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허내윤 대한소화기학회 2023 대한소화기학회지 Vol.81 No.2
Autoimmune liver disease is an important immune-mediated pathologic entity involving the liver and intrahepatic bile duct, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. Although it is necessary to ascertain its presence in acute or chronic liver disease without common causes, it is not easy to diagnose this disease straightforwardly because of its rarity. Recently, the incidence and prevalence of autoimmune hepatitis and primary biliary cholangitis have increased in several regions. In contrast, there is limited data dealing with the trend of the epidemiology of primary sclerosing cholangitis worldwide. Physicians should consider the epidemiologic characteristics of autoimmune liver disease because early diagnosis and proper treatment might prevent the progression of advanced liver disease. In addition, more sophisticated epidemiologic studies will be needed to elucidate the trend of these rare diseases nationwide.
간이식센터가 있는 3차 의료기관에 내원한 전격 간부전 환자의 임상적 특징
허내윤,김강모,이한주,정영화,이영상,서동진,임영석,강정민,오세일,박찬선,정석원,이윤선 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.1
Background/Aims: Striking geographic differences have been noted in the etiology of fulminant hepatic failure (FHF). The prognosis of patients with FHF who do not receive liver transplantation in a timely manner is quite dismal. This study intended to identify the etiology and outcome of FHF in Korean adults and to examine the role of urgent living-donor liver transplantation (LDLT) for treating this unique situation. Methods: We identified all the adult FHF patients who were referred to our unit between 1999 and 2004. FHF was defined as severe acute hepatitis complicated by the rapid development of hepatic encephalopathy within 8 weeks of the initial symptoms in the patients without a previous history of liver disease. Results: One hundred fourteen patients (47 males and 67 females) were identified. The mean age was 39.5±15.3 years. Drugs were the most common cause (28.1%) of FHF (herbal medications, 9.6%), and acute viral infection accounted for 23.7% (HBV accounted for 15.8%). Indeterminate etiologies were noted in 34%. The 90-day survival rate of the nontransplant group was only 15%. Fourteen patients received liver transplants (13 right- lobe LDLT, 1 cadaveric whole liver), and 12 of these (85.7%) survived and showed good graft function during 22 months of median follow-up. Conclusions: Although the causes of FHF in Korea were diverse, HBV infection and herbal medications were responsible for a significant proportion of the cases. Since urgent LDLT improved the overall survival rate of patients with FHF, this should be considered as an important treatment option for patients suffering with FHF. (Korean J Hepatol 2006;12:82-92) 목적: 전격 간부전은 수일 내지 수주 내에 대부분의 환자들이 사망에 이르는 치명적인 질환으로, 그 원인은 국가별, 시대별로 다를 것으로 추정되고, 최근에는 간이식술 등 적극적인 치료의 적용이 가능해짐에 따라 생존율도 향상된 것으로 추정된다. 그러나 우리나라에서 전격 간부전의 원인, 임상 경과, 간이식 후 생존율 및 예후 인자에 대해 조사된 자료는 아직 빈약하다. 이에, 본 연구자 등은 간이식센터를 운영하고 있는 한 3차 의료기관에서 전격 간부전으로 진단받은 환자들을 대상으로 원인과 임상 양상, 간이식 후 생존율을 알아보고, 각종 예후 인자들의 사망 예측 정확성을 평가하고자 하였다. 대상과 방법: 1999년 1월 1일부터 2004년 12월 31일까지 서울아산병원에 입원한 환자들 중 전격 간부전으로 진단된 환자들의 기록을 후향적으로 분석하였다. 전격 간부전의 진단은 증상 발현 후 8주 이내에 간성 뇌증이 발생한 경우로 하였으며, 기존에 어떤 만성 간질환이라도 있음이 확인된 경우는 모두 배제하였다. 결과: 상기 6년간 전격 간부전으로 진단된 환자는 총 114명이었다. 환자들의 평균 연령은 39.5±15.3세였으며, 남자가 47명(41.2%), 여자가 67명(58.8%)이었다. 원인으로는 약제 32명(28.1%), 바이러스 감염 27명(23.7%), 기타 원인 21명(18.4%)이었으나, 원인이 불분명한 경우가 34명(29.8%)으로서 가장 많았다. 이 중에서 B형간염 바이러스 감염이 전체의 18명(15.8%)으로 가장 흔한 단일 원인이었고, 한약 혹은 민간요법이 원인으로 추정되는 경우가 11명(9.6%)으로 그 다음으로 많았다. 간이식을 받을 수 있었던 환자는 14명(생체 부분간이식 13명, 뇌사자 전간이식 1명)이었다. 전체 환자군, 이식군 및 비이식군의 90일 생존율은 각각 21.9%, 85.7%, 15.0%였다. 비이식군에서 황달 발현부터 간성 뇌증까지 걸린 기간은 사망군에 비해 생존군에서 더 짧았다(P=0.020). KCH criteria는 전격 간부전 환자의 사망을 예측하는 데 있어, 민감도 67.8%, 특이도 63.0%, 양성 예측도 85.5%, 음성 예측도 37.0%, c-statistic 0.741이었다. 반면 MELD score는 생존군과 사망군 사이에 통계적으로 유의한 차이가 없었다. 결론: 우리나라에서 전격 간부전의 원인은 다양하나, HBV 감염과 한약 혹은 민간요법이 상당 부분을 차지하고 있었다. 또한, 긴급하게 시행된 생체 부분간이식은 전격 간부전 환자의 전체 생존율을 향상시키는 것으로 나타났으므로, 전격 간부전 치료의 효과적인 대안으로 고려되어야 할 것이다.
