저용량의 corticosteroid 복용이 B형 간염 바이러스 재활성화에 미치는 영향

이향이 ( Hyang Ie Lee ),곽금연 ( Geum Youn Gwak ),박문경 ( Moon Kyung Park ),서현주 ( Hyun Joo Suh ),이준혁 ( Joon Hyeok Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Chul Yoo ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

목적: 만성 B형 간염 바이러스 감염 환자에서 세포 독성 혹은 면역억제 치료를 받는 경우 상당수에서 B형 간염 바이러스의 재활성화가 일어나는 것으로 보고되고 있다. 이에 본 연구자들은 저용량의 corticosteroid 복용이 B형 간염 바이러스의 재활성화에 미치는 영향을 알아보고자 하였다. 방법: 1998년 8월부터 2007년 3월까지 삼성서울병원에서 악성 종양 혹은 장기 이식을 제외한 염증성 질환으로 1주 이상 경구 혹은 주사용 corticosteroid 제제를 투여 받은 병력이 있는 만성 B형 간염 바이러스 감염 환자들을 대상으로 후향적 의무기록 분석을 시행하였다. Corticosteroid 제제 투여 전후로 HBV DNA 역가가 1 log10 이상 증가한 경우 B형 간염 바이러스의 재활성화로 간주하였다. 결과: 대상 환자들은 16명이었으며, 평균 연령은 45.4±16.7세였고, 남녀비는 14:2였다. 동반 질환은 기관지 천식, 알레르기성 두드러기, 알레르기성 비염 등이었으며, 사용된 corticosteroid의 종류는 및 prednisolone, dexamethasone methyl-prednisolone 등이었다. Corticosteroid 사용량은 prednisolone equivalent dose로 환산하였을 때 하루 2.5~50 mg이었으며, 하루 20 mg 이하 사용군이 11명이었다. 평균 corticosteroid 투여 기간은 60.1일(범위: 7-364일)이었다. 대상 환자들 가운데 corticosteroid의 투약 전후로 B형 간염 바이러스의 재활성화를 보인 경우는 1예였다. 이 환자는 prednisolone (5 mg/day)을 364일간 복용한 강직성 척수염 환자였고, cortico-steroid 투약 전 HBeAg 양성이었으며, HBV DNA는 26.8 pg/mL에서 2183.2 pg/mL으로 증가하였으나 투약 전후 혈청 ALT를 포함한 albumin, bilirubin 및 PT의 악화 소견은 없었다. 결론: 만성 B형 간염 바이러스 감염 환자에서 단기간 저용량의 corticosteroid 복용은 B형 간염 바이러스 재활성화에 그다지 영향을 미치지 않을 것으로 여겨지나 장기간 복용시 재활성화를 일으킬 가능성이 있어 주의를 요한다. Background/Aims: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. Methods: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. Results: A total of 16 patients were included. They were 45.4±16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. Conclusions: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.(Korean J Med 74:619-623, 2008)

A retrospective study of hypopigmentation induced by corticosteroid injection and topical corticosteroids

( In Ho Bae ),( Min Sung Kim ),( Chan Ho Na ),( Hoon Choi ),( Bong Seok Shin ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: In clinical practice, there are many cases of hypopigmentation induced by corticosteroid injections or topical corticosteroids. However, few studies have summarized epidemiology and clinical symptoms. Objectives: In this study, we classify and summarize the epidemiology and clinical characteristics of hypopigmentation induced by by topical corticosteroids or injection. Methods: A retrospective study was conducted for the past 5 years. we enrolled 30 patients and investigated factors included age, sex, type of steroid therapy, location of lesions, duration and clinical course according to the type of steroid therapy and treatment modalities. Results: 22 patients were treated with corticosteroid injection and 8 patients were treated with topical corticosteroids. 12 patients were injected by orthopedists and rests of the patients were injected by neurosurgeon and dermatologists. In consideration of the difference in steroid treatment types, hypopigmentation after topical corticosteroids and corticosteroid injection treatment occurred 1.9 months and 3.6 months and improved 1.7 months and 4. 6 months on average. Hands and fingers were most frequently affected. Conclusion: Hypopigmentation induced by corticosteroid was more common in the upper extremities than lower extremities, face and trunk. It occurred mainly after the orthopedists injected into the joint area. The hypopigmented lesions induced by corticosteroid injection lasted longer and resolute more slowly.

