조직 생검으로 확인된 측두동맥염 1 예

송관규(Gwan Gyu Song),정문기(Moon Gi Chung),권오상(Oh Sang Kwon),박창규(Chang Gyu Park),백세현(Sei Hyun Baik),서홍석(Hong Seog Seo),오동주(Dong Joo Oh),이창홍(Chang Hong Lee),원남희(Nam Hee Won) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A Temporal arteritis is an inflammatory disease of the elastic artery with unknown etiology. It usually affects patients over the age of 50, and is often associated with polymyalgia rheumatica. We have experienced a 66-year-old female patient with temporal arteritis who presented as a new onset headache and temporal artery abnormalities. Temporal artery biopsy was performed, which showed typical findings of temporal arteritis. To our knowledge, this is the first case of temporal arteritis in Korea. We hereby report a case of temporal arteritis with a brief review of literature.

경피증 환자의 폐섬유화에 대한 cyclophosphamide 강압 요법과 소량의 부신피질 호르몬을 경구투여한 병합 요법의 효과에 관한 연구

송관규 ( Gwan Gyu Song ),이영호 ( Young Ho Lee ),심재정 ( Jae Jeong Shim ),강경호 ( Kyung Ho Kang ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.2

Objective: To investigate the efficacy of combined intravenous cyclophophamide pulse and low dose oral prednisolone treatment in patients with systemic sclerosis with interstitial lung disease. Method: Six patients with systemic sclerosis with interstitial lung disease were treated with intravenous infusion of cyclophosphamide (0.75g/m2 body surface area) and low dose oral prednisolone (10mg/day). Results: 1) Respiratory symptoms, cough and dyspnea, were improved in all patients in both frequency and severity. 2) The mean value of FVC, FEVl, and DLCO test showed tendency of increase during the follow up period (upto 24 months) compared to decrease in the past studies. 3) There was no serious side effect during the trreatment. Herpes zoster was developede in 1 patient during treament. Conclusions: Combined intravenous cyclophosphamide pulse and low dose oral prednisolone treatment is effective for the patients with systemic sclerosis with interstitial lung disease. A controlled prospective trial is warranted in patients with systemic sclerosis with interstitial lung disease.

경증 및 중등도 고혈압에서 Captopril 소량요법의 강압효과

송관규(Gwan Gyu Song),박창규(Chang Gyu Park),오동주(Dong Joo Oh),노영무(Young Moo Ro) 대한내과학회 1988 대한내과학회지 Vol.34 No.2

N/A The efficacy and safety of oral captopril, an angiotensin-converting enzyme inhibitor, were in 19 Korea patients (10 males, 9 females) with mild to moderate essential hypertension. The subjects with a sitting blood pressure of 140-189mmHg (systolic) and 95-114mmHg (diastolic) 2 weeks after the first blood pressure measurement while off all antihypertensive agents were enrolled in the study and were received captopril 25 mg bid for 6 weeks, b1ood pressure being measured every 2 weeks. Captopril significantly reduced systolic pressure from 161.6±14.6 to 146.6±15.5mmHg, diastolic pressure from 101.8±6.1 to 90.8±7.9mmHg, and mean pressure from 121.8±4.3 to 109.8±7.9mmHg (mean±SD, P<0.001 vs post-treatment 6th week blood pressure). Fall in systolic and diastolic pressure was 15.5±14.4mmHg and 11.1±9.5mmHg, respectively. In 66.6% diastolic blood pressure and in 37.5% systolic blood pressure were normalized. Side effects were noted in 2 cases (10.5%). One case showed transient elevation of transaminase level and the other headache, These findings suggest that low-dose captopril is an effective and safe first-line monotherapy for mild to moderate eseential hypertension.

전신성 홍반성 낭창 환자에서 유리형 Fas 단백질에 대한 연구

송관규 ( Gwan Gyu Song ),이영호 ( Young Ho Lee ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

