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간성 뇌중 환자에서 Flumazenil 의 효과 및 안정성에 관한 전향성 연구
추원석(Won Seok Choo),최호열(Ho Yul Choi),빈중선(Joong Sun Bin),최예원(Rye Won Choi),전용철(Yong Cheol Jeon),김학양(Hak Yang Kim),박충기(Choong Kee Park),유재영(Jae Young Yoo),이병철(Byung Chul Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.4
Objectivea: Ther are still many controversies on the pathogenesis of the hepatic encephalopathy. Recently, it has been postulated that endogenous benzodiazepine like substance (s) may be involved in the neuroinhibitory effect of gamma-aminobutyric acid (GABA). For this reason, benzodiazepine antagonist, flumazenil, has been advocated as a new treatment for hepatic encephalopathy. Several studies reported clinical improvement of hepatic encephalopathy in patients treated with flumazenil but these were not controlled studies. Methods: To investigate the effect of flumazenil, we performed a double-blind, prospective study in the 13 patients with hepatic encephalopathy who fulfilled the inclusion criteria of the protocol. The drug was administered intravenously (flumazenil 2.2 mg bolus injection followed by a continuous infusion with a rate of 1 mg/ h or placebo) in coded vial. After the code was open, 6 patients received flumazenil and the other 7 palcebo. The ages were 36 to 61(mean 54) years and 7 were male and 6 female. The causes of liver cirrhosis were HBV related in 7, HCV related in 3, and 3 were alcoholics. Results: In the fumazenil group, 4(67%) demonstrated immediate improvement of mental state with various degrees (from stage III to II in 1 and from stage I & II to 0 in 3). The significant and immediate improvement in the electroencephalographic (EEG) findings were noted in 3(50%), In the placebo group, however, 2(29%) showed an immediate improvement in EEG findings but only one (14%) showed the immediate improvement of mental status. There was no evidence of significant adverse reaction related to the treatment. Conclusion: This study shows that the benzodiazepine antagonist flumazenil may be effective and safe in patients with hepatic encephalopathy in the immediate mangement. Long term beneficial effect may be expected by treating the patients with more convinient oral administration.
유재영(Jae Young Yoo),박충기(Choong Kee Park),김학양(Hak Yang Kim),김용범(Yong Bum Kim),김동준(Dong Jun Kim),박태림(Tae Rim Park),서영일(Young Il Suh),서중산(Joong San Suh),빈중선(Joong Sun Bin),정복현(Bok Hyun Chung) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3
N/A We analyzed 166 patients with hepatocellular carcinoma (HCC) retrospectively for 3 years duration. The diagnosis was made by serologically, histologically and/or radiologically. They were 136 males and 30 females and ages ranged from 31 to 80 (mean: 56) years with a peak incidence during the sixth decade. Serum AST was normal in 39 (23%) and ALT in 113 (68%). In 20% of the patients, AST/ALT was greater than 3:1. Serum HB was positive in 110 patients (66%), anti HCV in 26 (16%), and no viral markers were dectected in 30 (18%). Among 110 HBsAg positive patients, 30 (27%) were positive for HBeAg and 34 (31%) were positive for HBV-DNA. Of the 30 patients who were both HBsAg and anti-HCV negative, evidence of past HBV infection (anti-HBs or anti-HBc) was found in 12. Using the polymerized chain reaction (PCR), HBxAg was detected in 90 (74%) of 122 patients studied: 71/82 (87%) in HBsAg positive, and 19/40 (48%) in HBsAg negative. The anti-HCV or HCV-RNA was detected in 8 (17%) ef 48 patients who were positive for HBsAg and in 18 (56%) of 32 patients who were neagtive. Liver cirrhosis was found in 148 patients (89%) when they initially came to the hospital. Portal vein thrombosis was noted in 63 patients (38%) by ultrasonography and/ or angiographically. Serum alpha fetoprotein (AFP) was elevated (greater than 400 ng/dl) in 9(60%). No correlation was found between the level of AFP and the extent of the tumor. Among 166 patients, small tumor (less than 5 cm in diameter) was found in 17 of whom surgical resection was done in 3, and 11 reeived transarterial embolization (TAE) and/or percutaneous ethanol injection (PEI). In conclusion, most of the patients with. HCC were complicated with decompensated liver cirrhosis when they initially came to the hospital. Therefore, it is absolutely recommended to perform the serial alpha fetoprotein measurement and ultrasonographic examination regularly to all the patients with chronic hepatitis regardless of the etiology of the liver disease.