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천갑진 ( Gab Jin Cheon ),김영돈 ( Young Don Kim ) 대한내과학회 2018 대한내과학회 춘계학술대회 Vol.2018 No.-
Nonalcoholic fatty liver disease (NAFLD) is an increasingly common cause of chronic liver disease in Korea. This is due to westernized diet, changes in lifestyle, lack of exercise, and an increase in obesity & diabetes. NAFLD is associated with increased liver-related mortality and hepatocellular carcinoma. So Appropriate treatment is needed. But the natural history and pathogenesis of NAFLD remains unclear. The prognosis of NAFLD depends on the histological subtype. The more than 60% patients had disease remission or remained the same. There is no definitive non-invasive diagnostic method. At present there are no approved pharmacologic therapies. The weight reduction proved to be the only effective. So diet and lifestyle modification remain the mainstay of treatment. For patients with NASH (Nonalcoholic steatohepatitis) and advanced fibrosis, current liver- directed pharmacotherapy with vitamin E and pioglitazone offer some benefits in selected cases. However, the beneficial effects of these therapies must be balanced with the potential adverse effects, limiting their widespread use. Coexisting comorbidity must be diagnosed and treated because cardiovascular disease remains primary cause of death in these patients. New drugs currently in clinical trials are expected to become effective and targeted drug therapies in this area. But, at present, pharmacologic treatment of NAFLD is controversial.
만성 B형 간염 치료에 있어 항바이러스 약제 이외의 치료
천갑진 ( Gab Jin Cheon ),김영돈 ( Young Don Kim ) 대한간학회 2015 Postgraduate Courses (PG) Vol.2015 No.1
The goals of chronic hepatitis B treatment are to decrease the mortality rate and increase the survival rate by alleviating hepatic inflammation and preventing the development of fibrosis, which ultimately decrease the progression of hepatitis to liver cirrhosis or HCC. Host, viral and environmental factors contribute to an HBsAg-positive patients`` risk of cirrhosis and HCC. The main risk factors for HCC are not only chronic hepatitis viruses (hepatitis B and C), but also alcohol drinking, tobacco smoking, and aflatoxin exposure. Oral contraceptive usage, iron overload, overweight, and diabetes are also known or suspected as risk factors of HCC. Currently, treatment of hepatitis B concentrates on antiviral agents mainly. Although Peginterferon and nucleos(t)ide analogues are effective, both therapies have limitations such aslow response rate, side effects, long term use and drug resistance. In contrast with viral factors, there are a few effort and study to improve the host and environmental factors. Considering the synergistic effects of host and environmental factors and HBV infection on the risk of HCC, efforts should be focused not only on abstinence but also on promoting and modifying generally healthy lifestyles. To maximize the effects of treatment for chronic hepatitis B, personalized approach should be conducted according to disease characteristics, individual preferences, medical comorbidities and social circumstances. And proper education should be considered
소화성 궤양에서 Helicobacter pylori 박멸의 장기적 효과에 대한 후향적 관찰
홍수진(Su Jin Hong),은수훈(Soo Hoon Eun),정준성(Joon Seong Jung),류권호(Kwon Ho Ryu),차상우(Sang Woo Cha),천갑진(Gab Jin Cheon),김진오(Jin Oh Kim),조주영(Joo Young Cho),이준성(Joon Seong Lee),이문성(Moon Sung Lee),심찬섭(Chan Sup Shi 대한내과학회 2002 대한내과학회지 Vol.63 No.1