전신성 홍반성 낭창의 발병기전에 대한 연구의 일환으로 전신성 홍반성 낭창 환자에서 유리형 Fas 단백질의 존재 여부를 확인함에 있다. 대상 및 방법: 30명의 전신성 홍반성 낭창 환자를 대상으로 하였으며 섬유조직염으로 진단받은 11명의 환자를 대조군으로 하였다. 환자의 대조군에서 모두 혈청을 채취하여 70℃의 냉장고에 보관한 후 sandwich ELISA 방법으로 동시에 측정하였다. 결과: 1. 전신성 홍반성 낭창 환자 30명중 6명(20%), 대조군은 11명중 1명(9.%)에서 양성으로 검사되어 전신성 홍반성 낭창 환자에서 양성율이 높은 경향을 보였다(p=0.41). 2. 환자의 연령은 sFas 양성인 군과 음성군간에 차이가 없었으나 sFas 양성군에서 이환기간이 짧고 질병의 활성도도 sFas 양성군에서 의미있게 높았으며 부신피질 호르몬의 투여량도 의미있게 낮았다. 3. 전신성 홍반성 낭창 환자를 다시 이환 기간 1개월 이하와 그 이상으로 나누어보면 1개월 이하의 이환 기간을 가진 12명중 6명(50%)에서 sFas가 검출되었고 1개월 이상의 이환 기간을 가진 18명의 환자에서는 1명도 sFas가 검출되지 않았다(p-0.0008, Table 2). 4. 전신성 홍반성 낭창 환자중 이환 기간이 1개월 이하인 환자 12명을 대상으로 sFas 양성과 음성의 2군으로 나누어 분서하면 2군간의 나이, 부신피질 호르몬의 투여용량, 질병의 활성도는 모두 차이가 없었으나 부신피질 호르몬의 투여용량은 sFas 양성군에서 적은 경향을 보였다(p=0.07). 결론: 이상의 결과로 이환 기간이 짧고 질병의 활동성이 높은 전신성 홍반성 낭창의 일부 환자에서는 혈중 유리형 Fas단백질이 증가되어 있고 유리형 Fas단백질에 의하여 apoptosis의 장애가 발생할 가능성이 있을 것으로 생각된다. Objective: To investigate soluble Fas(sFas) protein in the sera of patients with systemic lupus erythematosus (SLE). Methods: sFas protein was measured by sandwich ELISA method in the sera of 30 patients with SLE (mean age: 27.4±8.46, F:M=29:1) and 11 patients with fibromyalgia (mean age 35.8±11.5, F:M-11:0) as a control group. Results: sFas was elevated in 6 (20%) patients of SLE and 1 (9%) of patients with fibromyalgia (p=0.41). sFas level was correlated with a shorter duration, lower dosage of systemic steroid and higher disease activity in patients with elevated sFas levlel compared to patients with normal serum levels of sFas. All patients with elevated sFas had been diagnosed with SLE for less than 1 month. Fifty % (6 out of 12) patients with SLE for less than 1 month showed elevated sFas in serum. There was no difference of in the age between patients with elevated and normal levels of sFas. Conclusion: These data indicate that elevated sera levels of sFas was associated with the early active phase of disease in some patients with SLE and may play a role in defective apoptosis.

배양된 연골세포에서 각종 Cytokine과 성장인자가 β1-integrin 및 ICAM-1의 발현에 미치는 영향

송관규 ( Gwan Gyu Song ),노영무 ( Young Moo Ro ),유대현 ( Dae Hyu Yoo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1995 대한류마티스학회지 Vol.2 No.1

Objective: The cell-cell and cell-extracellular matrix interactions are critical to the embryogenesis, morphogenesis, maintenance of tissue integrity, and function of cells. This interactions are mediated by membrane glycoproteins called adhesion molecules. βl-integrins are heterodimeric transmembrane glycopro-teins which play critical roles in the ability of cells to elaborate and maintain extracellular matrix. ICAM-l is a sialylated glycoprotein and mediates various cell-cell interactions in immunity and inflammation. Articular cartilage consists of chondrocytes embedded in an extensive extracellular matirx. In normal tissue, the chondrocytes actively effect the stable equili-brium between the synthesis and degradation of matrix components, so that a constant concentration of these components is maintained. In osteoarthritis, the stable equilibrium is disrupted and the rate of loss of proteoglycan exceeds the rate of depositon of newly synthesized moleclues. This equilibrium is influenced by cytokines and growth factors such as IL-I, TNF-α, IGF-1 and TGF-β. Integrins and their ligands may mediate some of the interactions of chondrocytes and cellular matrix, and the cytokines and local growth factors may affect the expression of integrins on chondrocytes. ICAM-1 may mediate interactions with other cells in osteoarthritic joint, and also may be modulated by cytokines and growth factors. The effect of IL-I, TNF-α, IGF-1 and TGF-β in the expression of, β1-integrin (CD29) and ICAM-1(CD54) on chondrocytes was investigated. Methods: Cultured chondrocytes(3rd passages) from 2 osteoarthritc patient were used. Cells were incubated for 24hours with and without IL-1β 25U/ml, IL-l 50U/ml, TNF-α 1ng/ml, TNF-α 10ng/ml, IFN-γ 100U/ml, IGF-1 10ng/ml, IGF-1 50ng/ml, IGF-1 100ng/ml, TGF-β 10ng/ml, and TGF-β 30ng/ml. Chondrocytes were stained with monoclonal antibodies against, β1-integrin (CD29) and ICAM-1 (CD54), and positve cells were counted under the light microscpe. Results: 1) Cultured chondrocytes readily expressed, β1-integrin (82.9%). 2) β1-integrin was down-regulated by IL-1β(75.4%), TNF-α(61.2%), and TGF-β (77.0%), and was slightly up-regulated by IFN-γ(85.0%) and IGF-1 (88.9%). 3) ICAM-1 was presented in only 18.0% of cells. 4) Expression of ICAM-1 was readily up-regulated by IL-1β(84.0%) and TNF-α(80.3%), and mildly up-regulated by IFN-γ(33.0%), IGF-1(35.0%), and TGF-β(29.3%). Conclusions: The presence of, 81-integrin and ICAM-1 on chondrocytes and the modulation of their expression by cytokines and local growth factors suggest that they have important roles in the interaction of chondrocytes with cartilage matrix and with other cells of osteoarthritic joints. Their roles should be elucidated by further researches.

