만성 위염 환자에서 Helicobacter pylori 제균 1년후 COX-2 및 iNOS 발현의 감소

성용직 ( Seong Yong Jig ),김현재 ( Kim Hyeon Jae ),한석원 ( Han Seog Won ),김성수 ( Kim Seong Su ),방춘상 ( Bang Chun Sang ),김창환 ( Kim Chang Hwan ),김병욱 ( Kim Byeong Ug ),이동수 ( Lee Dong Su ),최황 ( Choe Hwang ),이인석 ( L 대한소화기학회 2003 대한소화기학회 추계학술대회 Vol.2003 No.-

<목적> Helicobacter pylori는 위점막의 COX-2와 iNOS의 발현을 유도하는 것으로 알려져 있다. 그러나 H. pylori 제균치료 후에 COX-2와 iNOS 발현의 변화에 대한 장기간에 걸친 보고는 드물다. 이에 저자는 만성위염환자를 대상으로 H. pylori 제균치료 1년 후에 위점막에서 COX-2와 iNOS 발현의 변화를 관찰하였다. <방법> H. pylori 감염이 확인된 만성위염 환자 58명을 대상으로 위전정부 점막에서 생검을

신기능이 정상인 신이식 환자에서 부갑상선 기능 항진증의 빈도 및 예측 인자

김영옥,성용직,김용수,방병기 대한신장학회 1997 춘계학술대회 초록집 Vol.1997 No.-

Helicobacter Pylori에 대한 약제의 감수성 검사

김진일,성용직,김성수,방춘상,박수헌,최명규,김재광,한석원,박두호,염정선,정인식,Kim, Jin-Il,Sung, Yong-Jick,Kim, Seong-Soo,Bhang, Choon-Sang,Park, Soo-Heon,Choi, Myung-Gyu,Kim, Jae-Kwang,Han, Sok-Won,Park, Doo-Ho,Yum, Chung-Sun,Chung, I 대한임상약리학회 1999 臨床藥理學會誌 Vol.7 No.1

연구배경 : Helicobacter pylori에 감염된 소화성 궤양에서 항생제를 이용한 제균 치료는 적극 시행되고 있으나, 가장 중요한 항생제 선택에는 아직 논란이 있다. 이에 연구자는 H. pylori가 감염된 상부 위장관 환자에서 H. pylori를 배양하여 항생제에 대한 감수성 검사를 시행하였다. 방 법 : 1998년 3월부터 1998년 9월까지 가톨릭대학교 의과대학 부속 병원에 상부 위장관 증상을 주소로 내원하여 내시경을 시행한 환자중 H. pylori에 감염된 환자 47명을 대상으로 하였다. 대상 환자는 만성위염 13명, 위궤양 11명 십이지장궤양 23명으로 남자 33명, 여자 14명이며, 평균 연령은 44.6${\pm}$11.25(26세-68세)세 였다. 대상 환자는 내시경 및 조직 생검을 시행하여 vortex를 이용하여 강하게 흔들어 상층액 200 ul를 혈액 한천 배지에 도말한 후 10% $CO_2$와 습도 95%의 조건으로 보정된 $CO_2$ 배양기에서 $37^{\circ}C$로 72시간 동안 배양하였으며, 혈액 한천 배지는 Glaxo selective supplement A를 이용하였다. H. pylori 집락이 나타나면 3회 계대 배양하여 순수 분리한 후 amoxicillin, tetracyclin, metronidazole, clarithromycin에 대한 감수성 검사를 시행하였다. 감수성 검사는 원판 확산 검사와 E-test를 병행하였다. 결 과 : (1) 배양 성공률은 58.8%였다. (2) H. pylori의 항생제에 대한 감수성 검사 47예에서 amoxicillin 43예 (91.5% ), tetracyclin 36예 (76.6% ), metronidazole 25예 (53.2% ), clarithromycin 36예 (76.6%)에서 항생제에 감수성을 보였다. (3) 47예의 대상 환자중 3예(6.4%) 에서 4가지 항생제 모두에 내성을 보였다. 결 론 : H. pylori 균주에 대하여 감수성 검사를 조사한 결과 우리 나라 에서는 amoxicillin에 대한 저항균이 처음으로 발견되었고, clarithromycin에 대한 저항균도 다른 나라보다 많았으며, metronidazole에 대한 저항균이 매우 많았다. 향후 4가지 항생제 모두에 내성을 보인 균주에 대한 치료 약제의 연구가 필요 할 것으로 생각된다. Background : Eradication therapy is recommended for the patients with Helicobacter pylori associated peptic ulcer, because eradication of H. pylori means cure of peptic ulcer disease. The eradication rate of H. pylori can be reached to 80% with PPI based triple therapy in Korea. Drug sensitivity, gastric pH, and compliance are known to affect the eradication rate of H. pylori. In Korea, drug sensitivity has not been studies because of the difficulty of H. pylori culture. It is required that the specific antimicrobial regimens be chosen in consideration of the resistant strains in Korea. Methods : To evaluate the susceptibility of the four antimicrobial agents (such as amoxicillin, tetracyclin, metronidazole, and clarithromycin) to H. pylori, and to determine the retreatment drugs for the patient who failed to initial eradication therapy, prospectively we evaluated 47 patients (23 duodenal ulcer, 11 gastric ulcer, 13 chronic gastritis). Upper endoscopy was performed in al1 patients, and H. pylori was cultured in blood agar plate included Claxo selective supplement A and drug sensitivity test was performed. Results : The results were as follows: 1) Overall culture rate of H. pylori was achieved in 47 of 80 patients (58.8%). 2) The bactericidal activity of amoxicillin, tetracyclin, metronidazole, and clarithromycin was 91.5%, 76.6%, 53.2%, and 76.6%, respectively. 3) The three strains (6.4%) were showed resistant to all four antibiotics. Conclusion : In Korea, amoxicillin resistant strains were identified for the first time, clarithromycin and metronidazole resistant strains were more frequent than in other developed countries.

