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결체조직 질환에서 99mTc-DTPA 연무스캔을 이용한 폐포-모세혈관 투과성의 평가
홍영훈 ( Yeong Hoon Hong ),류동한 ( Dong Han Ryu ),김성동 ( Sung Dong Kim ),박기도 ( Ki Do Park ),이은영 ( Eun Yeung Lee ),조인호 ( Ihn Ho Cho ),이충기 ( Choong Ki Lee ),이형우 ( Hyong Woo Lee ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.4
Objective: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. Methods: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). Results: The mean clearance rates of 99mTc-DTPA were 64.0±24.1 min (RA 70.7±26.2 min, SLE 61.6±14.0 min, Others 43.9±24.7 min), and 47.0±10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). Conclusion: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.
루푸스 환자에서 심혈관계 위험인자로서 경동맥 내막 중막 두께의 유용성
권창모 ( Chang Mo Kwon ),홍영훈 ( Yeong Hoon Hong ),이충기 ( Choong Ki Lee ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.4
전신성 홍반성 루푸스는 심근경색, 뇌졸중 등 심혈관계 합병증이 주요한 사망 원인으로 되어있다. 루푸스 환자에서 심혈관계 합병증을 증가시키는 원인으로 전통적인 죽상경화증 위험인자 외에 총 스테로이드 사용량, 신장 침범 유무, 자가항체 등이 알려져 있다. 본 연구에서는 CIMT를 이용하여 정상인과 비교하여 루푸스 환자에서 CIMT 증가 여부를 확인하고 이를 루푸스 환자의 심혈관계 합병증 위험인자로 사용할 수 있는지 보고자 하였다. 대상은 나이와 성별을 고려한 48명의 루푸스 환자와 32명의 건강 대조군으로 양 군 모두 B mode 초음파를 이용하여 경동맥 원위부 혈관벽의 내막-중막 두께를 측정하였으며 경동맥 내막-중막 두께에 영향을 줄 수 있는 나이, 체질량지수, 총콜레스테롤, 저밀도 지질단백, 고밀도 지질단백, 중성지방, 총 스테로이드 투여량, SLEDAI score 등을 조사하였다. 루푸스 환자군에서 CIMT는 정상대조군에 비해 유의하게 증가되어 있었으며, 환자군에서 CIMT는 나이와는 상관관계가 있었으나, BMI, SLEDAI score, ESR, 스테로이드 사용량, 유병기간, 보체, 항ds-DNA 항체 등의 다른 임상변수와는 연관성이 없었다. 루푸스 환자에서 죽상경화증의 발생이 스테로이드 사용량과 기간, 신질환 유무, 질병 활동도가 복합적으로 관여하겠지만 심혈관계 합병증이 없는 루푸스 환자에서 정상인에 비해 증가된 CIMT를 가진다는 결과가 실제로 향후 심혈관계 합병증의 발생에 어떤 의미를 가지는지에 대한 연구가 필요하리라 생각한다. Objective: The purpose of this study was to investigate the complication using carotid intima media thickness (CIMT) as an indicator for atherosclerosis and to verify the risk factors in systemic lupus erythematosus (SLE) patients compared with those of control group. Methods: The study recruited 48 asymptomatic SLE and 32 healthy control group. These are examined by B-mode ultrasound (Acuson(TM) SequoiaC256 8 MHz linear transducer) to measure the CIMT at the far wall of the common carotid artery. A wide range of contribution factors to CIMT including age, body mass index, lipid profile, total cumulative steroid dose, SLEDAI, and proteinuria were considered. Results: Although the results of CIMT in both groups were within normal limit (In healthy adult 0.25∼1.5 mm, values >1.0 mm often regarded as abnormal), the mean CIMT in patient group was 0.721±0.162 mm, which was thicker than that of control group with 0.5219±0.096 mm (p<0.001). In multiple regression analysis, only age showed significant contribution to CIMT (p<0.01). Disease duration, SLEDAI and serum lipids were of no statistical significance with CIMT. Conclusion: We were to elucidate the advance of atherosclerosis with measuring CIMT and assess factors associated with SLE. Even if the results of CIMT in both groups were within normal range, it is significant that the arterial thickening is more advanced in SLE than that of healthy control. Further studies based on CIMT are needed to screen and prevent cardiovascular complications from disease progression.
제2형 당뇨병과 슬골관절염이 동반된 환자에서 골증식체 형성의 저하
김봉준 ( Bong Jun Kim ),홍영훈 ( Yeong Hoon Hong ),류동한 ( Dong Han Ryu ),김성동 ( Sung Dong Kim ),박기도 ( Ki Do Park ),이충기 ( Choong Ki Lee ),최정윤 ( Jung Yoon Choe ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.2
Objective: Insulin has been known as a potent growth factor for connective tissues including cartilage and bone. The pathogenesis of type 2 diabetes mellitus is the insulin resistance due to insulin receptor or postreceptor abnormalities. In the present study, we investigate whether radiographic features of knee osteoarthritis in patients with type 2 DM differ from those in nondiabetogenic controls with knee osteoarthritis. Methods: Radiographs (knee) from 59 female patients with diabetes and knee osteoarthritis were compared with those from 74 female controls who were similar with respect to age, weight, and duration of OA symptoms. Based on the Kellgren and Lawrence criteria, an overall OA severity grade for the index knee was assigned and was rated for the severity of subchondral sclerosis, osteophytes, geodes and joint space narrowing. Patients with inflammatory arthritis such as RA, severe peripheral neuropathy, or diabetic nephropathy were excluded. Results: Although the 2 groups were similar with respect to the severity of joint space narrowing, geode formation, and subchondral sclerosis, osteophytes formation was less common in patients with type 2 diabetes (P=0.041) than controls. In the patients with symptomatic knee OA at least for 11 years, marked osteophyte formation was noted only in 7 of the 17 with DM (41%), but in 15 of the 27 controls (55%). Conclusion: Our results suggest that diminished availability of insulin at the cellular level or diabetic microvascular disease may attenuate the chondro-and osteogenesis required for osteophyte formation in the joint of patients with OA. The clinical significance of osteophyte and the pathologic mechanisms of diminished osteophyte formation in patients of knee osteoarthritis with type 2 diabetes is to be determined.
전신성 홍반성 루푸스에서 고용량 경정맥 당질코르티코이드로 치료된 단백질 소실성 장질환 1예
이규형 ( Kyu Hyung Lee ),권창모 ( Chang Mo Kwon ),김현도 ( Hyun Do Kim ),윤대영 ( Dae Young Yun ),이재웅 ( Jae Yoong Lee ),홍영훈 ( Yeong Hoon Hong ),이충기 ( Choong Ki Lee ) 영남대학교 기초/임상의학연구소 2005 Yeungnam University Journal of Medicine Vol.22 No.2
Generalized edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include: Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to our hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.