베체트 환자에서의 monocyte chemoattractant protein-1의 상승

도주호 ( Do Ju Ho ),정지현 ( Jeong Ji Hyeon ),박찬석 ( Park Chan Seog ),고지송 ( Go Ji Song ),김순섭 ( Kim Sun Seob ),최현철 ( Choe Hyeon Cheol ),손장명 ( Son Jang Myeong ),민도준 ( Min Do Jun ),박성환 ( Park Seong Hwan ),조철수 ( 대한내과학회 2003 대한내과학회지 Vol.65 No.4

목적: 베체트병에서는 림프구, 단핵구, 호중구에 의한 염증성 혈관염이 흔하게 발생하는데 특히 단핵구의 활성화와 충원을 책임지는 MCP-1과 같은 케모카인의 증가가 조직 내 염증세포의 충원과 침윤에서 중요한 역할을 할 것으로 생각되나 아직까지 이에 대한 연구는 없는 실정이다. 저자들은 본 연구에서 베체트병 환자의 혈청 혹은 세포배양액에서 MCP-1의 표현을 조사하고 RANTES, MIP-1α IL-8 등 다른 케모카인들과의 연관성을 조사하였다. 방법: 7 Background: Monocyte chemoattractant protein-1 (MCP-1) belongs to C-C subfamily of chemokines, which stimulates the migration of monocytes. MCP-1 exerts various effects on the monocytes, including the induction of integrin and tissue factor, and synthesis