Background: Eradication therapy for H. pylori infection is known to decrease the recurrence rate of peptic ulcer disease. The aim of this study was to evaluate longterm effect of H. pylori eradication on the recurrence of peptic ulcer disease and the reinfection rate after treatment in Korea. Methods: Between July 1996 and February 1997, 763 patients who were diagnosed peptic ulcer diseases and H. pylori infection after upper endoscopies in Soonchunhyang university hospital. Among those patients, we reviewed 32 patients who achieved eradication of H. pylori after eradication therapy and could be followed for up to 4 years by 13C-urea breath test or endoscopy. Results: The mean age of the patients was 51.7 years (range: 29∼68). Nine patients had gastric ulcer, 12 had duodenal ulcer and 11 had duodenal and gastric ulcer. An annual reinfection rate of H. pylori was 1.6% in our study. After H. pylori eradication, recurrence of peptic ulcer was detected in three patients (9.4%). Conclusion: In our study, the reinfection rate was similar to rates observed in developed countries. H. pylori eradication was effective for preventing recurrent peptic ulcers.(Korean J Med 63:23-28, 2002)
정우진 ( Woo Jin Jeong ),강경훈 ( Kyung Hoon Kang ),천갑진 ( Gab Jin Cheon ),엄대운 ( Dae Woon Eom ),장우성 ( Woo Sung Chang ),홍종삼 ( Jong Sam Hong ),권장훈 ( Jang Hoon Kwon ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6
Anaplastic large-cell lymphoma (ALCL) is a rare subgroup of non-Hodgkin`s lymphoma. Primary gastric ALCL is extremely rare. Patients with anaplastic lymphoma kinase (ALK)-positive primary systemic ALCL are known to have better overall survival than those with ALK-negative ALCL. We herein report a case of primary gastric ALK-positive anaplastic large-cell lymphoma. A 37-year-old woman presented with postprandial epigastric pain for 2 months. Endoscopic examination of the upper gastrointestinal tract showed multiple variably sized, round, elevated lesions with friable crater-erosion on the body and fundus. Pathologic examination revealed atypical large lymphoid cell infiltration in the lamina propria; the cells were positive for CD3, CD30, and ALK. We diagnosed the patient with ALCL. She underwent a cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone. However, she developed brain metastases. Despite two cycles of palliative chemotherapy with high-dose methotrexate for brain metastases, she died due to ALCL progression. (Korean J Med 2012;83:752-756)
약제 내성 만성 B형간염 환자에서 테노포비어를 포함한 구원치료의 효과
박재우 ( Park jae woo ),천갑진 ( Gab Jin Cheon ),최강혁 ( Kang Hyug Choi ),이한민 ( Han Min Lee ),전백규 ( Baek Gyu Jun ),김홍수 ( Hong Soo Kim ),김상균 ( Sang Gyune Kim ),김영석 ( Young Seok Kim ),김부성 ( Boo Sung Kim ),정승원 ( 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1
Background/Aims: Tenofovir disoproxil fumarate (TDF) plays a pivotal role in the management of drug-resistant chronic hepatitis B. However, it remains unclear whether TDF-nucleoside analogue combination therapy provides better outcomes than TDF monotherapy. This study aimed to compare the efficacy of TDF monotherapy with that of TDF-nucleoside analogue combination therapy in patients with drug-resistant chronic hepatitis B. Methods: This retrospective cohort study included 76 patients receiving TDF-based rescue therapy for more than 12 months. Suboptimal response was defined as serum HBV-DNA level of >60 IU/mL during prior rescue therapy. Multi-drug resistance was defined as the presence of two or more drug resistance-related mutations confirmed by mutation detection assay. The relationship between baseline characteristics and virologic response (HBV DNA <20 IU/mL) at 12 months were evaluated using logistic regression analysis. Results: Fifty-five patients (72.4%) were suboptimal responders to prior rescue therapy, and 26 (34.2%) had multi-drug resistance. Forty-two patients (55.3%) received combination therapy with nucleoside analogues. Virologic response at 12 months was not significantly different between the TDF monotherapy group and TDF-nucleoside analogue combination therapy group (p=0.098). The serum HBV DNA level was reduced to .4.49±1.67 log10 IU/mL in the TDF monotherapy group and to .3.97±1.69 log10 IU/mL in the TDF-nucleoside analogue combination therapy group at 12 months (p=0.18). In multivariate analysis, female sex (p=0.032), low baseline HBV-DNA level (p=0.013), and TDF monotherapy (p=0.046) were predictive factors for virologic response at 12 months. Conclusions: TDF monotherapy showed similar efficacy to that of TDF-nucleoside analogue combination therapy in patients with drug-resistant chronic hepatitis B.
