체내 철 저장 상태와 비알코올 지방간 발생과의 연관성

황상준 ( Sang Jun Hwang ),조용균 ( Yong Kyun Cho ),오세용 ( Se Yong Oh ),최효선 ( Hyo Sun Choi ),박정식 ( Jeong Sik Park ),김신연 ( Shin Yun Kim ),박정호 ( Jung Ho Park ),김홍주 ( Hong Joo Kim ),박동일 ( Dong Il Park ),손정일 ( Ch 대한내과학회 2007 대한내과학회지 Vol.73 No.6

목적: 비알코올 간질환의 발생과 진행에 있어 체내 철과잉 상태가 영향을 미치는지에 대한 연구가 다양하게 이루어지고 있지만, 체내 철 저장 상태의 단계에 따라 비알코올 지방간의 발생을 비교한 연구는 부족하였다. 이에 이번 연구는 건강 검진 수진자중 철결핍의 빈도가 상대적으로 높은 여성 수진자를 대상으로 체내 철 저장 상태가 비알코올 지방간 발생에 미치는 영향을 평가하고자 하였다. 방법: 일개 대학병원에서 건강 검진을 받은 여성 수진자들 중 의미있는 알코올 섭취(하루 20 g 이상)자, HBsAg 양성자, anti-HCV 양성자 등을 제외한 5,259명(평균 연령: 40.6±8.9세)을 연구에 포함시켰다. 임상양상, 복부 초음파검사, 인슐린 저항성 및 철대사와 관련된 생화학 검사를 포함한 혈액검사 소견을 파악하여 비알코올 지방간 발생과 체내 철 저장 상태와의 연관성을 분석하였다. 결과: 체내 철 저장 상태에 따른 비알코올 지방간의 유병율을 비교하였을 때, 정상 체내 철 저장 상태(10.6%), 저장 철 고갈 상태(4.1%), 철결핍성 적혈구 조혈 이상 상태(6.5%) 및 철결핍성 빈혈 상태(11.2%) 간에 유의한 차이를 보였다(p<0.001). 비알코올 지방간 발생에 영향을 미치는 인자들을 알아 보기 위하여, 다변량 분석을 시행하였을 때, 연령(odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.116-1.507) per 10 years), 과체중(OR=1.952; 95% CI: 1.395-2.732), 당뇨병(OR=1.694; 95% CI: 1.198-2.397), 고중성지방혈증(OR=2.434; 95% CI: 1.737-3.409, 복부 비만(OR=3.559; 95% CI: 2.538-4.992), 인슐린 저항성(OR=2.665; 95% CI: 1.979-3.587), 빈혈(OR=2.015; 95% CI: 1.150-3.532), 저장 철 고갈(OR=0.580; 95% CI: 0.405-0.830) 등이 유의한 연관성을 보였다. 결론: 체내 철 저장 상태가 비알코올 지방간의 발생에 영향을 미칠 수 있으며, 특히 저장철의 고갈 및 빈혈 발생에 의한 인슐린 저항성의 변화가 비알코올 지방간 발생과 관련되는 것으로 사료된다. Background: Although numerous reports have shown the influence of the iron overload state on the development of nonalcoholic fatty liver disease (NAFLD), there have been few reports on the prevalence of NAFLD according to the body iron stores. The aim of the present study was to determine the relationship of body iron stores with the development of NAFLD in apparently healthy women. Methods: The present cross-sectional study was performed with data obtained from 5,249 women (mean age: 40.6±8.9 years), that received an annual health check-up. All components of metabolic syndrome criteria, anthropometric parameters, fasting insulin levels, level of C-reactive protein and serum iron tests were measured in each subject. Results: The prevalence of NAFLD was significantly different according to body iron status (normal iron store/iron store depletion/iron deficient erythropoiesis/iron deficiency anemia: 10.6%/4.1%/6.5%/11.2%, p<0.001). Multivariate analysis revealed that age (odds ratio [OR]=1.284; 95% confidence interval [CI]: 1.1161.507) per 10 years), being overweight (OR=1.952; 95% CI: 1.3952.732), diabetes mellitus (OR=1.694; 95% CI: 1.198-2.397), hypertriglyceridemia (OR=2.434; 95% CI: 1.737-3.409), abdominal obesity (OR=3.559; 95% CI: 2.538-4.992), insulin resistance (OR=2.665; 95% CI: 1.979-3.587), anemia (OR=2.015; 95% CI: 1.150-3.532) and stored iron depletion (OR=0.580; 95% CI: 0.405-0.830) were profoundly associated with the development of NAFLD. Conclusion: The present study reveals a possible correlation between the development of NAFLD and body iron stores, and stored iron depletion and anemia seem to be key factors for this correlation. (Korean J Med 73:587-595, 2007)