위선종과 조기위암에서 투명캡을 이용한 흡인점막절제술의 임상적 유용성 평가

송호진,김상우,왕준호,성용직,김진일,방춘상,양영상,박수헌,최명규,한석원,정인식,박두호,최규용 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

간편하고 경제적인 신티그래피 위배출검사

박성규,최명규,이성희,성용직,최황,김진일,박수헌,김재광,한석원,정규원,손형선,선희식 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

신 이식 환자에서 발생한 Pneumocystis carinii 폐렴 2예

박주현,김용수,김영옥,김태균,성용직,방병기,서광용 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4

Renal allograft recipients are at risk for Pneumocystis carinii pneumonia(PCP) within the first year following transplantation and during treatment for graft rejection. We experienced two cases of PCP in renal allograft recipients. The first case was a 39-year-old female who had received renal allograft 7 years before. At the time of traosplantation, she was a carrier of hepatitis B surface(HBs) antigen. After transplantation, she had been received the rnaintenance dose of cyclosporine and oral prednisolone. Three months before adrnission, dosage of prednisolone was increased because of the increased serum creatinine level and generalized edema. A week before admission, syrnptom of exertional dyspnea, dry cough, and fever was developed. Chest X-ray film showed streaky interstitial infiltration in both lung fields and chest CT showed diffuse ground-glass appearance. Rronchoalveolar lavage revealed positive Grocott's methenamine silver stain for numerous clumps of pneu- mocystis carinii cysts. Despite the aggressive treatment, she died of respiratory and hepatic failure and GI bleeding. Another case was a 40-year-old male who had received renal allograft S years before. He had been received maintenance immune suppressive therapy with cyclosporine and oral prednisolone. He was admitted for evaluation of hypertension and elevated serum creatinine level. After several days of admission, he complained fever, dry cough and dyspnea. X-ray film showed pneumonic infiltration and the bronchial brushing and washing fluid revealed the Pneumocystis carinii cysts that were stained by methenamine silver. He was treated with the full dose of trimethoprim-sulfamethoxazole and clindamycin. Sacrificing the renal allograft, he recovered from Pneumocystis carinii pneumonia.