전신성 류마티스 질환에서 항 ENA 항체에 관한 연구

배상철(Sang Cheol Bae),송관규(Gwan Gyu Song),이인홍(In Hong Lee),유대현(Dae Hyun Yoo),김성윤(Seong Yoon Kim),김신규(Thin Kyou Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.4

N/A Objectives: Among a variety of nuclear antigens, extractable nuclear antigens(ENA) which can be extracted from nuclei by homogenization in neutral saline contain ribonucleoprotin, Sm, SS-A/Ro, SS-B/La and other antigens. Characterization of anti-ENA anti-bodies provides information about nosology, subset definition within diseases, clinical activity, specific organ involvement and prognosis. Methods: Authors have used double immunodiffusion test to detect antibodies to ENAs and studied the frequencies of autoantibodies to these antigens and their correlation with clinical and laboratory features in systemic rheumatic diseases. Results: 1) 1,063 patients were investigated for the presence of serum antibodies to ENAs and 180 out of 1,063 patients (16.9%) had anti-ENA antibodies. 3,412 tests were performed for the presence of antibodies to Sm, RNP, Ro, La, Scl-70 and Jo-1 respectively and 230 out of 3,412 tests (6.7%) were positive. 2) The profiles of 137 patients who had anti-ENA antibodies are systemic lupus erythematosus (61), rheumatoid arthritis with secondary Sj6gren's syndrome (26) and without secondary Sjogren's syndrom (9), mixed connective tissue disease (18), scleroderma (10), polymyosits/dermatomyositis (6), undifferentiated connective tissue diease (4), gout (1), fibromyalgia syndrome (1) and Hashimoto's thyroiditis (1). 3) The frequencies of antibodes to ENAs were 73.5% in patiets with systemic lupus erythemtosus, 9.6% in rheumatoid arthritis, 100% in mixed connective tissue disease, 71.4% in scleroderma and 46.2% in polymyostis/dermatomyositis. 4) The frequencies of antibodies to Sm, RNP, Ro and La in patients with systemic lupus erythematosus were 18.1%, 41.5% 43.9% and 4.9% respectively. (1) Patients with anti-Sm antbodies had a higher incidence of pleuritis than those without anti-Sm antibodies(p=0.029). (2) Patients with anti-RNP anibodies had a higher incidence of Raynaud's phenomenon and pleuritis and a lower incidence of renal disease than those without anti-RNP antibodies (p=0.008, p=0.019, p=0.029). (3) Patients with anti-Ro antibodies had a higher incidence of thrombocytopenia than those without anti- Ro antibodies. (4) There were no clinical and laboratory differences between patients with anti-La antibodies and without anti-La antibodies. 5) In patients with rheumatoid arthritis, anti-Ro anti-body was likely to be associated wih secondary Sjogren syndrome, although statistically significant association was not found (p=0.063). Conclusions: These results showed that the detection of antibodies to ENAs by double immunodiffusion test was expected to be a useful diagnostic marker and predict some clinical features in systemic rheumatic diseases.

