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국내 폐 랑게르한스세포 조직구증(Pulmonary Langerhans Cell Histiocytosis)의 임상양상
김철 ( Chul Kim ),정성환 ( Sung Hwan Jeong ),심재정 ( Jae Jeong Shim ),차승익 ( Seung Ick Cha ),손춘희 ( Choon Hee Son ),정만표 ( Man Pyo Chung ),박혜윤 ( Hye Yoon Park ),김영환 ( Young Whan Kim ),박종선 ( Jong Sun Park ),어수택 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2
Background: Pulmonary Langerhans cell histiocytosis (PLCH) is characterized by a proliferation of Langerhans cells and this results in granulomas that involve multiple organs of the body. Because the incidence of PLCH is very low in Korea and worldwide, collecting the clinical data of patients with PLCH nationwide is needed to determine the clinical features of Korean patients with PLCH. Methods: The patients with PLCH confirmed by biopsy at any body site were included and the patients should have lung lesions present. A questionnaire that had items on the symptoms, lung function tests, the roentgenographic findings and the treatment was collected retrospectively at a Korean ILD Research Meeting. Results: A total of 56 cases were collected. The number of males and females was 48 and 8, respectively, and their median age was 43 years (range: 18∼67 years). The patients were current or ex-smokers in 79% of the cases. The most frequent symptom was coughing (39%), followed in decreasing order by dyspnea (38%), sputum (20%) and chest pain (20%). Pneumothorax was observed in 16 (29%) patients. Lung function tests showed a normal, restrictive, mixed or obstructive pattern in 26 (61%), 7 (16%), 7 (16%) and 3 patients (7%), respectively. Nodular-cystic lesion was most frequently observed in 59% of the patients on HRCT. The lung lesions were located in the middle and upper lobes in almost the cases. The median follow-up period was 90 months (range: 1∼180 months) and only two patients died during this period. Conclusion: This study provides a national survey of the patients with PLCH during a long follow-up period.
대구 경북지역에서 진단된 노령자 폐암의 임상적 특징과 예후
김현숙 ( Hyun Sook Kim ),현대성 ( Dae Sung Hyun ),김경찬 ( Kyung Chan Kim ),이상채 ( Sang Chae Lee ),정태훈 ( Tae Hoon Jung ),박재용 ( Jae Yong Park ),김창호 ( Chang Ho Kim ),차승익 ( Seung Ick Cha ),이관호 ( Kwan Ho Lee ),정진홍 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.1
연구배경: 폐암은 우리나라 암 사망원인 질환의 가장 높은 비율을 차지하는 질환으로 특히 노령 인구에서 증가하는 추세이다. 그러나 노령의 폐암 환자는 동반된 질환, 노령에 따른 장기 기능의 저하 등의 이유로 적절한 치료를 받지못하는 경우가 많다. 이에 70세 이상의 노령 폐암 환자의 임상적 특징과 치료에 따른 생존기간 등을 알아보고자 한다. 방법: 2005년 1월부터 2005년 12월까지 대구, 경북지역에 소재하고 있는 대학병원 및 종합병원(경북대학병원, 구미 순천향병원, 대구가톨릭대학병원, 대구파티마병원, 동산의료원, 영남대학병원)에서 세포학적 혹은 조직학적으로 원발성 폐암을 진단받은 706명의 환자들을 70세 이상 환자군과 70세 미만 환자군으로 나누어 후향적으로 연구하였다. 결과: 전체 환자 중 70세 이상의 환자는273명(38.7%)이었다. 70세 이상의 환자는 70세 미만보다 호흡곤란의 증상이 많았으며(p<0.001), 만성폐쇄성폐질환의 빈도가 높았고(p<0.001), 활동도가 좋은 경우가 적었다(p<0.001). 비소세포폐암 환자의 중앙생존기간은 70세 미만의 환자와 70세 이상의 환자에서 유의한 차이를 보였지만(962일 vs 298일, p=0.001), 한 가지라도 치료를 받았던 환자들을 대상으로 했을 때는 두 군간에 의미 있는 차이가 없었다(1,109일 vs 708일, p=0.14). 결론: 70세 이상의 비소세포폐암 환자에서 환자의 활동도 등을 고려하여 적극적인 치료를 시행하는 것이 바람직할 것으로 생각된다. Background: Lung cancer is the leading cause of cancer death in South Korea since the year 2000 and it is more common in elderly patients, with a peak incidence at around 70∼80 years of age. However, these elderly patients receive treatment less often than do the younger patients because of organ dysfunction related to their age and their comorbidities, and they show poor tolerance to chemotherapy. The aims of this study were to analyze the clinical characteristics and treatment-related survival of elderly patients with lung cancer. Methods: In this retrospective study, we analyzed the clinical data of 706 lung cancer patients who were diagnosed at hospitals in Daegu and Gyeongsangbukdo from January 2005 to December 2005. We compared the clinical characteristics and outcomes of the patients who were aged 70 years and older (elderly patients) with those clinical characteristics and outcomes of the younger individuals. Results: The median age of the patients was 68 years (from 29 to 93) and the elderly patients were 38.7% (n=273) of all the study``s patients. Squamous cell carcinoma was the most common type of lung cancer in both the elderly and younger patient groups. Elderly patients had more symptoms of dyspnea and chronic obstructive pulmonary disease (COPD) than the younger patients (p<0.001 and p<0.001, respectively). A good performance status (ECOG 0-1) was less common for the elderly patients (p<0.001). The median survival of the non-small cell lung cancer (NSCLC) patients was significantly higher in the younger patient group than in the elderly patient group (962 days vs 298 days, respectively, p=0.001). However, the median survival of the NSCLC patients who received any treatment showed no significant difference between the younger patient group and the elderly patient group (1,109 days vs 708 days, respectively, p=0.14). Conclusion: Our data showed that appropriate treatment for selected elderly patients improved the survival of patients with NSCLC. Therefore, elderly NSCLC patients with a good performance status should be encouraged to receive appropriate treatment.
