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성인 특발성 신증후군의 임상적 고찰 -단일 기관 성적-
성정훈 ( Jung Hoon Sung ),황은아 ( Eun Ah Hwang ),곽진호 ( Jin Ho Kwak ),진규복 ( Kyu Bok Jin ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.1
목적: 성인 특발성 신증후군 환자의 남녀별, 연령별 및 병리조직학적 유형에 따른 임상상과 조사 시기에 따른 원인 질환의 발생 비율의 변화에 대해 조사하고자 하였다. 방법: 1978년부터 2005년까지 계명의대 동산병원 내과에 입원하여 신생검을 통해 특발성 신증후군으로 진단받은 15세 이상의 성인 환자 823 예를 대상으로 병리조직학적 유형별 비율, 그 유형에 따른 임상상, 관찰 시기에 따른 원인 신질환 비율의 변화를 후향적으로 분석 비교하였다. 결과: 대상 환자의 수는 823명이었고 평균 연령은 36.7세, 남녀비는 1.7:1로 남자에서 많았다. 병리조직학적 유형은 전체적으로 미세 변화형 신증후군이 51.6%로 가장 많았고, 그 다음이 막성 신염이 21.3%, 초점성 분절성 사구체경화증 12.1%, IgA 신병증 9.1%, 막증식성 사구체신염 3.8% 순이었다. 45세 이하에서는 미세 변화형 신증후군이 가장 흔한 병리조직학적 유형이었으나 45세 이상 군에서는 막성 신염의 비율이 높았다. 1978-1990년과 1991-2005년까지의 두 기간으로 구분했을 때 미세 변화형 신증후군은 다소 감소하는 경향을, 막성 신염은 유의하게 증가한 반면, 막증식성 사구체신염은 유의하게 감소하였다. IgA 신병증은 다소 증가하는 추세를 보였고, 초점성 분절성 사구체경화증은 유의한 변화가 없었다. 결론: 성인 특발성 신증후군의 원인 질환으로 전체적으로 미세 변화형 신증후군이 가장 많았다. 연령별로는 45세 이하에서는 미세 변화형 신증후군이, 45세 이상에서는 막성 신염의 비율이 가장 높았다. 과거에 비해서 최근에 막성 신염의 비율은 유의하게 증가한 반면 막증식성 사구체신염의 비율은 유의하게 감소하였다. Purpose: We examined the clinical characteristics and incidence of adults idiopathic nephrotic syndrome (NS) according to pathologic diagnosis, age, sex. Methods: We retrospectively reviewed the clinical and pathological characteristics of primary glomerular lesions in adults idiopathic NS taken a renal biopsy from 1978 to 2005 at the Dongsan Medical Center. We compared the prevalence of adults idiopathic NS according to the pathologic diagnosis between two time intervals 1978 to 1990 and 1991 to 2005. Results: The patients had mean age of 36.7±16.3 years and male to female ratio was 1.7:1 with male predominance. The frequency of histopathologic diagnoses were minimal change nephrotic syndrome (MCNS) 51.6%, membranous glomerulonephritis (MGN) 21.3%, focal segmental glomerulosclerosis (FSGS) 12.1%, IgA nephropathy 9.1%, membranoproliferative glomerulonephritis (MPGN) 4.2% in decreasing order of frequency. The mean age was youngest in MCNS (32.9±15.1) and oldest in MGN (46.2±16.6). Between 1978 to 1990 period and 1991 to 2005 period, the prevalence of MGN was significantly increased, whereas the prevalence of MPGN was decreased significantly. The prevalence of MCNS had a tendency to decrease and that of IgA nephropathy had a tendency to increase, however, both didn`t reach statistical significance. The incidence of FSGS didn`t show a significant change during the both study periods. Conclusion: MCNS was the most common disease among adults idiopathic NS. MGN was the most frequent etiology in patients older than 45 years. The incidence of MGN was increased over the 28-year period, and that of MPGN decreased significantly. There was no change in the frequency of FSGS.
