알레르기 환자에서 면역료법 전후의 말초혈액 Fcε 수용체 보유 림프구의 변화

강영모(Young Mo Kang),허영구(Young Gu Hoe),최귀애(Gui Ae Choi),김항재(Hang Jae Kim),김능수(Nung Soo Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.6

N/A We studied the effect of immunotherapy on the pro- portion of Fcε receptor bearing cells [Fcε R(+) cells] in PB lymphocytes, serum IgE and PB T cells with their subsets in 18 allergic patients with asthma or rhinitis who were treated with effective immunotherapy (6 months to 12 months) and 16 untreated allergic patients. The proportion of Fcε R(+) cells in PB lymphocytes in immunotherapy-treated patients was significantly lower than that in untreated patients, even though both of those showed higher levels than the normal ranges. However, there were no significant differences in serum IgE levels and the proportions of T cells with their subsets in PB lymphocytes between the groups of immunotherapy-treated patients and untreated patients. These findings may suggest that the proportion of Fcε R(+) cells in PB lymphocytes could be one of the parameters to monitor the early immunological changes in effective immunotherapy.

호흡기 알레르기 환자에서 혼합항원 추출액을 이용한 면역요법의 효과 및 그 예측 지표

강문수 ( Kang Mun Su ),최영환 ( Choe Yeong Hwan ),허영구 ( Heo Yeong Gu ),김항재 ( Kim Hang Jae ),김능수 ( Kim Neung Su ) 대한내과학회 1992 대한내과학회지 Vol.42 No.3

여러 가지 항원에 3+이상 양성인 천식 및 비염환자 217명을 대상으로 혼합항원추출액을 이용한 면역요법을 12개월이상 실시하여 면역요법의 효과를 조사하고 그 면역요법의 효과를 사전에 예측할 수 있는 지표의 유무를 찾고자 면역요법전의 여러 가지 지표를 즉 환자의 나이, 유병기간, 혈청 총 IgE치, 혈청특이 IgE치 및 말초혈약림프구와 그아형 그리고 천식의 경우 폐기능을 비교검토 하였다. 총 217명의 환자에서 12개월이상 면역요법후 증상의 호전이 있고 사용하는 약의 용량을 줄일수 있을 정도의 fair 이상의 효과를 보인 경우는 130명(60%) 이었다. 이중 천식환자에서는 58.7%, 비염환자는 61.5%에서 fair 이상의 효과를 보았다. 그리고 성별로는 그 효과에서 차이를 발견할 수 없었다. 사용한 알레르겐중에는 Dermatophagoides farinae 또는 Dermatophagoides pteronyssinus를 포함한 여러 allergen을 사용한 경우가 집먼지진드기만으로 면역요법을 한 경우보다 효과가 좋았다. 전체 알레르기 환자에서 면역요법의 효과를 보인 환자 가운데 상당기간 투약을 중지할 수 있을 정도의 증상의 호전이 있은 good/excellent 반응군에서는 무반응군보다 나이는 낮은 반면 말초혈액 T림프구 백분율은 유의하게 높았다. 그 외 유병기간, 혈청 총 IgE치, 말초혈액 호산구수, RAST score 및 림프구 아형 백분율에는 두군 사이에 유의한 차이가 없었다. 천신환자 가운데 good/excellent 반응군에서는 무반응군에 비하여 나이가 낮고, FEV1치는 높았다. 비염환자에서는 유병기간이 짧을수록 면역요법의 효과가 좋았다. 이상에서 알레르기 비염이나 천식환자에서 면역요법을 시행할 때는 환자의 나이, 유병기간, 알레르겐의 종류를 염두에 두어야하고 특히 천신의 경우는 FEV1도 고려해야 할 인자중에 하나라고 생각된다. The study was undertaken in 217 multi-allergen sensitive allergy patients (126 cases of asthma, 91 of rhinitis) ranging in age from 5 to 64 years to investigate the effect of immunotherapy and to find parameters that might predict the efficacy of specific immunotherapy. All the patients, who had received a subcutaneous standard immunotherapy for more than 12 months, was grouped into response groups and no response group by symptom-medication scoring system. Various parameters including patients`s age, duration of symptom, serum IgE level, RAST score and lymphocyte subsets as well as pulmonary function were compared between groups. The efficacy of better than poor response of specific immunotherapy was found in 130 patients (60%), 74 (58.7%) in asthma and 56 (61.5%) in rhinitis, among the 217 allergy patients, and the immunotherapy with mixedallergen extracts including house dust mites was appeared to be more effective than in only house dust mite immunotherapy. There showed lower mean age and higher T-cell count in good/excellent response group of total allergy patients. In asthma patients, the good/excellent group showed lower mean age of patients and higher FEV1 levels. However, short duration of symptom was the only parameter to predict good/excellent response in rhinitis patients. These results suggest that patient`s age, duration of symptom, kinds of allergens and pulmonary function should be considered in predicting the efficacy of immunotherpy with mixed-allergen extracts in respiratory allergy patients.

