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말기 신부전 환자에서 적극적 투석 요법이 염증 반응을 통해 좌심실 수축기능에 미치는 영향
부창수 ( Chang Su Boo ),우영석 ( Young Seok Woo ),이재원 ( Jae Won Lee ),고강지 ( Gang Jee Ko ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3
목적: 울혈성 심부전은 말기신질환자에 있어 생명을 위협하는 급성 합병증이다. 적극적 투석 요법은 효과적으로 체액량을 감소시키고 요독물질을 제거하여 심장의 수축기 기능을 향상시킨다. 비록 심혈관계 질환의 병인에 염증반응이 중요한 역할을 하나, 적극적 투석 요법이 염증인자들과 좌심실의 수축기 기능장애에 어떠한 영향을 미치는지에 대해서는 명확하지 않다. 이번 연구는 적극적 투석요법이 좌심실의 수축기 기능과 혈청 싸이토카인에 어떠한 변화를 일으키는지 조사하였다. 방법: 투석을 받는 말기신질환자 중에서 좌심실 기능부전으로 인한 급성 폐부종이 발생한 환자를 대상으로 하였다. 적극적 투석요법은 매일 4시간씩 7일간 연속적으로 시행하였다. 모든 결과는 전향적으로 모았으며 적극적 투석요법 전후로 심장초음파 검사를 시행하였다. 혈청 TNF-α 와 IL-10을 적극적 투석요법 전후로 비교하였고 내독소 자극 후 이들 싸이토카인들 역시 비교하였다. 결과: 적극적 투석요법 이후에 환자들의 체중과 평균동맥혈압은 의미 있게 감소하였고 그리고 심박출계수는 적극적 투석 이후 의미 있게 증가하였다. 혈청 IL-10과 TNF-α는 적극적 투석요법 후에 의미 있게 감소하였다. 반면 내독소로 자극 후 분비되는 IL-10과 TNF-α는 의미있게 증가하였다. 또한 CRP 변화 정도와 심박출계수 변화 정도는 의미 있는 상관관계를 보여주었다. 결론: 급성 좌심실 기능부전을 동반한 말기신질환자에서 적극적 투석요법은 심박출계수를 의미 있게 증가시켰으며 적절한 면역반응을 회복시키며 염증반응을 조절하는 것으로 나타났다. 따라서 급성 좌심실 기능부전을 동반한 말기신질환자에 있어 적극적 투석요법을 시행하는 것이 심기능 개선 및 염증반응 조절 및 면역반응의 회복증진에 도움이 될 것으로 생각된다. Purpose: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. Methods: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-α and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. Results: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-α levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. Conclusion: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
혈액투석을 받는 만성신부전 환자에서 하지불안증후군과 삶의 질
최현석,강승걸,부창수,이헌정,조원용,김형규,김린,Choi, Hyun-Seok,Kang, Seung-Gul,Boo, Chang-Su,Lee, Heon-Jeong,Cho, Won-Yong,Kim, Hyoung-Kyu,Kim, Leen 대한수면의학회 2007 수면·정신생리 Vol.14 No.2
목 적:혈액투석을 받고 있는 만성신부전 환자들에서 하지불안증후군(restless legs syndrome, RLS)의 발생빈도와 삶의 질과의 관계에 대한 연관성을 평가하는 것을 목적으로 하였다. 방 법:고대안암병원 인공신장실에서 만성신부전증으로 혈액투석 중인 83명의 환자들을 대상으로 직접 면담과 설문지를 통해 International Restless Legs Syndrome Study Group(IRLSSG) 진단기준에 합당한 지를 검사하였고 International Restless Legs Scale(IRLS), Athens insomnia scale(AIS), Epworth sleepiness scale(ESS), Medical Outcome Study Short Form-36(SF-36)을 설문지를 통해 측정하였다. 또한 각 환자들의 정신적 상태와 우울증에 대한 선별을 위해 Clinical Global Impression(CGI)와 Hamilton Depression Rating Scale(HDRS)을 시행하였다. 결 과:31명(37.3%)이 IRLSSG 진단기준에 합당한 RLS 환자로 판명이 되었고 RLS 증상을 가지는 환자들은 51.8%에 이르렀다. RLS로 판정된 경우에는 높은 AIS, ESS, HDRS, CGI 점수와 통계적으로 유의한 관련성이 있었다. 또한 RLS 환자로 판정된 경우 낮은 SF-36 총점, 신체적 정신적 요소 점수를 보였고 특히 세부항목으로는 낮은 신체적 역할 제한, 전반적인 건강상태, 신체적 역할제한, 정신적 역할제한, 정신건강 점수와 통계적으로 유의한 관련성이 있었다. 결 론:혈액투석을 하는 만성신부전 환자에서 높은 RLS 유병률을 보이고 있다. RLS를 동반한 경우는 동반하지 않은 경우보다 전반적인 삶의 질의 저하를 보였고 세부적으로는 역할의 제한, 전반적인 건강 및 정신건강 상태 항목에서의 저하가 뚜렷하게 나타났다. Objective: Restless legs syndrome (RLS) is known to be associated with chronic renal failure (CRF) patients on hemodialysis, however the prevalence of RLS in CRF patients on hemodialysis is variable due to different diagnostic criteria or dialysis technique. A few reports have indicated the association between RLS symptom and lower life quality in CRF patients on hemodialysis. This study aims to investigate the prevalence of RLS and its association with the quality of life in CRF patients of a single dialysis unit in Korea. Methods: A total of 83 Korean CRF patients on hemodialysis in the Korea University Hospital were examined. International Restless Legs Syndrome Study Group (IRLSSG) criteria and International Restless Legs Scale (IRLS) were used to determine the diagnosis and severity of RLS. Questionnaires including Athens Insomnia Scale (AIS), Epworth sleepiness scale (ESS), and Medical Outcome Study Form-36 (SF-36) were administered to all the patients for the assessment of sleep and quality of life. Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) were also measured for depression and status of mental illness by psychiatrist. Results: Of the 83 patients, 31 (37.3%) patients were found to have RLS and 43 (51.8%) patients met at least one of the RLS diagnostic criteria. The AIS (t=2.40, p=0.019), ESS (t=2.41, p=0.018), HDRS (t=3.85, p<0.001) and CGI (t=3.52, p=0.001) were higher in the subjects with RLS compared to other subjects. The SF-36 scores were significantly lower in the patients with RLS except physical functioning and bodily pain. Total (p=0.005), physical component (p=0.019), and mental component scores (p=0.019) of SF-36 were significantly lower in patients with more severe RLS symptoms. Conclusion: There was significant relationship between RLS and poor quality of sleep and life. More severe RLS symptom was proven to be an important factor to make a quality of life worsen.
말기신부전 환자에서 투석치료의 시작이 염증상태 및 면역반응에 미치는 영향에 관한 연구
이재원 ( Jae Won Lee ),김혜원 ( Hye Won Kim ),박은범 ( Eun Bum Park ),부창수 ( Chang Su Boo ),고강지 ( Gang Jee Ko ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5
Purpose : inflammation is a common feature in chronic kidney disease patients, and it could contribute to long-term morbidity and mortality related with malnutrition and atherosclerosis. In this study, we aimed to investigate the effect of initiating dialysis on inflammatory state, nutritional parameter, and immune response in end-stage renal disease (ESRD) patients. Methods : 57 ESRD patients who initiated hemodialysis (HD, n=31) or continuous ambulatory peritoneal dialysis (CAPD, n=26) were enrolled. Pro-inflammatory cytokine, tumor necrosis factor (TNF)-α, and anti-inflammatory cytokines, interleukin (IL)-10 and adiponectin were measured before and 3 months after initiation of dialysis. Inflammatory marker, highly sensitive C-reactive protein (hs-CRP), and nutritional parameter, albumin, were also checked. Lipopolysaccharide (LPS)-stimulated production of TNF-α and IL-10 were measured for the evaluation of immune response by external stimuli. Results : As uremia was reduced by initiating dialysis, serum level of TNF-α was decreased and adiponectin was increased. These changes were accompanied by the decrease of hs-CRP and the increase of serum albumin. LPS-stimulated cytokines production was increased after initiating dialysis. There differences in these parameters comparing HD and CAPD patients except more increase of serum adiponectin level in CAPD patients. Conclusion : Our study demonstrated that initiation of dialysis results in decrease of inflammation, improvement of nutritional status, and restoration of proper immune responsiveness in ESRD patients. These results suggest that correction of uremic milieu through dialysis has beneficial effects. Therefore, initiation of dialysis might have the advantage of improving inflammatory and nutritional status, and correcting immune dysfunction in ESRD patients.
