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자가면역 간염 환자의 간 섬유화 및 치료 반응 평가에서 2-D shear wave elastography의 유용성
소은규 원광대학교 일반대학원 2022 국내석사
배경 및 목적 자가면역 간염 환자에서 간 섬유화 정도는 환자의 예후에 중요하다. 현재, 간 조직검사를 시행하는 것이 이를 평가하는 데에 가장 정확한 표준 검사방법으로 여겨진다. 하지만 조직검사는 침습적이기 때문에 비침습적이고 반복적으로 간 섬유화를 평가 할 수 있는 검사에 대한 필요성이 대두되고 있다. 최근 조직검사를 대체할 수 있는 비침습적 검사로서 간 탄성초음파 검사가 폭넓게 활용되고 있다. 따라서 본 연구의 목적은 자가면역 간염 환자의 간 섬유화 및 치료 후 반응평가에서 liver stiffness (LS)와 dispersion slope (DS)를 이용한 two-dimensional shear wave elastography (2-D SWE)의 유용성을 알아보고자 하였다. 대상 및 방법 본 연구는 단일 기관 연구로 2014년 6월부터 2021년 6월까지 자가면역 간염으로 진단되었으며 2-D SWE를 시행한 환자를 후향적으로 분석하였다. 환자는 병리학적 간 섬유화 등급에 따라 경도 섬유화 (F1), 의미 있는 섬유화 (F2), 심한 섬유화 (F3), 간경화 (F4) 로 분류되었다. 각각 환자들의 기본적 특징, 혈청학적 검사결과, 병리학적 검사 결과 및 2-D SWE 측정값을 분석하였다. 스테로이드 치료 전과 후를 비교하기 위해 대응표본 T 검정 분석을 하였고, Bonferroni 검정을 하였다. 또한, 병리학적 간 섬유화 등급에 따라 LS와 DS 측정값이 달라지는지 일원분산분석을 통해 분석하였다. 또, LS의 간 섬유화의 진단능을 수신자 운영 특성 곡선의 곡선 하 면적 (area under the receiver operating characteristic curve)을 통해 분석하였다. 결과 총 69명 환자(여:남 = 60:9; 평균 연령 = 59.7)에서 LS 측정값은 환자의 간 섬유화 등급에 따라서 차이를 보였다 (P < 0.001). 분산분석계수의 곡선 하 면적은 의미 있는 섬유화(≥ F2)에서 0.903, 심한 섬유화(≥ F3)에서 0.815, 간경화(= F4)에서 0.854로 나타났다. LS의 진단능은 간경화 (= F4)를 진단할 때의 fibrosis index-4를 제외하고는 혈청 표지자의 진단능보다 우수하였다 (P < 0.05). 69명 환자 중 44명의 환자가 스테로이드 치료를 받았으며, 치료 후 의미 있는 LS와 DS 값의 감소를 보였다 (P = 0.012, 0.011). 결론 결론적으로, 2-D SWE는 자가면역 간염 환자에서 간 섬유화를 평가하는 데에 유용한 방법으로, 치료 후 경과 관찰에서도 LS와 DS가 치료 반응을 평가하는 데에 믿을 수 있는 지표로 활용될 수 있을 것으로 판단된다. Background and Objective In patients with autoimmune hepatitis (AIH), it is important to evaluate hepatic fibrosis for monitoring disease progression. Currently, liver biopsy is considered as the reference standard for quantifying liver fibrosis. However, being invasive, there has been a need for the development of non-invasive and repeatable test to assess liver fibrosis of AIH. As an accurate non-invasive method for assessment of liver fibrosis, ultrasound (US) elastography has been widely used. Therefore, the aim of this study was to determine the usefulness of two-dimensional shear wave elastography (2-D SWE) with assessment of liver stiffness (LS) value and dispersion slope (DS) to evaluate hepatic fibrosis and treatment response of AIH patients. Materials and Methods Between June 2014 and June 2021, patients who diagnosed as AIH and performed 2-D SWE were enrolled in this retrospective study. We classified patients into four groups, mild fibrosis (F1), significant fibrosis (F2), advanced fibrosis (F3), and cirrhosis (F4) according to their histologic stages of fibrosis. Baseline characteristics, laboratory test results, histologic results, and 2-D SWE results were reviewed retrospectively. To compare variables between before and after the treatment, the paired t test with Bonferroni correction were used. One-way analysis of variance (ANOVA) was used to compare LS and DS among different histologic liver fibrosis stages. The diagnostic performance of LS in staging of liver fibrosis was evaluated by receiver operating characteristic curve with measurement of area under the curve. Results A total of 69 patients (F:M = 60:9; mean age = 59.7) were analyzed. The LS values were different according to the stages of liver fibrosis (P < 0.001). The AUC of the LS value was 0.903, 0.815, and 0.854 for detecting ≥ F2, ≥ F3, and = F4, respectively. The diagnostic performance of LS measurement was significantly greater than that of serum biomarkers except fibrosis index-4 for F4 (P < 0.05). Forty-four patients of 69 patients received steroid therapy. There was statistically significant difference of both LS value and DS on follow up examination. (P = 0.012, 0.011, respectively). Conclusion In conclusion, 2-D SWE is a useful method for assessment of hepatic fibrosis in AIH patients. For follow-up examination, LS and DS can be used as reliable parameters to evaluate treatment response.
