전신성홍반성낭창과 특발성혈소판감소성자반증 환자 혈청에서 항혈소판항체의 출현빈도 및 항원특이성에 관한 연구

송영욱(Yeong Wook Song),이제환(Je Hwan Lee),이윤재(Yoon Jae Lee),박선양(Seon Yang Park),최강원(Kang Won Choe),박명희(Myung Hee Park) 대한내과학회 1990 대한내과학회지 Vol.39 No.4

N/A There is a special relationship between systemic lupus erythematosus (SLE) and idiopathic thrombocytopenic purpura (ITP), both of which are autoimmune diseases. Some patients with thromhocytopenic purpura, labeled as idiopathic at the onset, later develop a classical course of SLE, suggesting that ITP may be an early manifestation of SLE. Furthermore, a thrombocytopenic purpura, indistinguishable from ITP, is a common feature of SLE. Recent studies by several laboratories show that some patients with ITP produce autoantibodies against the glycoprotein IIb/IIIa complex and glycoprotein lb. Since in most cases of SLE an increase of platelet-associated IgG has been observed, it was suggested that the destruction of platelets might be dependent on the coating of the platelets with specific antibodies or on the binding of the immune complexes. A better knowledge of the antigen recognized by the antibodies present in the patients with SLE might help to clarify the cause of the thrombocytopenia. In this study, serum antiplatelet antibody was detected using platelet suspension immunofluorescence test in SLE and ITP patients. The positive rate of serum antiplatelet antibody was 85% (17/20) in SLE, 66.7% (10/15) in ITP, 60% (3/5) in platelet alloimmunization, and 0% (0/13) in the normal group. Sera from patients of SLE and ITP were incubated with platelet fractions immobilized on nitrocellulose paper (Western blotting) to detect platelet antigen specificity using a 125I-goat anti-human IgG. Normal sera reacted with platelet fractions in the range of 190~200 KD, 142~152 KD, and 87~90 KD, Howerver, 11 of the 20 SLE sera (55%) and seven of the 15 ITP sera (46.7%), bound to one or more fractions with large variations in the number and molecular weights in the platelet fractions, did not react with normal sera. Binding was directed to the platelet fractions in the range of 162 KD, 117~123 KD, 60~69 KD, 53~55 KD, 40~45 KD, and 37~39 KD in the SLE group, along with 117~123 KD, 106 KD, and 60~69 KD in the ITP group. The antigenic determinants were located in the cytoplasmic fraction of the platelets. This observation surggests the presence of multiple antigenic binding site for platelet-specific immunoglobulin, as well as differences, of antigen specificity in SLE and ITP sera. This variation may reflect heterogeneous antibodies binding to diverse antigens, or homogeneous antibodies bound to a limited number of antigenic determinants shared by the discrete platelet molecules.

특집: 류마티스 관절염 진단과 치료의 최신지견 : 최근 조명된 류마티스 관절염의 병태 생리

송영욱 ( Yeong Wook Song ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

Rheumatoid arthritis is a chronic inflammatory disease that primarily affects joint synovium. Although its etiology has yet to be identified, the underlying mechanism of joint inflammation is understood as autoimmune process. The inflamed synovium is thickened due to synovial hyperplasia and infiltrating mononuclear cells such as T and B lymphocytes, macrophages, and plasma cells. Key inflammatory cytokines TNF-α and IL-1, as shown by the significant therapeutic effect of their blockade, are mainly secreted by macrophages whereas IL-17 is secreted by a newly recognized subset of T cells (Th17 cells) and induces TNF-α and IL-1 production by adjacent macrophages, synoviocytes, and chondrocytes. IL-17 has also been shown to induce RANKL from osteoblasts, thereby indicating that this cytokine plays as an upstream molecule that regulates inflammation and osteoclastogenesis. More importantly, IL-17 has been shown to convert acute inflammation into chronic inflammation and when combined with already important cytokines, more marked inflammation occurs. The role of B cells as antigen presenting cells are now being recognized based on the therapeutic effect of rituximab, a B cell inhibitor, in rheumatoid arthritis. Great attention has been turned to anti-citrullinated peptide antibodies because they form immune complex and contribute to inflammation by activating complement system. Recently, clinical trials showed therapeutic efficacy of tocilizumab, monoclonal antibody against IL-6 receptor, suggesting relevant involvement of IL-6 in disease process of rheumatoid arthritis. Thus, various cellular and molecular players seem to interact within rheumatoid synovium to perpetuate inflammation. Further studies are needed to explore the exact mechanisms of development and maintenance of inflammation in rheumatoid arthritis. (Korean J Med 76:1-6, 2009)

