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혈액투석 중인 말기 신질환 환자에서 대사성 산증과 칼슘대사 장애의 연관성
현상훈,한성우,구자룡,채동완,김근호,박우정,노정우,김형직,전노원 대한내과학회 2000 대한내과학회지 Vol.58 No.4
목적 : 혈액투석 중인 말기 신질환 환자에서는 지속적인 혈액투석에도 불구하고 경도의 대사성 산증이 발생한다고 알려져 왔으나 이로 인한 임상적 결과에 대해서 알려진 바는 거의 없다. 저자들은 혈액투석 중인 말기 신질환 환자에서 대사성 산증의 분포와 정도를 측정하고, 칼슘 대사와 관련하여 그 의의를 평가하고자 하였다. 방법 : 2개월 이상 지속적으로 혈액투석 중인 124명의 환자를 대상으로 투석전 동맥혈가스분석, 혈액화학검사, 부갑상선호르몬 농도 등을 측정하여, 대사성 산증 환자군의 임상적 특성을 분석하고 정상 산-염기평형 환자군과 비교하였다. 결과 : 투석전 동맥혈가스분석 결과 124명 중 92명(74.2%)에서 대사성 산증이 있었고, 12명(9.7%)은 정상 산-염기평형을 보였다. 대사성 산증 환자군은 정상 산-염기 환자군에 비해 투석기간이 길었으나(34.3±2.8 vs. 17.2±4.3개월, p$lt;0.05), 투석액의 종류, 주간 투석시간 및 KT/V는 차이가 없었다. 대사성 산증 환자군은 정상 산-염기 환자군에 비해 혈청 칼슘이 낮고(7.90±0.16 vs. 8.68±0.17 mg/dL, p$lt;0.05), 인(4.96±0.16 vs. 3.68±0.39 mg/dL, p$lt;0.05), 알칼리포스파타제(233.6±22.7 vs. 145.9± 13.7 U/L, p$lt;0.05) 및 었으나, 초산염 투석액군에서 혈청 총칼슘(7.28±0.25 vs. 7.96±0.17mg/dL, p$lt;0.05) 및 이온화칼슘 농도(0.85±0.05 vs. 1.08±0.04 mmol/L, p$lt; 0.05)가 낮았고, 혈청 알칼리포스파타제(457.1±170.2 vs. 209.4±15.9 U/L, p$lt;0.05) 와 부갑상선호르몬 농도(364.4±83.7 vs. 155.4±23.6 pg/mL, p$lt;0.05)는 높았다. 결론 : 현재 시행 중인 혈액투석방법에서 말기 신질환 환자의 대사성 산증은 현저하게 진행되고, 이는 체내 칼슘평형의 악화와 관련이 있을 것으로 생각한다. Background: Mild metabolic acidosis is frequently found among the stable patients treated with maintenance hemodialysis. However, its clinical effects have yet to be clarified. This study was undertaken to estimate the prevalence of metabolic acidosis in the patients undergoing chronic hemodialysis and to evaluate the clinical significance of metabolic acidosis, especially in relation to calcium metabolism. Methods: In 124 patients undergoing maintenance hemodialysis, analysis of arterial blood gas and measurement of various biochemical markers and parathyroid hormone were carried out with predialysis blood obtained from arterial side of arteriovenous fistula. Results: Ninety two patients(74.2%) had metabolic acidosis. Their arterial pH was 7.32±0.01, arterial bicarbonate concentration 17.1±0.3 mEq/L, and PaCO2 33.1±0.5 mmHg. The patients with metabolic acidosis showed a lower calcium(7.90±0.16 vs. 8.68±0.17 mg/dL, p$lt;0.05), and higher phosphorus(4.96±0.16 vs. 3.68±0.39 mg/dL, p$lt;0.05), alkaline phos(233.6±22.7 vs. 145.9±13.7 U/L, p$lt;0.05) and parathyroid hormone(176.5±23.7 vs. 52.8±14.4 pg/mL, p$lt;0.05) levels compared to those with normal acid-base balance. In the patients with metabolic acidosis, PaCO2 level showed a positive correlation with arterial bicarbonate concentration(r=0.62, p$lt;0.001). The lower arterial bicarbonate was, the higher serum potassium(r=-0.24, p$lt;0.05), phosphorus(r=-0.42, p$lt;0.001) and anion gap(r=-0.28, p$lt;0.01) were. When the patients were divided into two groups according to the dialysate buffer used, the lower calcium-acetate group showed lower total calcium(7.28±0.25 vs. 7.96±0.17 mg/dL, p$lt;0.05) and ionized calcium(0.85±0.05 vs. 1.08±0.04 mmol/L, p$lt;0.05) levels and higher alkaline phosphatase(457.1±170.2 vs. 209.4±15.9, p$lt;0.05) and parathyroid hormone (364.4±83.7 vs. 155.4±23.6 pg/mL, p$lt;0.05) levels compared to the higher calcium-bicarbonate group. Conclusion: Current hemodialytic practice is less than ideal, as evidenced by a high prevalence of metabolic acidosis. Thacidosis in maintenance hemodialysis is associated with abnormal calcium metabolism, suggesting that a more aggressive correction of metabolic acidosis may be required by individualizing dialysis prescription.(Korean J Med 58:420-429, 2000)
