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최재철 ( Jae Chol Choi ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6
Tuberculosis (TB) and diabetes mellitus (DM) are major global health problem. The link between DM and TB has been recognized for centuries. And, there are growing evidences that diabetes is a risk factor for tuberculosis. However, the risk varies according to races and regional prevalence, but limited data is available in South Korea. The report of Park et al. showed that the relative odds ratio was 2.220 (95% CI 1.090~4.523) in diabetic group, compared with hypertensive group. Although this study has some limitations, it is a meaningful data. A large-scale multi-center prospective study is needed in Korean population. (Korean J Med 79:643-645, 2010)
만성 하기도 증상을 보이는 환자에서 진균 알레르기 검출을 위한 피부단자시험과 혈청 알레르겐-특이 IgE 검사 결과의 비교 분석
정재우 ( Jae Woo Jung ),전은주 ( Eun Ju Jeon ),이혜민 ( Hye Min Lee ),조성근 ( Sung Gun Cho ),강형구 ( Hyung Koo Kang ),곽희원 ( Hee Won Kwak ),송주한 ( Ju Han Song ),최재철 ( Jae Chol Choi ),신종욱 ( Jong Wook Shin ),김재열 ( Jae 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.1
Background: Skin prick tests (SPTs) has relatively a good correlation with allergen-specific IgE against house dust mites and pollens, whereas their correlation to fungi remains low. Objective: We aimed to investigate the prevalence and correlation between fungus-specific IgE and SPTs in patients with chronic lower respiratory symptoms. The difference between fungus-specific IgE-positive and -negative groups was also examined. Method: A total of 566 patients were included in this study, all of whom had either negative SPT results, positive for one or more fungi, or positive for dusts or mixed threshings. Result: SPTs and allergen-specific IgE tests for fungus were positive in 9.4% and 11.8% of the patients, respectively. The positive concordance rate for fungus-specific IgE with SPTs was 47%. The k statistic for the agreement between SPTs and fungus-specific IgE test was 0.349. In all populations negative for SPTs, total eosinophil counts, total IgE, ECP and bronchial reversibility were higher in the fungus-specific IgE-positive group. In the group that tested only positive for dusts or mixed threshings with SPTs, total IgE and bronchial hyperresponsiveness were higher in the fungus-specific IgE-positive group (P<.05). Conclusion: The rate of successful detection of fungus using SPTs was low compared to a fungus-specific IgE. Thus, fungus-specific IgE may be useful to detect fungus allergies in patients with chronic lower respiratory symptoms. (Korean J Asthma Allergy Clin Immunol 2009;29:33-38)
기계환기폐렴의 원인균 진단에서 인공기도 흡인액을 이용한 Multiplex PCR과 세균배양 결과의 비교
송주한 ( Ju Han Song ),명순철 ( Soon Chul Myung ),최송호 ( Song Ho Choi ),전은주 ( Eun Ju Jeon ),강형구 ( Hyung Gu Kang ),이혜민 ( Hye Min Lee ),조성근 ( Sung Keun Cho ),최재철 ( Jae Chol Choi ),신종욱 ( Jong Wook Shin ),박인원 ( 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3
연구배경: 기계환기폐렴의 원인균을 조기에 진단하면 이 질환의 예후를 개선할 수 있다. 본 연구에서는 기관내튜브 흡인액을 이용하여 기계환기폐렴의 주된 원인균인 녹농균, 폐렴막대균 그리고 메치실린내성 포도알균에 대한 multiplex PCR법을 시행하여 기계환기폐렴의 원인균을 조기에 진단할 수 있는지 살펴보았다. 방법: 기계환기폐렴으로 진단된 환자에서 24시간 이내에 기관내튜브 흡인액을 채취하여 -20°C 냉동실에 보관하였고, 추후에 multiplex PCR을 시행하였다. Forward & reverse primer는 각각의 원인균에 특이한 부위에 맞춰서 제작하였다(녹농균의 oprL gene, 폐렴막대균의 16S rRNA, 메치실린내성 포도알균의 mec gene). 기관내튜브흡인액의 배양검사를 포함한 기계환기폐렴 환자의 임상적 및 검사실 소견을 함께 분석하였다. 결과: 총 24명(남자 18명, 여자 6명)의 기계환기폐렴 환자가 연구에 포함되었다. 나이(평균±표준편차)는 70±11세였다. 모든 환자는 기저질환을 가지고 있었다. 기관내튜브 흡인액의 배양에서 11명에서 원인균이 검출되었다(녹농균 2예, 폐렴막대균 1예, 메치실린내성 포도알 균 2예, 기타 그람음성간균 3예, 폐렴알균 2예, 복합감염 1예). 녹농균에 대한 multiplex PCR은 3예에서 양성이 나왔으며, 2예가 배양결과와 일치하였다. 폐렴막대균에 대해서는 4예에서 양성이었으며, 1예가 배양결과와 일치하였다. 메치실린내성 포도알균은 2예에서 양성이었으나, 모두 배양결과와 일치하지 않았다. 기계환기폐렴의 예후는 적절한 항생제의 사용 여부와 폐렴 발생 당시의 APACHE III score에 영향을 받았다. 