기관지폐포세척액에서 세포수 측정을 위한 처리방법의 비교

박재석,김재열,이귀래,유철규,한성구,심영수,김영환,Park, Jae-Seuk,Kim, Jae-Yeal,Lee, Gwi-Lae,Yoo, Chul-Gyu,Han, Sung-Koo,Shim, Young-Soo,Kim, Young-Whan 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

연구배경: 기관지폐포세척술로 얻은 기관지폐포세척액의 총세포 숫자와 감별숫자는 특발성폐섬유증을 포함한 간질성 폐질환의 진단과 예후 및 치료방침의 결정에 유용한 검사방법이다. 그러나 기관지폐포세척액 처리 방법에 대한 표준 방법 (standard method)이 아직 정립되어 있지 않고, 병원마다 처리 방법이 상이한 경우가 많아 검사 결과의 해석에 어려움이 많은 실정이다. 이에 본 연구에서는 기관지폐포세척액의 처리방법 중에서 면거즈 (cotton gauze)로 걸르는 방법, 세척액의 원심 분리 후 재부유하는 방법, 기관지폐포세척액의 보관 시간등이 총세포숫자와 감별숫자에 미치는 영향을 관찰하였다. 방 법: 활동성 폐질환이 없는 6명의 사람에 대해서 기관지내시경을 하여 얻은 기관지폐포세척액을 모아서 siliconized glass tube에 분주한 후, 0, 1, 2, 4겹의 면거즈 (pore size: 1mm)로 걸른후 일부를 trypan blue로 염색한 후 hemocytometer로 총세포숫자를 계수하고 일부는 cytocentrifuge한 후 Wright-Giemsa stain을 하여 감별숫지를 하였다. 그리고 일부의 세척액을 두 겹의 거즈로 걸른 후에 원심분리(400g, 30min) 하고 RPMI1640으로 재부유액을 만들어 총세포숫자와 감별숫자를 하였다. 그리고 나머지는 $4^{\circ}C$ 냉장고에 보관하였다가 2시간, 24시간, 48시간 후에 각각 같은 방법으로 총세포숫자와 감별숫자를 하였다. 결 과: 기관지폐포세척액을 면거즈로 거르지 않은 경우와 여러겹의 면거즈로 걸른 경우 총세포숫자와 감별숫자에 차이가 없었으나 기관지폐포세척액을 면거즈로 거르지 않았을 경우 두 예(33%)에서 점액사 때문에 세포가 뭉치고 겹쳐져서 총세포숫자와 감별숫자가 어려웠다. 기관지폐포세척액을 원심분리하였을 경우 총세포숫자는 감소하였으나 ($24{\pm}18%$), 감별숫자에는 차이가 없었다. 보관시간에 따른 총세포숫자에 있어서 2시간 보관했을 경우에는 총세포숫자의 감소가 없었으나 24시간 이상 보관시 유의하게 감소하였으며 (24시간: $28{\pm}21%$, 48시간: $41{\pm}24%$), 감별숫자에 있어서는 보관시간에 따른 차이는 없었으나 48시간 보관시에는 세포변성으로 감별숫자가 어려웠다. 결 론: 기관지폐포세척액의 총세포숫자와 감별숫자를 위한 기관지폐포세척액의 처리과정에서 면거즈로 걸러서 두시간 아내에 처리하는 것이 좋으며 원심분리는 하지 않는 것이 좋을 것으로 생각된다. Background: The total and differential cell count of bronchoalveolar lavage(BAL) fluid are useful assessing activity, prognosis and response to therapy in diffuse interstitial lung disease. But controversy exist as to the appropriate method in processing BAL fluid. Therefore we investigated the effect of gauze filtration, centrifugation and different storage time of BAL fluid on the total and differential cell count. Methods: We obtained BAL fluid from 6 persons with no active lung lesion and divided pooled BAL fluid into several siliconized glass tubes and filtered through 0, 1, 2, 4 folds of cotton guaze(pore size: 1mm), and compared total cell count using hemocytometer after trypan blue staining and differential cell count after Wright-Giemsa staining of cytocentrifuged preparations. And we also counted total and differential cell count after centrifugation(400g for 30 min) and various storage time(2hr, 24hr, and 48hr). Results: There was no difference in total and differential cell count according to folds of gauze filtraion. But without gauze filtration, mucus threads that hampered total and differential cell count were found in 2 cases (33%). Centrifugation resulted in loss of total cell count($24{\pm}18%$) without change in differential cell count. There was no change in total cell count after 2hr storage but significant cell loss was found after 24hr storage time(24hr : $28{\pm}21%$, 48hr : $41{\pm}24%$). However there was no change in differential cell count with 48hr storage time. Conclusion: Total and differential cell count of BAL fluid may be best performed after cotton gauze filtration without centrifugation and within 2 hours.