성정훈 ( Jung Hoon Sung ),곽충환 ( Chung Hwan Kuak ),진규복 ( Kyu Bok Jin ),이기태 ( Ki Tae Lee ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ),김현철 ( Hyun Chul Kim ) 대한내과학회 2005 대한내과학회지 Vol.68 No.2
배경 : 특발성 막증식성 사구체신염은 주로 소아 및 청년에서 발병하며 약 50%에서 만성 신부전으로 진행하는 예후가 불량한 것으로 알려져 있으나 국내에서는 이들 환자의 임상적 특징 및 장기 예후에 대한 보고는 드물다. 방법 : 1982년 6월부터 2004년 3월까지 만 21년간 계명의대 동산병원에서 신생검을 통해 원발성 사구체신염으로 진단된 1,971예 가운데 특발성 막증식성 사구체신염이 진단된 51명(2.6%)을 대상으로 이들 환자의 진단시 임상양상, Background : Idiopathic membranoproliferative glomerulonephritis (MPGN) is a chronic primary glomerular disease that occurs in both children and adults, with generally progressive course. We have examined the clinical and long-term outcome of patients wit
고려인삼에 의한 신경면역 및 염증반응 조절: 백삼사포닌에 의한 교세포에서의 TNF-α, IL-1β 및 No 생성 증가
성정훈(Jung-Hoon Sung),최동희(Dong-Hee Choi),김동훈(Dong-Hoon Kim),전보권(Boe-Gwun Chun),최상현(Sang-Hyun Choi) 고려인삼학회 2004 Journal of Ginseng Research Vol.28 No.2
Glial cells such as astrocytes and microglial cells are the main source of proinflammatory cytokines and nitric oxide(NO) in the central nervous system, which exert neuroimmune and inflammatory functions and other various neurobiologic effects. Though Panax ginseng CA. Meyer has been known to strengthen the body's defence mechanisms and also to maintain the homeostasis in the central nervous system, the effects of Panax ginseng on the production of immune and inflammatory mediators have not been studied well in the brain. Therefore. this study was designed to study the effects of ginseng saponins on the production of prointlammatory cytokines and NO in the primary cultures of mixed glial cells. White ginseng saponin, 200-500 ㎍/ml, showed significant cytotoxicity after 72 hrs and increased TNF- α, IL- β. and NO production. Lower doses of 50-100 /ml showed little cytotoxicity until 72 hrs and also increased the production of TNF- α, IL- β, and NO. Triple immune staining showed that white ginseng saponin, 200 ㎍/ml for 72 hrs. induced stellation of astrocytes and iNOS expression exclusively in microglial cells. Taken together, the white ginseng saponin increased the production of proinflammatory cytokines such as TNF-a and IL-β, and induced iNOS expression and NO production in mixed glial cell cultures, which may be ascribed to the enhancement of central immune responses and the regulation of intlammatory reactions by Panax ginseng.
히드록시프로필메칠셀룰로오스 프탈레이트 및 에칠셀룰로오스를 이용한 이부딜라스트 함유
오동훈 ( Dong Hoon Oh ),이종달 ( Jong Dal Rhee ),유동성 ( Dong Sung Ryu ),장기영 ( Ki Young Jang ),임종섭 ( Jong Seub Im ),성정훈 ( Jung Hoon Sung ),한묘정 ( Myo Jung Han ),권태협 ( Tae Hyup Kwon ),양호준 ( Ho Joon Yang ),박병철 ( 韓國藥劑學會 2007 Journal of Pharmaceutical Investigation Vol.37 No.6
정상 심기능을 보이는 노인 환자에서 정형외과 수술 전 NT-proBNP의 역할
고은정 ( Eun Jung Ko ),문재연 ( Jae Youn Moon ),임영민 ( Yeong Min Lim ),홍원정 ( Won Jung Hong ),신석표 ( Suk Pyo Shin ),김상훈 ( Sang Hoon Kim ),양우인 ( Woo In Yang ),성정훈 ( Jung Hoon Sung ),김인재 ( In Jai Kim ),임상욱 ( San 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Background/Aims: Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of postoperative cardiovascular complications. The present study investigated whether blood NT-proBNP values are suitable for predicting postoperative cardiovascular complications after non-cardiac surgery in elderly patients showing normal left ventricular (LV) function on preoperative echocardiograms. Methods: This study was performed by analyzing the medical records of elderly patients referred to the cardiology department for the purpose of assessing their cardiac function before orthopedic surgery. Of the patients who underwent echocardiography and NT- proBNP assessment simultaneously, 275 patients aged ≥ 70 years and with an LV ejection fraction of ≥ 55% were included in the study. Results: Major adverse cardiac and cerebrovascular events (MACCEs) occurred in 33 (12%) of the 275 patients, and the NT-proBNP concentration was higher in patients with complications than in those without complications (1,904.20 ± 2,300.23 vs. 530.58 ± 882.27 pg/mL, p < 0.01). The ROC area under the curve was 0.756 (95% confidence interval 0.701-0.805, p < 0.001) with an optimal cutoff of 416.3 pg/mL (69.7% sensitivity, 67.36% specificity). A multivariate analysis showed that a preoperative age of > 80 years (odds ratio, 2.313; p = 0.047) and an increased blood NT-proBNP concentration (odds ratio, 3.189; p = 0.009) were independent risk factors for the prediction of MACCEs. Conclusions: Although elderly patients scheduled to undergo non-cardiac surgery may show normal LV systolic function on echocardiography, measurement of their preoperative blood NT-proBNP concentration is useful for predicting MACCEs occurring after non-cardiac surgery. (Korean J Med 2014;87:302-310)