신증후군환자에서의 HLA 항원분포

이시래 ( Si Rhae Lee ),정태훈 ( Tae Hoon Jung ),김항재 ( Hang Jae Kim ),조현숙 ( Hyun Sook Cho ),이인걸 ( In Geol Lee ),김홍태 ( Tae Hong Kim ),김능수 ( Neung Soo Kim ),김재식 ( Jeh Sik Kim ) 대한내과학회 1984 대한내과학회지 Vol.27 No.4

비체중 및 체용적지수와 피부두겹 두께로 산출한 체지방율과의 비교 관찰 - 30 및 40 대 성인 남녀를 대상으로 -

박희명(Hi Myung Park),원경화(Kyung Hwa Won),김종석(Jong Suk Kim),김성국(Sung Kook Kim),조미경(Mi Kyung Jo),김항재(Hang Jae Kim),김보완(Bo Wan Kim) 대한내과학회 1991 대한내과학회지 Vol.40 No.4

N/A To evaluate the validity of relative body weight (RBW), body mass index (BMI), and percentage of body fat (%BF) estimated by skinfold-thickness in assessing obesity, comparison of prevalence of overweight assessed by each of these indices was made in 177 men and 148 women aged from 30 to 49 years. The correlation of %BF with RBW and BMI was also studied. The prevalence of overweight assessed by %BF was some- what higher in women and lower in men than those by RBW or BMI. The correlation of %BF with RBW and BMI, as a whole, was significantly high in both sexes with the correlation coefficients of approximately 0.7, reconfirming that these indices are clinically useful. Nonetheless, the correlation of %BF with RBW and BMI was unexpectedly low in those with % BF of more than 20 in men and less than 25 in women. This suggests that both RBW and BMI may be inadequate indices in the assessmant of overweight in those with body weight markedly deviated from the general mean.

급성신부전증에서의 복막투석에 관하여

이시래 ( Si Rhae Lee ),윤병철 ( Byung Chyull Yoon ),이길양 ( Kil Yang Lee ),장석락 ( Seog Rag Jang ),김항재 ( Hang Jae Kim ) 대한내과학회 1982 대한내과학회지 Vol.25 No.4

급성 전벽 심근경색증 환자에서 심전도 하벽 유도 ST 절 하강의 임상적 의의

최정현(Jeong Hyun Choi),전영주(Young Joo Jeon),정병기(Byung Ki Jung),최희만(Hee Man Choi),이중기(Choong Ki Lee),전재은(Jae Eun Jun),김항재(Hang Jae Kim),채성철(Shung Chull Chae),박의현(Wee Hyun Park) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A To determine the significance of inferior ST segment depression during the early stages of acute transmural anterior myocardial infarction, we examined cardiac enzymes, in-hospital complications and indices of ST segment elevation in 51 patients presenting with acute anterior myocardial infarction. The patients were allocated to two electrocardiographic groups. Group I consisted of 19 patients (37%) with a 1 mm or more ST segment depression in at least two of leads II, III, and aVF, Group II consisted of 32 patients without this finding. Compared with group II, patients in group I had a higher peak creatine kinase and lactic dehydrogenase and experienced congestive heart failure, shock, arrhythmias requiring treatment, and death more frequently. Indices of ST segment elevation did not show a significant difference in both groups. The degree of inferior wall ST segment depression correlated weakly with the magnitude of the anterior ST segment elevation(r=0.63, p<0.01). Thus, the inferior ST depression during acute anterior infarction is a reliable marker of more extensive myocardial damage and an adverse hospital course. Such an inferior ST depression might reflect not only reciprocal change, but also ischemia in a remote inferior region.