Chang-Ho Kang,Sang-Hyun Han,Ja-Ryoung Koo,소재성 한국생물공학회 2013 Biotechnology and Bioprocess Engineering Vol.18 No.3
In this study, the anti-inflammatory effects of Chrysanthemum zawadskii var. latilobum were evaluated on lipopolysaccharide (LPS)-treated RAW 264.7 macrophages. C. latilobum ethanolic extracts were fractionated sequentially with n-hexane, chloroform, ethyl acetate, and n-butanol. C. latilobum extracts significantly decreased LPS-induced nitric oxide (NO) and prostaglandin E2 (PGE2) production in a concentration-dependent manner. In particular, nhexane soluble fractionates from 95% ethanol of C. latilobum (CLNH, at a concentration of over 20 μg/mL, P < 0.001) strongly inhibited NO and PGE2 synthesis. Consistent with these findings, CLNH reduced the LPSinduced expression of inducible nitric oxide synthase (iNOS) and Cyclooxygenase-2 (COX-2) gene expression. iNOS and COX-2 mRNA expression in LPS-treated RAW cells was tested by using reverse transcription polymerase chain reaction (RT-PCR). These results suggest that C. latilobum may have a strong inhibitory effect against iNOS and COX-2 gene expression and may be useful for reducing the production of inflammatory mediators in chronic diseases and oxidative stress.
증예보고 : 하악골에 발생한 해면동상 골혈관종의 치험예
김학원(Hak Won Kim),구자용(Ja Ryoung Koo),황경곤(Kyung Kon Hwang) 대한악안면성형재건외과학회 1985 Maxillofacial Plastic Reconstructive Surgery Vol.7 No.1
This is a case report of cavernous central hemangioma of the mandible by hemimandiblectomy and bone graft for reconstruction of the mandible. Before the operation, we performed the external carotid angiography. It was proper evaluation of vascular supply in preoperation. And then, we performed the hemimandiblectomy under external carotid artery ligation and hypotensive anesthesia. Also, bane graft performed for construction of the mandible after 6 months. Post-operative results are good and no recurrence occurred.
조영필(Young Pill Cho),구자용(Ja Ryoung Koo),유시봉(Si Bong Yoo) 대한악안면성형재건외과학회 1985 Maxillofacial Plastic Reconstructive Surgery Vol.7 No.1
This is a case report of bilateral mandibular prognathism associated with macroglossia treated by C-sliding osteotomies in the rami with V-shaped partial glossectomy. The results are as follows: 1. The selection of the operation method can be decided by the clinical evaluation, the cephalometric analysis and the model analysis. 2. The bilateral mandibular prognathism is corrected esthetically and functionally by C-sliding osteotomies in the rami of mandible. 3. It was able to prevent from relapsing after practice of partial glossectomy.