황은아(Eun Ah Hwang),성정훈(Jung Hoon Sung),한승엽(Seung Yeup Han),박성배(Sung Bae Park),김현철(Hyun Chul Kim),김형태(Hyung Tae Kim),조원현(Won Hyun Cho) 대한내과학회 2002 대한내과학회지 Vol.63 No.3
목적 : 복막투석 환자에서 복막염은 복막투석의 실패와 사망에 가장 중요한 합병증의 하나이다. 저자들은 계명대학교 동산의료원에서 복막투석을 시행한 환자들을 대상으로 하여 복막염의 발생 및 역학에 대해 조사하였다. 방법 : 1996년 1월에서 2000년 12월 사이에 계명대학교 동산의료원에서 복막투석을 시행받은 환자들 중 추적기간이 2개월 이상인 238명을 대상으로 하여 후향적으로 조사하였다. 결과 : 5년간의 복막염의 발생율은 평균 0.94회/환자-년(12.8개월당 1회)이었고, 복막염 원인균의 빈도는 그람 양성균이 41.7%, 그람 음성균이 14.1%, 진균이 1% 순이었으며 배양 음성인 경우가 42.7%였다. 그람 양성균 중에는 Staphylococcus aureus가 47.5%로 가장 많았고, 그람 음성균에서는 Acinetobacter가 29.6%를 차지하였다. 균배양 양성율은 Bactec 혈액 배양 방식의 도입 이전 52.5%, 도입 후 72.2%로 균배양 양성율이 유의하게 향상되었다. 복막염은 항생제의 사용으로 치료된 예는 85.6%였고, 11.8%에서는 도관이 제거가 필요하였다. 도관을 제거하였던 경우 출구 감염이 도관을 제거하지 않 았던 군보다 유의하게 많았다(17.4% vs 4.7%). 전체 109명의 환자 중 60예에서 복막투석을 중단하였고, 그 중 28예가 혈액투석으로 전환하였으며 그 원인으로는 복막염이 82.1%로 가장 많았다. 도관 생존율은 복막염을 경험한 환자군에서는 1년, 3년, 5년 도관 생존율이 각각 87.0%, 35.1%, 11.9%였으며 복막염을 경험한 환자군에서는 1년, 3년, 5년 도관 생존율이 각각 81.7%, 58.1%, 54.0%였다. 관찰 기간 동안 6예가 사망하였으며 그 중 절반이 복막염에 의한 패혈증으로 사망하였다. 결론 : 앞으로 복막염의 발생을 감소시키기 위해서는 투석액 교환시 감염 및 도관 주위감염에 대한 적극적인 치료와 주기적인 환자 교육이 필요할 것으로 생각된다. Background : Peritonitis is one of the major complication leading to mortality and technique failure in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We have examined the incidence and etiology of CAPD peritonitis at Keimyung University Dongsan medical center. Methods : Between January 1996 and December 2000, 238 new patients received peritoneal dialysis and were reviewed retrospectively. Results : In 238 patients, 109(45.8%) patients experienced peritonitis and a total of 192 episodes of peritonitis has occurred during study period. The overall incidence of peritonitis during CAPD averaged 0.94/patient-year and there was no essential change during the last five years. The most common causative organism was Gram positive organism (41.7%), followed by Gram negative organism (14.1%), and fungus (2%). In Gram positive organism, Staphylococcus aureus (47.5%) was the most common microorganism, followed by coagulase negative Staphylococcus (23.5%), Streptococci (7.5%), and Enterococci (5.5%). Gram negative organism were Acinetobactor (29.6%), Escherichia coli (18.5%), Klebsiella (18.5%) and Pseudomonas (7.4%) in decreasing order of frequency. With the use Bactec blood culture system for peritoneal fluid culture since April 2000, the culture yield has been improved significantly than before (52.5% vs 72.2%, p<0.05). Peritonitis was cured in 164 cases (85.6%) with the administration of antibiotics. However catheters had to be removed in 23 cases (11.8%). Exit-site infection was more frequent in catheter removal group than in catheter retaining group (17.4% vs 4.7%, p<0.05). The CAPD failure occured in 28 patients during study period, and peritonitis was the major reason for technique failure (82.1%). The catheter removal rate was significantly higher in the patients with peritonitis than those without peritonitis (55.0% vs 30.2%, p<0.05). There were six deaths during study period. Septicemia associated with peritonitis accounted for the half of the mortality. Conclusion : Better exit-site care and continuing patient education is needed the incidence of peritonitis and peritonitis related mortality in CAPD patient.(Korean J Med 63:314-321, 2002)
황은아(Eun Ah Whang),성정훈(Jung Hoon Sung),한승엽(Seung Yeup Han),박성배(Sung Bae Park),김현철(Hyun Chul Kim),강민경(Min Kyung Kang) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5
Posttransplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus, is commonly regarded as a form of type 2 diabetes mellitus. Diabetes ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type 1 diabetes mellitus. We report two patients who presented with diabetic ketoacidosis after kidney transplantation. Two patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was treated with a cyclosporine-based regimen, and the other with a tacrolimus-based regimen. Both were found to have moderate to high serum levels of calcineurin inhibitors on presentation. Our experience suggests that post-transplant diabetes mellitus, in association with calcineurin inhibitor, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post transplant diabetes mellitus can be an atypical form of adult-onset diabetes with features of both type I and type 2 diabetes mellitus.