사향이 CCl₄로 유발된 mouse의 간 손상에 미치는 영향

박재석,김성욱,이규재,권기록,Park, Jae-Seuk,Kim, Seung-Wook,Lee, Kyu-Jae,Kwon, Ki-Rok 대한약침학회 2006 Journal of pharmacopuncture Vol.9 No.1

Objectives : This study was aimed at investigating liver protection mechanism of Moschus by inducing liver toxicity through $CCl_4$ in mice and evaluated histological and serological findings. Methods : Experiment groups was categorized into untreated normal group, $CCl_4$ treated control group, and orally administered Moschus experiment group. At the termination of experiment, gross examination of the liver as well as histological findings, and Total protein, Total bilirubin, Direct bilirubin SGOT, SGPT, and ALP contents in the serum were evaluated. Results : 1. For gross examination and histological findings, $CCl_4$ treated control group showed destroyed lobular structure, increased fibrosis, as well as hepatic cirrhosis. For the group treated with Moschus, the lobular structure suffered less damage, and showed lower level of fibrosis and liver cirrhosis compared to the control group. 2. For serum analysis, Total protein were significantly increased in the Moschus experiment group than the control group. 3. Total bilirubin didn't show significant differences between the two groups. but direct bilirubin was significantly increased in the Moschus experiment group than the control group. 4. SGOT, SGPT, were significantly decreased in the normal and Moschus experiment groups compared to the control group. 5. ALP was significantly decreased in the normal group compared to the control group, but Moschus experiment group didn't show significant differences compared to the control group. Conclusion : Taken together, Moschus can be effectively used for recovering the liver functions and further researches must be conducted to verify the efficacies of Moschus bile juice.

Interferon-$\gamma$가 사람 폐포대식세포의 결핵균 탐식과 활성화에 미치는 영향

박재석,김재열,이귀래,유철규,김영환,한성구,심영수,Park, Jae-Seuk,Kim, Jae-Yeal,Lee, Gwi-Lae,Yoo, Chul-Gyu,Kim, Young-Whan,Han, Sung-Koo,Shim, Young-Soo 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

