의학강좌:개원의를 위한 모범처방 : 전신성 홍반성 루푸스의 진단과 치료

최진정 ( Jin Jung Choi ) 대한내과학회 2010 대한내과학회지 Vol.78 No.4

류마티스 관절염에서 제 2형 콜라겐에 대한 T림프구 증식반응과 염증지표 및 관절손상과의 관계

최진정 ( Jin Jung Choi ),김완욱 ( Wan Uk Kim ),조미라 ( Mi La Cho ),이명수 ( Myeung Su Lee ),서영일 ( Young Il Seo ),민도준 ( Do June Min ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),김기준 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.2

Objective: To investigate the role of T cell responses to type II collagen (CII) in disease progression in rheumatoid arthritis (RA). Methods: T cell proliferative responses to bovine CII by peripheral blood mononuclear cells (PBMC) from early RA patients (duration <5 years) were assayed by mixed lymphocyte culture. Clinical and laboratory variables including erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were examined at the time of sampling. Radiographic damage on hand X-rays was evaluated by the method of Steinbrocker and Sharp. Results: In a cross-sectional study, patients (n=22) with positive T cell responses (stimulation index: SI≥2) had higher levels of CRP and ESR than those (n=21) not showing T cell responses. The number of damaged joints (by Steinbrocker`s method) and damaged joint scores (by Sharp`s method) were significantly higher in patients with positive T cell responses than in those without. The joint space narrowing scores correlated well with T cell responsiveness to CII. Patients (n=15) with both positive T cell responses and RA-susceptible allotypes, HLA-DR1 or DR4, had greater damaged joint scores than the rest of patients (n=24). Conclusion: T cell proliferative responses to CII are associated with inflammatory activity and radiographic severity in RA. Our data suggest that CII reactive T cells may play an important role in the pathogenic process of joint damage.

Streptozotocin 에 의해 유도된 당뇨병성 통증시 Nitric Oxide 의 역할

최진정(Jin Jung Choi),전병화(Byeong Hwa Joen),윤석화(Seok Hwa Yoon),이영호(Young Ho Lee),김무강(Moo Gang Kim),김광진(Kwang Jin Kim) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1

N/A Background: It is controversial whether the change in nitric oxide (NO) expression in the dorsal root ganglia (DRG) may be responsible for developtment and/or maintenance of painful diabetic neuropathy. The aim of this study was to clarify the role of NO in the pathogenesis of painful diabetic neuropathy. Methods: The effect of L-nitroargine methylester (L-NAME) or sodium nitroprusside (SNP) on allodynia was measured in streptozotocin (STZ)-induced diabetic rats. NO concentration was measured in the cerebrospinal fluid (CSF) and plasma of the diabetic rats. NADPH-diaphorase (NADPH-d) histochemistry was performed on the DRG and spinal cords of the STZ-induced diabetic rats. Results: L-NAME, an inhibitor of nitric oxide synthase, alleviated allodynia, while SNP, a nitric oxide donor, aggravated allodynia in diabetic rats. Plasma NO level in the diabetic rats was significantly de- creased compared with control rats. NO level in the CSF of diabetic rats did not differ from that of the control rats. NADPH-d positive cells were decreased in the DRG of diabetic rats. However, NADPH-d histochemistry in the diabetic spinal cord was not different from that of the control rats. Conclusions: Downregulation of NO expression in the diabetic rats may not be causally related to the development and/or maintenance of painful diabetic neuropathy.

Acquired Susceptibility to Autoimmune diseases in patients with Escherichia coli (E.coli) infection

이현주,한만용,최진정 대한내과학회 2022 대한내과학회 추계학술발표논문집 Vol.2022 No.2

패혈증을 동반한 감염성 좌심방 점액종 1 예

김윤자,김병모,김광희,한승수,최진정,서용희,이두용 대한내과학회 1987 대한내과학회지 Vol.33 No.3

An infected left atrial myxoma is very rare and several cases are reported since 1956. A 50-year-old female patient was admitted to the department of internal medicine of Hanil Hospital because of intermittent fever and dyspnea after dental extraction without evidence of the systemic emboli. Echocardiography showed a large left atrial mass moving between left atrium and left ventricle during systolic phase and distolic phase. Streptococcus viridans was seen by routine blood culture. Operation was done and the myxoma in the left atrium was confirmed. Bacterial myxoma was demonstrated by gross and microscopical examination. So, we presented this case with a review of literature.

