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원발성 간암환자의 간염 바이러스 감염유형에 따른 임상양상 및 예후
한광협(Kwang Hyub Han),문희용(Hee Yong Moon),김범수(Bum Soo Kim),백용한(Yong Han Paik),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한내과학회 2001 대한내과학회지 Vol.60 No.1
Background : Hepatocellular carcinoma(HCC) is one of the important causes of cancer-related mortality and morbidity in East Asia, including Korea. Most of the hepatocellular carcinoma in Korea are associated with hepatitis B and C virus infection. The clinical characteristics and prognosis of the patients with HCC were evaluated in relation to the type of hepatitis virus. Methods : A retrospective analysis of the clinical data and survival rate was done in 603 patients(M:F=4.9:1, mean age; 54.2 years) who were admitted to Yonsei medical center from April, 1991 through April, 1994. Results : Among 603 patients, tests for HBsAg and anti-HCV was done simultaneously in 455 patients. Out of the 455 HCC patients, 303 patients (66.6%) were classified as Group B(HBsAg+ve, anti-HCV-ve), 102 patients (22.4%) were classified as Group C (HBsAg-ve, anti-HCV+ve), 45 patients (9.9%) were classified as Group non-BC (HBsAg-ve, anti-HCV-ve), and 5 patients (1.1%) were classified as Group BC (HBsAg+ve, anti-HCV+ve). The mean age of the patients in Group C was older than that of Group B (64.9 vs. 51.3 yr) (p<0.05). Liver cirrhosis was frequently noticed in Group C than Group B (84.3 vs. 68.0%) (p<0.05). The number of the patients whose serum FP level was elevated (>400 ng/mL) was significantly higher in Group B than in Group C (70.0 vs. 52.0%)(p<0.05). According to the gross type, nodular type was more common in Group C than in Group B(72.0 vs. 38.1%) (p<0.01). The incidence of portal vein thrombosis was significantly lower in Group C compared with that in Group B (16.7 vs. 31.4%)(p<0.05). The number of the patients whose tumor size of less than 5 cm was significantly higher in Group C than in Group B (35.3 vs. 17.8%) (p<0.05). Using multivariant analysis, independent prognostic factors were found to be Child grading, FP level, size of the tumor, gross type, and the type of hepatitis virus. The cumulative survival rate of 1, 2, and 3 year in each Group was 31.5%, 17.5%, and 10.8%, respectively in Group B, and 55.7%, 30.2%, and 21.6%, respectively in Group C. The median duration of survival of Group B was significantly shorter than that of Group C(5.0 vs. 13 months)(p<0.05). Conclusion : About 90 % of HCC was associated with hepatitis B or C viral infection in Korea. Hepatitis B virus associated HCC had poorer prognosis compared with hepatitis C virus associated HCC in Korea.(Korean J Med 60:22-31, 2001)
한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2(S)
Liver fibrosis is the results of chronic injury and a similar feature of all chronic liver diseases. Beyond being a marker of injury, it appears to play a direct role in the pathogenesis of hepatocellular dysfunction and portal hypertension. Furthermore, the prognosis and treatment plans of chronic liver diseases strongly depend on the degree of liver fibrosis. Thus, from a clinical management viewpoint, accurately assessing the extent and progression of fibrosis is important and clinical interests are being raised in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative noninvasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new noninvasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few decades notably with the appearance of several serological markers, which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation and influences of extrahepatic conditions make it less accessible to clinicians. Recently, transient elastography using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally noninvasive and reproducible and gives an immediate result with low intra- and inter-observer variability. Here, we review the currently available data on transient elastography for assessing liver fibrosis.