위장관 : Helicobacter pylori 제균 치료 1년 후 위 점막의 Cyclooxygenase-2 및 Inducible Nitric Oxide Synthase 발현 변화

김성수 ( Sung Soo Kim ),성용직 ( Young Jick Sung ),박민경 ( Min Kyoung Park ),임창훈 ( Chang Hoon Lim ),양홍준 ( Hong Jun Yang ),김태호 ( Tae Ho Kim ),김창환 ( Chang Whan Kim ),김진일 ( Jin Il Kim ),한석원 ( Sok Won Han ),정인식 ( 대한소화기학회 2008 대한소화기학회지 Vol.52 No.5

목적: H. pylori는 직접 혹은 간접적으로 위 점막의 COX-2와 iNOS 발현을 유도하며, H. pylori를 제균하면 이들 단백의 발현은 감소한다. 그러나 H. pylori 제균 치료 후에 COX-2와 iNOS 발현 변화에 대한 장기간의 관찰 보고는 없었다. 이에 저자는 만성위염 환자를 대상으로 H. pylori 제균치료 1년 후에 위 점막에서 COX-2와 iNOS 발현의 변화를 관찰하고자 하였다. 대상 및 방법: H. pylori 감염이 확인된 만성위염 환자 58명을 대상으로 하였으며, 45명에 제균 치료를 했다. H. pylori 제균 치료 전과 1년 후에 위전정부 점막 조직에서 면역화학 염색을 이용하여 COX-2와 iNOS 단백의 발현 강도 및 발현율 변화를 관찰하였다. 결과: COX-2와 iNOS 단백은 상피세포와 염증세포 및 점막근판의 평활근세포에서 발현되었다. 제균 치료에 성공한 38명에서 제균 치료 1년 후에 COX-2 및 iNOS의 발현율은 모두 유의하게 감소되는 것을 관찰할 수 있었다. 그러나 제균 치료에 실패하였거나 제균 치료를 받지 않아 H. pylori 감염이 있는 환자에서 COX-2 및 iNOS 발현은 변화가 없었다. COX-2의 발현율은 위 점막의 H. pylori 밀도, 중성백혈구 및 단핵구 침윤 정도와 유의한 상관관계를 보였으며, iNOS 발현율은 위 점막의 H. pylori 밀도와 중성백혈구의 침윤 정도와 유의한 상관관계를 보였다. 결론: H. pylori의 제균 치료는 COX-2와 iNOS의 발현을 장기간 억제할 수 있으며 이는 H. pylori 제균 및 이로 인한 위 염증 감소와 관련 있을 것으로 생각한다. Background/Aims: The cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), the proteins that have the role in the gastric carcinogenesis, are stimulated by H. pylori infection in the gastric mucosa. The aim of this study was to evaluate the expression of COX-2 and iNOS proteins one year after the eradication of H. pylori. Methods: Gastric antral mucosa from fifty eight patients with chronic gastritis who were all infected with H. pylori was examined for the expression of COX-2 and iNOS proteins before and one year after the eradication of H. pylori by immunohistochemical stain. Results: COX-2 and iNOS proteins were expressed in the epithelial cells and interstitial inflammatory cells of gastric mucosa. Percent expressions of COX-2 and iNOS were significantly decreased one year after the eradication in the patients with cured infection, but not in those having persistent H. pylori. COX-2 and iNOS expressions were well correlated with H. pylori density, acute and chronic inflammation of gastric mucosa. Conclusions: The eradication of H. pylori can decrease the expression of COX-2 and iNOS in the gastric mucosa in long-term period. This seems to be due to the removal of H. pylori itself and related regression of gastric inflammation. (Korean J Gastroenterol 2008;52:286-292)

상용량의 Cyclooxygenase-2 선택적 및 비선택적 비스테로이드성 항염제가 위점막 손상, Prostaglandin E2, Tumor Necrosis Factor-alpha 및 중성 백혈구 침윤에 미치는 영향