교원성 질환에서의 혈장 Endothelin-1 증가와 손톱 모세혈관 이상과의 연관성

도주호 ( Do Ju Ho ),김호연 ( Kim Ho Yeon ) 대한내과학회 2004 대한내과학회지 Vol.66 No.3

목적 : Endothelin-1은 강력한 혈관수축제로서 교원성 질환에서 증가되어 있다고 알려져 있다. 저자들은 손톱 모세혈관 현미경상에서 이상소견의 유무와 혈관의 확장 정도를 정량적으로 측정하여 모세혈관 현미경 검사가 혈장 endothelin-1 농도를 대변할 수 있는지 알아보았다. 방법 : 전신성 경화증 환자 18명, 전신성 홍반성 루푸스 환자 54명, 복합 교원성 질환 4명, 다발성근염/피부근염 3명 총 79명을 대상으로 레이노 현상의 유무와 기간 그리고 혈장 endothelin-1 농도를 측정하였다. 동시에 손톱 모세혈관 현미경 검사를 실시하여 거대 모세혈관, 모세혈관의 확장, 모세혈관의 꼬임, 모세혈관의 출혈 혹은 모세혈관 수의 감소와 같은 이상소견의 유무와 모세혈관상의 첨단 사지 너비, 모세혈관 너비 그리고 모세혈관 길이를 측정하여 정량적 검사를 하였다. 결과 : 검사 당시의 레이노 현상 유무에 따라서는 레이노 현상이 있는 군의 endothelin-1 농도가 레이노 현상이 없는 군의 농도보다 높았으나 통계적인 의미는 없었다(2.433±2.259 n=33, vs. 1.905±1.371 pg/mL n=46, p=non specific). 18명의 전신성 경화증 환자는 모두 레이노 현상을 가지고 있었으며, 이상 손톱 모세혈관 소견의 유무에 따른 endothelin-1 농도는 이상 모세혈관 소견이 있는 군에서 증가되어 있었다(3.940±3.335 pg/mL (n=12), vs 1.573±1.006 pg/mL (n=6), p<0.05). 54명의 전신성 홍반성 루푸스 환자 중 레이노 현상과 이상 손톱 모세혈관 소견을 같이 가지고 있는 경우 endothelin-1 농도가 4.191±1.696 pg/mL (n=5)로서, 레이노 현상은 있으나 이상 모세혈관 소견은 가지고 있지 않은 경우 1.364±0.636 pg/mL (n=16), 레이노 현상은 없으나 이상 모세혈관 소견을 가지고 있는 경우 2.575±1.690 pg/mL (n=8) 그리고 레이노 현상을 가지고 있지 않고 이상 모세혈관 소견도 없는 경우 1.691±1.215 pg/mL (n=25)보다 높았다(p<0.05). 전신성 경화증 환자 중 레이노 현상의 기간과 endothelin-1 농도를 비교해 보았을 때 통계적인 연관성이 없었으나, 레이노 현상과 이상 손톱 모세혈관 소견을 동시에 가지고 있는 환자에서는 레이노 현상의 기간이 짧을수록 endothelin-1 농도가 증가되어 있었다. Endothelin-1 농도와 손톱 모세혈관의 크기를 정량적으로 측정 하였을 때, 전신성 결화증 환자에서는 첨단 사지 너비의 증가와 endothelin-1 농도의 증가와 통계적 유의성이 있었고(r_(s)=0.577 p<0.05), 전신성 홍반성 루푸스 환자에서는 첨단 사지너비와 모세혈관 너비 증가가 endothelin-1 농도의 증가와 통계적 유의성이 있었다(r_(s)=0.425 p<0.01, r_(s)=0.278 p<0.05, respectively). 결론 : 레이노 현상을 동반한 교원성 질환을 가진 환자에서 손톱 모세혈관 현미경 검사 특히 정량적 손톱 모세혈관 현미경 검사상 이상 소견은 혈장 endothelin-1 농도의 증가와 연관이 깊다. 그러므로 손톱 모세혈관 검사로서 혈장 endothelin-1 농도의 증가와 질병 활성도의 증가를 간접적으로 추측할 수 있으며, 이는 교원성 질환 특히 레이노 현상을 동반한 환자에서의 추적관찰 및 섬유화 합병증의 조기 발견과 치료에 도움이 될 수 있을 것이다. Background : Since the endothelin-1 may be implicated in the pathogenesis of peripheral vascular diseases associated with connective tissue diseases (CTDs), we examined the plasma endothelin-1 level in association with quantitative nailfold capillaroscopy in patients with CTDs. Methods : We investigated 79 patients with connective tissue diseases (54 systemic lupus erythematosus (SLE), 18 systemic sclerosis (SSc), 4 mixed connective tissue disease, 3 polymyositis/dermatomyositis). Plasma samples were obtained and endothelin-1 levels were measured by sandwich enzyme-linked immunosorbent assay. The presence and duration of Raynaud phenomenon as well as nailfold capillaroscopy were evaluated in each patient. To examine the quantitative nailfold capillaroscopy, we measured the length of apical limb width, capillary width and capillary length. Results : According to the presence or absence of Raynaud phenomenon, there was no statistically increased plasma endothelin-1 level between two groups (2.433±2.259 pg/mL n=33, vs. 1.905±1.371 pg/mL n=46, p=non specific). All the SSc patients had Raynaud phenomenon and according to the presence of abnormal capillaroscopic findings, there were increased level of endothelin-1 in abnormal capillaroscopy group compared to normal capillaroscopy group (3.940±3.335 pg/mL (n=12), vs 1.573±1.006 pg/mL (n=6), p<0.05). As compared quantitative examination of nailfold capillaroscopy with plasma endothelin-1 level, in SSc patients the endothelin-1 level correlated well with the length of apical limb width (r_(s)=0.577 p<0.05). In SLE patients the endothelin-1 level correlated well with the length of apical limb width and capillary width (r_(s)=0.425 p<0.01, r_(s)=0.278 p<0.05, respectively). Conclusion : Our data demonstrate that the presence of abnormal capillaroscopic findings reflect increased plasma endothelin-1 level in patients with connective tissue diseases, and quantitative analysis of nailfold capillaroscopy can be useful to predict the disease activity with the evidence of increased plasma endothelin-1.

