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제초제 Paraquat 중독환자에서 vitamin C 투여가 plasma total antioxidant capacity에 미치는 영향
홍세용(Sae Yong Hong),은수훈(Soo whon Eun),한찬희(Chan Hee Han),윤영근(Yung Kun Yoon),양동호(Dong Ho Yang),조성란(Suk Ran Cho),김휘준(Whi Jun Kim),한찬수(Chan Soo Han),박영현(Yung Hyun Park) 대한내과학회 2000 대한내과학회지 Vol.58 No.6
Background : This study was undertaken to evaluate the effect of plasma concentration of vitamin C is on the plasma total antioxidant status(TAS) in patients with paraquat intoxication. Methods : As a preliminary research for this study, we measured plasma vitamin C levels, uric acid, TAS, and bilirubin from 100 healthy Koreans aged between 25-55 years. Various concentrations of vitamin C were constructed in vitro with normal pooled plasma between 1mg/dl and 100 mg/dL and TAS was measured. Both vitamin C concentrations and TAS were measured from the blood samples, taken at 0.5, 1, 2, 3, 5, 7, 9 hours after a bolus injection of vitamin C(50 mg/kg) from 7 volunteers who had been recruited from medical students at our hospital. Various amounts of vitamin C were given to 10 patients with paraquat intoxication for 5 consecutive days in the morning : first day ; 100 mg single dose, second day; 500 mg single dose, third day ; 1,000 mg single dose, fourth day : 3,000 mg single dose, and fifth day ; 3,000 mg three times every 8 hours. Results : The mean value of TAS and vitamin C measured in 100 healthy Korean adults was 2.22 ±0.16 mmol/L and 0.48±0.10 mg/dL. Age and sex do not influence these levels(p>0.05, data are not presented). A direct correlation was observed between TAS and vitamin C concentrations of 1 mg/dL and 100 mg/dL both in vivo and vitro. As the vitamin C concentration was increased gradually 5 consecutive days, the TAS values increased in the same way as follows : first day(vitamin C 100 mg) 2.26±0.98 mmol/L, second day(vitamin C 500 mg) 2.76±0.78 mmol/L, third day(vitamin C 1.000 mg) 2.81±0.68 mmol/L, fourth day(vitamin C 3.000 mg) 3.18 mmol/L. On the fifth day when 3.000 mg of vitamin C was given by bolus intravenous injection 3 times(every 8 hours for a day), the TAS values measured one hour after the injection was 3.58±0.37 mmol/L. Conclusion : When vitamin C is used as a free radical scavenger, the loading dose and maintenance dose should be around 2278 mg intravenous bolus and 146 mg/hour. High doses of vitamin C are effective and safe for patients with acute paraquat intoxication.(Korean J Med 58:666-674, 2000)
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Extended Broad -Spectrum β-lactamase 생성 Escherichia coli와 Klebsiella pneumoniae
이창숙,조성란,정윤섭,이경원,권오헌 대한감염학회 1994 감염 Vol.26 No.4
목적:최근 그람음성 간균에 강력한 항균제인 제 3세대 cephalosporin, moxalactam, monobactam등에 대한 내성균주의 증가가 보고되고 있어서, E. coli와 K.pneumoniae의 cefotaxime에 대한 감수성 추이를 분석하고, 그 내성 원인이 extended broad-spectrum β-lactamase(EBS-Bla)에 의한 것인지를 조사하고자 하였다. 방법: 1986년-1993년에 세브란스병원 외래 및 입원환자에서 분리된 세균 중 E. coli와 K.pneumoniae의 cefotaxime에 대한 NCCLS 디스크확산법의 감수성 시험 결과를 분석하였고, 그 내성 원인이 EBS-Bla에 의한 것인지를 조사하고자 cefotaxime에 내성인 균주를 대상으로 cefotaxime과 amoxicillin/clavulanic acid를 이용한 double disk synergy 시험을 하였다. 결과: 지난 8년간 세브란스병원에서 분리된 E.coli와 K. pneumoniae 중에는 cefotaxime에 내성인 균주의 비율이 각각 1%에서 11%로, 6%에서 30%로 점차 증가하였고, cefotaxime에 내성인 균주는 다른 항균제에서도 내성인 균주가 많았으며, 이런 균주들은 외래환자의 검체에서 보다는 병실, 특히 중환자실 환자의 검체에서 많이 분리되었다. EBS-Bla생성균주가 cefotaxime에 감수성인 E. coli와 K. pneumoniae 중에는 없었으나, 중간이나 내성인 균주 중에는 각각 69%와 76%였다. 결론: 이 성적으로 미루어, 우리나라에서 분리되는 E. coli와 K. pneumoniae 중에는 cefotaxime에 내성인 균주의 비율이 점차 증가하고 있고, 그 중 EBS-Bla 생성균주가 많아서, 이들 EBS-Bla 생성균주에 대한 정확한 성상을 규명하여, 이런 내성균주의 전파방지 및 치료대책이 마련되어야 한다는 결론을 얻었다. Background: Third generation cephalosporins were very active against gram-negative bacilli, however increased resistance to these drugs was noted recently, and this study was to determine the prevalence of cefotaxime resistance and extended broad-spectrum β-lactamase(EBS-Bla) in E. coli and K. pneumoniae. Methods: Cefotaxime resistance was analyzed from the data obtained by NCCLS disk diffusion method during 1986 and 1993 at Severance hospital. One hundred eighty-seven strains (79 of E. coli and 108 of K.pneumoniae) isolated in 1994, were examined for EBS-Bla by double disk synergy test using cefotaxime and amoxicillin/clavulanic acid disks. Results: Cefotaxime-resistance rates increased from 1% to 11% in E. coli and from 6% to 30% in K. pneumoniae respectively for the recent 8 years. The isolates from ICU patients showed higher resistance rates than those from general wards or outpatient clinics. Among those which showed intermediate or resistant to cefotaxime, 69% of E. coli and 76% of K.pneumoniae isolate were EBS-Bla producers. Conclusions: The cefotaxime-resistant strians of E. coli and K.pneumoniae are increasing in proportion, EBS-Bla-producing strains are common among them and it is needed to investigate the detailed properties of EBS-Bla to make the guidelines for the therapeutic regimens and the prevention of transmission of EBS-Bla-producing strains.
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