 vs. 58.6±11.5세, p=0.017), II 군에서 고혈압(59/115 vs. 75/194예, p=0.033)과 고지혈증(60/115 vs. 75/194예, p=0.024)의 빈도가 높았다. 고지혈증의 경우 II 군이 I 군에 비해 혈중 총 콜레스테롤(201.4±42.6 mg/dL vs. 184.3±39.9 mg/dL, p=0.001), 중성지방(147.1±96.2 mg/dL vs. 121.2±61.6 mg/dL, p=0.005), 저밀도 콜레스테롤(134.1±37.8 mg/dL vs. 120.3±35.1 mg/dL, p=0.002)이 높았으나, 고밀도 콜레스테롤(42.3±10.2 mg/dL vs. 44.5±12.1mg/dL, p=0.109)은 차이가 없었다. 관상동맥 조영술이나 중재술과 연관된 인자는 두 군에서 차이가 없었다. 178예(I 군 109예, II 군 69예)의 환자에서 6개월 추적 관상동맥 조영술이 시행되었다. 재협착은 I 군에서 14예(12.8%), II 군에서 18예(26.1%)가 발생하여 II 군이 I 군에 비해 재협착율이 유의하게 높았다(p=0.025). 결론: 비만을 동반한 급성 심근경색증 환자에서는 고지혈증과 고혈압이 동반되는 경우가 많았으며, 관상동맥 중재술 후 재협착이 유의하게 많이 발생함을 알 수 있었다. 따라서 비만에 대한 적극적인 치료가 심근경색증 환자에서 중재술 후 재협착 예방에 중요할 것으로 생각되었다. Background: Obesity is one of the major risk factors for coronary artery disease. However, the long-term clinical effects of obesity after percutaneus coronary intervention (PCI) in Korean patients with acute myocardial infarction (AMI) have not been sufficiently evaluated. Methods: A total of 309 patients (mean age 60.5±11.3 years, M:F=243:66) that underwent PCI with a diagnosis of AMI between February 2002 and June 2006. Thepatients were divided into two groups according to the body mass index (BMI): group I (n=194; BMI<25 kg/m2; mean age 61.7±11.1 years, M:F=151:43) and group II (n=115; BMI≥25 kg/m2, mean age 58.2±11.3 years, M:F=92:23). Clinical characteristics and risk factors, and major adverse cardiac events during a six-month follow-up were compared between patients in the two gropus. Results: The mean age of group I patients was older than that of group II patients (61.7±11.1 years vs. 58.6±11.5 years, p=0.017). The prevalence of hypertension was higher in group II patients (75/194, 38.7% vs.59/115, 51.3%, p=0.033) and hyperlipidemia was more prevalent in group II patients (75/194, 38.7% vs. 60/115, 52.2%, p=0.024). The levels of total cholesterol (184.3±39.9 mg/dL vs. 201.4±42.6 mg/dL, p=0.001), triglycerides (121.2±61.6 mg/dL vs. 147.1±96.2 mg/dL, p=0.005), low-density lipoprotein-cholesterol (120.3±35.1 mg/dL vs. 134.1±37.8 mg/dL, p=0.002) were lower in group I patients than in group II patients. The restenosis rate on a follow-up coronary angiogram was higher in group II patients (18/69, 26.1%) than in group I patients (14/109, 12.8%, p=0.025). Conclusions: Obesity is associated with hyperlipidemia and hypertension in patients with AMI. The restenosis rate after PCI was higher in obese AMI patients. (Korean J Med 73:603-610, 2007)