P189 : Comparison of high-dose corticosteroid pulse therapy and combination therapy using oral cyclosporine with low-dose corticosteroid in severe alopecia areata

( In Kwon Yeo ),( In Pyeong Son ),( Kap Sok Li ),( Chang Kwun Hong ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Severe alopecia areata (AA) is resistant to conventional treatment. Although systemic oral corticosteroids are an effective treatment for patients with severe AA, they have many adverse effects. Corticosteroid pulse therapy has been introduced to increase therapeutic effects and reduce adverse effects. However, there is still controversy about treatment modality in severe alopecia areata. Objectives: To evaluate the effectiveness of corticosteroid pulse therapy in patients with severe AA compared to a group treated with oral cyclosporine with corticosteroid. Methods: A total of 82 patients with severe AA were treated with corticosteroid pulse therapy, and 60 patients were treated with oral cyclosporine with corticosteroid. Both groups were retrospectively evaluated for therapeutic efficacy according to AA type and disease duration. Results: In 82 patients treated with corticosteroid pulse therapy, 53 patients (64.6%) were good responders (regrowth greater than 50%). AA patients with plurifocal (PF) type and those with short disease duration (≤ 3 months) showed better responses. In 60 patients treated with oral cyclosporine with corticosteroid, 30 patients (50.0%) showed a good response. AA type or disease duration, however, did not significantly affect the response to treatment. Conclusion: Corticosteroid pulse therapy may be a more successful treatment option than combination therapy in severe AA patients with PF type.

스테로이드성 주사 환자 66예의 임상적 고찰

심우행 ( Woo Haing Shim ),문제호 ( Je Ho Mun ),좌승욱 ( Seung Wook Jwa ),송마가렛 ( Margaret Song ),김훈수 ( Hoon Soo Kim ),고현창 ( Hyun Chang Ko ),김병수 ( Byung Soo Kim ),김문범 ( Moon Bum Kim ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.12

Background: Topical corticosteroids are not uncommonly abused in patients with facial dermatoses. Although it iswell known that uncontrolled use of topical corticosteroids cause steroid-induced rosacea, its clinical manifestation isnot studied yet in Korean patients.Objective: The purpose of this epidemiological study was to investigate a usage history of topical corticosteroid andclinical manifestation of steroid-induced rosacea.Methods: Among the 424 rosacea patients who visited the dermatologic clinics of Pusan National University Hospitalbetween January 2006 and May 2011, a face-to-face structured questionnaire was given to 66 rosacea patients witha history of topical corticosteroid use on the face for more than 1 month before onset of rosacea symptoms.Investigated factors include sex, age, history about use of topical corticosteroids and clinical manifestations.Results: Of the 66 patients, 41 were female and 25 were male with the mean age of 52.1±14.6 (range 16∼76)year. Celestone-G(R)(n=14) was the most commonly used product in the 34 patients who remembered the brandname of topical corticosteroids, which they had used. Forty-three patients used topical corticosteroids for treatmentof facial skin lesions without diagnosis. Eighteen patients purchased topical corticosteroids without doctor`sprescription. The mean duration and frequency of topical corticosteroid use was 3.8 years and 1.3 times per day,respectively. Constant erythema (n=31) was the most common symptom and it started to occur 2 months after useof topical corticosteroid.Conclusion: High-potency topical corticosteroids are frequently used for patients with facial dermatoses withoutcorrect diagnosis and without doctor`s prescription. Besides, abuse of topical corticosteroids cause rosacea symptoms,such as constant erythema. To prevent the occurrence of steroid-induced rosacea, there should be a great socialconcern for abuse and misuse of topical corticosteroid in patients with facial dermatosis. (Korean J Dermatol2012;50(12):1036∼1041)

