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성인에서 기관지과민성과 폐기능의 지표로서 High-Sensitivity C-Reactive Protein의 의미
김민혜 ( Min Hye Kim ),김세훈 ( Sae Hoon Kim ),강혜련 ( Hye Ryun Kang ),박흥우 ( Heung Woo Park ),장윤석 ( Yoon Seok Chang ),김동희 ( Dong Hee Kim ),조상헌 ( Sang Heon Cho ),민경업 ( Kyung Up Min ),김유영 ( You Young Kim ),김선신 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.2
Background: Bronchial hyperresponsiveness is a characteristic feature of asthma and closely related with airway inflammation in part. Serum high-sensitivity C-reactive protein (hs-CRP) is a very sensitive marker for systemic inflammation, and several studies has reported the association between hs-CRP and bronchial hyperresponsiveness. Objective: The objectives of this study are to evaluate the association between hs-CRP and bronchial hyperresponsiveness or lung function in healthy Korean subjects. Method: A total of 7,709 subjects underwent methacholine bronchial provocation tests in Seoul National University Hospital health care Gangnam center from October 2003 to January 2009. Among them, 508 subjects were positive for the methacholine bronchial provocationtest. Another 508 subjects negative for the test were enrolled as control, who were matched for age, sex and body mass index. We reviewed the medical records and compared serum hs-CRP levels and the results of the methacholine bronchial provocation test and pulmonary function tests. Result: Bronchial hyperresponsiveness was more frequently observed in subjects with higher hs-CRP levels (group IV). (24.6% vs. 14.8%) than in subjects with lower hs-CRP levels (group I). There was a negative correlation with hs-CRP levels and FEV1, FVC or FEV1/FVC. Conclusion: There was a negative association between serum hs-CRP levels and bronchial hyperresponsiveness or lung function. (Korean J Asthma Allergy Clin Immunol 2009;29:112-116)
이상민 ( Sang Min Lee ),강혜련 ( Hye Ryun Kang ),박흥우 ( Heung Woo Park ),장윤석 ( Yoon Seok Chang ),김선신 ( Sun Sin Kim ),조상헌 ( Sang Heon Cho ),김유영 ( You Young Kim ),민경업 ( Kyung Up Kim ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.2
Celecoxib (Celebrex(R)) is a nonsteroidal anti-inflammatory drug (NSAID) which selectively inhibits cyclooxygenase (COX)-2. Celecoxib rarely induces serious cutaneous adverse reaction such as erythema multiforme, Steven-Johnson syndrome and toxic epidermal necrosis. We report a case of erythema multiforme induced by celecoxib. In this case, celecoxib was proved as a causative drug by the patch test. (Korean J Asthma Allergy Clin Immunol 2009;29:138-141)
패혈증환자에서 혈청 TNF-$\alpha$ 및 IL-1$\beta$
김재열,이춘택,김영환,한성구,민경업,김유경,심영수,유철규,Kim, Jae-Yeol,Choi, Hyung-Seok,Lee, Choon-Taek,Kim, Young-Whan,Han, Sung-Koo,Min, Kyung-Up,Kim, Yoo-Young,Shim, Young-Soo,Yoo, Chul-Gyu 대한결핵및호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.49 No.2
패혈증에서는 지속적인 내독소 자극에 의해 염증 반응이 계속 유발될 수 있으나, 염증반응에 주도적인 역할을 하는 말초혈액 단핵구는 반응도를 스스로 낮춤으로서 염증 반응을 감소시키는 경향을 보이는데, 이러한 현상을 내독소 내성(endotoxin tolerance)라고 한다. 내독소 내성은 과다한 염증반응에 대한 자체의 방어작용으로 이해되고 있다. 본 연구에서는 조직액에서 감염균이 증명된 패혈증 환자를 대상에서 추출한 말초 혈액 단핵구에서 내독소 내성의 현상을 관찰하고자 하였다. 방법 : American College of Chest Physician-Society의 Critical Care Medicine Consensus Conference에서 정한 sepsis의 기준을 만족하고, 감염균이 확인된 14명의 환자를 대상으로 하였으며 질환의 중증도는 APACHE II score를 이용하여 평가하였다. 대상환자의 혈청에서 TNT-$\alpha$와 IL-1$\beta$의 농도를 측정한 뒤, 말초혈액 단핵구를 추출, 배양하여, 내독소(100 ng/ml)로 자극하였다. 내독소 자극 후 24시간 뒤에 배양 상층액에서 ELISA 방법으로 TNT-$\alpha$와 IL-1$\beta$의 농도를 측정하였다. 결과 : 대상 환자는 총 14명(남자 : 8 명, 여자 6명)으로 APACHE II score는 12.2$\pm$5.7 이었다. 