B 형 간염 바이러스 ( HBV ) 감염 후 B 형 간염 바이러스 표면 항원 ( HBsAg ) 에 대한 세포 면역성 반응

김대곤(Dae Ghon Kim),이남심(Nam Sim Lee),류완희(Wan Hee Yoo),안득수(Deuk Su Ahn),양두현(Doo Hyun Yang),조백환(Baik Hwan Cho) 대한내과학회 1996 대한내과학회지 Vol.51 No.1

N/A Objectives: The immune reaction of host, esp., cell-mediated, is provided as an important factor to determine the progression of disease after hepatitis H virus infection. The change of suppressor cell that control T cells, decrease of lymphocytic proliferation, or production of IL-2 production in PBMC is reported. Thus we were undertaken this study to investigate cell-mediated immunopathogenic mechanism in hepatitis B virus infection. Methods: 5 groups were studied; non-immune donors, immune donors, asymptomatic HBsAg carriers, patients with chronic active hepatitis (CAH) and patients with acute hepatitis (AH). The present study was tried to estimate the proportional variation of T cell subsets of the peripheral blood mononuclear cells (PBMC), proliferative responses of PBMC which was cultured with rIL-2, concanavalin (Con A) and phytohemagglutinin (PHA), or hepatitis B surface antigen (HBsAg), and changes of HLA-DR and IL-2R expression of stimulated lymphocytes as lymphocyte-activation markers in each groups. Results: There were no proportional changes of CD3 positive cells in subjects of each group, but the proportion of CD4 positive cells (18.4±2.9%) was signifiantly(p<0.01) reduced in patients with CAH. The CD4: CDH ratio was significantly decreased in carriers, in patients with CAH, and in patients with AH. Also the proliferative responses of cultured lymphocyes after stimulation with exogenous rIL-2 were not significantly changed in above three groups compared with that of unstimulated control culture. Enhanced HBsAg-specific proliferation was not detected after stimu1ation with rI1-2+HBsAg. HLA-DR and IL-2R expression of unstimulated lymphocytes were significantly decreased in patients with CAH and patients with AH. The HBsAg-specific HLA-DR expression was not demonstrated in subjects of each group. But, increased HLA-DR expressions after stimulation with rIL-2+HBsAg were observed, 48±6.2% in asymptomatic carriers, 34.5±5.0% in patients with CAH and 43.7±3.3% in patients with AH, compared with that of nonimmune donors. A weak HBsAg-specific IL-2R expression was demonstrated in patients with CAH, but there were no HBsAg-specific IL-2R expression in subjects of other 8 groups. After stimulation with rIL-2 or rIL-2+ HBsAg, there were increased IL-2R expression in asymptomatic HBsAg carriers, in patients with CAH, and in patients with AH, compared with that of nonimmune donors. Conclusion: These results suggested that impaired HLA-DR and IL-2R expression would be associated with HBsAg immunogenicity or/and IL-2 activity, and may be important immunogenetic role in the course of post-HRV infection.

B 형 만성활동성간염 환자에서 말초혈액 단핵세포의 ³H - Deoxyglulose 섭취

이용기(Yong Ki Lee),이남심(Nam Sim Lee),송석현(Secok Hyun Song),김대곤(Dae Ghon Kim),안득수(Deuk Soo Ahn) 대한내과학회 1989 대한내과학회지 Vol.36 No.4

N/A The cellular metabolic change of glucose uptake stimulated by immunological activation was measured to evaluate the impairment of cell mediated immunity which was considered to be a pathogenesis of chronic active hepatitis B. Patients were divided into four groups of serologically negative normal controls, chronic carriers, chronic active hepatitis patients and antibody positive patients. A microassay for ³H-deoxyglucose uptake was performed at the optimal conditions of 5×105 cells/well, 0.78 μCi/ml of ³H-deoxyglucose and an incubation time of 30 minutes at 37℃ with the peripheral blood mononuclear cells and T cell depleted mononuclear cells (monocytes and B lymphocytes) after stimulation by Con A, PHA, specific HBs Ag and PMA. In the microassay with peripheral blood mixed mononuclear cells, there was the significant (p<0.01) decrease of glucose uptake stimulated by Con A in the chronic carrier group as compared to the negative normal control. There was a significant (p<0.05) decrease of glucose uptake stimulated by PHA, HBs Ag and PMA in patients with chronic active hepatitis B. In order to analyze the effects of T lymphocytes on glucose uptake in T cell depleted mononuclear cells was investigated. There was a recovery from inhibition of glucose uptake induced by Con A which showed in the chronic carriers. It was revealed that there was recovery or a reverse of inhibition of glucose uptake induced by PHA or HBs Ag in patients with chronic active hepatitis. But there was no difference in glucose uptake by PMA stimulation between mixed mononuclear cells and T cell depleted mononuclear cells. In conclusion, it was suggested that by immunological activation, T cell mediated inhibitory function of cellular metabolism persisted in patients with chronic active hepatitis B, and inhibitory function of cellular metabolism by activation of Con A induced suppressor cells was maintained in chronic carriers.