장기간 전신 스테로이드제 사용 중인 피부질환자에서 고관절 방사선 촬영의 의의

정홍대 ( Hong Dae Jung ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.1

Background: Systemic corticosteroid is one of the most common drugs used in dermatology departments. However, physicians are well aware that there are quite a number of side effects from systemic corticosteroid. One of them, avascular necrosis of femoral head, has been frequently documented in association with systemic corticosteroid. Objective: The aim of this study was to evaluate the clinical usefulness of hip x-rays to ascertain the presence of avascular necrosis of the femoral head in patients who have used or are using systemic corticosteroid for a long period of time. Methods: A total of 151 patients who were using systemic corticosteroid and who underwent hip x-ray at our university hospital from December 2004 to July 2007 were enrolled in this study. We reviewed the patients` charts to determine the existence of abnormal results on hip and chest x-rays and also other side effects of corticosteroid, and we wanted to calculate the dosage of corticosteroid that had been used by these patients. Results: Out of the 151 patients who underwent hip x-ray, 5 patients had avascular necrosis of the femoral head, but only 3 patients` cases (2%) were involved with corticosteroid. Three patients showed old tuberculosis findings when they underwent chest x-ray. Among the other side effects of corticosteroid, weight gain side effect was the most common and 14 patients experienced this. Conclusion: This study demonstrates that those patients who use systemic corticosteroids for a long period of time for the treatment of chronic dermatologic disease are advised to undergo regular hip x-rays to screen for avascular necrosis of the femoral head. (Korean J Dermatol 2009;47(1):12~17)

중증 원형탈모증에서 고용량 스테로이드 주기 요법과 Cyclosporine과 저용량 스테로이드 병합 요법의 비교 연구

박주희 ( Ju Hee Park ),유광호 ( Kwang Ho Yoo ),노용관 ( Yong Kwan Rho ),한태영 ( Tae Young Han ),이갑석 ( Kap Sok Li ),서성준 ( Seong Jun Seo ),홍창권 ( Chang Kwun Hong ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.11

Background: Severe alopecia areata (AA) is difficult to treat. Treatment modalities such as topical and systemic immune modulators, corticosteroids and topical sensitizers have been tried. Among them, encouraging results have been reported with high dose pulse corticosteroid therapy. Objective: The aim of this study was to determine the effectiveness of a high dose corticosteroid pulse therapy in patients with severe AA compared with a group treated with oral cyclosporine with low dose corticosteroid. Methods: A total of 105 patients with severe AA were treated with high dose corticosteroid pulse therapy and 41 patients those were treated with oral cyclosporine (3~5 mg/kg/day) with low dose methylprednisolone (2.5~5 mg/day). Results: Therapeutic effect of high dose corticosteroid pulse therapy was better in shorter disease duration (<6 months, 81.4%; >6~12 months, 52.6%; >13 months, 37.3%) and less extensive type (AA multiplex, 80.0%; alopecia totalis, 41.2%; alopecia universalis, 27.8%). Therapeutic effect of oral cyclosporine with low dose corticosteroid therapy was better in less extensive type (AA multiplex, 75.0%; alopecia totalis, 41.2%; alopecia universalis, 25.0%). Disease duration did not significantly affect treatment response. High dose corticosteroid pulse therapy was more effective method (65.7%) than combination regimen of oral cyclosporine with low dose methylprednisolone (46.3%), especially in the case of shorter disease duration (p<0.05). Conclusion: High dose corticosteroid pulse therapy might be a more effective therapy for severe AA than other treatments, especially when in the acute stage (<6 months). (Korean J Dermatol 2009;47(11):1220~1226)

FCT 9 : Efficacy of a short course of oral corticosteroid in the treatment of chronic spontaneous urticaria: a preliminary analysis