전신홍반루푸스 환자에서 혈청 Osteoprotegerin 증가

신용주,홍경희,유승아,최진정,김완욱,조철수 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Objective: To determine the serum levels of soluble osteoprotegerin (OPG), decoy receptor of receptor activator of nuclear factor kB ligand (RANKL), in patients with systemic lupus erythematosus (SLE) and to assess the its relationships with certain clinical manifestations. Methods: Serum levels of OPG in 60 patients with SLE and 30 healthy controls were determined by enzyme-linked immunosorbent assay. At the time of serum sampling, clinical manifestations and lupus disease activity index (SLEDAI) were assessed. Results: Serum levels of OPG in 60 patients with SLE were significantly higher than in 30 healthy controls (1,058±699 versus 806±113 pg/mL, p=0.008). Patients with active disease had higher levels of OPG levels than those with inactive disease (1,355±837 versus 760±113 pg/mL, p<0.001). Serum OPG levels correlated with SLEDAI (γ=0.588, p<0.0001), anti-dsDNA antibody titers (γ=0.337, p=0.009) and serum MCP-1 levels (γ=0.485, p<0.0001). In particular, serum OPG levels were found to be significantly increased in patients with neurological manifestation compared to those without (1,504±1,152 versus 918±376 pg/mL, p=0.004). Conclusion: The results of this study suggest that serum OPG levels are increased in patients with SLE. Serum OPG has a role as marker for disease activity and its increased levels reflect the involvement of neurological manifestation.

복수를 주 증상으로 발현된 전신성 홍반성 루푸스 1예와 문헌고찰

추지민,강산하,송지현,한규현,양태영,최진정,홍성표 대한내과학회 2013 대한내과학회 추계학술발표논문집 Vol.2013 No.1

국내에서 보고된 문헌에 따르면 복수의 원인으로 간경변증이 60%, 악성 종양 26%, 결핵 7%로 나타났다. 신기능 상실 및 심인성 질환을 포함한 기타 경우가 8%로 이중 자가면역질환에 의한 복수는 그 발생률이 미미하다. 저자들은 복수를 포함한 위장관 증상이 첫 임상증상으로 나타난 전신성 홍반성 루푸스 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 환자는 28세 여성으로 내원 1주일 전부터 시작된 구토, 설사, 복통, 복부팽만으로 타 의료기관에 입원하던 중 증세 악화되어 전원 되었다. 구강궤양 및 복부 팽만, 복부 압통/반발통 있었고 복부 전산화 단층 사진에서는 위, 소장 및 대장에 걸쳐 장벽비후가 있었으며 대량의 복수가 확인되었다. 복수 천자를 시행하였고, 백혈구 106/㎣ (seg 8%), ADA 16.1 IU/U이었다. 혈청-복수 알부민 농도차는 0.6 g/dL이었고, CA-125 125.1 U/mL (정상범위 0-35)로 상승하여 골반자기공명 영상 시행하였으나 이상소견은 없었다. 이후 자가면역 질환의 감별 위해 시행한 검사상 혈청 보체 C3 50 mg/dL (90-180)로 감소되어 있었고, 항핵항체 양성(speckled pattern, 1:320), 항Sm항체 양성(1.1), 항dsDNA항체 양성(117 IU/mL)이었다. 전신성 홍반성 루푸스로 진단하여 스테로이드로 치료 시작하였고 이후 위장관 증상 및 복수는 호전되어 퇴원, 현재 외래 추적 관찰 중에 있다. 루푸스 환자의 8-11%에서 복수가 발견되며, 신증후군, 단백소실성 창자병증, 협착성 심낭염, 심부전, Budd-Chiari 증후군, 내장의 경색, 복막염 등이 원인이다. 초기 임상 증상이 복수로 나타난 예는 드물어 국내에서는 총 4건 보고되었다. 부검에서는 약 63%의 환자에서 루푸스 복막염이 확인되나 임상적으로는 10%에서 진단된다. 루푸스 복막염에 의한 복수는 급성이나 만성적으로 발생할 수 있으며, 통증을 동반하기도 한다. 루푸스 복막염에서는 자가면역 항체들이 면역 복합체를 이루어 복막에 침착하고 이로 인해 염증반응 및 괴사가 발생하여 복막조직이 손상된다. 또한 복막 혈관 및 복부 장기의 장막에 혈관염이 유발되어 혈관투과성이 저하되어 단백질이 풍부한 삼출성의 복수가 발생하게 된다. 복수의 흔한 질환들이 배제되고 전산화 단층 사진에서 복수와 함께 장의 광범위 부종이 있는 경우 의심의 단서가 될 수 있기에 불명확한 원인의 복수를 감별 진단하는 질환에 루푸스도 염두에 두어야 하겠다.