Increased Frequency of Antifilaggrin Antibody in Patients With Rheumatoid Arthritis

송영욱(Yeong Wook Song),이은봉(Eun Bong Lee),백한주(Han Joo Baek),정은숙(Eun Sook Chung),김현아(Hyun Ah Kim),김인규(In Gyu Kim),최경호(Kyung Ho Choi) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

혈관염을 포함한 류마티스 질환에서의 항호중구세포질 항체 양성율

송영욱 ( Yeong Wook Song ),백경란 ( Kyong Ran Peck ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

연구 배경: Anti-neutrophil cytoplasmic antibody(ANCA)는 호중구와 단핵구의 세포질내에 존재하는 단백질에 대한 자가항체로, 많은 전신성 괴사성 혈관염 환자들의 진단에 도움이 되는 지표로서 이용이 되고 있고. ANCA가 전신성 혈관염에 비교적 특이적인 항체이어서, 다른 면역학적인 검사와 함께 실시하면 전신성 혈관염과 류마티스 질환을 감별진단하는데 도움이 되는 것으로 알려져 있다. 저자들은 전신성 혈관염 중 우리 나라에 많은 베체트병 타카야수 동맥염에서의 ANCA 양성율과 그 외 여러 류마티스 질환에서의 ANCA 양성율에 대한 조사를 하고자 본 연구를 시행하였다. 방법: 서울대학교병원 내과 류마티스 크리닉에 다니는 활동성 류마티스 질환 및 혈관염성 질환 환자를 대상으로 간접면역형광법을 이용하여 혈청의 ANCA 양성률을 조사하였다. 대상 환자는 총 185명(여자 115명, 남자 70명)이었고, 질환 별로는 전신성홍반성낭창 41예, 류마티스양관절염 31예, 베체트병 50예, 그리고 타카야수 맥염 11예이었다. 그밖에 Henoch-Schonlein 자반증(HSP)과 베게너 육아종증 환자가 각각 1예씩 있었다. 결과: 전신성홍반성낭창 환자 41예 중에서는 2예가 P-ANCA 양성이었고, C-ANCA가 양성인 예는 없었으며, P-ANCA가 양성인 2예는 특별히 혈관염 증상 및 징후가 관찰되지는 않았다. 피부 근염 및 다발성근염 환자 22예 중에서 1예가 P-ANCA 양성이었고 역시 C-ANCA 양성을 보이는 환자는 없었다. 류마티스양관절염 환자 31예, 강직성척추염 환자 9예, 진행성전신경화중 환자 19예는 모두 ANCA 음성이었다. 베체트병, 환자 50예 중 P-ANCA 양성은 2예 있었고, C-ANCA 양성은 없었다. P-ANC가 양성인 2예는 모두 완전형(complete type)으로 구강궤양, 성기궤양, 포도막염 및 피부병변이 있었고, 이중 1예는 혈관염 병변으로 우측 대퇴정맥의 폐쇄소견이 있었다. 타카야수 동맥염 11예와 Henoch-Schonlein 자반증 1예에서 ANCA 양성을 보이는 예는 없었다. 베게너 육아종중 환자 1예는 전형적인 C-ANCA 양성을 보였다(Table 2). 이 환자는 치료 후 관해가 온 다음에는 C-ANCA가 음전되었다. 결론: 이상의 결과로 한국인에 많은 혈관염 및 류마티스질환의 ANCA 검사가 ANCA 양성 혈관염과 다른 류마티스질환을 감별하는데 도움이 될 것으로 사료되었다. Background: Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies that are specific for proteins in the cytoplasm of neutrophils and monocytes. In the 10 years since their discovery, ANCA have become widely used serological markers for various systemic necrotizing vasculitides, including Wegener`s granulomatosis, polyarteritis nodosa, crescentic glomerulonephritis, and Churg-Strauss syndrome. Rheumatic manifestations (such as arthralgia, myalgia, even frank arthritis) are observed frequently in the group of primary vasculitides. In the group of collagen vascular diseases and the various forms of chronic inflammatory arthritis, vasculitis may severely complicate the course of the disease. Since atypical vasculitic diseases are indistingushable from other rheumatic disorders in the initial period of disease, immunological studies must be performed. We conducted this study for obtaining the seroprevalence of ANCA in rheumatic disorders including vasculitides which are common in Korea. Method: ANCA was detected with indirect immunofluorescent microscopy of alcohol-fixed granulocytes. Results: Total 185 patients were enrolled in this study. There was no patient having C-ANCA except one patient with Wegener`s granulomatosis. Total 5 patients were positive for P-ANCA; 2 of 41 SLE patients, 1 of 22 dermatomyositis/polymyositis patients, 2 of 50 Behcet`s disease patients. All 11 patients with Takayasu`s arteritis were ANCAnegative. These results were similar to those of others. Conclusion: ANCA, as a adjunct to other autoantibodies, will be helpful for differential diagnosis of various vasculitides and rheumatic disorders.