연구배경: IFN-$\gamma$는 단핵식세포를 활성화시키며 여러 종류의 세포내 세균에 대한 숙주의 방어기전에 중요한 역할을 하는 것으로 알려져있다. 그러나 사람에 있어서 IFN-$\gamma$의 항 결핵 효과와 작용기전에 대해서는 거의 알려진 바가 없다. 본 연구에서는 결핵의 발병기전에서 IFN-$\gamma$의 역할을 알아보기 위해 폐포대식세포의 결핵균 탐식과 TNF-$\alpha$ 생산에 IFN-$\gamma$가 미치는 영향을 알아보았다. 방 법: 활동성 폐질환이 없는 8명의 사람에게서 얻은 기관지 폐포세척액에서 폐포대식세포를 표면흡착법으로 분리하여 결핵균과 같이 배양하면서 ($1{\times}10^6$ cells/ml, $3{\times}10^7$ bacteria/ml) 배양액에 IFN-$\gamma$(300U/ml), LPS(0.5ug/ml), 자가혈청(10%)을 첨가하여 2시간 배양 후 항산성 염색(modified Kynion method)을 하여 결핵균을 탐식한 폐포대식세포를 관찰하였다. 그리고 폐포대식세포배양액에 IFN-$\gamma$(300U/ml), MTB($1{\times}106bacteria/ml$) and LPS(0.5ug/ml)를 각각 첨가하여 24시간 배양 후 상층액에서 TNF-$\alpha$의 농도를 ELISA method로 측정하였다. 그리고 IFN-$\gamma$(300U/ml), LPS(0.5ug/ml)로 24시간 자극한 폐포대식세포의 결핵균 탐식율도 관찰하였다. 결 과: IFN-$\gamma$는 폐포대식세포의 결핵균 탐식율을 증가시키지 않았으며(percentage of PAM-phagocytosed MTB: control: $22.1{\pm}4.9$, IFN-$\gamma$: $20.3{\pm}5.3$), 폐포대식세포를 24시간 자극하였을 때 폐포대식세포의 TNF-$\alpha$의 생산을 증가시키지 않았다 (control: $21{\pm}38pg/ml$, IFN-$\gamma$: $87{\pm}106pg/ml$). 그리고 IFN-$\gamma$로 24 시간 전처치한 폐포대식세포의 결핵균 탐식율 또한 증가하지 않았다(control: $24.5{\pm}9.5$, IFN-$\gamma$: $23.4{\pm}10.1$). 결 론: IFN-$\gamma$는 폐포대식세포의 결핵균 탐식과 TNF-$\alpha$ 생산에 영향을 미치지 않는다. Background: IFN-$\gamma$ is known to activate mononuclear phagocytes and to mediate host defense mechanism against some intracellular microorganisms, but little is known about anti-mycobacterial activity and mechanism of IFN-$\gamma$ in human. In this study, we investigated the role of IFN-$\gamma$ in the pathogenesis of tuberculosis by observing the effect of IFN-$\gamma$ on the phagocytosis of M.tuberculosis(MTB) and on the production of TNF-$\alpha$ by human pulmonary alveolar macrophage. Method: Pulmonary alveolar macrophage(PAM) were prepared with adhesion purification method from bronchoalveolar lavage fluid obtained from 8 persorn without active lung lesion and cultured($1{\times}10^6cells/ml$) with MTB($3{\times}10^7$ bacteria/ml) with or without IFN-$\gamma$(300U/ml), LPS(0.5ug/ml) and autologous serum(10%). After 2 hours, the percentage of PAM-phagocytosed MTB was counted after AFB staining(modified Kynion method). TNF-$\alpha$ production by PAM stimulated by IFN-$\gamma$(300U/ml), MTB($1{\times}10^6bacteria/ml$) and LPS(0.5ug/ml) for 24hours was measured in culture supernatant using ELISA method. The degree of phagocytosis of MTB by PAM stimulated with IFN-$\gamma$(300U/ml) and LPS(0.5ug/ml) for 24hours was also investigated. Results: IFN-$\gamma$ did not influence the phagocytosis of MTB by PAM(percentage of PAM-phagocytosed MTB: control: $22.1{\pm}4.9$, IFN-$\gamma$: $20.3{\pm}5.3$) and did not increase TNF-$\alpha$ production by PAM (control: $21{\pm}38pg/ml$, IFN-$\gamma$: $87{\pm}106pg/ml$), and the degree of phagocytosis of MTB by PAM pre-stimulated with IFN-$\gamma$ for 24 hours, was not increased (control: $24.5{\pm}9.5$, IFN-$\gamma$: $23.4{\pm}10.1$). Conclusion: IFN-$\gamma$ does not influence on the phagocytosis of MTB and TNF-$\alpha$ production by PAM.

결핵균을 탐석한 말초혈액단핵구 배양상층액에 의해 유도되는 폐상피세포주에서의 NF-${\kappa}B$ 의존성 IL-8 분비기전

박재석,지영구,최은경,김건열,이계영,Park, Jae-Seuk,Jee, Young-Koo,Choi, Eun-Kyong,Kim, Keun-Youl,Lee, Kye-Young 대한결핵및호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.51 No.4