한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5
Progressive liver fibrosis is a similar feature of all chronic liver diseases and eventually develops liver cirrhosis. The prognosis and treatment plans of chronic liver diseases depend strongly on the degree of liver fibrosis. These facts raise clinical interests in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative non-invasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new non-invasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few years notably with the appearance of several serological markers which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation, cost problems, and influences of extrahepatic conditions make it less accessible to clinicians. Recently, liver stiffness measurement using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally non-invasive and reproducible and gives an immediate result without intra- and inter-observer variability. Its clinical use in comparison with liver biopsy and several available serologic markers is now intensively being investigated. Here, we review the currently available data on FibroScan(R).(Korean J Med 74:463-471, 2008)
간세포암 환자에서 간동맥 화학색전술 후 발생한 급성 간부전의 위험인자
백용한 ( Yong Han Paik ),전재윤 ( Chae Yoon Chon ),조재용 ( Jae Yong Cho ),안상훈 ( Sang Hoon Ahn ),이관식 ( Kwan Sik Lee ),한광협 ( Kwang Hyub Han ),문영명 ( Young Myoung Moon ),이도연 ( Do Yeon Lee ),이종태 ( Jong Tae Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.6
Background : Transcatheter Arterial Chemoembolization (TACE) has been the most widely used treatment for advanced hepatocellular carcinoma (HCC) in Korea. However a number of complications associated with TACE have been reported in many studies. Acute hepatic failure is one of the most serious complications of TACE, because of its grave prognosis. The aim of this study was to investigate the risk factors associated with acute hepatic failure after TACE. Methods : A total of 263 TACE procedures performed in 163 patients with HCC were included in this study. We reviewed retrospectively the complications that occurred after TACE and analysed the risk factors associated with acute hepatic failure after TACE. Results : Complications included post-embolization syndrome (187 cases), temporary hepatic insufficiency (90 cases), acute hepatic failure (13 cases), hepatic arterial injury (9 cases), intrahepatic biloma (4 cases), liver infarction (2 cases), liver abscess (2 cases), tumor rupture (1 cases), gastrointestinal bleeding (14 cases), septicemia (3 cases), gall bladder infarction (2 cases), thrombocytopenia (2 cases), gastric perforation (1 cases), pneumonia (1 cases), urticaria (1 cases), sensorineural hearing loss (1 cases), femoral artery aneurysm (1 cases). According to univariate analysis, risk factors associated with acute hapatic failure after TACE were serum bilirubin and albumin, prothrombin time, dose of adriamycin, pre-TACE Child-Pugh class, tumor size, diffuse tumor type, portal vein thrombosis and TNM stage. Multivariate analysis revealed that serum bilirubin {odd ratio=3.86 (95% CI: 1.59-9.32)}, and diffuse tumor type {odd ratio=5.29 (95% CI: 1.46-23.86)} were statistically significant risk factors. Conclusions : It is recommended that above mentioned risk factors should be considered carefully before TACE to prevent the occurrence of acute hepatic failure after TACE in HCC patients.(Korean J Med 69:622-630, 2005)
군 입영자에서의 B형 간염 발생 규모와 B형 간염 바이러스 보유자가 이에 미치는 영향
김록권,서일,남정모,한광협,Kim, Rock-Kwon,Suh, Il,Nam, Chung-Mo,Han, Kwang-Hyub 대한예방의학회 1997 Journal of Preventive Medicine and Public Health Vol.30 No.2
The purpose of this study was to investigate the incidence rate of hepatitis B in the military service and to examine the effect of the asymptomatic hepatitis B surface antigen(HBsAG) carries on the incidence of hepatitis B. The subject were 223,270 men who were conscripted to the Korean Army from 1991 to 1994. According to the conscripted year, four conscription cohort were constructed. At the screening examination for military service no test for hepatitis B were performed in 1991 and 1992. In 1993, a screening test for hepatitis B were performed and those who were confirmed as HBsAg positive o. showed high titers $(\geqq100IU)$ of nm glutamic-pyruvic transaminase(SGPT) were excluded from conscription. In 1994, the criteria for conscription was changed and those who were HBsAg positive were not excluded from conscription. Only those who showed $\geq$ SGPT 100IU were excluded. The main results were as follows ; 1. The positive rate of HBsAg is 5.5% in the conscripted men. 2. The incidence rates of the hepatitis B in 1991 and 1992 conscription cohort were 9.96 and 8.10 per ten thousand person-year, respectively. The incidence rate of the hepatitis B was 1.34 per ten thousand person-year in 1993 conscription cohort which was confirmed as HBsAg negative at the screning test, and 7.41 per ten thousand person-year in 1994 conscription cohort which included the HBsAg positive. 3. The incidence rate of hepatitis B was 99.98 per ten thousand person-year in HBsAg positive group and 2.25 per ten thousand person-year in HBsAg negative group. The incidence rate of the group with high SGPT and HBsAg positive was 255 times higher than that of normal population. 4. The incidence of hepatitis B in HBsAg negative group did not increase even though the probability of personal contact with HBsAg positive had been increased. from the above results, the men who have high SGPT with HBsAg positive should be excluded from military service, and it can not be said that asymptomatic HBsAg carriers influence on the hepatitis B incidence among the HBsAg negative through personal contact.