이세환 ( Sae Hwan Lee ),천갑진 ( Gab Jin Cheon ),김홍수 ( Hong Soo Kim ),김영돈 ( Young Don Kim ),김상균 ( Sang Gyune Kim ),김영석 ( Young Seok Kim ),정승원 ( Soung Won Jeong ),장재영 ( Jae Young Jang ),김부성 ( Boo Sung Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.1
목적: 지속적인 간세포 손상은 간 섬유화의 진행을 유도하여 궁극적으로 간경변증과 간세포암종과 같은 치명적인 합병증을 유발할 수 있다. 이 연구에서는 만성적으로 알라닌아미노 전달효소가 상승되어 있는 환자를 대상으로 DDB와 UDCA의 효과와 안전성을 비교하고자 하였다. 대상 및 방법: 이 연구는 다기관, 무작위배정, 이중눈가림, 활성대조, 4상 임상시험으로 설계되었다. 피험자들은 24주간 하루에 DDB 750 mg 혹은 UDCA 300 mg을 투여받았다. 모두 135명의 환자가 임상시험에 배정되고 약물을 투약 받았으며 93명의 환자들은 비알코올 지방간질환 환자, 27명은 알코올성 간질환 환자, 15명은 만성간염으로 분류되었다. 이 연구의 일차 목적은 치료 종료 시점인 투약 후 24주에 알라닌아미노 전달효소가 정상화된 피험자의 분율이었으며 이차 목적으로 아스파르테이트아미노전달효소의 변화량과 변화율 및 간 탄성도 검사의 변화를 분석하였고 이상반응의 발생 유무를 관찰하였다. 결과: 모두 101명의 환자가 24주 간의 임상시험을 완결하였다. 알라닌아미노전달효소의 정상화 분율은 DDB군에서 80.0%였으며 UDCA군에서 34.8%였다(p<0.001). 기저치와 비교하여 24주째 알라닌아미노전달효소의 평균치의 변화는 DDB군에서 -70%였으며 UDCA군에서 -35.9%였다(p<0.001). 그러나 두 군 사이에 아스파르테이트아미노전달효소의 정상화 분율 (p=0.53)과 간 탄성도 검사의 변화율(p=0.703)은 통계적으로 의미 있는 차이가 없었다. 중증 이상약물반응이 DDB군의 1명에서 발생하였으나 약제 중단 없이 임상시험을 완결하였다. 결론: 알라닌아미노전달효소가 상승되어 있는 만성간질환 환자를 대상으로 한 24주간의 임상시험에서 DDB는 알라닌아미노전달효소의 정상화 효과가 뛰어났으며 UDCA에 비하여 그 효과와 안전성이 열등하지 않았다. Background/Aims: Chronic hepatocellular damage is closely associated with hepatic fibrosis and fatal complication in most liver diseases. The aim of this study is to compare the efficacy and safety of biphenyl dimethyl dicarboxylate (DDB) and ursodeoxycholic acid (UDCA) in patients with abnormal ALT. Methods: One-hundred thirty-five patients with elevated ALT were randomized to receive either 750 mg/day of DDB or 300 mg/day of UDCA for 24 weeks in 4 referral hospitals. Ninety-three (69%) patients had non alcoholic steatohepatitits, 27 (20%) had alcoholic hepatitis, and 15 (11%) had chronic hepatitis. The primary end point was the rate of ALT normalization at week 24. The secondary endpoints were changes in AST, liver stiffness, and the incidence of adverse events. Results: A total of 101 patients completed 24 weeks of therapy. ALT normalization at week 24 was observed in 44 (80.0%) patients in DDB group and 16 (34.8%) in UDCA group (p<0.001). Higher mean reduction of ALT levels from baseline to 24 weeks was seen in DDB group compared with UDCA group (-70.0% vs. -35.9%, p<0.001). Normalization of AST level (p=0.53) and change in the liver stiffness (p=0.703) were not significantly different between the two groups. Severe adverse drug reaction occurred in 1 patient in DDB group but the subject continued therapy during the study period. Conclusions: DDB was not inferior to UDCA for normalizing ALT level. Furthermore it was safe and well tolerated by patients with abnormal ALT. (Korean J Gastroenterol 2014;64:31-39)