간경변증 환자에서 t - PA , Euglobulin 섬유소용해능 및 Protein C , S 의 변화와 식도정맥류출혈과의 관계

황성규(Seong Gyu Hwang),백승호(Seung Ho Baik),양동호(Dong Ho Yang),이문호(Moon Ho Lee),조용욱(Yong Wook Cho),김순길(Soon Gil Kim),오도연(Don Yeun Oh),조성원(Sung Won Cho),김선주(Sun Joo Kim),홍세용(Sae Yong Hong) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Bleeding is common complication and a leading cause of death in cirrhotic patients, Accelerated fibrinolysis and coagulation inhibitor were contributing factors to bleeding. Method: In a study of 20 normal control and 20 liver cirrhosis (10 liver cirrhosis without esophageal variceal bleeding and 10 liver cirrhosis with esophageal variceal bleeding), we tried to evaluate fibrinolytic activity 8r inhibitory factors of the coagulation in liver cirrhosis and to find correlation between variceal bleeding and parameters of fibrinolysis % coagulation inhibitors. Results: 1) t-PA antigen was significantly increased(p <0.05) in patients with liver cirrhosis(22.2±12.5ng/ml) than in normal contro1(3.9±1.9ng/ml), but there was no statistically significant increase in cirrhotic patients with bleeding(26.2±13.8ng/ml) as compared to cirrhotic patients without bleeding(18.2±10.1ng/ml). 2) Euglobulin fibrinolytic activity was significantly higher(p<0,05) in patients with liver cirrhosis(145±37.6 BAU) than in normal control(91±7.8 BAU), but there was no statistically significant increase in cirrhotic patients with bleeding(150±64 BAU)as compared to cirrhotic patients without bleeding(131±22 BAU). 3) The activities of protein C was significantly lower(p<0.05) in patient with bleeding(41±9%) than in patient siwthout bleeding(54±18%). 4) The activities of protein S was lower in patient with bleeding(62±18%) than in patients without bleeding group(77±17%), but there was no statistical significance. 5) There was a significantly linear correlatian between t-PA antigen and euglobulin fibrinolytic activity in normal control and in patients with liver cirrhosis (r=0.807, p<0.01). Conclusion: Fibrinolytic activity(t-PA k euglobulin fibrinolytic activity) was increased in cirrhotic patients, but there was no statistically significant increase of fibrinolytic activity with relation to esophageal variceal bleeding. The activities of protein C was significantly decreased in liver cirrhosis with relation to esophageal variceal bleeding.

소화기 ; ALT<80 IU/L인 만성 B형 간염 환자의 중등도 이상 간섬유화 유병률

이우진 ( Woo Jin Lee ),박승하 ( Seung Ha Park ),김동준 ( Dong Joon Kim ),이성화 ( Sung Hoa Lee ),이찬우 ( Chan Woo Lee ),박규태 ( Kyu Tae Park ),정재연 ( Jae Youn Cheong ),조성원 ( Sung Won Cho ),황성규 ( Seong Gyu Hwang ),이연재 대한내과학회 2010 대한내과학회지 Vol.78 No.1