Piroxicam(Brexin)에 의한 신증후군을 동반한 간질성 신염 1예

김상훈,조용균,김신연,김향,이상종,이규백,박찬필,박문향 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5

Abnormalities of body fluid and electrolyte balance, acute renal failure, nephrotic syndrome, interstitial nephritis and papillary necrosis are well known disease of wide spectrum of NSAID induced renal side effect. Many different mechanism such as inhibition of prostaglandin pathway, delayed hypersensitivity reaction and direct toxicity are reported to relate to development of disease. Recently, overuse of NSAID has steadily increased the cases of NSAID induced side effects and in some cases permanent damage to kidney has been reported. Authors experienced a 67-year-old male patient who presented with gross hematuria, edema and azotemia and diagnosed as interstitial nephritis accompanying nephrotic syndrome. Kidney biopsy shows the edema and the diffuse infiltration of lymphocytes in the interstitium. The glomerular changes suggest minimal change lesion or focal segmental glomerular sclerosis in early stage. The patient had continuously consumed piroxicam for 6 months and had improved after discontinuation of this drug as well as treatment with steroid but remained renal damage. This case suggest that piroxicam may be an agent that causes interstitial nephritis and nephrotic syndrome. Therefore clinician should use it with caution especially in patients with high risk factors.

한국인의 인슐린비의존형 당뇨병과 정상 대조군간의 Leptin 농도 차이

김상훈,이화영,김준영,심대중,김신연,정을순,최홍업,최윤상,이상종 대한비만학회 1999 The Korean journal of obesity Vol.8 No.2

Background: Obesity is risk factor for a number of chronic disease, including NIDDM, hypertension, cardiovascular disease. The etiology of obesity is unclear, although it appears that both genetic and enviromental factors contribute to develope. Identification of the ob gene and its product, Leptin, has increased our understanding of the pathophysiology of obesity. Change in glycemia precedes change in body weigth, suggesting that insulin may have a direct effect on Leptin. another, insulin may have a direct effect on Leptin. authors questioned whether NIDDM patients altered regulation of serum Leptin levels. We compared diabetic patients and norrnal persons with serum Leptin level and other metabolic profiles. Methods: Using radioimmunoassay, we measured serum Leptin concentrations in 80 NIDDM patients (male 40, female 40) and 80 controls (male 40, female 40) matched by age, sex and BMI. The data were using t-test of difference in serum Leptin concentration and other factors means between two groups. The association between serum Leptin concentration and other factors were measured by correlation analysis. Results: 1) NIDDM patients had a slightly high body mass index and Leptin concentration than controls, although these were not stastically significant (p$gt;0.05). 2) Women had significant higher Leptin concentration than men (p$lt;0.05). 3) Old age groups had higher Leptin concentrations than young groups (p$lt;0.05), 4) A significant correlation between serum Leptin concentration with age (r=0.173, p$lt;0.05), female sex (r=0.599 p$lt;0,01), BMI (r=0.355, p$lt;0.01) was observed in NIDDM patients. 5) Serum Leptin concentration did not differ by diabetic status. Conclusion: Leptin concentration did not differ by diabetic status. serum Leptin concentrations were significantly correlated with age, sex, BMI. we concluded serum Leptin concentrations were not different in diabetic and non diabetic subjects.

악성 변화를 일으킨 췌장의 고형성 유두상 상피종양 치험 1예

이상일,박창영,이승원,신준호,김신연,전우규,김병익,이승세,손정일,정올순,금주섭 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3

The solid and papillary epithelial neoplasm of the pancreas is a relatively uncommon disease. It accounts for approximately 1 to 2 percent of all exocrine pancreatic tumors. This benign or low grade malignant tumor is reported to occur predominantly in young women and rarely in men. Recurrence and development of metastasis after resection are found only in a small fraction of the general population. A case is herein reported involving a solid and papillary epithelial neoplasm of the pancreas which extensively spread to nearby organs, in a 34 year-old man. Chief complaints were black stool. Physical examination revealed tenderness on the left upper quadrant of the abdomen. Esophagogastroduodenoscopy revealed multiple cardiac variceal bleeding. Abdominal sonography and CAT scan findings showed a huge lobulated mass on the left upper quadrant area with an internal necrotic portion. Surgical findings showed determined a splenic vein tumor thromboembolus, portal vein involvement, distal stomach involvement, and multiple colonic invasion. Therefore, distal pancreatectomy, wedge resection of the stomach, splenetomy, segmental resection of the transverse colon, and excision of the mass were all performed. Pathologic examination revealed a solid and papillary epithelial neoplasm in the pancreatic tail with a marked dilated splenic vein filled with tumor thromboembolus. The patient has been under chemotherapy since then, and is being closely observed.