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폐알루미늄 분진으로부터 용도별 합성 Zeolite 제조 연구
소은규 국립부경대학교 대학원 2024 국내석사
In this study, zeolite synthesis raw material was recovered as slag from waste aluminum dust using a dry melting process, and synthetic zeolite was manufactured using the recovered slag. The prepared zeolite was modified with various cations (Mg2+, Ca2+, K+) and then a comparative experiment on heavy metal removal rate was conducted. In addition, a comparison experiment of hard/soft water conversion ratio was conducted to evaluate the water hardness control performance of Na-Zeolite and K-Zeolite, which can be used to control water hardness. A comparative experiment was conducted according to the amount of carbon added for the dry melting process, and as a result of XRD analysis, it was confirmed that when 4g of carbon was added, the highest Al2O3 and SiO2 content and a single phase of mullite(Al6Si2O13) were formed. The zeolite synthesis process was conducted through comparative experiments depending on the concentration of NaOH, and as a result of XRD analysis, a 50wt.% NaOH solution in which Na-Zeolite was synthesized in the form of a single phase was derived as the optimal process condition. A comparative experiment was conducted on the heavy metal removal rates of the manufactured Na-Zeolite and Mg-Zeolite, Ca-Zeolite, and K-Zeolite converted through cation modification. Standard reagents for four heavy metals, Pb, Hg, Cr6+, and Cd, were prepared and heavy metal removal rate comparison experiments were conducted. The standard reagent was diluted with distilled water, and 5 g of zeolite was added to 50 ml of a 100 ppm concentration heavy metal solution and stirred at room temperature at a speed of 300 rpm for 30 minutes. After stirring, the concentration of heavy metals remaining in the solution was measured using ICP-OES analysis and the removal rate was calculated. In addition, a hard/soft water conversion rate evaluation experiment was conducted to confirm the water hardness control characteristics of Na-Zeolite and K-Zeolite prepared through Na-Zeolite cation modification. In order to confirm the hardness control characteristics of the prepared synthetic zeolite, a solution of 300ppm as CaCO3 or more was arbitrarily prepared and a hard/soft water conversion ratio comparison experiment was conducted. 5 g of K-Zeolite was added to 50 ml of prepared hard water and stirred for 30 minutes at room temperature at a speed of 300 rpm. After stirring was completed, the concentrations of Ca and Mg remaining in the solution were measured using ICP-OES analysis and the average value was calculated. As a result of the experiment, it was confirmed that Mg-Zeolite had the best heavy metal removal ability, and through the comparison test results of hard/soft water conversion rate, it was confirmed that K-Zeolite was more suitable for hard/soft water conversion than Na-Zeolite.
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