( Gyeong Yul Park ),( Hyun Sun Park ),( Soyun Cho ),( Hyun Sun Yoon ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: While the oral corticosteroid therapy is widely used on chronic spontaneous urticarial (CSU), the standardized treatment regimen and its efficacy are still obscure. Objectives: We sought to assess the effectiveness of a short course of oral corticosteroids on CSU. Methods: A retrospective chart review of medical records for patients treated between Feburary 1, 2012, and May 31, 2014, was conducted. A total of 74 patients (mean age 43) diagnosed with CSU was included. Those who did not respond to antihistamine treatment were prescribed a 2-week course of oral corticosteroid. The treatment was considered effective if CSU was controlled with anti-histamine only after stop taking corticosteroid. Results: Of 74 patients, 62 patients (83.8%) responded well to antihistamine treatment alone. Twelve patients (16.2%) who did not respond to antihistamines started a 2-week course of oral corticosteroid. While a single course of oral corticosteroid was enough to control the antihistamine-resistant CSU in 10/12 patients (83.3%), subsequent 2nd cycle of treatment was needed in 2 patients and induced remission in 1 patient additionally. One patients (8.3%) showed recurrence right after 2nd course of treatment and were classified as steroid-dependent CSU. Conclusion: This study demonstrated the excellence of a 2-week course of oral corticosteroid in antihistamine-resistant CSU and propose standardized corticosteroid treatment regimen.

건강보험 청구자료를 이용한 궤양성 대장염 치료제의 처방 양상과 전신 스테로이드 처방에 미치는 영향요인

김지율,박소희,신주영 한국임상약학회 2020 한국임상약학회지 Vol.30 No.2

Objective: To analyze the prescription patterns for the treatment of ulcerative colitis (UC) and to investigate factors co-occurring with systemic corticosteroid use. Methods: We used patient-level data from Korean National Health Insurance claims database to identify patients diagnosed with UC (ICD-10 code : K51) and their medications prescribed for UC between January 1 and Decemeber 31, 2017. We found that medications for UC treatment were 5-aminosalicylic acid (5-ASA), immunomodulators, biologics, and corticosteroids. We presented the prescription pattern according to the sex, age group, type of health insurance, site of UC, type of medical institution, and concomitant medication. To evaluate factors associated with prescription of systemic corticosteroids for UC, we used a multivariate logistic regression model to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs). Results: Of 1,469 UC patients, 74.5% used 5-ASA and 15.2% used systemic corticosteroids. 5-ASA constituted 77.5% of all prescriptions and systemic corticosteroids accounted for 13.1%. The most widely used therapy was 5-ASA monotherapy (54.8%), followed by a double therapy with 5-ASA and immunomodulators (8.2%) or 5-ASA and systemic corticosteroids (7.2%). Systemic corticosteroids were more likely to be prescribed with immunomodulators (aOR=1.88, 95% CI=1.54- 2.28) and biologics (aOR=2.82, 95% CI=2.28-3.50) than without them. Conclusions: We found that 15.2% of UC patients were prescribed with a systemic corticosteroid, which is less than reported previously. Systemic corticosteroids were more likely to be prescribed with immunomodulators and biologics.