기관지 천식환자에서 운동후 즉시형 및 지연형 기관지 수축

김항재 慶北大學校 醫科大學 1989 慶北醫大誌 Vol.30 No.1

기관지 천식환자 17명(남7, 여10)을 대상으로 treadmill을 이용한 운동부하검사를 실시하여 다음과 같은 결과를 얻었다. 즉시형 기관지 수축반응은 대상환자 17명중 6명에서 나타났으며(35.3%) 운동후 5분내지 10분이내에 가장 심하여 FEV_1이 운동전보다 24% 내지 73% 감소하였다. 지연형 기관지 수축반응은 즉시형반응을 보인 6명중 한명에서 나타나 이상성반응을 보였고 운동후 8시간 40분후에 나타났고 FEV_1감소는 70%이상이어서 즉시형의 60%보다 심하였다. 운동후 기관지 수축반응을 보인 6예와 그렇지않는 11예에서의 운동전 천식의 증상이나 FEV_1 및 %MMF는 양군사이에 유의한 차이를 볼 수 없었다. In order to study the prevalence of exercise induced asthma and biphasic bronchial response after exercise, the exercise test with treadmill was performed in seventeen subjects with asthma(7 male and 8 female). With 20% fall in FEV_1 as cut-off level, immediate bronchoconstriction was noted in six of seventeen patients(35.3%) and the %fall in FEV_1 was maximal within 5 to 10 minutes after exercise. One patient had biphasic response with late brooncho-constiction at about 9 hours after the exercise. In this patient, %fall in FEV_1 was more severe than that of the immediate response. No Singificat differances were observed in the clinical severity of asthma, diurnal variation in FEV_1 and %MMF between patients with EIA and those without EIA.

알레르기 환자에서 면역요법에 따른 면역학적 지표의 변화

최영환,허영구,김항재,김능수 慶北大學校 醫科大學 1991 慶北醫大誌 Vol.32 No.2

혼합 항원추출액으로 면역요법시 경과 관찰에 도움이 되는 객관적인 지표를 설정하기 위하여 D. farinae 또는 D. pteronyssinus를 포함한 2내지 6가지 복수의 기인 항원을 갖고 면역요법을 6∼12개월 받은 환자(제Ⅱ군)와 2년 이상 받은 환자(제Ⅲ군)를 대상으로 말초혈액 호산구수, 혈청총IgE치, RAST score, 피부반응도, 말초혈액 IgE수용체보유림프구, 말초혈액 T, B림프구 및 T림프구 아형을 측정하여 면역요법을 받지 않은 알레르기 환자(제Ⅰ군)들에서의 성적과 비교 검토하였다. 혈청총IgE치는 6∼12개월 면역요법군 및 2년이상 면역요법군에서 면역요법을 받지 않은 군보다 유의하게 낮았다. (각각 P<0.05) 면역요법전혈청총IgE치가 400IU/㎖이상인 환자에서는 면역요법후 그 감소가 뚜렷하였으나 300IU/㎖이하인 경우는 유의한 감소를 볼 수 있다. 면역요법을 받지 않았는 군에서의 피부반응도지수의 평균은 1.80±1.79였고 6∼12개월 면역요법을 받은 제Ⅱ군 및 2년이상 면역요법을 받은 제Ⅲ군의 피부반응도지수는 제Ⅰ군보다 각각 유의하게 낮았다. 말초혈액 FcεR(+)림프구는 면역요법을 받지 않았는 Ⅰ군보다 Ⅱ군 및 Ⅲ군에서 유의하게 낮았으나 여전히 정상치 이상이었다. 그러나 혈중 호산구수, RAST score, 말초혈액림프구 및 그 아형은 면역요법 전후 유의한 변화를 나타내지 않았다. 이상의 성적에서 혈청총 IgE치, 피부반응도지수, 말초혈액FcεR(+)림프구는 면역치료의 경과를 대체로 추적할 수 있는 지표가 될 수 있을 것으로 생각된다. To determine the reliable parameters for assessing the efficacy of immunotherapy in multi-allergen sensitive allergy patients, we observed the changes of peripheral blood eosinophil counts, total and specific IgE levels, skin-test reactivity index, Fcε receptor-bearing lymphocytes, T/B lymphocytes and T-subsets in peripheral blood in the three groups of allergic asthma or rhinitis patients, the first group(group Ⅰ) of 102 patients who were not on immunotherapy, the second group(group Ⅱ) of 28 patients who received 6-12 months immunotherapy, and the third one(group Ⅲ) of 24 patients who received 2 years immunotherapy. Those patients were sensitive to 2-6 aeroallergens including D. farinae or D. pteronyssinus and all the patients in group Ⅱ and group Ⅲ had been immunized with the specific desensitization vaccine (SDV, Bencard®), resulting good response on symptoms. Total serum IgE levels were significantly decreased in the groups of Ⅱ and Ⅲ, compared with groupⅠand the decrease in IgE was more prominent in the patients of high IgE level over 400IU/㎖ prior to immunotherapy. The mean of skin-test reactivity index was 1.80±0.79 in group Ⅰ and this index was significantly lowered in group Ⅱ and Ⅲ. Significant decrease in Fcε receptor-bearing lymphocytes in peripheral blood was developed in immunotherapy-received groups(Ⅱ and Ⅲ). However, the patients still had higher levels of Fcε receptor-bearing lymphocytes in peripheral blood than normal controls, even after more than 2 years of immunotherapy. The differences of peripheral blood eosinophil counts, RAST score, T/B lymphocytes and T-subsets were not significant between before and after immunotherapy. These findings suggest that serum IgE, skin-test reactivity index and Fcε receptor-bearing lymphocytes in peripheral blood could be useful parameters in assessing the efficacy of immunotherapy with extracts of multi-allergens.