무릎 골관절염에서의 초음파 소견에 따른 소염진통제와 아세트아미노펜의 유효성 비교

도주호 ( Ju Ho Do ),허성은 ( Sung Eun Hur ),백승인 ( Seung In Paek ),나종명 ( Jong Myoung Nah ),김충현 ( Choong Hyun Kim ),이상헌 ( Sang Heon Lee ),박성환 ( Sung Hwan Park ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),김완욱 ( 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.1

Objective: To compare the clinical efficacy between nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen in knee osteoarthritis according to ultrasonographic findings. Methods: We administered 12 mg of NSAIDs (lornoxicam) plus misoprostol 300μg or 1,950 mg of acetaminophen in 40 randomly selected patients who fulfilled the ACR criteria for knee osteoarthritis. The effectiveness of these drugs on osteoarthritis was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. In addition, we performed ultrasonography of the knee joints and assessed length of capsular distension, length of medial and lateral osteophyte, amount of joint effusion, and the presence of synovial proliferation. Results: There were significant correlations between WOMAC score and length of capsular distension and length of medial/lateral osteophyte. At 6 weeks, both lornoxicam and acetaminophen-treated patients had significant lower levels of WOMAC score compared to the entry into the trial (p<0.01 and p<0.05, respectively). As compared the clinical efficacy between the two groups, the lornoxicam-treated patients showed a greater decrease in WOMAC score than patients treated with acetaminophen (p=0.026). When we further divided the patients into the subgroups according to the sonographic severity, the patients with severe capsular distension (≥0.7 cm) or severe medial osteophyte (length of osteophytes ≥0.4 cm) showed better responses to lornoxicam than to acetaminophen in terms of the reduction of WOMAC score (p=0.008 for severe capsular distension, p=0.03 for severe medial osteophyte). However, in the subgroup with mild forms of capsular distension (<0.7 cm) or medial osteophytes (<0.4 cm), no difference was found in the reduction of WOMAC score 6 weeks after treatment with lornoxicam versus acetaminophen. Conclusion: Patients with osteoarthritis of the knee had significantly greater improvements in pain score over 6 weeks with lornoxicam than with acetaminophen, particularly in patients with severe forms of capsular distension and medial osteophyte on joint ultrasonography. Ultrasonography could be an useful tool to determine the usage of NSAIDs versus acetaminophen in knee osteoarthritis patients.

Wiskott-Aldrich 증후군 환자에서 발생한 감염성 관절염

도주호 ( Ju Ho Do ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.2

The Wiskott-Aldrich syndrome is a rare disease characterized by thrombocytopenia, recurrent eczema and a marked vulnerability to recurrent infection. Patients with Wiskott-Aldrich syndrome have frequent infections by bacteria which have polysaccharide capsules such as Pneumococcus, Hemophilus influenzae and Neisseria meningitidis due to poor antibody response to polysaccharide antigens. We experienced a 21 years old man with septic arthritis combined with Pneumococcal pneumonia, multifocal abscesses in back and iliacus muscle. After treatment with antibiotics for one month, he was treated successfully.

전신홍반루푸스 환자에서 Ceftriaxone과 Isepamicin 투여 후 발생한 전염성 단핵구증 유사 증후군

도주호 ( Ju Ho Do ),류성열 ( Seong Yeol Ryu ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.2

A severe adverse reaction to certain drug could be associated with hypersensitivity syndrome, showing the clinical features of infectious mononucleosis including maculopapular rash, fever, lymphadenopathy, leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance. We report a systemic lupus erythematosus patient who developed infectious mononucleosis-like syndrome with administration of ceftriaxone/isepamicin for the treatment of pneumonia. This case warrants careful attention to infectious mononucleosis-like syndrome associated with antibiotics administration, especially in febrile patients with known autoimmune diseases such as systemic lupus erythematosus.