연구배경 : IL-8은 강력한 화학주성인자로서 결핵감염 부위로 염증세포들을 동원함으로서 결핵균에 대한 숙주의 방어기전에 있어서 중요한 역할을 한다. IL-8의 유전자의 발현에 있어서 NF-${\kappa}B$가 중요한 역할을 한다. 저자들은 결핵 감염시 폐상피세포가 NF-${\kappa}B$ 의존성으로 IL-8을 분비하는지 알아보고자 하였다. 방 법 : 말초혈액단핵구에 결핵균을 감염시키고 24시간 배양 후 배양상층액(CoMTB)을 얻었다. 결핵균, CoMTB로 자극한 A549 세포주의 IL-8 분비 정도를 ELISA 방법으로 측정하였다. CoMTB로 자극한 A549 세포주의 IL-8 mRNA 의 발현 정도를 RT-PCR로, $I{\kappa}B{\alpha}$의 분해를 western blot 분석으로, NF-${\kappa}B$의 핵이동과 DNA 결합은 electrophoretic mobility shift assay(EMSA)를 이용하여, 그리고 NF-${\kappa}B$ 의존성 IL-8 유전자의 전사활성은 luciferase reporter gene assay를 이용하여 측정하였다. 결 과 : A549 세포주를 CoMTB로 24시간 자극하여 얻은 배양액의 IL-8 농도는 $46.8{\pm}4.8\;ng/ml$로 분비하여 결핵균으로 직접 자극하였을 때의 $6.8{\pm}2.9\;ng/ml$보다 높았다. CoMTB로 A549 세포주를 자극하였을 때 IL-8 mRNA의 발현이 증가하였고, $I{\kappa}B{\alpha}$의 분해가 일어났으며, NF-${\kappa}B$의 핵이동과 DNA 결합이 일어났으며, NF-${\kappa}B$ 의존성 IL-8 유전자의 전사활성이 증가하였다. 결 론 : 결핵병변에서 폐상피세포는 결핵균을 탐식한 단핵식 세포와의 상호작용에 의해 NF-${\kappa}B$ 의존성으로 IL-8을 분비한다. Background : IL-8 is a potent chemotactic cytokine that plays an important role in the host defense mechanism against M. tuberculosis by recruiting inflammatory cells to the site of the infection. Lung epithelial cells, as well as alveolar macrophages are known to produce IL-8 in response to M. tuberculosis. IL-8 gene expression is mainly regulated on the level of transcription by NF-${\kappa}B$. This study investigated whether or not A549 cells produce IL-8 in NF-${\kappa}B$ dependent mechanism in response to macrophages phagocytosing M. tuberculosis. Methods : Peripheral blood monocytes that were obtained from healthy donors were cultured for 24 h with M. tuberculosis and a conditioned medium(CoMTB) was obtained. As a negative control, the conditioned medium without M. tuberculosis (CoMCont) was used. A549 cells were stimulated with M. tuberculosis, CoMCont and CoMTB and the IL-8 concentration in the culture media was measured by ELISA. The CoMTB induced IL-8 mRNA expression in the A549 cells was evaluated using RT-PCR, and CoMTB induced $I{\kappa}B{\alpha}$ degradation was measured using western blot analysis. CoMTB induced nuclear translocation and DNA binding of NF-${\kappa}B$ was also examined using an electrophoretic mobility shift assay(EMSA), and the CoMTB induced NF-${\kappa}B$ dependent IL-8 transcriptional activity was measured using a luciferase reporter gene assay. Results : CoMTB induced IL-8 production by A549 cells($46.8{\pm}4.8\;ng/ml$) was higher than with direct stimulation with M. tuberculosis ($6.8{\pm}2.9\;ng/ml$). CoMTB induced IL-8 mRNA expression increased after 2 h of stimulation and was sustained for 24 h. $I{\kappa}B{\alpha}$ was degraded after 10 min of CoMTB stimulation and reappeared by 60 min. CoMTB stimulated the nuclear translocation and DNA binding of NF-${\kappa}B$. The CoMTB induced NF-${\kappa}B$ dependent IL-8 transcriptional activity($13.6{\pm}4.3$ times control) was higher than either CoMCont($2.0{\pm}0.6$ times control) or M. tuberculosis ($1.4{\pm}0.6$ times control). Conclusion : A conditioned medium of peripheral blood monocytes phagocytosing M. tuberculosis stimulates NF-${\kappa}B$ dependent IL-8 production by the lung epithelial cells.