건강한 한국인의 요추부 운동과 흉부 확장 운동에 대한 연구

이영호 ( Young Ho Lee ),송관규 ( Gwan Gyu Song ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.2

목적: 건강한 한국인의 요추부 운동 및 흉부 학장 운동에 대한 연령, 성별 및 신장에 따른 표준치를 구하여 강직성척추염의 진단시에 척추 운동 장애의 유무를 판단하기 위한 참고치를 설정하고자 하였다. 방법: 강직성척추염 호발 연령인 16세에서 40세 사이의 요통이나 척추모양에 이상이 없는 건강한 한국인 573명(남 438명, 여 135명)을 대상으로하여 Schober 검사, 수정된 Schober 검사, 측방 굴곡운동, 손끝과 지면사이의 거리 및 흉부 확장 검사를 시행하였다. 결과: 1. 전체 대상자의 평균 Schober 검사 측정치는 15.7±0.1 cm(남 16.1±0.1, 여 14.6±0.1), 수정된 Schober 검사 측정치는 22.2±0.1 cm(남 22.7±0.1, 여 20.8±0.2), 측방 굴곡 운동측정치는 25.5±0.1 cm(남 25.7±0.1 여 24.5±0.2), 흉부 확장 운동 측정치는 4.8±0.1 cm(남 5.1±0.1, 여 3.9±0.2)였고 손끝과 지면 사이의 길이측정은 전체 573명중 63명중(10.1%)이 지면에 손이 닿지 않았고 이중 남자는 438명중 34명(7.8%), 여자는 135명중 29명(21.5%)이었고 손끝 과 지면사이의 길이는 6.6±0.9㎝(남 8.0±0.9, 여 5.0±0.7)로 각 검사 측정치는 남자에서 여자보다 더 길었다. 2. 나이에 따른 Schober 검사, 수정된 Schober 검사 및 측방 굴곡 검사 측정치는 나이가 증가함에 따라 감소하는 경향을 보였으나 흉부 확장 운동 검사치는 변화가 없었다(각각 r=-0.25, p<0.001, r=-0.21, p<0.001, r=-0.17, p=0.001, r=-0.04 p=0.035). 3. 신장에 따른 Schober 검사 측정치는 150~159 ㎝인 경우 14.2±0.2 ㎝ 이였으나 160~169 ㎝에서는 15.5±0.1 ㎝, 170~179 ㎝에서는 16.0±0.1 ㎝, 180 ㎝ 이상에서는 16.8±0.2 ㎝으로 뚜렸한 양적 선형관계를 보였고, 신장에 따른 수정된 Schober 검사 측정치는 150~159 ㎝인 경우 20.2±0.2 ㎝ 이였으나 160~169 ㎝에서는 22.0㎝±0.2 ㎝, 170~179 ㎝에서는 22.6±0.1 ㎝, 180 ㎝ 이상에서는 23.2±0.2 ㎝으로 뚜렷한 양적 선형관계를 보였다(각각 r=0.39, p<0.001, r=0.39, p=0.001). 4. 신장에 따른 측방 굴곡 검사와 흉부 확장 검사측정치도 신장이 증가함에 따라 증가하는 경향을 보였다.(각각 r=0.29, p<0.001, r=0.28, p=0.001). 결론: 건강한 한국인 선인의 평균 Schober 검사측정치는 15.7±0.1 ㎝ 이였고 흉부 확장 운동 측정치는 4.8±0.1 ㎝ 였으며, Schober 검사, 수정된 Schober 검사, 축방 굴곡 검사, 손끝과 지면사이의 거리 및 흉부 확장 운동 측정치들은 남자에서 여자보다, 나이가 적을수록 그리고 신장이 클수록 측정치도 증가하는 소견을 보였다. 척추 운동 장애를 측정하는데 있어서 특히 신장에 따른 Schober 검사 및 수정된 Schober 검사 측정치의 적용이 필요할 석으로 생각된다. Objective: To investigate the lumbar movement and chest expansion in healthy Koreans. Methods: Schober test, modified schoer test, lateral flexion, finger to ground distance and chest expansion were measured in 573 healthy Koreans. They were analysed according to age, sex and height. Results: 1) Mean length of Schober test in total subjects was 15.7±0.1 ㎝ (male 16.1±0.1 ㎝, female 14.6±0.1 ㎝) and mean length of chest expansion in total subjects was 4.8±0.1 ㎝ (male 5.1±0.1 ㎝, female 3.9±0.2 ㎝). 2) Mean length of Schober test, modified Schober test, lateral flexion, finger to ground distance and chest expansion were longer in male than in female. 3) As the age increased, mean length of Schoaer test, modified Schober test and lateral flexion revealed the trend to decrease but mean length of chest expansion did not revealed the trend to increase or decrease (each r=-0.25, p<0.001, r=-0.21, p<0.00l, r=-0.17, p<0.00l, r=-0.04, p<0.35). 4) As the height increased, mean length of Schober test, modified Schober test, lateral flexion and chest expansion revealed the trend to increase(each r=0.39, p<0.00l, r=0.39, p<0.001, r=0.29, p<0.001, r=0.28, p<0.001). Conclusion: Length of Schober test and chest expansion in healthy Koreans were 15. 7±0.1 ㎝ and 4.8±0.1 ㎝ and they were longer in male than in female. As the age increased, length of Schober test and lateral flexion had the tendency to decrease and as the height increased, length of Schober test, lateral flextion and chest expansion had the tendency to increase. Therefore it is needed that length of lumbar movement and chest expansion were applied according to age, sex and height to detect early disorder of lumbar motility.