자침이 류마치스성 관절염에 미치는 효과

朴慶寔 대한동의병리학회 1998 동의생리병리학회지 Vol.12 No.2

류마치스성 관절염의 주 요인은 면역 관련 질환으로 보아서 사람의 IgG 항체를 항원으로 하는 자가항체, 즉 IgM 항체의 생성에 있다고 보고 있으며 이것을 류마치스성 인자(rheumatoid factor, RF)라고 부른다. 따라서 임상예의 경우 면역억제 요법이 주효한 것 또한 사실이며 흔히 사용되는 방법이기도 하다. 침자에 의하여 면역기능의 변화를 모색한 몇몇 연구들이 근래 발표되고 있는데 류마치스성 관절염의 경우 항 염증치료제 또는 면역억제제로서 부신피질호르몬인 cortisol을 실제 임상에서 흔히 사용한다. 이에 본 실험에서는 류마치스성 관절염 치료에 있어 근간이 되는 천연 corticosteroid의 체내 생성과 관련하여 침이 과연 생체내 corticosteroid를 생성할 수 있는지, 그리고 류마치스성 관절염의 기본치료 요구를 모두 수용할 수 있는 corticosteroid의 혈중농도를 가장 높게 변화시켜주는 침자부위를 확인하고 아울러 금침의 효과를 확인하고자 한다. 평균 24.6세 전후의 남녀를 각 그룹당 12-16명을 대상으로 하여 자침직전과 자침30분후, 그리고 이튿날 체혈함을 반복하여 혈중 corticosteroid의 농도를 분석하였고 이때 일반침과 금침 적용간에 차이를 Independant sample t-test로 분석하였다. 자침 30분째는 혈중 cortisol과 corticosterone 농도가 대조군에 비하여 모두 억제되고 자침후 1일째는 증가되는데 이런 현상은 금침 적용시, 그리고 현종 배합혈시 두드러지는 경향이었다. This study was carried to identify whether acupuncture at several meridian points can control the rheumatic arthritis or not. We investigated the effect of general and gold acupuncture on the change of serum corticosteroids which have frequently applied to rheumatic disease owing to its immune-suppressive anti inflammatory properties in practice. The result obtained were as follows; 1. Serum cortisol level was suppressed significantly (p<0.05) at 30 minutes after general acupuncture on Gwan-weon, Jog Sam Ri, or Hyeon-Jong, compared with that of control group. But on 1day after acupuncture, this tends to increase averagely, particularly in case of acupuncture on Hyeon-Jong meridian point. 2. In above-mentioned situation, Gold-acupuncture showed the more suppressive effect of serum cortisol at 30minutes after acupuncture (p<0.01 ) and more increased concentration on 1day after acupuncture than general acupuncture did. 3. General acupuncture mixedly applied to Hyeon-Jong, Gi-Hae, Sin-su, Ti-Sil in addition to Gwan-Weon, Jog Sam Ri meridian point have represented suppressive corticosterone level in serum in comparison with that in control group except for mixed acupuncture application to Hyeon-Jong meridian point on 1day after acupuncture. 4. Gold-acupuncture have represented decreased serum corticosterone level at 30 minutes after acupuncture in comparison with control group and increased serum concentration on 1day after acupuncture. Such tendency was remarkable in case of mixed application to Hyeon-Jong meridian point. 5. The inhibitory inclination of serum corticosteroid which appeared at 30minutes after acupuncture was more distinct when Gold-acupuncture was applied to than when general acupuncture was applied. On the contrary Gold-acupuncture have represented more increased serum concentration on 1day after acupuncture than general acupuncture have, compared with control group. From the above results, it is concluded that at 30minutes after acupuncture both Gold and general acupuncture have suppressed the corticosteroid level in serum, but on the other side it is no so on 1day after acupuncture. Speaking once more, Gold-acupuncture group has displayed more increased corticosteroid concentration in serum on 1day after acupuncture than general acupuncture group has, compared with control group, particularly in case of application to Hyeon-Jong meridian point.

Effect of corticosteroid therapy in the early phase of acute respiratory distress syndrome: a propensity-matched cohort study

( Moon Seong Baek ),( Yunkyoung Lee ),( Sang-bum Hong ),( Chae-man Lim ),( Younsuck Koh ),( Jin Won Huh ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.1

Background/Aims: It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of moderate to severe ARDS is associated with improved outcomes. Methods: We analyzed the data of patients who received corticosteroids within 7 days of the onset of ARDS between June 2006 and December 2015 at a single tertiary teaching hospital. A total of 565 patients admitted with moderate to severe ARDS were eligible. The outcomes of patients treated with methylprednisolone 40 to 180 mg/day or equivalent (n = 404) were compared to those who did not receive steroids (n = 161). The primary and secondary outcomes were 28- and 90-day mortality rates, respectively. Propensity scores were used to adjust for baseline covariates. Results: The overall mortality at 28 days was not significantly different between the corticosteroid-treated and control groups (43.8% vs. 41%, p = 0.541). At 90 days, the overall mortality rate was higher in the corticosteroid-treated group than in the control group (59.2% vs. 48.4%, p = 0.021). However, on propensity score matching, corticosteroid therapy was not associated with a higher 28-day mortality rate (odds ratio, 1.031; 95% confidence interval, 0.657 to 1.618; p = 0.895) and 90 days (odds ratio, 1.435; 95% confidence interval, 0.877 to 2.348; p = 0.151). Conclusions: Corticosteroid therapy was not associated with 28- or 90-day mortality in the early phase of moderate to severe ARDS on propensity score matching analysis.