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박민기 ( Min Gi Park ),이지현 ( Ji Hyun Lee ),김성준 ( Sung Jun Kim ),박수호 ( Su Ho Park ),박석기 ( Suk Ki Park ),최준설 ( Joon Sul Choi ),황지연 ( Ji Yeon Hwang ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Gitelman syndrome is a condition caused by a mutation of the thiazide sensitive Na-Cl cotransporter gene on the distal convoluted tubule. It results in a variety of clinical features, including hypokalemia, hypomagne-semia, hypocalciuria, and metabolic alkalosis. It is often diagnosed in asymptomatic adults presented with unexplained hypokalemia; however, it is sometimes associated with muscular cramps, numbness, fatigue, weakness, or paralysis. We experienced a case of rheumatoid arthritis accompanied by Gitelman syndrome, presented with hand tremor. We diagnosed her using renal clearance study and genetic analysis. Here, we report our experiences regarding this case along with a literature review.
류마티스관절염 활성도와 호중구-림프구 비, 혈소판-림프구 비의 상관관계
김성준 ( Sung Jun Kim ),이지현 ( Ji Hyun Lee ),김성만 ( Seong Man Kim ),박민기 ( Min Gi Park ),박수호 ( Su Ho Park ),김동규 ( Dong Kyu Kim ),황지연 ( Ji Yeon Hwang ),최준설 ( Joon Sul Choi ),박석기 ( Suk Ki Park ) 대한류마티스학회 2016 대한류마티스학회지 Vol.23 No.2
Objective. Although previous trials suggested a relationship between neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic inflammatory response, clinical utility of NLR and PLR in rheumatoid arthritis (RA) is not well defined. This study was conducted to assess the efficiency of NLR and PLR as an inflammatory index in patients with RA. Methods. A total of 107 patients with newly diagnosed RA who had never used steroid and a control group of 50 age- and gender-matched healthy subjects whose high sensitive C-reactive protein (hsCRP) was within normal range were included. Those with cerebrovascular diseases, diabetes, malignancies, or any cardiovascular diseases were excluded from both groups. The patients were divided into two groups according to the Disease Activity Score of 28 joints (DAS28). Group 1 included patients with a DAS28 score of 3.2 and lower (low disease activity) and group 2 included patients with a score higher than 3.2 (moderate to high disease activity). Results. NLR and PLR in the patient group were 2.99±2.04, 170.90±86.49, significantly higher than that of the control group. NLR and PLR in group 2 were 4.16±2.50, 225.23±93.21, significantly higher than those of group 1 patients (2.26±1.22, 137.15±61.92). NLR and PLR both showed correlation with rheumatoid factor, hsCRP, serum albumin, Korean Heath Assesment Questionnaire, and DAS28. Conclusion. These data showed a positive correlation between NLR or PLR level and RA disease activity, suggesting that NLR or PLR can be used as an additional inflammatory marker in patients with RA. (J Rheum Dis 2016;23:96-100)
Fracture Risk Assessment와 Framingham Risk Score를 중심으로 한 골절 위험도와 심혈관 질환 위험도와의 상관관계
구인혜 ( In Hye Ku ),이지현 ( Ji Hyun Lee ),김성만 ( Seong Man Kim ),강성민 ( Sung Min Kang ),김해구 ( Hae Koo Kim ),김동규 ( Dong Kyu Kim ),최준설 ( Joon Sul Choi ),박석기 ( Suk Ki Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
Background/Aims: Although trials have suggested an association between osteoporosis and cardiovascular disease (CVD), the relationship between fracture risk and cardiovascular disease is not well defined. Here, we examined whether subjects with a higher risk of fracture also share an increased likelihood of developing CVD. Methods: This study included 477 subjects; patients with a history of diabetes, chronic hepatopathy, nephritic syndrome, or any cardiovascular diseases were excluded. We used dual energy X-ray absorptiometry to assess the bone mineral density (BMD) of the lumbar spine and femur, and calculated fracture risk based on the Fracture Risk Assessment (FRAX) score. The Framingham risk score (FRS) was used to estimate cardiovascular risk. Results: Of the 477 subjects, 222 had osteopenia and 150 had osteoporosis; the remaining 105 had a normal BMD. In men, no significant differences were observed in systolic blood pressure (SBP), diastolic blood pressure, low-density lipoprotein, high-density lipoprotein (HDL), and triglyceride (TG) between groups. Men with osteoporosis were generally older, and had significantly higher total cholesterol (TC). In women, age and FRS were significantly higher in the osteoporosis group. In the multivariate analysis, age, SBP, TC, HDL, TG, and FRAX were all significantly associated with FRS. Conclusions: These data suggest that patients with a higher risk of fracture are also at greater risk of developing CVD, indicating a possible mechanistic link between CVD and osteoporosis. (Korean J Med 2015;88:547-554)
증례 : 류마티스 ; 류마티스관절염 환자에서 동반된 혈전혈소판감소자색반병 1예
강성민 ( Sung Min Kang ),이지현 ( Ji Hyun Lee ),구인혜 ( In Hye Ku ),김해구 ( Hae Koo Kim ),남경식 ( Kyoung Sik Nam ),박석기 ( Suk Ki Park ) 대한내과학회 2015 대한내과학회지 Vol.89 No.1
혈전혈소판감소자색반병은 혈소판 감소, 미세혈관병증용 혈빈혈과 신경학적 기능 이상이 특징인 질환으로 드물게 자가면역질환과 관련되어 발생한다. 저자들은 류마티스관절염 환자에서 수술 후 요로 감염과 함께 의식 저하 및 미세혈관병증용혈빈혈, 혈소판 감소가 발생하여 혈전혈소판감소자색 반병으로 진단 후 혈장분리교환술과 고용량의 스테로이드로 치료하여 의식 저하 및 빈혈, 혈소판 감소는 호전을 보였으나 결국 폐혈증으로 사망한 1예를 경험하고 문헌고찰과 함께 보고하는 바이다. Thrombotic thrombocytopenic purpura (TTP) is a blood coagulation disorder that damages numerous organs, including the kidney, heart and brain. Features indicative of TTP include thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, kidney failure and fever. Infections, toxins, pregnancy and, rarely, autoimmune diseases are all known to be associated with TTP. We encountered a rare case of rheumatoid arthritis accompanied by TTP following tympanoplasty. The patient’s confusion, thrombocytopenia and renal failure all improved after plasmapheresis and high-dose glucocorticoid therapy, but she eventually expired due to sepsis. We report on this case herein and also review the relevant literature. (Korean J Med 2015;89:122-126)