목적: 우리나라의 만성 B형 간염에 대한 항바이러스 치료의 보험기준은 AST/ALT가 80 IU/L 이상이지만, 최근 발표된 연구들에 따르면 정상 상한치의 두 배 미만의 ALT 수치를 가진 환자에서도 상당수의 중등도 이상 섬유화가 관찰 되었다. 이 연구는 국내에서 ALT가 80 IU/L 미만인 환자 중 중등도 이상 섬유화가 얼마나 있는지를 확인하고자 하였으며, 임상에서 흔히 접할 수 있는 자료를 이용하여 중등도 이상 섬유화를 예측할 수 있는 방안을 찾아보고자 하였다. 방법: 여섯 곳의 3차 병원에서 최소 6개월 이상 B형 간염 표면항원를 지니고 있으면서, 혈청 ALT가 80 IU/L 미만이고, 항바이러스 치료를 한 적이 없는 만성 B형 환자 중 간생검을 받은 총 136명의 환자를 대상으로 하였다. 생검 조직의 간섬유화 정도는 METAVIR 기준의 간 섬유화병기에 따라 분류하였으며, F2 이상의 간섬유화를 중등도 이상 간섬 유화로 정의하였다. 임상 자료를 토대로 간섬유화에 대한 비침습 예측모델을 만들었으며, 이의 유용성 및 섬유화 정도 평가에 따른 적절한 경계값을 알아보기 위하여 AUROC 분석을 시행하였다. 결과: 혈청 ALT가 80 IU/L 미만인 만성 B형 환자 전체의 71.3%에서 중등도 이상 섬유화가 관찰되었다. 간생검에서 나타난 섬유화의 정도와 예측모델[위험점수=(3.9×Ln 나이)+(2.7×Ln AST)]의 측정값과는 유의한 연관성을 보였다(r= 0.644, p<0.001). 예측모델에서 진단의 정확성은 높게 측정되었다[AUROC in training set: 0.86 (95% CI, 0.78~0.94), AUROC in validation set: 0.90 (95% CI, 0.78~0.99)]. 이 예측모델의 음성 예측치는 낮았지만, 양성 예측치[90.9% (95% CI, 77.4~97.0), 96.2% (95% CI, 78.4~99.8)]는 높았다. 결론: 우리나라에서도 ALT가 80 IU/L 미만인 만성 B형 간염 환자들 중 중등도 이상 간섬유화를 보이는 경우가 많은 것이 확인되었다. 현재 우리나라의 보험규정에 따라 만성 B형 간염 환자를 치료할 경우 많은 환자들이 적절한 치료를 받지 못하므로 이에 대한 시정이 필요하다. 또한 임상에서 흔히 접할 수 있는 자료로 만들어진 예측모델은 간생검을 시행하지 않고도 간섬유화의 정도를 추정할 수 있는 유용한 비침습 검사방법으로 생각된다. 그러나 이 예측모델을 임상에 적용하기 위해서는 향후 대규모의 독립적인 환자군을 대상으로 하는 검증이 필요하다. Background/Aims: The aims of this study were to investigate the prevalence of significant fibrosis in patients with chronic hepatitis B (CHB) virus infections and alanine aminotransferase (ALT) <80 IU/L, and to develop a noninvasive predictive model for significant fibrosis. Methods: The 136 patients with CHB who underwent liver biopsy were recruited from six tertiary hospitals. The diagnostic value of predictors was judged using multivariate logistic modeling and the area under the receiver operating characteristic (AUROC) curve. Results: Significant fibrosis was diagnosed in 97 patients (71.3%, 95% CI, 63.7~78.9%). In the training set (n = 85), the most important clinical data for predicting significant fibrosis were age and aspartate aminotransferase (AST). The AUROC of this model was 0.86 (95% CI, 0.78~0.94). The validation set (n=51), obtained from another institute, yielded similar results [AUROC: 0.90 (95% CI, 0.78~0.99)]. Conclusions: A high prevalence of significant fibrosis in CHB patients with ALT <80 IU/L was observed. A simple model that includes age and AST provides an easily applicable tool for physicians to guide the decision-making process regarding the need to perform a liver biopsy in individual patients. However, additional studies are needed to explore the model`s performance in larger, independent patient populations. (Korean J Med 78:68-74, 2010)

후복막강에 발생한 신경초종

박상흠(Sang Heum Park),김선주(Sun Joo Kim),이문호(Moon Ho Lee),문수남(Soo Nam Moon),정일권(Il Kwun Jung),백진기(Jin Ki Paik),김도진(Do Jin Kim),황성규(Seung Gyu hwang),김의한(Eu Han Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

Bengn solitary neurilemmoma of the retroperitoneum is a rare disease of nerve sheath origin. A 40-year-old male patient was admitted to our hospital for evaluation of retroperitoneal mass. Abdominal ultrasonography and computed tomogaphy (CT) revealed a solid tumo in the retroperitoneum. On exploratory laparatomy, this mass turned out to be an baseball sized mass of the retroperitoneum. The mass was excised surgically in an encapsulated state. Histological section and immunohistochemical stain revealed a typical neurilemmoma. We report it with a review of literature.

HBeAg 양성인 만성 HBV 보유자에서 HBV Core Promoter 변이의 임상적 의의

김성일,조주영,이준성,김진오,이문성,황성규,김연수,심찬섭,조영덕,이희발,홍수진,문종호,황승덕 대한소화기학회 1997 대한소화기학회지 Vol.30 No.6

Background/Aims: Transcriptions of precore and pregenomic mRNAs of hepatitis B virus(HBV) are under the control of fee core promoter. Therefore, mutations in this promoter region might change the activity of liver diseases through altered transcriptional level of either mRNA. In chronic HBV carriers, mutations of the promoter are repoited to be frequent in HBV carriers with anti-HBe rather than those with HBeAg. The present study was carried out to identify the .difference in patterns of the mutations according to the severity of the liver diseases, and to investigate whether the presence of the mutant might affect the seroconversion from HBeAg to anti-HBe. Methods: DNA sequences of the core promoter region were determined in various chronic HBV carriers with HBeAg, including five cases of asymptomatic carrier(ASC, 21 clones), eight with chronic hepatitis (CH, 50 clones) and two with liver cirrhosis died of liver failure due to spontaneous exacerbation(LC-SE, 13 clones). Results: Core promoter mutations were found in 3 cases of ASC (11 clones), all of CH(48 clones) and LC-SE(13 clones). 1762(A→T) and 1764(G→A) mutations were found in all of CH(40 clones) and LC-SE(13 clones), whereas they were not detected in any case of ASC. These mutants were isolated as a dominant strain in the five cases of CH irrespective of natural or interferon-induced seroconversion from HBeAg to anti-HBe. Compared with the patterns of mutations encountered in the cases of CH, similar patterns of mutation were found in the cases of LC-SE. Conclusions: 1762(A→T) and 1764(G→A) mutation was most frequent in chronic hepatitis and liver cirrhosis. Taken together, it is likely that the presence of the mutants has little effect on the difference of disease severity or seroconversion from HBeAg to anti-HBe in chronic hepatitis and liver cirrhosis.