종설 : 류마티스 관절염에서 항 CCP 항체의 임상적 의의

노영희 ( Young Hee Rho ),송관규 ( Gwan Gyu Song ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6

복합 교원성 질환(Mixed connective tissue disease) 18예의 임상적 고찰

이인흥 ( In Hong Lee ),송관규 ( Gwan Gyu Song ),정성수 ( Sung Soo Jung ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),김신규 ( Thin Kyou Kim ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

목적: 복합 교원성 질환은 1972년 Sharp 등에 의해서 처음 명명되었으며 전신성 홍반성 낭창, 다발성근염, 경피증의 임상적 양상을 함께 나타내는 질환으로서 고농도의 항 nRNP항체만이 양성 소견을 보이는 특징을 갖는다. 방법: 1989년 10월부터 1992년 9월까지 한양대학병원 류마티스 센터에서 MCTD로 진단된 18명의 환자를 대상으로 임상적 분석을 시행하였다. 결과: 1) Sharp의 진단기준에 부합되는 MCTD환자는 18명이었으며 모두 여자 환자였고 연령 분포는 23세에서 61세로 평균 38.6세였다. 2) 18명 모두가 관절통을 호소하였으며 이중에서 13명(72%)은 관절염 소견을 나타냈고, 류마티스인자는 15명(83%)에서 양성이었다. 3) 수부 부종(hand swelling)은 15명(83%)에서 관찰되었으며 18명 모두가 Raynaud 현상을 나타냈다. 4) 18명 모두가 근육통 소견을 보였으며, 12명에서 근육 조직검사 소견상 근염이 관찰되었다. 5) 혈청학 검사에서 항 핵항체와 항 nRNP항체는 18명 모두가 높은 역가를 나타냈으며 항 Sm항체는 모두 음성이었다. 결론: 향후 이 질환에 대한 보다 세밀한 임상 분석이 시행되기를 고대하며 이 질환에 대한 보다 많은 관심이 주어지기를 기대한다. Objective: Mixed connective tissue disease (MCTD) was first described by Sharp and coworkers in 1972 as distinct rheumatic diseases characterized by the overlapping features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and dermatomyositis/polymyositis and associated with the serologic marker anti-nRNP antibody at high titer. Methods: We reviewed 18 cases (all females) of MCTD who were admitted or visited to rheumatism center of Hanyang University Hopital, from October 1989 to September 1992. Results: 1) The average age at onset of MCTD was 38.6 years. The average duration of the disease was 5.3 years. 2) Raynaud`s phenomenon was found in 100%. Arthritis was found in 13 cases but rheumatoid factor was found in 15 cases. 3) Hand swelling was found in 15 cases and myositis was found in 56% (10 cases). 4) All patients with MCTD have anti-nRNP antibodies by high titer. In general, the titer does not correlate with disease activity. Conclusions: These data suggested that the clinical features of MCTD in Korean patients revealed similar to those of previous reports regarding foreign ethnic groups.

혈관 조영 검사술에서 혈관의 폐쇄를 보인 공피증 2례

이영호 ( Young Ho Lee ),송관규 ( Gwan Gyu Song ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

Scleroderma is a systemic disorder with multiorgan involvement. About 90% of patients with scleroderma has Raynaud`s phenomenon and microvascular involvement is well recognized in scleroderma, but macrovascular involvement is not recognized. We experienced 2 cases of scleroderma with peripheral vascular occlusions that had been diagnosed by femoral angiography. The one patient with limited scleroderma had anticentromere antibody and angiography of both femoral arteries showed nonvisualization of posterior tibial artery. The other patient with diffuse scleroderma had anti-Scl-70 antibody and angiography of right femoral artery showed occlusion of both anterior and posterior tibial arteries and stenosis of distal portion of peronial artery. Both patients didn`t have the risk factors of atherosclerosis such as hypertension, hypercholesterolemia, obesity, and smoking. In recent years, there have been reports that scleroderma is associated with macrovascular disease. In the future, the study on the freguency, prevention and treatment of macrovasular disease in scleroderma is necessary. We report 2 cases of scleroderma with peripheral vascular occlusions that had been diagnosed by femoral angiography with review of literatures.