결론: 기관내튜브 흡인액을 이용한 multiplex PCR법은 기계환기폐렴에서 그람음성균의 진단에는 가능성을 보였으나, 향후 실제 유용성에 대해서는 추가 연구가 필요 할 것으로 사료된다. Background: Early identification of pathogens can improve the prognosis of patients with ventilator associated pneumonia (VAP). In the present study, we evaluated the feasibility of performing multiplex PCR for endotracheal aspirates to detect three important pathogens (P. aeruginosa, K. pneumoniae and MRSA) in patients with VAP. Methods: The endotracheal aspirates of 24 patients were collected within 24 hours of the diagnosis of VAP for performing multiplex PCR. Forward and reverse primers were designed to target the specific site of each pathogen (the oprL gene for P. aeruginosa, 16S rRNA for K. pneumoniae and the mec gene for MRSA). We analyzed the clinical data of the VAP patients, including the culture reports for the endotracheal aspirates. Results: Twenty-four patients (M:F=18:6, mean age=70±11) with VAP were enrolled. Pathogens were isolated from 11 patients (P. aeruginosa in 2, K. pneumoniae in 1, MRSA in 2, other enteric Gram negative bacilli in 3, S. pneumoniae in 2 and mixed infection in 1). Multiplex PCR detected three cases of P.aeruginosa (2 cases coincided with the culture reports) and four cases of K. pneumoniae (1 matched with the culture report). PCR detected two MRSA cases, which did not coincide with the culture reports. Conclusion: Multiplex PCR of the endotracheal aspirate showed some ability to detect Gram negative bacilli, although caution is required when interpreting the results. (Tuberc Respir Dis 2008;64:194-199)
객담 도말 양성 환자에서 폐결핵과 비결핵 항산균 폐질환의 구별을 위한 결핵균 PCR 검사의 유용성
유창민 ( Chang Min Yu ),고원중 ( Won Jung Koh ),류연주 ( Yon Ju Ryu ),전경만 ( Kyeong Man Jeon ),최재철 ( Jae Chol Choi ),강은해 ( Eun Hae Kang ),서지영 ( Gee Young Suh ),정만표 ( Man Pyo Chung ),김호중 ( Ho Joong Kim ),권오정 ( O 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.6
만성 폐쇄성 폐질환의 운동부하 심폐기능검사에서 무산소역치 예비 호흡지수의 의의
이병훈 ( Byoung Hoon Lee ),강순복 ( Soon Bock Kang ),박성진 ( Sung Jin Park ),지현석 ( Hyun Suk Jee ),최재철 ( Jae Chol Choi ),박용범 ( Yong Bum Park ),안창혁 ( Chang Hyuk Ahn ),김재열 ( Jae Yeol Kim ),박인원 ( In Won Park ),최병 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.6
노인 환자에서 발생한 거짓막 괴사성 기관지 아스페르길루스증
이승은 ( Seung Eun Lee ),전은주 ( Eun Ju Jun ),송주한 ( Ju Han Song ),신종욱 ( Jong Wook Shin ),김재열 ( Jae Yeol Kim ),박인원 ( In Whon Park ),최병휘 ( Byoung Whui Choi ),최재철 ( Jae Chol Choi ),김미경 ( Mee Kyoung Kim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.3
Invasive aspergillus tracheobronchitis is uncommon manifestation of infection due to Aspergillus species, occurring in severely immunocompromised patients who are generally neutropenic with haematological diseases, AIDS, or after heart and lung transplantation. The pseudomembranous form is the most severe condition and is usually fatal despite treatment with antifungal agents. However, there are a few cases reported with no apparent severe compromise in the host defences. We encountered a pseudomembranous necrotizing bronchial aspergillosis in a 73-year old male patient, who was treated successfully with antifungal agents. (Tuberc Respir Dis 2007; 63: 278-282)
폐외 결핵에서 전혈 인터페론 감마 측정법의 진단적 유용성
이혜민 ( Hye Min Lee ),조성근 ( Sung Gun Cho ),강형구 ( Hyung Koo Kang ),박성운 ( Sung Woon Park ),이병욱 ( Byung Ook Lee ),이재희 ( Jae Hee Lee ),전은주 ( Eun Ju Jeon ),최재철 ( Jae Chol Choi ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4
Background: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). Methods: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. Results: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. Conclusion: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.
반복적인 호흡기 감염과 천식 악화가 동반된 IgG3 아형 결핍증 성인 환자에서 intravenous immunoglobulin 사용 1예
이홍열 ( Hong Yeul Lee ),윤상원 ( Sang Won Yoon ),김영 ( Young Kim ),조환준 ( Hwan Jun Cho ),이주영 ( Joo Young Lee ),구강모 ( Kang Mo Gu ),박태연 ( Tae Yun Park ),최재철 ( Jae Chol Choi ),신종욱 ( Jong Wook Shin ),김재열 ( Jae Y 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.3
The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations. (Allergy Asthma Respir Dis 2016;4:225-229)