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연구논문 : 만성 B형간염 환자에 대한 초치료제로서 엔테카비어의 항바이러스 효과와 그 예측인자
명형준 ( Hyung Joon Myung ),정숙향 ( Sook Hyang Jeong ),김진욱 ( Jin Wook Kim ),김희섭 ( Hee Sup Kim ),장제혁 ( Je Hyuck Jang ),이동호 ( Dong Ho Lee ),김나영 ( Nayoung Kim ),황진혁 ( Jin Hyeok Hwang ),박영수 ( Young Soo Park ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1
목적: 항바이러스 약제에 대한 치료 경험이 없는 국내 만성 B형간염 환자의 초치료제로서 엔테카비어의 치료 효과와 치료 반응의 예측인자를 알아보고자 하였다. 대상 및 방법: 2007년 2월부터 2009년8월까지 본원에 내원한 만성 B형간염 환자 중 과거 항바이러스 약제 사용력이 없으며 24주 이상 엔테카비어를 복용한 160명을 대상으로 후향적으로 연구하였다. 엔테카비어 투여 중 혈청 HBV DNA의 소실(2000 copies/mL 미만)을 바이러스 반응으로, 혈청 ALT의 정상화를 생화학적 반응으로 정의하였고, 혈청 HBeAg 소실과 HBeAg 혈청전환을 평가하였다. 바이러스 돌파는 HBV DNA치가 2번의 연속된 검사에서 이전 검사 결과보다 1 log10이상 증가하였을 경우로 정의하였다. 결과: 총 160명의 환자 중, 남자는 85명(53.1%), HBeAg 양성인환자는 85명(53.1%), 간경변이 동반된 환자는 70명(43.8%)이었고, 치료 전 혈청 ALT의 중앙값은 99IU/L, 혈청 HBV DNA의 중앙값은 7.57 log10copies/mL였다. 평균 58.8주 동안 추적관찰하였다. 누적 바이러스 반응률은 12주에 37.5%, 24주에 68.1%, 48주에 87.4%, 72주에 95.8%였고, 누적 생화학적 반응률은 12주에 40.0%, 24주에 66.2%, 48주에 84.5%, 72주에 92.7%였다. 누적 HBeAg 소실률은 12주에 10.6%, 24주에 18.8%, 48주에 27.0%, 2주에 34.5%였고, 누적 HBeAg 혈청전환율은 12주에 3.5%, 24주에 7.1%, 48주에 9.0%, 72주에 13.2%였다. 일차 치료 실패에 해당하는 환자나 바이러스 돌파 현상을 보인 환자는 없었다. 바이러스 반응과 관련된 유의한 예측인자는 치료 전 HBeAg이 음성, HBV DNA치의 상용로그 변환값이 8 미만인 경우였다. 결론: 엔테카비어 치료는 국내의 항바이러스제 치료 경험이 없는 만성 B형간염 환자에서 강력한 항바이러스 효과를 보였으며, 바이러스 반응의 예측인자는 치료 시작 전 HBeAg의 유무, HBV DNA 값이다. 향후 장기간의 치료 성적에 대한 연구가 필요하다. Background/Aims: The aim of this study was to elucidate the antiviral efficacy and the predictors of entecavir treatment in nucleoside-naive chronic hepatitis B patients. Methods: A total of 160 patients treated with entecavir (0.5 mg daily) for at least 24 weeks were consecutively enrolled. The virologic response (HBV DNA<2,000 copies/mL), biochemical response (ALT≤ upper limit of normal), and virologic breakthrough (>1 log10 copies/mL increase in HBV DNA level above nadir on two consecutive occasions) were retrospectively analyzed. Results: The mean follow-up duration was 58.8 weeks, and 85 patients (53.1%) showed HBeAg positivity. The median pretreatment levels of serum ALT and HBV DNA were 99 IU/L and 7.6 log10 copies/mL, respectively. The cumulative rates at 12, 24, 48, and 72 weeks were 37.5%, 68.1%, 87.4%, and 95.8%, respectively, for the virologic response; 40.0%, 66.2%, 84.5%, and 92.7% for the biochemical response; 10.6%, 18.8%, 27.0%, and 34.5% for HBeAg loss; and 3.5%, 7.1%, 9.0%, and 13.2% for HBeAg seroconversion. There was no case of virologic breakthrough. An absence of HBeAg and a low serum HBV DNA level (<8 log10 copies/mL) at baseline were significant predictors of the virologic response in a multivariate analysis (P<0.01). Conclusions: Entecavir therapy showed excellent efficacy in nucleoside-na?ve chronic hepatitis B patients. The predictors of a virologic response were an absence of HBeAg and a low baseline HBV DNA level. (Korean J Hepatol 2010;16:57-65)
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황유정 ( Yu Jeong Hwang ),진석재 ( Suk Je Jin ),정용진 ( Yong Jin Jeong ),명형준 ( Hyung Joon Myung ),신혜영 ( Hae Young Shin ),김호동 ( Ho Dong Kim ),주영은 ( Young Eun Joo ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.5
A 54-year-old man was transferred from another hospital due to a hematoma in the third portion of the duodenum on abdomen CT. He had been admitted for 2 weeks due to vomiting at another hospital. He had abdominal discomfort and nausea without abdominal pain when he visited the Gwangyang Sarang Hospital. Other than a distended abdomen and mild general abdominal tenderness, the results of physical examination were unremarkable. Abdominal CT revealed an approximately 9 cm thick walled hematoma at the anteroinferior site of the duodenal third portion. Upper endoscopy revealed stenosis of the third portion of the duodenum without mucosal lesions. The endoscope was not advanced through the narrowed duodenal lumen. A retroperitoneal hematoma was diagnosed, and his state was classified as subacute rather than acute based on the duration. The surgeon did not recommend surgical treatment. Urgent treatment was unnecessary; he was managed conservatively. The size of the hematoma decreased from 9.0 cm to 5.8 cm on the following CT. He could begin to eat food on the 26th admission day, and he was discharged on the 31st admission day. The hematoma disappeared entirely on the following CT. This paper describes a rare case of idiopathic retroperitoneal hematoma with a spontaneous resolution. (Korean J Gastroenterol 2021;78:295-299)
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대장내시경 전처치 4 L Polyethylene Glycol 단독요법과 2L Polyethylene Glycol 및 Sodium Phosphate 용액 병합요법 비교
이정원 ( Jung Won Lee ),김나영 ( Nayoung Kim ),차병효 ( Byung Hyo Cha ),이병환 ( Byoung Hwan Lee ),황태준 ( Tae Jun Hwang ),정유정 ( Yu Jeong Jeong ),최태혁 ( Tae Hyuck Choi ),김희섭 ( Hee-Sup Kim ),명형준 ( Hyung-Joon Myung ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.5
Background/Aims: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. Methods: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. Results: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group`s compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. Conclusions: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method. (Korean J Gastroenterol 2010;56:299-306)
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