급만성 간질환에서 혈청 LCAT 활성도와 HDL - C 치 변동

안관용(Kwan Young Ahn),허영상(Yeoung Sang Heo),이용기(Young Gi Lee),이남심(Nam Sim Lee),김대곤(Dae Ghon Kim),안득수(Deuk Su Ahn) 대한내과학회 1988 대한내과학회지 Vol.34 No.3

N/A Serum lecithin-cholesterol acyltransferase(LCAT) activity was assayed for evaluation of the hepatocellular dysfunction in acute and chronic liver disease. Furthermore the relationships between serum LCAT and each change of serum high density lipoprotein (HDL) level, cholesterol ester fraction, alanine aminotransferase (ALT), aspartate aminotransferase (AST) activity, or albumin level were comparativerly investigated, then the applicability to a index of liver function test was considered. As a result these following conclusions were obtained. LCAT activity in normal control was 26.5±5.7 ㎍/ ml/hr and LCAT activities were decresed in patients with acute and chronic liver disease, especially significantly (p<0.05) decreased in patients with drug induced hepatitis, chronic hepatitis, cirrhosis, and hepatoma. In correlation between serum HDL-C level and LCAT activity, serum LCAT activity trend to decrease with decreased HDL-C level but these is no significancy in patients with acute liver disease. On the contrary serum LCAT activity showed very significant (p=0.001) correlation (r=0.542) according to decreasing HDL-C level in patients with chronic liver disease. Between serum cholesterol ester fraction and LCAT activity. At first in patients with acute liver disease, serum LCAT activity decreased with significant (p<0.001) correlation (r=0.762) to cholesterol ester fraction, also very significant (p=0.002) correlation (r=0.512) was noted in patients with chronic liver disease. Between serum ALT, or AST and LCAT activity, No significant correlation was found in patients with acute and chronic liver disease. In serum albumin level and LCAT activity, no significant correlation was showed in patients with acute liver disease but very significant (p<0.001) correlation (r=0. 609) in patients with chronic liver disease. From above results, it was suggested that measurements of serum LCAT acitivity and cholesterol ester fraction may be better indices for liver function test in patients with acute and chronic liver disease, and HDL-C level be better index in patients with chronic liver disease.

B형 만성활동성간염 환자에서 Leukoryte Adherence Inhibition ( LAI ) 반응과 그와 관련된 Prostaglandin E2 ( PGE2 ) 직 변동

허영상(Yeong Sang Heo),안득수(Deuk Soo Ahn),김대곤(Dae Ghon Kim),안중기(Joong Ki Ahn),송석현(Suk Hyun Song),이남심(Nam Sim Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.1

N/A A leukocyte adherence inhibition (LAI) assay was performed for the evaluation of cellular immune dysfunction in patients with chronic active hepatitis (CAH) B and the effects of prostaglandin E, (PGE,), endogenous and exogenous immune modulator, on LAI reaction were investigated. 1) In patients with CAH, the non adherence index (LAI) was 18.8±1.7 (mean±SE)%, and there was a significant (p<0.001) decrease of LAI as compared to 48.8±1.6% in the antibody positive healthy control group. In chronic HBV carriers LAI was 6.2±1.5%. There was no significant difference in contrast to 8.8±1.3% in the negative normal control group. 2) Changes of the endogenous PGE2 level in the supernatant of the mononuclear cell mixture for LAI were measured and the differences of PGE, levels by specific antigen stiumlation (HBs) and by non specific antigen stimulation (OVA) were calculated. In CAH the difference was -11.4±3.6pg/ml and this was significantly decreased as compared to 19.3±6.3 pg/ml in the positive control group. In chronic HBV carriers the difference was 6.2±1.5 pg/ml and was as low as that in the negative normal control. 3) When only exogenous PGE2 was added to the mononuclear cell mixture, significantly (p<0.01) elevated NAI was observed as compared to the untreated control. On treatment with exogenous PGE, and indomethacin (PG inhibitor), or exogenous PGE, and LiCl (adenyl cyclase inhibitor), inhibitions of increasing NAI were observed. From the above results, in patients with CAH, LAI reflected cellular immunity was declined and this might be related to decreased release of endogenous PGE2 Furthermore, it was suggested that endogenous and exogenous PGE2 should accentuate LAI reaction.