소세포폐암에서 Multidrug Resistance-1 유전자의 다형성과 Etoposide-cisplatin 항암화학요법 반응의 관계
손지웅 ( Ji Woong Sohn ),이신엽 ( Shin Yup Lee ),이수정 ( Su Jung Lee ),전효성 ( Hyo Sung Jeon ),이재희 ( Jae Hee Lee ),박재형 ( Jae Hyung Park ),김은진 ( Eun Jin Kim ),차승익 ( Seung Ick Cha ),김창호 ( Chang Ho Kim ),강영모 ( You 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.2
배경 및 목적 : Multidrug Resistance-1 (MDR1) 유전자는 다약제내성에 관여하는 P-glycoprotein을 암호화한다. MDR1 유전자의 다형성은 P-glycoprotein의 발현과 기능의 차이를 일으켜 항암화학요법 반응에 영향을 미칠 수 있을 것이다. 저자들은 소세포폐암 환자에서 MDR1 유전자의 다형성과 일배체형에 따른 항암화학요법에 대한 반응을 조사하였다. 대상 및 방법 : 경북대학병원에서 병리적으로 소세포폐암으로 진단받고
한국인에서 Myeloperoxidase (MPO) 유전자의 -463G>A 다형성과 원발성 폐암의 위험도
박재형 ( Jae Hyoung Park ),박정민 ( Jung Min Park ),김은진 ( Eun Jin Kim ),윤석진 ( Suk Jin Yun ),이승준 ( Sung Jun Lee ),차승익 ( Sung Ick Cha ),이응배 ( Eung Bae Lee ),김창호 ( Chang Ho Kim ),감신 ( Sin Kam ),김동선 ( Dong Sun 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.59 No.2
만성폐쇄성폐질환에 폐렴과 급성악화로 입원한 환자의 임상적 특성 및 예후 비교
정승욱 ( Seung Wook Jeong ),이재희 ( Jae Hee Lee ),최금주 ( Keum Ju Choi ),황보엽 ( Bo Yup Hwang ),김이영 ( Yi Young Kim ),이윤지 ( Yun Ji Lee ),윤원경 ( Won Kyung Yoon ),김민 ( Min Kim ),차승익 ( Sung Ick Cha ),박재용 ( Jae Yong 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.1
Background: Data comparing the clinical characteristics and outcomes in chronic obstructive pulmonary disease (COPD) patients hospitalized with community-acquired pneumonia (CAP-COPD) and acute exacerbation (AE-COPD) are very limited. Methods: Eighty episodes of hospitalization in 65 CAP-COPD patients, and 111 episodes of hospitalization in 82 AE-COPD patients were included in this study. The baseline characteristics, clinical presentations, potential bacterial pathogens and clinical outcomes in these patients were retrospectively reviewed and compared. Results: No significant differences were found between the two groups in parameters related to COPD and co-morbidities, except a higher rate of male among CAP-COPD patients. Clinical presentations by symptoms and laboratory findings on admission were significantly more severe in CAP-COPD patients, who showed higher rates of fever and crepitation, but less wheezing than AE-COPD patients. S. pneumoniae and P. aeruginosae were the most common bacterial pathogens in both groups. With no difference in the overall hospital mortality between both groups, the mean length of hospital stay was significantly longer in the CAP-COPD patients than in AE-COPD patients (15.3 vs. 9.8 days, respectively, p<0.01). Additional analysis on CAP-COPD patients showed that systemic steroid use did not influence the length of hospital stay. Conclusion: Although there was no significant difference in bacterial pathogens and overall hospital mortality between the two groups, CAP-COPD patients had more severe clinical symptoms and laboratory findings at presentation, and longer hospital stay than AE-COPD patients.
