고중성지방혈증 환자에서 단기간의 Fenofibrate 투여가 혈중 크레아티닌 농도에 미치는 영향

현철원 ( Cheol Won Hyeon ),최영환 ( Young Hwan Choi ),현성협 ( Seonghyup Hyun ),권지은 ( Jee Eun Kwon ),김은영 ( Eun Young Kim ),신승용 ( Seung Yong Shin ),이왕수 ( Wang Soo Lee ),이광제 ( Kwang Je Lee ),김상욱 ( Sang Wook Kim 대한내과학회 2014 대한내과학회지 Vol.86 No.6

목적: 고중성지방혈증 환자에서 단기간 fenofibrate를 투여하였을 때에 혈중 크레아티닌 농도의 변화와 이에 영향을 미치는 인자들을 관찰해 보고자 하였다. 방법: 혈중 중성지방 농도가 200 mg/dL 이상인 86명의 고중성지방혈증 환자를 대상으로 하였다. 이들을 micronized fenofibrate 160 mg을 투여한 Fenofibrate 투여군과 대조군으로 나누었다. 혈중 지질농도와 신기능을 나타내는 인자들을 치료 전과 치료 후 2개월에 측정하였다. 결과: 추정 사구체여과율은 Fenofibrate군에서 감소한 반면에(p < 0.001), 대조군에서는 변화가 없었다(p = 0.80). 이것의 백분율 변화는 각각 -18.6 ± 8.6%와 0.9 ± 9.6%로 두 군사이에 차이가 있었다(p < 0.001). 크레아티닌 농도는 Fenofibrate군에서 증가한 반면에(p < 0.001), 대조군은 변화가 없었다(p = 0.37). 크레아티닌 농도의 백분율 변화는 Fenofibrate 군에서 대조군에 비해 유의하게 더 많이 증가하였다(p < 0.001). 전체 환자(n = 86)에서 크레아티닌 농도의 백분율 증가는 fenofibrate 투여(r = 0.71, p < 0.001)와 고령(r = 0.27, p < 0.05) 과 독립적 연관이 있었다. Fenofibrate군에서 크레아티닌 농도의 백분율 증가는 고령(r = 0.51, p < 0.001), 비흡연(r = 0.42, p < 0.005)과 독립적 연관이 있었다. 전체 환자에서 크레아티닌 농도의 증가가 20% 이상인 군(n = 21)과 20% 미만인 군(n =65)으로 나누었을 때에, 20% 이상의 증가는 다변수 로지스틱 회귀분석에서 fenofibrate 투여(p < 0.001)와 고령(p < 0.005)과 연관이 있었다. Fenofibrate군에서는 단지 고령(p < 0.001)과 연관이 있었다. 결론: 고중성지방을 가진 한국인 환자에서 단기간의 fenofibrate의 투여는 크레아티닌 농도를 의미 있게 증가시키며 이러한 증가는 고령에서 더 뚜렷하였다. 따라서 fenofibrate를 투여할 때에는 신기능의 추적관찰이 특히 고령에서 투약 초기에 필요할 것으로 생각된다. Background/Aims: Previous studies have reported that fenofibrate therapy increases blood creatinine levels. The aim of this study was to evaluate the effect of fenofibrate therapy on the renal function in patients with hypertriglyceridemia and to determine the parameters associated with changes in renal functions. Methods: This prospective study enrolled 86 hypertriglyceridemic patients (triglycerides ≥ 200 mg/dL) who were divided into two groups: the fenofibrate group (n = 43), who received 160 mg of fenofibrate, and the control group (n = 43). Lipid profiles and renal function were measured at the beginning of the study and after 2 months. Results: The estimated glomerular filtration rate (eGFR) decreased in the fenofibrate group (p < 0.001), but did not change in the control group (p = 0.80). Accordingly, the decrease was more pronounced in the fenofibrate group than the control group (-18.6 ± 8.6 vs. 0.9 ± 9.6%, respectively; p < 0.001). Changes in serum creatinine (p < 0.001) and blood urea nitrogen (p < 0.005) levels were similar to those of eGFR. In a stepwise linear regression analysis, the percent change in creatinine was independently associated with fenofibrate therapy (r = 0.71; p < 0.001) and old age (r = 0.27; p < 0.05) in all patients. In the fenofibrate group, percent change in creatinine was associated with age (r = -0.51; p < 0.001) and smoking (r = 0.42; p < 0.005), while percent change was associated with body mass index (r = 0.31; p < 0.05) in the control group. Elevation of creatinine by 20% or more was associated with fenofibrate therapy (p < 0.001) and old age (p < 0.005) in all patients, and with old age (p < 0.001) in the fenofibrate group. Conclusions: Short-term fenofibrate therapy significantly impaired the renal function of hypertriglyceridemic patients, and this effect was more pronounced in elderly patients. This finding suggests that creatinine levels should be followed in patients receiving fenofibrate therapy. (Korean J Med 2014;86:702-709)