감염의 원발 부위는 뇨관감염, 폐렴, 아급성심내막염, 도관감염, 급성담관염 등이었다. 감염 원인균은 그람음성 간균 10례, 그람 양성균 6례였고, 이 중에는 복합감염이 2례가 있었다. 환자군의 혈청 TNF-$\alpha$는 4명에서 측정이 기능했고 평균치는 29.7$\pm$527.7 pg/ml 이었다. IL-1$\beta$는 1명에서 측정가능했고 측정치는 16.1 pg/ml 이었다. 내독소 자극 후 말초혈액 단핵구 배양 상층액의 TNF-$\alpha$농도는 패혈증 환자는 2,703$\pm$2,066 pg/ml, 대조군은 2,101$\pm$1914 pg/ml 이었고, IL-1$\beta$ 농도는 환자군은 884$\pm$1,050 pg/ml, 대조군은 575$\pm$558 pg/ml으로 두 군 사이에 의미있는 차이는 없었다. 결론 : 본 연구에서는 예상과는 달리 패혈증 환자의 말초혈액 단핵구에서 내독소내성을 관찰할 수 없었다. 향후 보다 중증의 환자를 대상으로 하고, 조기에 혈액을 채취하며, 말초혈액 상층액에 혈청을 추가하는 등의 보완을 통하여 재평가가 필요할 것으로 판단된다. Background : It is well known that when macrophages are stimulated with endotoxin, they produce a wide variety of cytokine mediators, including TNF-$\alpha$ and IL-1$\beta$. However, there is an alteration in the macrophages' responsiveness when they are challenged with repeated bouts of endotoxin, termed "endotoxin tolerance" which is regarded as a self-protective phenomenon from continuous stimulation. In this study, endotoxin tolerance in the peripheral blood monocytes of sepsis patients was evaluated. Methods : Fourteen patients with organism-documented sepsis were included. The severity of illness was evaluated by APACHE II score. Peripheral blood monocytes were isolated from the patients and diluted to $1{\times}10^5$ well. After stimulation with endotoxin (LPS of E. coli O114 : B4, 100 ng/ml), they were incubated at $37^{\circ}C$ in 5% $CO_2$ incubator for 24 hours. Supernatant was collected for the measurement of TNF-$\alpha$ and IL-1$\beta$ with ELISA method. Peripheral blood monocytes of seven healthy volunteers were used as control. Results : The APACHE II score (mean$\pm$SD) of the patients at the time of blood sampling was 12.2$\pm$5.7. The primary infection foci were urinary tract infection, pneumonia, subacute bacterial endocarditis, and catheter related infection, etc. The causative organisms were gram negative rods (10 cases), gram positive cocci (6 cases) with two cases of mixed infection. Serum TNF-$\alpha$ could be measured in 4 cases with 29.9$\pm$27.7 pg/ml. Serum IL-1$\beta$was measurable in only one patient. The TNF-$\alpha$ level of supernatant of cultured peripheral blood monocytes was 2,703$\pm$2,066 pg/ml in patients and 2,102$\pm$1914 pg/ml in controls. The IL-1$\beta$level of supernatant was 884$\pm$1,050 pg/ml in patients and 575$\pm$558 pg/ml in controls. There was no difference of TNF-$\alpha$ and IL-1$\beta$ level between patients and controls. Conclusion : We cannot prove the phenomenon of endotoxin tolerance in this study. Future study needs to be focused on the more severe sepsis patients who were taken for sampling earlier. Addition of serum to the culture medium could be an another valuable option for the success of this study.
이병재,김윤근,조상헌,민경업,김유영 ( Byung Jae Lee,Yoon Keun Kim,Kyung Up Min,You Young Kim ) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.3
IgE-mediated sensitization to natural rubber latex can induce immediate hypersensitivity reactions ranging from contact urticaria to life threatening anaphylaxis. Recent reports suggest that asthma is also relatively frequent manifestation of latex allergy. In this case report, lat,ex induced asthma is described in an operat.ing room nurse regularly exposed t,o latex gloves. Her latex sensitivity was detected by skin prick testing. Specific bronchial provocation test with latex extract showed an early asthmatic reaction. Her symptoms had been much improved after avoidance. Occupational asthma induced by latex may be not uncommon among health care workers.