한국인에서 DNMT3b의 39179G>T 다형성과 원발성 폐암의 위험도
이신엽,이재희,박재형,김은진,이수정,전효성,손지웅,차승익,김창호,정태훈,박재용 대한내과학회 2004 대한내과학회지 Vol.66 No.6
목적 : DNA 메틸화는 후생유전적인 변형의주요 기전이며 암 발생에서 중요한 역할을 한다. 유전자 촉진자의 메틸화는 유전자 발현의 중요한 조절기전으로 종양억제유전자 촉진자의 과메틸화는 종양억제유전자의 불활성화를 초래한다. 저자들은 한국인에서 de novo 메틸화에 관여하는 유전자인 DNMT3b의 39179G>T 다형성에 따른 폐암의 위험도를 조사하였다. 방법 : 경북대학교병원 호흡기내과에서 병리학적으로 폐암으로 진단된 392에(편평상피암 194예, 선암 128예, 대세포암 16예, 소세포암 54예)를 대상으로 하였으며 대조군은 경북대학교병원 건강검진센타를 방문한 건강인 가운데 환자군과 연령 및 성을 match하여 무작위로 선택한 391명을 대상으로 하였다. 시료는 전혈 5cc에서 DNA를 추출하고 PCR-RELP법을 통해 DNMT3b 유전자 다형성을 조사하였다. 결과 : DNMT3b 39179G>T의 유전자형은 환자군은 GG형, GT형, TT형이 각각 0.8%, 19.9%, 79.3%였고, 대조군은 각각 1.5%, 25.1%, 73.4%로 유의한 차이는 없었다. TT형에 대한 GT+GG형의 폐암 대응비(OR)는 0.71(95% CI\0.51∼1.00, p=0.05)이었다. 폐암을 조직형에 따라 구분한 경우 TT형에 대한 GT+GG형의 선암 대응비는 0.46 (95% CI=0.26∼0.80, p=0.006)으로 통계적으로 유의하게 낮았다. 선암 환자군과 대조군을 연령, 성, 흡연력 및 흡연양(흡연 갑-년)으로 구분하여 TT형에 대한 GT+GG형의 선암 대응비를 구하였을 때 61세 이상 (OR=0.23, 95% CI=0.09∼0.58, p=0.02), 35갑-년 이상(OR=0.34, 95% CI=0.13∼0.88, p=0.028)의 경우에서 유의하게 낮았다. 결론 : DNMT3b 유전자의 39179G>T 다형성은 한국인에서 선암의 위험도를 결정하는 유전적 인자 가운데 하나로 생각된다. Background : DNA methylation is the main mechanism of epigenetic modification of genes and plays an important role in carcinogenesis. The methylation of promoter can inactivate the tumor suppressor gene by repression of transcription. We investigated the relationship between the 39179G>T (-579bp from exon 1B) polymorphism in DNMT3b gene, which is involved in de novo methylation, and the risk of primary lung cancer in Koreans. Methods : The DNMT3b 39179G>T genotypes were determined using PCR-RFLP method in 392 primary lung cancer patients and 391 healthy controls who were frequency (1:1) matched based on age and sex. Results : although the frequencies of GG, GT, TT genotypes among cases (0.8%, 19.9%, 79.3%, respectively) were not significantly different from those among controls (1.5%, 25.1%, 73.4%, respectively) the frequency of wild-type G allele among cases was significantly different from that of controls (14.1% vs 10.7%, p=0.05). The combined GT and GG genotype was associated with a significantly decreased risk of lung cancer [adjusted odds ratio (OR)=0.71, 95% confidence interval (CI)=0.51∼1.00, p=0.05] when TT genotype was used as reference. When the lung cancers were categorized by tumor higtology, the combined GT and GG genotype was associated with a significantly decreased risk of adenocarcinoma (adjusted OR=0.46, 95% CI=0.26∼0.80, p=0.006). In adenocarcinoma, the decreased risk of the combined GT and GG genotype was statistically significant in older patients (≥61 years, adjusted OR=0.23, 95% CI=0.09∼0.58, p=0.002) and in heavier smokers(≥35 pack years, adjusted OR=0.34, 95% CI=0.13∼0.88, p=0.028) in stratification analyses. Conclusion : DNMT3b 39179G>T polymorphism may be a genetic determinant of lung cancer, especially adenocarcinoma in Koreans.