골관절염 치료효과 및 안전성에 있어 S-Adenosylmethionine과 Ibuprofen의 비교 연구

김대성,정영옥,도주호,고혁재,백승인,김호연,이상헌,Kim, Dae-Sung,Jung, Young-Ok,Do, Ju-Ho,Koh, Hyek-Jae,Baek, Seung-In,Kim, Ho-Youn,Lee, Sang-Heon 대한임상약리학회 2003 Translational and Clinical Pharmacology Vol.11 No.2

Objective : To compare the efficacy and safety of S-adenosyl-methionine (SAMe) and ibuprofen in the treatment of patients with knee osteoarthritis. Methods : Sixty patients with knee osteoarthritis (OA) were enrolled in this study. Patients received a daily oral dose of 1200mg of SAMe and 1200mg of ibuprofen for 4 weeks Treatment efficacy was evaluated with clinical parameters as Lequesne's functional index and visual analog scale (VAS) of pain. Adverse effects were monitored from patient interviews and blood sampling. Results: The treatment efficacy evaluated by clinical parameters was not different in both groups. Gastrointestinal adverse effects were more frequently observed in ibuprofen group than in SAMe. Conclusion : SAMe was equally effective to ibuprofen in efficacy and better tolerated in short term treatment of patients with knee OA.

콜라겐으로 경구 관용을 유도한 관절염 동물 모델의 세포 특이적 면역 반응 조사

민소연,황수연,이재선,김주영,이강은,김경운,김영훈,도주호,김호연,Min, So-Youn,Hwang, Sue-Yun,Lee, Jae-sun,Kim, Ju-Young,Lee, Kang-Eun,Kim, Kyung-Wun,Kim, Young-Hun,Do, Ju-Ho,Kim, Ho-Youn 대한면역학회 2003 Immune Network Vol.3 No.2

Oral administration of antigen has long been considered as a promising alternative for the treatment of chronic autoimmune diseases including rheumatoid arthritis (RA), and oral application of type II collagen (CII) has been proven to improve pathogenic symptoms in RA patients without problematic side effects. To further current understandings about the immune suppression mechanisms mediated by orally administered antigens, we examined the changes in IgG subtypes, T-cell proliferative response, and proportion of interleukin (IL)-10 producing Th subsets in a time course study of collagen induced arthritis (CIA) animal models. We found that joint inflammation in CIA mouse peaked at 5 weeks after first immunization with CII, which was significantly subdued in mice pre-treated by repeated oral administration of CII. Orally tolerized mice also showed increase in their serum level of IgG1, while the level of IgG2a was decreased. T-cell proliferation upon CII stimulation was also suppressed in lymph nodes of mice given oral administration of CII compared to non-tolerized controls. When cultured in vitro in the presence of CII, T-cells isolated from orally tolerized mice presented higher proportion of $CD4^+IL-10^+$ subsets compared to non-tolerized controls. Interestingly, such increase in IL-10 producing cells were obvious first in Peyer's patch, then by 5 weeks after immunization, in mesenteric lymph node and spleen instead. This result indicates that a particular subset of T-cells with immune suppressive functions might have migrated from the original contact site with CII to inflamed joints via peripheral blood after 5 weeks post immunization.

류마티스 관절염 환자의 혈중 아연 및 구리 농도와 질병 활성도와의 관계

이명수 ( Myeung Su Lee ),강효종 ( Hyo Jong Kang ),홍승재 ( Seung Jae Hong ),도주호 ( Ju Ho Do ),윤종현 ( Chong Hyeon Yoon ),김완욱 ( Wan Uk Kim ),민도준 ( Do June Min ),윤지희 ( Jee Hee Youn ),박성환 ( Sung Hwan Park ),조철수 ( Ch 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.4

Objective: To investigate the relationship between serum trace element levels with disease activity in Korean patients with rheumatoid arthritis (RA). Methods: The serum levels of zinc, copper and ceruloplasmin were measured by inductively coupled plasma atomic emission spectrometers in 80 patients with RA, 26 osteoarthritis (OA), and 30 healthy controls (HC). We also measured the levels of zinc and copper in the synovial fluid (SF) of patients with RA. We investigated the clinical parameters simultaneously obtained at sampling of serum and analyzed correlation between serum levels of trace elements and disease activity in RA. Results: In RA, the levels of serum zinc were significantly lower than that of HC, and the levels of serum copper and ceruloplasmin were significantly higher than those of HC. In active RA, the levels of serum zinc were more decreased, and the levels of serum copper and ceruloplasmin were more increased than those of inactive group of RA. The levels of both copper and ceruloplasmin showed positive correlation with the levels of serum ESR and CRP. On the other hand, the levels of serum zinc showed negative correlation with the levels of serum ESR and CRP. Conclusion: Serum zinc levels are significantly lower and serum copper levels significantly higher in patients with active RA and these trace elements were useful parameter of disease activity in RA.

