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저용량의 corticosteroid 복용이 B형 간염 바이러스 재활성화에 미치는 영향
이향이 ( Hyang Ie Lee ),곽금연 ( Geum Youn Gwak ),박문경 ( Moon Kyung Park ),서현주 ( Hyun Joo Suh ),이준혁 ( Joon Hyeok Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6
Background/Aims: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. Methods: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. Results: A total of 16 patients were included. They were 45.4±16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. Conclusions: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.(Korean J Med 74:619-623, 2008)
대전 지역에서 급성 A형 간염의 유전자형에 따른 임상 특성 고찰
이영우 ( Young Woo Lee ),양현웅 ( Hyeon Woong Yang ),이진아 ( Jin A Lee ),윤기호 ( Ki Ho Yun ),양성은 ( Seong Eun Yang ),이민지 ( Min Ji Lee ),박세영 ( Se Young Park ),김새희 ( Sae Hee Kim ),이향이 ( Hyang Ie Lee ),이윤정 ( Yun Ju 대한내과학회 2011 대한내과학회지 Vol.80 No.5
Background/Aims: Acute viral hepatitis A is a major health problem in Korea and the influx of genotype IIIA is thought to be one reason. We examined the differences in the clinical characteristics and laboratory findings of genotypes IA and IIIA in Daejeon. Methods: From November 2009 to June 2010, 81 patients positive for IgM anti-HAV were enrolled prospectively. The hepatitis A was genotyped using real-time polymerase chain reaction. The clinical characteristics and laboratory results were compared on the Results: The mean patient age was 32.6±7.4 years. The mean hospitalization was 7.7±2.4 days. The patient occupation varied. Clinically, vomiting and diarrhea were relatively more prevalent in genotype IIIA than in IA. Abdominal pain and skin spots were relatively more prevalent in genotype IA than in IIIA. The hemoglobin, peak aspartate aminotransferase (AST) level, and C-reactive protein were statistically higher in genotype IIIA than in IA. The distributions of the peak AST, alanine aminotransferase (ALT) and total bilirubin values tended to be perched in genotype IIIA than in IA. The international normalized ratio (INR) tended to be slightly prolonged in genotype IIIA than in IA. Conclusions: Recently, genotype IIIA of acute viral hepatitis A has become prevalent in Daejeon. Hepatitis A genotype IIIA probably causes worse laboratory abnormalities than genotype IA.
Efficacy of Initial Treatment with Clevudine in Naive Patients with Chronic Hepatitis B
( Hyeon Woong Yang ),( Byung Seok Lee ),( Tae Hee Lee ),( Heon Young Lee ),( Kwan Woo Nam ),( Young Woo Kang ),( Hee Bok Chae ),( Seok Hyun Kim ),( Seok Bae Kim ),( Hyang Ie Lee ),( An Na Kim ),( Il H 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.4
Background/Aims: Clevudine, a pyrimidine nucleoside analogue, has potent antiviral effects in patients with chronic viral hepatitis B (CHB). We report the efficacy of initial treatment with clevudine in naive patients with CHB living in Daejeon and Chungcheong Province, South Korea. Methods: One hundred five adults with CHB were administered 30 mg of clevudine per day for an average of 51 weeks. We evaluated viral markers and liver biochemistry retrospectively every 3 months. Results: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B