결핵균 항원 자극에 의한 결핵성 흉수 림프구의 IFN-${\gamma}$ mRNA 발현

박재석,김윤섭,지영구,이계영,Park, Jae Seuk,Kim, Youn Seup,Jee, Young Koo,Lee, Kye Young 대한결핵및호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.1

연구배경 : IFN-${\gamma}$는 결핵균에 대한 숙주의 면역학적 방어기전에서 핵심적인 역할을 한다. 그러므로 결핵균 항원들이 IFN-${\gamma}$ 유전자 발현에 미치는 영향을 알아보는 것은 결핵균에 대한 숙주의 방어기전을 밝히고 이를 이용한 백신의 개발에 이용될 수 있을 것이다. 방 법 : 결핵성 흉막염 환자의 흉수에서 얻은 림프구 배양액에 결핵균(H37Rv), PPD, Ag85B, man-LAM, ara-LAM을 첨가하여 자극한 후 림프구의 IFN-${\gamma}$ mRNA의 발현 정도를 역전사 중합효소연쇄반응을 이용하여 비교하였다. 결 과 : 1) 결핵균(H37Rv)이 결핵성 흉수 림프구의 IFN-${\gamma}$ mRNA의 발현을 증가시켰다. 2) 결핵균 항원 중 PPD와 Ag85B는 결핵성 흉수 림프구의 IFN-${\gamma}$ mRNA의 발현을 증가시켰지만 man-LAM은 결핵성 흉수 림프구의 IFN-${\gamma}$ mRNA의 발현을 억제시켰다. 3) LAM 중에서 man-LAM은 용량이 증가함에 따라 결핵성 흉수 림프구의 IFN-${\gamma}$ mRNA의 발현의 억제 정도가 증가하였지만 ara-LAM의 경우 이와 같은 현상이 관찰되지 않았다. 결 론 : 결핵성 흉수 림프구의IFN-${\gamma}$ mRNA의 발현은 PPD와 Ag85B의 자극에 의해 항진되지만 man-LAM의 자극에 의해서는 억제되었다. Background : IFN-${\gamma}$ is the main effector mediator of the host immune response against Mycobacterium tuberculosis. Evaluating the IFN-${\gamma}$ gene expression in response to M. tuberculosis antigens may help in elucidating the host defense mechanism against M. tuberculosis and in the development of a vaccine. Methods : The IFN-${\gamma}$ mRNA expression in the lymphocytes obtained from pleural effusions from tuberculous pleurisy patients (TB-PLC) after in vitro stimulation with whole cell M. tuberculosis(H37Rv), purified protein derivatives(PPD), man-lipoarabinamman (man-LAM), ara-LAM and Antigen 85B(Ag85B) were evaluated. The degree of IFN-${\gamma}$ mRNA expression was determined by a semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) method. Results : M. tuberculosis induced the expression of IFN-${\gamma}$ mRNA in the TB-PLC in time and dose dependent manners. The PPD and Ag85B induced high levels of IFN-${\gamma}$ mRNA expression in the TB-PLC. However, man-LAM inhibited IFN-${\gamma}$ mRNA expression in the TB-PLC, while ara-LAM did not. Conclusion : IFN-${\gamma}$ mRNA expression in TB-PLC is stimulated by PPD and Ag85B, but inhibited by man-LAM.

Sweet Bee Venom의 비글견을 이용한 4주 반복 근육시술 독성시험

박재석,이광호,권기록,Park, Jae-Seuk,Lee, Kwang-Ho,Kwon, Ki-Rok 대한약침학회 2010 Journal of pharmacopuncture Vol.13 No.4