Influence of Previous Statin Therapy on Cholesterol-Lowering Effect of Ezetimibe

최영환,김영,현철원,현승협,권지은,원호연,신승용,이왕수,이광제,김상욱,김태호,김치정 대한심장학회 2014 Korean Circulation Journal Vol.44 No.4

Background and Objectives: The inhibition of cholesterol absorption by ezetimibe increases cholesterol synthesis. The effect of inhibition of cholesterol synthesis on cholesterol absorption is controversial. The influence of these interactions on cholesterol levels is unknown. We investigated on the extent to which cholesterol levels were affected by the reaction of one pathway to the inhibition of the other pathway. Subjects and Methods: This case-controlled study enrolled 198 patients who needed cholesterol-lowering drugs. Ezetimibe (10 mg) was administered to the patients with (n=58) and without on-going statin therapy (n=58). Simvastatin (20 mg) was administered to the patients treated with (n=41) and without ezetimibe (n=41). Results: Ezetimibe without statin lowered the total cholesterol by 13.3±8.8% (p<0.001) and the low density lipoprotein-cholesterol (LDL-C) by 18.7±15.3% (p<0.001). Ezetimibe added to statin decreased the total cholesterol by 21.1±7.7% (p<0.001) and the LDL-C by 29.9± 12.6% (p<0.001). The total cholesterol and LDL-C were reduced more by ezetimibe in patients with statin therapy than in those without statin therapy (p<0.001 and p<0.001, respectively). The differences in the effect of simvastatin on total cholesterol and LDL-C between the patients with and without ezetimibe showed borderline significance (p=0.10 and p=0.055, respectively). Conclusion: A prior inhibition of cholesterol synthesis by statin enhanced the effect of ezetimibe on total cholesterol and LDL-C by 7.8% and 11.2%, respectively. This finding suggests that ezetimibe increased cholesterol synthesis, resulting in a significant elevation of cholesterol levels.

대퇴골 간부 골절의 교합성 골수강내 금속정 고정후 발생한 교합 나사못의 파단

조원호,김도영,임군일,신주호,현철원 대한골절학회 2000 대한골절학회지 Vol.13 No.3

Purpose: We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw. Materials and methods: Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test k Chi-sqare test for statistical analysis. Result: Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type 1V fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 1 1mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, l 1mm in 13 patients, 12mm in 25 patients, l3mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p$lt;0.05), but the level of fracture didn't(p$gt;0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision. Conclusion: It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.

전이성 대장암에서 Oxaliplatin, 5-Flurouracil, Leucovorin 복합항암화학 요법 도중 발생한 간질성 폐질환 1예

태재현,황인규,권민석,안대건,안미영,권오영,제은영,최영환,현철원,장주영 중앙대학교 의과대학 의과학연구소 2014 中央醫大誌 Vol.39 No.4

The combination chemotherapy of oxaliplatin with 5-fluorouracil and leucovorin (FOLFOX regimen) has become the standard treatment in patients with colorectal cancer. Side effects of this regimen include neutropenia, diarrhea, and neurosensory toxicity, but rarely associated with pulmonary toxicities. With increasing use of oxaliplatin for colorectal cancer, awareness of this complication is important. We report a case of rapidly developing interstitial lung disease after using oxaliplatin, 5-fluorouracil and leucovorin combination chemotherapy in patient with colorectal cancer, and which improved after steroid pulse therapy.