복수를 주 증상으로 발현된 전신 홍반 루푸스

추지민,강산하,송지현,한규현,신선영,양태영,최진정,홍성표 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown etiology and is characterized by presence of variable pathogenic auto-antibodies and multiple organ involvement. Serositis is common in SLE, but peritoneal involvement is relatively rare. This is a case report of 28-year-old female who initially presented with abdominal pain and ascites. After ruling out many other possibilities such as liver cirrhosis, neoplasm, and infectious etiologies, we confirmed SLE with clinical features, serologic tests and radiological findings. To conclude, her abdominal pain and ascites were caused by lupus peritonitis. After administration of corticosteroid therapy, her symptoms fairly improved.

Characterization of antiphospholipid antibodies in chronic hepatitis B infection

허지영,Dae Young Yi,황성규,최진정,강명서 대한혈액학회 2011 Blood Research Vol.46 No.1

Background :Many infections are associated with antiphospholipid antibodies (aPLs). The purpose of this study was to investigate the prevalence, persistence, clinical significance, and characteristics of aPLs in hepatitis B virus (HBV)-infected patients. Methods :This study included 143 patients with HBV infection and 32 healthy individuals as controls. The presence of anticardiolipin antibodies (aCL Ab), anti-b2-glycoprotein I antibodies (b2GPI Ab), and lupus anticoagulant (LA) was assessed. Results :The total prevalence of aPLs in HBV-infected patients was 12.6% (18 of 143). Of these 18 patients, 15 had low to medium titers of aCL Ab (10 with IgM, 4 with IgG, and 1 with both isotypes). b2GPI Ab and LA were detected in 3 (2.1%) and 2 (1.4%) patients with HBV infection, respectively. In follow-up specimens from 14 patients with elevated levels of aCL Ab or b2GPI Ab, 10 (71.4%) showed the persistent presence of aPLs. No clinical manifestations related to aPLs were identified. Conclusion :In HBV-infected patients, the most frequently detected antiphospholipid antibodies were IgM aCL Ab, which have a weak association with the clinical manifestations of APS. Unlike the transient presence reported for other infection-associated aPLs, most aPLs were persistently detected over a 12-week period in patients with HBV infection.

항인지질 항체 증후군 환자의 혈청 내 Monocyte Chemoattractant Protein-1의 증가

박종서 ( Jong Seo Park ),박경수 ( Kyung Su Park ),최진정 ( Jin Jung Choi ),윤종현 ( Jong Hyeon Yoon ),김용주 ( Yong Ju Kim ),김완욱 ( Wan Uk Kim ),민도준 ( Do Jun Min ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 ( Ho 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Objective: To determine the association of serum monocyte chemoattractant protein-1 (MCP-1) concentration and clinical variables of antiphospholipid syndrome (APS). Methods: We investigated the serum concentration of MCP-1 in systemic lupus erythematosus (SLE) patients by ELISA. The clinical features of APS were evaluated in SLE patients, and anticardiolipin antibody (aCL) was determined at the time of blood sampling. Results: Serum MCP-1 levels (median [range]) in 76 SLE patients were significantly higher than those in 99 healthy controls (192 pg/ml [116, 560] versus 91 pg/ml [26~251], p<0.001). Patients with APS had higher levels of serum MCP-1 than those without (p=0.013). Seum MCP-1 levels were significantly higher in patients with thrombosis and recurrent fetal loss than those without. Among APS patients, patients with longer disease duration (>3 years) had higher levels of MCP-1 than those without (263 pg/ml [166,534] versus 196 pg/ml [116,322], P=0.023). Furthermore, serum MCP-1 levels correlated well with IgG aCL titers (r=0.62, p<0.001). Conclusion: Serum MCP-1 levels were elevated in SLE patients, particularly in those with APS, and correlated well with titers of IgG aCL and thrombosis. Our data suggest that increased MCP-1 may play a critical role in the development of APS in SLE patients.