이재원 ( Jae Won Lee ),김선철 ( Sun Chul Kim ),오세원 ( Se Won Oh ),차진주 ( Jin Joo Cha ),김혜원 ( Hye Won Kim ),부창수 ( Chang Su Boo ),이지은 ( Ji Eun Lee ),권영주 ( Young Joo Kwon ),표희정 ( Heui Jung Pyo ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.2
The introduction of plasma exchange has significantly improved the outcome of thrombotic thrombocytopenic purpura (TTP) and the survival rate was increased from 10 to 80-90%. TTP refractory to plasma exchange therapy, however, is still a therapeutic challenge. We describe here a patient who partially responded to plasma exchange therapy, but remained dependent on plasma infusions. To discontinue plasma therapy, several attempts using agents such as rituximab, vincristine, and cyclosporine A had been tried, but all failed. After splenectomy, serum LDH and blood platelet count were normalized. Plasmapheresis were we able to discontinue after 2 weeks of splenectomy. Steroid and cyclosporine were tapered off after 3 months and 5 months after splenectomy respectively, and the patient has been staying in remission ever since. We suggest that splenectomy is a worthwhile treatment option in patients with refractory TTP.
신동맥 결찰술 후 발생한 신증후군 범위의 단백뇨를 동반한 신혈관성 고혈압 ACE 억제제와 안지오텐신 2 1형 수용체 차단제 병합요법에 의한 성공적 치료
오세원 ( Se Won Oh ),김선철 ( Sun Chul Kim ),차진주 ( Jin Joo Cha ),김명규 ( Myung Gyu Kim ),우영석 ( Young Seok Woo ),부창수 ( Chang Su Boo ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.3
A 27-year-old woman presented with severe hypertension and nephrotic range proteinuria. She had a blunt renal trauma 4 weeks ago and was treated by the left main renal artery ligation. The plasma renin activity, angiotension II and aldosterone levels were very high and the abdominal angiography showed the occlusion of the left main renal artery with relatively preserved blood flow in upper pole of the left kidney. In captopril renal scan, relatively preserved perfusion in upper pole of left kidney was further compromised after captopril administration. The massive proteinuria and hypertension were improved after combination of ACE inhibitor and angiotensin II type 1 receptor blocker treatment.
혈액투석을 시행하는 만성 신부전 환자에서 IL-10 유전자형 및 혈중농도와 심혈관계 합병증과의 관계에 대한 고찰
고강지 ( Gang Jee Ko ),김정엽 ( Jeong Yup Kim ),김명규 ( Myung Kyu Kim ),서순용 ( Soon Yong Suh ),최혜민 ( Hye Min Choi ),현영율 ( Young Youl Hyun ),부창수 ( Chang Su Boo ),이지은 ( Jee Eun Lee ),성수아 ( Su Ah Sung ),조상경 ( San 대한내과학회 2005 대한내과학회지 Vol.68 No.5
Background : Chronic systemic inflammation in ESRD patients due to uremia and hemodialysis procedure itself comes into notice as a main factor for premature mortality secondary to rapid progressing atherosclerosis. Various pro-inflammatory cytokine, known
급성 신부전으로 발현되어 다발성 장기부전을 동반한 λ형 경쇄침착질환
고강지 ( Gang Jee Ko ),김정엽 ( Jeong Yup Kim ),김명규 ( Myung Kyu Kim ),최혜민 ( Hye Min Choi ),현영율 ( Young Youl Hyun ),부창수 ( Chang Su Boo ),성수아 ( Su Ah Sung ),원남희 ( Nam Hui Won ),조상경 ( Sang Kyung Jo ),조원용 ( Won 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.6