有熱患者의 血液培養에서 分離된 病原菌에 關하여

張錫洛,金弘泰,金恒在,金能守 慶北大學校 醫科大學 1981 慶北醫大誌 Vol.22 No.2

1976년 1월부터 1980년 12월까지 경북의대 부속병원을 來院한 유열환자에서 혈액배양으로 분리된 587菌株를 대상으로 다음과 같은 결과를 얻었다. 분리된 587菌株 가운데 가장 많은 菌種은 Staphy-lococcus였고, 다음으로는 Salmonella 및 E. coli 였으며, 그 밖에 Enterobacter, Serratia, Pseudo-monas, Klebsiella, Streptococcus, Acinetobac-ter, Proteus 및 Str. pneumoniae 등이 분리되었다. Staphylococcus 가운데는 coagulase 양성균이 66例, coagulese음성균이 96例였으며, Salmonella 가운데는 group D 가 100例, group A가 25例였다. 연령별로 본 균혈증의 원인균으로서 10세 미만에서 Staphylococcus가 많고 10代에서 40代 사이에서는 Salmonella와 Staphylococcus, 50代 이후에서는 E. coli 가 많았다. E. coli 는 20代 이후 연령층이 증가할수록 그 분리빈도가 높았다. Salmo-nella의 분리빈도는 하절기에 가장 높았으나 全例의 16%는 동절기에 분리되었다. 감염의 原發病巢별로 본 균혈증의 원인균으로는 호흡기계, 피부 및 창상 감염에서는 Staphylococcus가 가장 많았고 간·담도계감염 및 복강내농양에서는 E. coli, 비뇨생식기계 감염에서는 Staphylococcus와 E. coli 가 많았다. Underlying condition에 따라서는, 당뇨병, 암, 혈액질환, 간·담도계이상 및 부신피질홀몬 長期使用者에서는 E. coli, 수술 및 의료시술에서는 Staphylococcus 그리고 화상에서는 Pseudomonas가 각각 균혈증의 가장 빈번한 원인균이었다. Five hundred and eighty seven pathogens were isolated from blood cultures of the febrile patients at Kyungpook National University Hospital during past five years(1976-1980). The results were summerized as follows: Staphylococcus was observed in the highest number followd by Salmonella, E. coli, Entero-bacter, Serratia, Pseudomonas and Str. pneumoniae in decreasing order. Among isolated Staphylococcus, coagulase positive strains were 66 and negative strains were 96. In case of Salmonella, group D strains were 100 of the total 125 Salmonella cases and the remainders were group A. According to the age groups of the patients, Staphylococcus was the most common agent of the bacteremia under the age group of 10 years old, Salmonella and Staphylococcus were the predominant agents in the age group from the 2nd to 5th decade, while over the age group of 50 years old, E. coli was the most common agent. Staphylococcus was the most frequent causative organism of the bacteremia following the in-fection of the respiratory tract, and the infection of the skin and wound, but in the cases of intrapertioneal and hepatobiliary infections, E. coli was the most common agent of the bactere-mia. And in bacteremia due to infection of the genitourinary tract, E. coli and Staphylococcus were the common agents. In the patients of the diabetes mellitus, cancer, blood dyscrasias, hepatobiliary abnormalities and in parients with chronic corticosteroid therapy, E. coli was the most frequent organism of the bacteremia. E. coli and staphylococcus were the common agents of the bacteremia folliwing operation and medical procedures, while Pseudomonas following burn.