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정상 혈청 총 IgE치를 보이는 알레르기 천식환자의 임상적 특성
최인선 ( In Seon S. Choi ),김옥기 ( Ok Ki Kim ),정성훈 ( Seong Hoon Jeong ),이우진 ( Won Jin Lee ),이성지 ( Seong Ji Lee ),신홍준 ( Hong Joon Sin ),한의령 ( Eui Ryoung Han ),정지민 ( Ji Min Jeong ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.2
Background: Although allergic diseases occur through IgE-mediated reaction, about 20% of allergic asthmatics have normal total serum IgE levels. Objective: To characterize the allergic asthmatics with normal total serum IgE levels. Method: Medical records of 430 consecutive allergic asthmatics, who received the tests for both total IgE and allergen-specific IgE in the serum or on the skin, were reviewed. According to the total and specific IgE levels, the subjects were classified to 4 groups (I, increased/strong; II, normal/strong; III, increased/weak; IV, normal/weak). Result: The Dermatophagoides farinae-specific IgE level in the serum was significantly related to the total serum IgE level (r=0.322, P<0.001). The D. farinae-specific IgE levels were significantly lower in the group II than in the group I (3.27±0.14 vs. 1.83±0.30, P<0.01) and the group IV than in the group III (0.79±0.05 vs. 0.44±0.13, P<0.01). The results for D. pteronyssinus and sum of checked allergens were similar. The proportion of the patients sensitized to single allergen to total subjects was 7.5%/13.5%/33.0%/40.0% for I/II/III/IV groups (χ2=44.5, P<0.001). Conclusion: The allergic asthmatics with normal total serum IgE levels had lower allergen-specific IgE levels and a higher proportion of the patients sensitized to single allergen. The levels of total serum IgE may be determined by the degree of sensitization in allergic asthma. (Korean J Asthma Allergy Clin Immunol 2009;29:96-104)
최인선 ( Inseon S. Choi ),임호 ( Ho Lim ),박선영 ( Seon Yeong Park ),고영일 ( Youngil I. Koh ),정세웅 ( Se Woong Chung ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.2
Background:It has been suggested that excessive airway narrowing in asthma may be de-tected by a decrease in forced vital capacity (FVC). A volume difference between slow vital capacity (SVC) and FVC may be used as a surrogate index of airway collapse. Ob
서일국 ( Il Kook Seo,),최인선 ( In Seon S. Choi ),김상훈 ( Sang Hoon Kim ),한의령 ( Eui Ryoung Han ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.1
Background: Anti-asthma treatments correct impaired dyspneaperception. Objective: To investigate whether dyspnea perception in asthmatics vary whenever they are hospitalized. Method: We retrospectively analyzed the medical records of 64 patients (32 men and 32 women) with acute asthma who were hospitalized at least twice and assessed using the Borg scale-based dyspnea perception score while breathing through an inspiratory muscle trainer at each admission. Poor perceiver was defined as a Borg score of ≤5 at the highest resistive load (HR) and HR-induced ΔBorg score of ≤3. Result: Between the first and econd admissions, the relationship of forced expiratory volume in 1 s (r=0.773, P <0.001) and the concordance of severity of asthma attack (κ=0.503, P<0.001) were significant, but the relationship of HR-induced ΔBorg score and the concordance of poor perceivers were not. During the first admission, as lung function increased gradually, the HR-induced ΔBorg score became higher in poor perceivers (1.83±0.39→3.42±0.57→4.00±0.67, P=0.048). Conclusion: Although asthmatic patients who suffered from a severe asthma attack tended to have a severe attack again at the following admission, dyspnea perception differs among the admissions. Impaired dyspnea perception during acute asthmatic attack would be correctable with anti-asthma treatments. (Korean J Asthma Allergy Clin Immunol 2011;31:20-26)
알레르기 ; 메타콜린과 운동 유발 기관지 수축반응의 상관관계에 대한 종단적 연구
김창성 ( Chang Seong Kim ),최인선 ( In Seon S. Choi ),김상훈 ( Sang Hoon Kim ),우학 ( Hak Woo ),심현정 ( Hyeon Jeong Sim ),한의령 ( Eui Ryoung Han ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4
목적: 천식의 AHR에는 기도 염증과 관련된 가변성 AHR과 기도 재형성과 관련된 지속성 AHR이 있다. 가변성 AHR은 운동 등 간접 자극이 잘 반영하고, 지속성 AHR은 메타콜린 등 직접 자극이 반영한다고 알려졌으나 AHR 두 가지를 구별하여 추적검사한 논문은 없어서 이를 연구하였다. 방법: 2004년 12월~2008년 2월에 전남대학교병원에서 메타콜린 AHR 검사와 운동 유발시험을 함께 시행하고 나중에 반복 시행하였으며, 운동 유발성 천식이 1회 이상 증명된 젊은 남자환자 36명의 진료부 자료를 후향적으로 분석하였다. 각 자극에 대한 반응의 심한 정도를 0~ 3점으로 점수화하여 비교하였다. 결과: 처음과 추적검사 사이의 간격은 평균 9.8개월(5~58개월)이었다. 처음 검사에서는 차이가 없었으나 추적검사 때는 메타콜린 AHR 점수에 비해 운동 AHR 점수가 유의하게 낮았다(1.58±0.16 대 1.19±0.15, p<0.01). 처음 검사에 비해 추적 검사 때 메타콜린 AHR 점수는 유의한 차이가 없었으나 운동 AHR 점수는 유의하게 저하되었고(1.67±0.13 대 1.19±0.15, p<0.01), 두 점수의 차이는 유의하게 상승하였다(0.03±0.13 대 0.39±0.13, p<0.05). 메타콜린 PC20은 운동 후 FEV1의 최대 저하치와 유의한 상관관계가 있었고(r=-0.571, p<0.001), 처음과 추적검사 사이의 메타콜린 PC20와 운동 후 FEV1의 최대 저하치 변화도 유의한 상관관계가 있었다(r=-0.467, p<0.01). 결론: 운동 유발성 기관지수축과 메타콜린 AHR은 서로 상관관계가 있으나 메타콜린 AHR 변화는 운동 유발반응의 변화보다 작았다. 