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유도객담에서 호산구 증가가 있는 만성 기침 환자의 원인 분석
손성욱 ( Seong Wook Sohn ),양민석 ( Min Seok Yang ),이소희 ( So Hee Lee ),송우정 ( Woo Jung Song ),이상민 ( Sang Min Lee ),권혁수 ( Hyouk Soo Kwon ),김덕인 ( Deok In Kim ),박창한 ( Chang Han Park ),박흥우 ( Heung Woo Park ),장윤석 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2
Background: Eosinophilic bronchitis (EB) is recently regarded as an important cause of chronic cough. However, sputum eosinophilia is commonly encountered in the other causes of chronic cough such as upper airway cough syndrome (UACS) and asthma. Objective: To evaluate the cause of chronic cough with sputum eosinophilia. Method: We investigated patients with chronic cough. Induced sputum, methacholine bronchial provocation test, skin prick test, throat examination, chest X-ray, paranasal sinus (PNS) x-ray and rhinoscopy were performed. Result: Sputum was induced in 287 patients. Sputum eosinophilia greater than 3% was present in 117 (40.8%) patients. Among 117 patients with sputum eosinophilia, eosinophilic asthma was diagnosed in 36 (30.8%) patients, chest X-ray abnormality or ACEI use was detected in 18 (15.4%) patients, and the remaining 63 (53.8%) patients could be considered to have EB. Among 63 patients with EB, UACS and GERD were found to be combined in 48 (76.2%) and 2 (3.2%) patients, respectively. EB alone without the other causes was diagnosed in 13 (11.1%) patients. Among total 287 patients, EB was detected in 22.0%, and EB alone without the other causes in 4.5%. Conclusion: Sputum eosinophilia can be frequently detected in chronic cough. EB is the common cause in chronic cough with sputum eosinophilia. However, EB is likely to be associated with UACS, which should be considered in cases of EB. (Korean J Asthma Allergy Clin Immunol 2007;27:125-130)
Leukotriene C4 Synthase 유전자 Promoter 부위 유전적 다형과 아스피린 과민성 천식의 연관성
김상헌 ( Sang Heon Kim ),박흥우 ( Heung Woo Park ),손성욱 ( Seong Wook Sohn ),이상민 ( Sang Min Lee ),오선영 ( Sun Young Oh ),김선신 ( Sun Sin Kim ),박준우 ( Joon Woo Bahn ),장윤석 ( Yoon Seok Chang ),신은순 ( Eun Soon Shin ),이 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.2
Background: The 5-lipoxygenase, 5-lipoxygenase associated protein and leukotriene C4 (LTC4) synthase are enzymes involved in the synthesis of cysteinyl leukotrienes which are known to be important lipid mediators for the development of aspirin-intolerant asthma (AIA). Several studies have evaluated genetic association between polymorphisms of these enzymes and AIA, reporting inconsistent results. Objective: To evaluate the genetic effect of polymorphisms of promoter areas of ALOX5, ALOX5AP and LTC4S genes in the development of AIA. Method: Polymorphisms in promoter areas of ALOX5 (-1761G>A, -1708G>A), ALOX5AP (21A/18A repeat) and LTC4S (-444A>C) were genotyped in patients with AIA (n=44), aspirin-tolerant asthma (ATA, n=104), and healthy-normal controls (NC, n=107). Result: The frequency of LTC4S -444 AC or CC alleles was significantly lower in AIA patients than in ATA patients (19.0% vs. 36.5%, P=0.005, OR=0.23, 95%CI 0.08∼0.64). However, the frequency of these genotypes was not different between AIA and NC (19.0% vs. 24.8%, P=0.458). As to LOX5 -1761G>A, -1708G>A, and ALOX5AP 21A/18A repeat, the frequency of these genotypes was not different between AIA and ATA patients and between AIA and NC. Conclusion: A significant association was found between LTC4S -444A>C and the frequency of AIA. This finding suggests that LTC4 synthase may be involved in the development of AIA in the Korean population. (Korean J Asthma Allergy Clin Immunol 2006;26:115-121)
Allopurinol 투여 후 발생한 심한 약물 이상 반응 13예의 임상적 고찰
송우정 ( Woo Jung Song ),이상민 ( Sang Min Lee ),양민석 ( Min Seok Yang ),이소희 ( So Hee Lee ),권혁수 ( Hyouk Soo Kwon ),김덕인 ( Deok In Kim ),박창한 ( Chang Han Park ),손성욱 ( Seong Wook Sohn ),김상헌 ( Sang Heon Kim ),박흥우 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.3
Background: Allopurinol-induced hypersensitivity reactions are rare but increasing recently in clinical practice; however, little has been known about its clinical characteristics and underlying mechanism. Objective: The goal of this study was to obtain more accurate information on the clinical feature and course of allopurinol-induced hypersensitivity reactions. Method: We retrospectively reviewed medical records of 13 patients diagnosed with allopurinol-induced severe cutaneous adverse drug reactions between September, 2003 and April, 2006. Result: All patients (n=13) showed skin rash as an initial manifestation. Eleven patients had severe skin rash and multiple organ involvements such as peripheral blood eosinophilia, hepatitis, or renal dysfunction. They were diagnosed with drug hypersensitivity syndrome (n=5), Stevens-Johnson syndrome (n=5), or toxic epidermal necrolysis (n=1). There was one mortality with toxic epidermal necrolysis. Conclusion: Allopurinol-induced hypersensitivity is associated with significant morbidity, and potentially life-threatening. Therefore, attention should be given when prescribing allopurinol. (Korean J Asthma Allergy Clin Immunol 2006; 26:225-232)
천식 환자에서 메타콜린 기도 과민성에 미치는 임상적 인자 평가
김희규 ( Hee Kyoo Kim ),이현승 ( Hyun Seung Lee ),이상민 ( Sang Min Lee ),송우정 ( Woo Jung Song ),손성욱 ( Seung Wook Sohn ),박창한 ( Chang Han Park ),김경묵 ( Kyung Mook Kim ),박흥우 ( Heung Woo Park ),김상헌 ( Sang Heon Kim 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.1
Background: Airway hyperresponsiveness (AHR) is a key phenotype of asthma. The expression of AHR is known to be variable in asthma patients, but the underlying mechanisms are poorly understood. Objective: The aim of this study was to evaluate the relationship of clinical characteristics such as smoking history, duration, atopy, total IgE levels, basal lung function, disease severity, and airway inflammation with methacholine AHR in patients with asthma. Method: A total of 109 asthma patients underwent spirometry and methacholine bronchial provocation test (MBPT). According to PC20, asthma patients were classified by mild AHR group (PC20 between 4 to 25 mg/mL) and by severe AHR group (PC20 of less than 4 mg/mL). They gave induced sputum for airway inflammation and serum for total IgE, and atopy were evaluated by the skin prick test to common aeroallergens. Result: Atopy and serum total IgE levels were not significantly different between the two groups. Basal FEV1 was significantly higher in mild AHR group (87.5±14.7%) than in severe AHR group (80.5±17.4%)(P=0.023). In addition, frequencies of severe severity were higher in severe AHR group than in mild AHR group (5.8% vs. 19.3%; P=0.002). The number of neutrophils and eosinophils in induced sputum was enhanced in the former group than in the latter group, although the statistical significances were not found (18.9±88.0 vs. 8.2±8.8×105/g; 7.1±16.6 vs. 2.8±5.9×105/g, respectively). Conclusion: Basal airway obstruction and asthma severity were positively associated with severity of methacholine airway responsiveness in asthma patients. (Korean J Asthma Allergy Clin Immunol 2006;26:59-63)