당뇨병 환자에서 혈장 및 요중 N-acetyl-β-D-Glucosaminidase 활성도의 변동

이남심,김원호,김진홍,백홍선,고규영 의과학연구소 1987 全北醫大論文集 Vol.11 No.2

기능성 위장관 질환의 증상에 대한 Clebopride의 치료효과

이남심,안관용,안득수 전북대학교 의과학연구소 1985 全北醫大論文集 Vol.9 No.3

To evaluate the effect of clebopride on the symptoms of various functional G-Ⅰ disease, we observed improvement of the individual clinical symptoms and the side effects after administration of the drug in the 43 cases of patients with gastric ptosis, chronic gastritis, cascade stomach, iriitable bowel syndrome and alimentary tract neurosis, etc. in the department of Internal Medicine of Chonbuk National University Hospital from Mar. 1984 to Aug. 1984. Gastric empting times(G.E.T.'s, T½) of solid phase and serum gastrin levels were also measured with radioisotope(^99^mTc) and radioimmunoassay. The results were as follows ; 1) In the 43 cases of functional G-Ⅰ tract disease, symptomatic improvement were observed in cascade stomach(70%), chronic gastritis(65%), gastric ptosis(60%). 2) The G.E.T.(T½) of the solid phase measured by using the ^99^mTc isotope were within normal range(77.1sec) in 8 cases. There was no significant difference in the improvement of the symptoms between these 8 cases and normal control. 3) In thr group of the patients with severs synptoms in association with low gastrin levels, good to symtomatic improvement were observed in 85.3% effect. 4) Individual symptoms improved by the administratio of the drug included epigastric fullness and discomfort, indigestion, nausea, hunger pain, hypertonia and substernal discomfor. 5) Side effects of the drug observed were not specific, but drowsy, lassitude, mild headache, reappearance of pre-existing symptoms after withdrawal of the drug were observed.

폐에 발생한 과오종 1예

유관희,이남심,조광호,이양근 전북대학교 의과학연구소 1986 全北醫大論文集 Vol.10 No.4

The hamartoma is the most common benign tumor of the lung, but the incidence is very low. Most of hamartomas are revealed accidentally as coin lesion on routine chest x-ray because the are no symptoms usually, and the tumor frequently mimic clinically the more common lung tumors such as cancer. Recently, we have experienced on case of pulmonary hamartoma which was diagnosed with percutaneous needle lung biopsy and was confirmed with operation. Her postoperative course was uneventful. She was discharged in a good condition. (Key words : hamartoma, lung)

다발성 내분비종양 Type I 1 예

유관희,이남심,백홍선,오강렬,장동석 대한내과학회 1986 대한내과학회지 Vol.31 No.2

Multiple endocrine neoplasm type I includes hyperparathyroidism, pancreas islet cells and the pituitary tumors. Recently we had an opportunity to observe a patient with pituitary tumor, pancreas tumor, hyperparathyroidism. This 36 years old woman was admitted to Chonbuk University Hospital because of thirst, palpitation, weight loss and huge enlarged mass on anterior neck, On physical examination, mans like face, enlarged thyroid gland and hepatomegaly were noted. Hormonal study showed increased parathyroid hormone, T-3, T4,, growth hormone, cortisol, 17-ketosteroid and 17-hydroxycorticosteroid. On skull series and long bone study, thickening of skull vault with overpneumatization of frontal and maxillary sinuses, and prognatous jaw, marked ballooning of sella turcica, enlargement of terminal tuft of the distal phalangeal bones and spur like bony projection adjacent to the joint surface of distal phalangeal bones of both hand k foot were noted. On abdominal and brain C-T scanning, widening of sella turcica with enhanced mass in it and thickening of calvarium and prominent frontal sinus, hepatomegaly with lower densities, enlarged pancreas with vascular fat sign, and displacenent of small intestine and stomach to anterior were noted. Thyroid scanning showed huge enlargement of thyroid gland with uneven uptake. These laboratory and roentgenographic findings are suggestive of a rare case of MEN type I, We present this case with a review of literature.