Objectives: This study was performed to analyse four week repeated dose toxicity of Sweet Bee Venom(Sweet BV) extracted from the bee venom in Beagle dogs. Methods: All experiments were conducted under the regulations of Good Laboratory Practice (GLP) at Biotoxtech Company, a non-clinical study authorized institution. Male and female Beagle dogs of 5-6 months old were chosen for the pilot study of four week repeated dose toxicity of Sweet BV which was administered at the level of 0.56mg/kg body weight which is eighty times higher than the clinical application dosage as the high dosage, followed by 0.28 and 0.14mg/kg as midium and low dosage, respectively. Equal amount of excipient(normal saline) to the Sweet BV experiment groups was administered as the control group every day for four weeks. Results: 1. No mortality was witnessed in all of the experiment groups. 2. All experiment groups were appealed pain sense in the treating time compared to the control group, and hyperemia and movement disorder were observed around the area of administration in all experiment groups, and higher occurrence in the higher dosage treatment. 3. For weight measurement, Neither male nor female groups showed significant changes. 4. In the urine analysis, CBC and biochemistry didn't show any significant changes in the experiment groups compared with control group. 5. For weight measurement of organs, experiment groups didn't show any significant changes compared with control group. 6. To verify abnormalities of organs and tissues, thigh muscle which treated with Sweet BV, cerebrum, liver, lung, kidney, and spinal cords were removed and conducted histologocal observation with H-E staining. In the histologocal observation of thigh muscle, cell infiltration, inflammatory, degeneration, necrosis of muscle fiber, and fibrosis were found in both thigh tissue. And the changes were depend on the dose of Sweet BV. But another organs were not detected in any abnormalities. 7. The proper high dosage of Sweet BV for the thirteen week repeated test in Beagle dogs may be 0.28mg/kg in one time. Conclusion: Above findings suggest that Sweet BV is relatively safe treatment medium. Further studies on the subject should be conducted to yield more concrete evidences.

폐결핵환자 접촉자에서 결핵감염의 빈도와 결핵감염의 위험인자

박재석 ( Jae Seuk Park ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2

Background: Detection and treatment of tuberculosis (TB) infection with contact investigation is a key component of TB control program. I evaluated the prevalence and risk factors for TB infection among contacts of recently diagnosed pulmonary TB patients in a tertiary hospital in Korea. Methods: 206 contacts of 90 adult pulmonary TB patients underwent tuberculin skin tests (TST) and chest radiography. The TST results were considered positive with an induration of 10 mm or more, suggesting TB infection. A standardized questionnaire was used to assess risk factors associated with TB infection. Results: TST was positive in 97 of 206 contacts of TB patients (47.1%) and positive rate of TST increased with age. The risk of TB infection was significantly associated with close contact with TB patients (sleeping in the same room) (odd ratio [OR], 4.94; 95% confidence interval [CI], 1.43∼17.00).Conclusion: TB infection rate was higher in the elderly, and the risk of TB infection was significantly increased with close contact of TB patients.

호흡기내과 의사를 위한 Respiratory Review of 2009 비결핵 항산균

박재석 ( Jae Seuk Park ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.5

As the prevalence of tuberculosis declines, the proportion of nontuberculous mycobacterial (NTM) lung disease is increasing in Korea. The combined use of liquid and solid media increases the sensitivity of mycobacterial culture and shortens culture time. Because NTMs are ubiquitous in the environment, NTM lung disease requires strict diagnostic criteria to prevent over-diagnosis of NTM lung disease. Mycobacterium avium complex is the most common pathogen of NTM lung disease in Korea and present in two forms: upper lobe cavitary and nodular bronchiectatic form. Decision of treatment of NTM lung disease depends on the infecting species and overall condition of the patient. Because medical therapy requires the use of multiple drugs over 18 to 24 months, surgery for localized disease may be useful for those species refractory to medical therapy.

노인 호흡기질환의 효과적 관리 : 노인 폐결핵의 치료

박재석 ( Jae Seuk Park ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

Although the incidence of tuberculosis has declined dramatically recently, tuberculosis is still one of the great public health problems in South Korea. Older persons are more susceptible to tuberculosis than younger persons. Older pulmonary tuberculosis patients may have few symptoms and atypical radiographic findings, so clinicians need to have high index of suspicion to make a diagnosis of pulmonary tuberculosis. The basic approach to treatment of tuberculosis in elderly is the same as in younger patients. Standard chemotherapy of drug susceptible tuberculosis consists of a 2-months intensive phase (isoniazid, rifampin, ethambutol, pyrazinamide) followed by 4-months maintenance phase (isoniazid, rifampin, ethambutol). Vitamin B6 (pyridoxine) is usually given to prevent isoniazid induced peripheral neuropathy which is more common in elderly patients. Older tuberculosis patients are more susceptible to adverse effects of anti-tuberculosis drugs. Monitor liver function and educate elderly patients and their family members about the signs and symptoms of adverse drug reactions and encourage to report promptly to their physician any of adverse drug reactions. Compliance to treatment of elderly tuberculosis patients is poor due to frequent co-morbid conditions and low socioeconomic conditions. Public-private collaboration will improve the compliance of elderly tuberculosis patients managed in private hospitals. (Korean J Med 75:141-148, 2008)