춘계학술대회 : 구연 ; 전격성 간부전의 원인, 임상양상, 사망예견인자 -이식센터가 있는 한 3차 의료기관의 사례-
허내윤,임영석,정석원,이윤선,김강모,정영화,이영상,서동진 대한간학회 2005 Clinical and Molecular Hepatology(대한간학회지) Vol.11 No.3(S)
배경/목적: 전격성 간부전은 수일 내지 수 주 내에 대부분의 환자들이 사망에 이르는 치명적인 질환으로서, 그 원인은 국가별, 시대별로 다를 것으로 추정되고, 최근에는 간이식술등 적극적인 치료의 적용이 가능해짐에 따라 생존률도 향상된 것으로 추정된다. 그러나, 우리나라에서 전격성 간부전의 원인과, 임상경과, 간이식후 생존률 및 예후인자에 대해 조사된 자료는 아직 빈약하다. 이에, 본 연구자 등은 간이식센타를 운영하고 있는 한 3차 의료기관에서 전격성 간부
허내윤,임영석,이우창,안지현,이단비,심주현,김강모,이한주,이영상,서동진 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.2
Background/Aims: There are few available data regarding the association between the single nucleotidepolymorphisms (SNPs) of the gene encoding interleukin 28B (IL28B) and a sustained virologic response (SVR) topeginterferon (PEG-IFN) plus ribavirin (RBV) therapy in Korean chronic hepatitis C patients. Methods: This was a retrospective cohort study of 156 patients with chronic hepatitis C virus (HCV) infection whoreceived combination treatment of PEG-IFN plus RBV. Blood samples from these patients were analyzed to identifythe IL28B SNPs at rs12979860, rs12980275, rs8099917, and rs8103142. Association analyses were performed to evaluatethe relationships between each IL28B SNP and SVRs. Results: Seventy six patients with HCV genotype 1 and 80 with genotype non-1 were enrolled. The frequencies ofrs12979860 CC and CT genotypes were 90.4% and 9.6%, respectively; those of rs12980275 AA and AG genotypes were87.2% and 12.8%, respectively; those of rs8099917 TT and TG genotypes were 92.3% and 7.7%, respectively; and thoseof rs8103142 TT and CT genotypes were 90.4% and 9.6%, respectively. Among the patients with HCV genotype 1, theSVR rates were 69.7% and 80.0% for rs12979860 CC and CT, respectively (P=0.71). Among the HCV genotype non-1patients, SVR rates were 88.0% and 100% for rs12979860 CC and CT (P=1.00), respectively. Conclusions: Genotypes of the IL28B SNP that are known to be favorable were present in most of the Korean patientswith chronic hepatitis C in this study. Moreover, the IL28B SNP did not influence the SVR rate in either the HCVgenotype 1 or non-1 patients. Therefore, IL28B SNP analysis might be not useful for the initial assessment, predictionof treatment outcomes, or treatment decision-making of Korean chronic hepatitis C patients.
허내윤 대한소화기학회 2019 대한소화기학회지 Vol.74 No.3
The HEV is a known cause of water-borne outbreaks of acute non-A non-B hepatitis in developing countries, which affects young people and may result in high mortality in pregnant women. In recent decades, however, HEV genotypes 3 and 4 have been known as a cause of sporadic zoonotic infections in older males from swine HEV worldwide. Most acute HEV infections are self-limited. On the other hand, in immunosuppressed patients, including solid organ transplant recipients, chronic HEV infections may exist and progress to liver cirrhosis or decompensation. Therefore, physicians need to recognize HEV as a major pathogen for acute and chronic hepatitis of unknown causes and investigate this disease.
대사증후군 요소와 관련된 만성 간질환에서 Biphenyl Dimethyl Dicarboxylate와 Ursodeoxycholic Acid 병합요법의 효과 및 안전성
허내윤 ( Nae-yun Heo ),박승하 ( Seung Ha Park ),최준혁 ( Joon Hyuk Choi ),김은주 ( Eunju Kim ),김태오 ( Tae Oh Kim ),박종하 ( Jongha Park ),이진 ( Jin Lee ),박용은 ( Yong Eun Park ),오은혜 ( Eun Hye Oh ),황준성 ( Jun Seong Hwang 대한소화기학회 2021 대한소화기학회지 Vol.77 No.4
Background/Aims: Steatohepatitis related to metabolic syndrome is a chronic liver disease prevalent in patients not only with non-alcoholic steatohepatitis but also with alcoholic liver disease and chronic viral hepatitis. On the other hand, there is limited data on the effects of hepatotonic agents in these patients. Therefore, this study evaluated the efficacy of a combined hepatotonic agent in this population. Methods: Thirty-three adults with chronic hepatitis and one or more components of metabolic syndrome were assigned randomly to receive biphenyl dimethyl dicarboxylate/ursodeoxycholic acid or a placebo for 24 weeks. The primary outcome was the normalization of ALT (≤40 U/L). The secondary outcomes were the change in controlled attenuation parameter, transient elastography, and Chronic Liver Disease Questionnaire score. Results: The 33 patients were assigned randomly to two groups. Eight (50%) of 16 patients who received the intervention drug showed the normalization of ALT, whereas only one (6%) of 17 patients in the placebo group did so. In contrast, the change in controlled attenuation, transient elastography, and Chronic Liver Disease Questionnaire were similar in the two groups. ALT was changed significantly during the four assessment periods, and this change was affected by the group. The interaction between the group and time was also significant. AST was changed significantly during the same period. This change was not affected by the group. Conclusions: Biphenyl dimethyl dicarboxylate/ursodeoxycholic acid combination reduced ALT in chronic liver disease related to metabolic syndrome. On the other hand, there is no evidence that this leads to improved hepatic steatosis and fibrosis within 6 months. (Korean J Gastroenterol 2021;77:179-189)