virus (HBV) DNA before the treatment were 184 ± 188 IU/L, 150 ± 138 IU/L, and 7.1 ± 1.2 log copies/mL, respectively. Undetectable rates (< 60 IU/mL) of DNA were 36.2%, 68.9%, 83.6%, 76.2%, and 75.8% at 12, 24, 36, 48, and 60 weeks, respectively. Seroconversion rates were 9.1%, 13.6%, 24.6%, 26.5%, and 26.1% and ALT normalization rates were 64.5%, 78.1%, 87.9%, 90.0% at 12, 24, 36, and 48 weeks, respectively. Six patients (5.7%) had a viral breakthrough. Conclusions: Clevudine is a useful drug in the initial treatment of patients with CHB, with a potent antiviral effect and low incidence of viral breakthrough. (Korean J Intern Med 2010;25:372-376)
연구논문 : 대전과 충청남북도에 거주하는 만성 C형간염 환자에서 페그인터페론 알파 2a와 2b의 초치료 효과 비교
김정일 ( Jeong Il Kim ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),이헌영 ( Heon Young Lee ),이태희 ( Tae Hee Lee ),강영우 ( Young Woo Kang ),이향이 ( Hyang Ie Lee ),김안나 ( An Na Kim ),남순우 ( Soon Woo Nam ),박병출 ( By 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4
목적: 페그인터페론 알파 2a와 알파 2b는 만성 C형간염의 표준치료제로 사용되고 있으나 두 약제의 치료반응을 비교한 연구는 거의 없는 실정이다. 본 연구는 만성 C형간염의 초치료로서 리바비린과의 병합요법 시 페그인터페론 2a와 2b의 치료 효과와 부작용을 비교해 보고자 하였다. 대상과 방법: 2004년 1월부터 2007년 7월까지 대전과 충청남북도에 위치한 7개의 대학병원에서 만성 C형간염 또는 이로 인한 대상성 간경변증으로 진단받고 페그인터페론과 리바비린 병합요법을 시행한 환자 97명의 의무기록을 후향적으로 분석하였다. 페그인터페론 알파 2a군이 48명, 2b군이 49명이었으며, HCV 유전자형 1형에 감염된 환자에 대해서는 페그인터페론 알파 2a (180 ?g/주) 또는 알파 2b (1.5 ?g/kg/주) 및 리바비린(1,000~1,200 mg/일)을 48주간, 비1형 환자에 대해서는 위와 동일한 용량의 페그인터페론과 리바비린(800 mg/일)을 24주간 투여하였다. 결과: 전체 환자에서 페그인터페론 알파 2a와 2b의 조기 바이러스반응(89.6% vs. 89.7%), 치료 종료 바이러스반응(79.2% vs. 79.5%) 및 지속바이러스반응(72.9% vs. 73.5%)은 두 약제 간에 유의한 차이가 없었다. 또한 HCV 유전자형에 따라 각 바이러스반응을 분석하였을 때도 유전자 1형과 비1형 모두에서 두 약제 간에 유의한 차이를 발견할 수 없었다. 총 97명 중에 치료를 조기 중단한 환자는 10명(10.3%)이었고, 페그인터페론 알파 2a와 2b가 각각 7명(14.6%), 3명(6.1%)이었으나 유의한 차이는 없었다. 부작용으로는 독감양 증상이 가장 흔하였으며, 부작용의 종류별 발생빈도는 두 약제간에 유의한 차이가 없었다. 결론: 만성 C형간염 환자의 초치료로서 리바비린과의 병합치료 시 페그인터페론 알파 2a와 2b 간에 치료효과와 부작용 발생빈도에 있어 유의한 차이가 없었다. Backgrounds/Aims: Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. Methods: Ninety-seven patients were treated with peginterferon alpha-2a (180 ?g/week, n=48) or peginterferon alpha-2b(1.5 ?g/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. Results: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peg-interferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. Conclusions: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients. (Korean J Hepatol 2008;14:493-502)
( Yun Jung Lee ),( Sung Hee Jung ),( Woo Jin Hyun ),( Sae Hee Kim ),( Hyang Ie Lee ),( Hyeon Woong Yang ),( Anna Kim ),( Sang Woo Cha ) The Editorial Office of Gut and Liver 2009 Gut and Liver Vol.3 No.4
Abdominal tuberculosis is not a rare disease, but obstructive jaundice caused by tuberculosis (tuberculous lymphadenitis, tuberculous enlargement of the head of pancreas, and/or tuberculous stricture of the biliary tree) is rare. We recently experienced a case of obstructive jaundice as a result of paradoxical reaction of periportal tuberculous lymphadenopathy that was treated successfully with corticosteroid and biliary drainage. No similar cases have been reported previously. (Gut and Liver 2009;3:338-342)