전신성 홍반성 루푸스 환자와 신장이식 환자에서 발생한 결핵의 임상적 특징 비교

김충현 ( Choong Hyun Kim ),김완욱 ( Wan Uk Kim ),양철우 ( Chul Woo Yang ),정영옥 ( Young Ok Jung ),도주호 ( Ju Ho Do ),고혁재 ( Hyeok Jae Ko ),김해림 ( Hae Rim Kim ),윤종현 ( Chong Hyeon Youn ),이상헌 ( Sang Heon Lee ),박성환 ( Su 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.3

Objective: To compare the incidence and clinical characteristics of tuberculosis (tbc) between patients with systemic lupus erythematosus (SLE) and kidney transplantation (KT) recipients. Methods: Six hundreds and twenty-two patients who were diagnosed as SLE from 1990 to 2001 in Kang-Nam St. Mary`s hospital were reviewed, retrospectively. As a control group, 347 kidney transplant recipients in the same center were evaluated. The extent of tbc was categorized into two groups: (1) limited disease (2) extensive disease. Cumulative steroid dosage and disease activity index including SLEDAI, serum complement levels, and anti-dsDNA titers were compared between the two groups. Results: The cumulative incidence rate of tbc was similar in both groups (37 cases and 5.7% in SLE versus 17 cases and 4.9% in KT). Mean interval from SLE diagnosis or KT to tbc development was not different between the two groups. The most common site of tbc was lung/pleura, and the others included lymph nodes (2 cases), knee joint (1), bone marrow (1), critecentral nervous system (1), kidney (1), colon (1), liver (1), and skin (1) in SLE. In contrast, most of tbc (16/17) developed exclusively in the lung and pleura in KT recipients. Cumulative doses of prednisolone 1 or 6 months before tbc diagnosis were not different between the two groups. Interestingly, extensive disease tended to be more frequent in SLE patients than in KT recipients although immuno-suppressants such as cyclosporine and azathioprine were more frequently administered in KT recipients. There were no differences in disease activity index including SLEDAI, complement levels, and anti-ds DNA titers at the time of tbc diagnosis as well as in the cumulative doses of steroid between extensive and limited diseases of tbc in SLE. Conclusion: The cumulative incidence rate of tbc was higher in SLE patients than in general population. The patterns of tbc tended to be more extensive in SLE compared to KT recipients in whom a stronger immuno-suppression was required, suggesting that immune dysfunction implicated by SLE itself may play an important role in determining the incidence and patterns of tbc infection.

부신기능 저하증을 동반한 전이성 부신암 1례

도주호,류성열,황준영,정재진,이동욱,이상준,권기영,이인규 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.2

Adrenal insufficiency is caused by destruction of the adrenal cortex, deficient pituitary ACTH secretion, or deficient hypothalamic secretion of corticotropin releasing hormone. The prominent symptoms are weakness, fatigue, weight loss, and gastrointestinal complaints, but these symptoms are common to many other diseases. Thus, the diagnosis of adrenal insufficiency needs the exception of other diseases. Primary adernal insufficiency comes from autoimmune disease, granulomatous disease, metastatic malignancies such as lung and breast carcinoma, hemorrhagic infarction associated with anticoagulant therapy or meningococcemia, and rare hereditary diseases. In this paper, we present a case of lung cancer with adrenal metastasis which causes adrenal insufficiency. The patient was treated with chemotherapy and steroid replacement therapy successfully.