폐결핵의 증상과 진단 지연의 위험인자

박재석 ( Jae Seuk Park ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

목적: 결핵의 진단과 치료가 지연될 경우 환자가 심한 결핵으로 고통을 당할 뿐 아니라 주위 사람들에게 결핵균을 전파할 기회가 증가하게 된다. 이에 본 연구에서는 우리나라의 한 대학병원에서 결핵으로 치료 중인 환자들을 대상으로 진단 당시 결핵의 증상, 진단 지연의 정도, 그리고 진단을 지연시키는 위험인자들에 대하여 알아보았다. 방법: 2011년 7월부터 2012년 7월까지 단국대학교병원에서 결핵으로 치료중인 환자들에 대하여 설문조사를 시행하여 진단 당시 결핵의 증상들과 처음 방문한 의료기관의 종류 등을 조사하였고, 이들 환자들의 의무 기록을 후향적으로 분석하여 진단 지연의 정도와 진단 지연에 영향을 미치는 인자들을 분석하였다. 결과: 총 107명의 결핵 환자 가운데 결핵의 증상을 주소로 의료기관을 방문하여 진단된 환자가 85명(79.4%)이었고, 건강검진이나 다른 질환의 진료 중에 결핵으로 진단된 환자가 22명(20.6%)이었다. 결핵의 증상을 주소로 의료기관을 방문하여 진단된 환자들 중에서 평균 환자 지연(첫 증상부터 의사 진료까지의 기간)은 16.7일(±15.1)이었으며 평균 의사 지연(첫 의사 진료부터 결핵 진단까지의 기간)은 22.2일(±21.3)이었다. 증상 발생 후에 약국을 먼저 방문한 경우 의료기관을 바로 방문한 경우보다 환자 지연이 더 길었다. 증상 발생 후 개인 의원을 처음으로 방문한 경우 보건소나 2차 또는 3차 병원을 처음 방문한 경우보다 의사 지연이 더 길었고 객혈이 있을 경우에는 의사 지연이 더 짧았다. 결론: 결핵의 진단 지연을 줄이기 위해서는 결핵의 증상이 있을 때 조기에 의사의 진료를 받도록 국민들을 홍보하고, 개인 의원 의사들을 대상으로 결핵 의심 강도를 높이도록 교육해야 한다. Background/Aims: Delayed diagnosis and treatment of pulmonary tuberculosis (TB) can result in progressive disease and contribute to the spread of TB. Presenting symptoms and factors associated with delayed diagnosis of pulmonary TB were evaluated in a tertiary university hospital in South Korea. Methods: Patients with pulmonary TB diagnosed from July 2011 to July 2012 were interviewed with questionnaires regarding symptoms of pulmonary TB and the type of health care facilities first visited. Medical records were also reviewed to evaluate the extent of diagnostic delay and factors associated with delayed diagnosis. Results: Of 107 patients with pulmonary TB, 85 (79.4%) were diagnosed after visiting doctors for evaluation of pulmonary TB symptoms and 22 (20.6%) were diagnosed after medical check-ups. Among patients diagnosed with pulmonary TB symptoms, the mean patient delay (time from symptom onset to initial doctor visit) was 16.7±15.1 days, and the mean doctor delay (time from initial doctor visit to diagnosis of pulmonary TB) was 22.2±21.3 days. First visit to a drugstore was associated with longer patient delays (hazard ratio [HR], 2.533; 95% confidence interval [CI], 1.424-4.506). First visit to a primary clinic was associated with longer doctor delays compared with first visit to a public health center or secondary/tertiary hospital (HR, 1.767; 95% CI, 1.003-3.114). The presence of hemoptysis was associated with shorter doctor delays (HR, 0.438; 95% CI, 0.203-0.944). Conclusions: To reduce delays in diagnosis of pulmonary TB, patients should be educated to quickly consult with a doctor when they have symptoms of pulmonary TB, and primary clinic doctors should be educated to maintain a high index of suspicion for pulmonary TB. (Korean J Med 2013;84:221-228)