이것은 메타콜린 AHR이 운동 유발반응과 관련된 가변성 AHR 뿐 아니라 시간 경과에 따라 점차 심해진 지속성 AHR을 함께 반영하기 때문일 것이다. Background/Aims: The airway hyperresponsiveness (AHR) in asthma has variable and persistent components that are related to airway inflammation and remodeling, respectively. This longitudinal study examined the relationship of airway responses between exercise (reflecting variable AHR) and methacholine (reflecting persistent AHR). Methods: The charts were reviewed of 36 young adult males who underwent both methacholine and exercise challenges at different times and were diagnosed with exercise-induced asthma. The severity of the response to each stimulus was scored (0~3). Results: The mean interval between the baseline and follow-up tests was 9.8 (5~58) months. The AHR score was significantly lower with the exercise challenge than with methacholine at follow-up (1.58±0.16 vs 1.19±0.15, p<0.01), but not at baseline. Compared to baseline, the AHR score was significantly lower with exercise (1.67±0.13 vs 1.19±0.15, p<0.01), but not with methacholine, and the difference in the AHR scores between exercise and methacholine increased significantly from baseline to follow-up (0.03±0.13 vs 0.39±0.13, p<0.05). The maximum fall in the forced expiratory volume in 1 s following exercise was significantly related to methacholine AHR (r=-0.571, p<0.001). Conclusions: Exercise-induced bronchoconstriction was significantly related to methacholine AHR. However, the change in methacholine AHR in a follow-up test was significantly lower than that in the exercise response, which might have resulted from persistent worsening of the AHR with time because methacholine AHR reflects both variable and persistent AHR. (Korean J Med 77:472-479, 2009)
김광원(Kwang Won Kim),최인선(In Seon S . Choi),박석채(Seog Chea Park),장안수(Ahn Soo Jang),임호(Ho Lim) 대한내과학회 1999 대한내과학회지 Vol.57 No.1
N/A Researches on the characteristics of fatality-prone asthmatics have been performed in western countries, but there are few reports in this field in Korea. The purposes of this study were to clarify the magnitude of the problem and to identify the risk factors of near-fatal asthma(NFA). Methods : The records of patients admitted due to asthma attack were analyzed retrospectively. Results :1) The subjects had NFA in 50.6% and PaCO2 > 45mmHg in 22.9%. Five(11.1%) among NFA patients and 3 out of 19(15.8%) subjects with PaCO2 > 45mmHg required mechanical ventilation. 2) There were no significant differences between NFA and non-NFA in age, sex, resident place, academic career, familial and personal history of atopic diseases, serum total IgE level, positive skin prick test to house dust mites, accompanying allergic rhinitis and aspirin intolerance, emphysema on chest high resolution computerized tomogram, dyspnea perception, previous asthma education, regular OPD follow-up, and use of antiinflammatory drugs. 3) However, cigarette smoking(62.2% vs 38.6%), accompanying paranasal sinusitis(66.7% vs 45.3%), chronic asthma severity(severe persistent: 55.5% vs 29.5%), hospitalization frequency(2.93 vs 1.58), and duration of recent asthma exacerbation(6.6 vs 18.8 days) in NFA were significantly different from those in non-NFA.4) The relative risk for NFA was high in patients with history of hospitalization > 3, severe persistent asthma, exacerbation period < 3 days, smoking, or sinusitis in the order of frequency. Conclusion : Near-fatal asthma is a prevalent problem in clinical practice and asthma admission history, severe persistent asthma, short exacerbation period < 3 days, smoking, and paranasal sinusitis are the risk factors warning near-fatal asthma attack in advance.
BALB/c 마우스에서 Ovalbumin으로 유발된 아토피피부염 양 병변에 Dehydroepiandrosterone의 경구투여가 미치는 영향
원준호 ( June Ho Won ),김성진 ( Seong Jin Kim ),최인선 ( In Seon S. Choi ),원영호 ( Young Ho Won ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.4
Background: Atopic dermatitis (AD) is a chronic cutaneous inflammatory disorder. Dehydroepiandrosterone (DHEA) is a sex hormone normally secreted from the adrenal gland and is used to treat various disorders. It decreases in the serum of AD patients and is known to attenuate dust mite-induced airway allergic responses associated with reduced Th2 cytokine. Objective: The authors attempted investigate the effect of DHEA on AD-like skin lesions by reviewing the cytokine profile and specific IgE production in BALB/c mice sensitized with ovalbumin (OVA). Method: Mice were sensitized by intraperitoneal injection of OVA, followed by epicutaneous sensitization for 5 weeks. DHEA was given by the oral route. After all mice were sacrificed at the end of the experiment, skin, spleen tissue and blood were harvested. Result: Gross and histological examinations of skin lesions showed inflammation. The severity was mild or absent in DHEA-ingested mice and the number of inflammatory cells was significantly reduced. The IL-5 levels in the cultured splenocytes significantly decreased in the sensitized mice than in the control group. The IFN-γ/IL-5 ratio significantly increased in the sensitized mice. Conclusion: DHEA ingestion may suppress OVA-induced AD-like skin lesions and prevents the cytokine production of Th2 cells. (Korean J Asthma Allergy Clin Immunol 2009;29:269-276)