김진일,정인식,유진영,선희식,박두호,성용직,한석원,김성수,송호진,방춘상 대한소화기학회 2001 대한소화기학회지 Vol.37 No.2

Background/Aims: Recent studies suggested that neutrophil and tumor necrosis factor-alpha (TNF-α) could play a significant role in NSAID-induced gastric mucosal damage. However, there is no data about the relationship between daily usual doses of NSAID and prostalglandin, neutrophil, or TNF-α. Methods: We divided mice into 3 groups and administered indomethacin (3 mg/kg, indomethacin group), NS-398 (3 mg/kg, NS-398 group) or vehicle alone (control group) orally to each mice group for 7 days. Then, we evaluated the concentrations of prostaglandin E2 (PGE2) and TNF-α, neutrophil infiltration and mucosal damage score for their gastric tissue. Results: Indomethacin group showed the lowest concentration of PGE2 and the highest values in TNF-α concentration, neutrophil infiltration and mucosal damage score (p$lt;0.01). NS-398 group showed a lower PGE2 concentration and a higher microscopic mucosal damage score than the control group (p$lt;0.01), but there were no differences in TNF-α concentration, neutrophil infiltn and gross mucosal damage scores. The PGE2 concentration was inversely related to TNF-α concentration (r=-0.768). Conclusions: We suggest that decrease of prostaglandin concentration and increase of TNF-α production and neutrophil infiltration play important roles in NSAID-induced gastric mucosal damage. Cyclooxygenase-2 (COX-2) selective inhibitors, which have less effect on prostaglandin and TNF-α concentration and neutrophil infiltration, can reduce the gastric mucosal damage, as compared with the conventional NSAID.

신기능이 정상인 신이식 환자에서 부갑상선 기능항진증의 빈도 및 혈청 Alkaline Phosphatase와의 관계

박주현,김용수,김영옥,장윤식,방병기,양철우,성용직,성광용 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.1

The hyperparathyroidism which causes renal osteodystrophy is a common complication in patients with end stage renal diseases. It is usually normalized after successful renal transplantation, but it remains in some renal transplant recipients. It is not well known whether hyperparathyroidism decreases bone mineral density in renal allograft recipients or not. To evaluate the incidence and predictive marker for hyperparathyroidism in renal allograft recipients and to describe the impact of hyperparathyroidism on the bone mineral density, we measured intact parathyroid hormone(iPTH) in 193 renal allograft recipients with stable renal and hepatic function. The mean age of patients was 42?12(13-76) years old and male female ratio was 1.9. The patients were on pre-transplant dialysis for 14.4?15.6(0-130) months and were followed up for 43.8?35.7(2-204) months after transplantation. Of the total 193 patients, 13 patients(6.7%) had high iPTH level. All patients showed normal serum calcium and phosphorous levels. i levels were positively correlated to pre- and post-transplant serum alkaline phosphatase levels(vs. pre-transplant r=0.32, P$lt;0.001, vs post-transplant r=0.63, P$lt;0.001). There was no difference in pre-and post-transplant serum calcium, phosphorus, post-transplant serum creatinine and hemoglobin levels between the patients. There were no statistical differences in age, sex, duration of pre-transplant dialysis, duration of post-transplant follow-up, number of transplantation, donor type, primary renal disease and episodes of acute rejection. Of the total 193 patients, bone mineral density was studied in 37 patients. Bone mineral densities did not correlated to iPTH levels. In conclusion, the incidence of hyperparathyroidism in renal allograft recipients with stable renal function was 6.7%. Pre-and post-transplant serum alkaline phosphatase levels might be used as a useful marker for hyperparathyroidism. Serum iPTH level was not correlated to bone mineral density.

Hemoclip 접근이 어려운 소화성 궤양 출혈에서 EVL 용 투명캡의 사용

박수헌,김진일,정인식,김재광,정규원,성용직,한석원,김성수,방춘상,추교영,한준열,신희식 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.4

Background/Aims: There was some technical difficulty in applying the hemoclip on the posterior wall of the body, cardia of the stomach and posterior wall of duodenum because the angle of approach was tangential. Use of transparent cap on the tip of the endoscope could reduce some of these problems. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap. Methods: From August 1997 to July 2000, 75 patients with bleeding peptic ulcer and stigmata of recent hemorrhage were treated with endoscopic hemoclipping. There was technical difficulty in applying the hemoclip in 18 patients and the transparent cap was used. Results: There was no statistically significant difference between the patients treated with cap and the patients treated withoup cap in initial hemostasis rate (91.1% vs 94.4%), rebleeding rate (11.8% vs 11.7%), and permanent hemostasis rate (92.9% vs 94.4%). Conclusions: Use of transparent cap on the tip of the endoscope was an efficient method when the angle of approach was tangential.