베체트병에서의 혈액응고 이상에 관한 연구

강성욱 ( Seong Wook Kang ),신기철 ( Ki Chyul Shin ),이윤종 ( Yun Jong Lee ),이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),김현아 ( Hyun Ah Kim ),송영욱 ( Yeong Wook Song ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Objective: The predominant histopathologic lesion in Behcet`s disease is vasculitis. Thrombotic complications have been reported in approximately 10~40% of patients with Behcet`s disease, but the precise mechanisms are not known. To investigate the coagualtion abnormalities in patients with Behcet`s disease, coagulation and fibrinolytic activities were examined. Methods: Thirty-two patients with Behcet`s disease and thirty-two healthy individuals as a control group were included in the study. The presence of thrombosis and risk factors for hypercoagulability, and blood components concerning coagulation and fibrinolytic activites were evaluated. Results: Of thirty-two patients with Behcet`s disease, thrombosis was found in four patients(13%). No patient had risk factors for hypercoagulability except one with lymphoma. Levels of white blood cell count(mean±SD 8,362±2,893 vs 5,934±1,755/mm3, p<0.001), erythrocyte sedimentation rate(40.5±37.6 vs 3.3±2.73 mm/hr, p<0.001), C reactive protein(2.26±3.99 vs 1.20±0.26mg/dl, p=0.008), fibrinogen(387.7±128.5 vs 240.6±49.5mg/dl, p<0.001) and von Willebrand factor antigen(131.9±46.6 vs 105.2±1.75%, p=0.008) were significantly higher in patients with Behcet`s disease compared with controls. The level of fibrinogen correlated with erythrocyte sedimentation rate(r=0.721, p<0.001) and C reactive protein (r=0.454, p=0.018). High density lipoprotein(HDL) cholesterol(46.6±12.7 vs 65.5±16.1mg/dl, p<0.001), apolipoprotein A-1(118.8±24.7 vs 134.6±18.5mg/dl, p=0.018) and antithrombin III (92.8±16.7 vs 106.3±14.7%, p=0.004) were significantly lower in patients with Behcet`s disease. No differences were observed in lipoprotein(a), plasminogen, protein C, and protein S activities. Activated protein C(APC) resistance was not observed in any patients with Behcet`s disease. Lupus anticoagulant was positive in four patients(13%). one of whom had deep vein thrombosis. Antiphospholipid antibody was found in one patient(3%), but thrombosis was not found. Conclusions: Significantly higher level of von Willebrand factor antigen was observed in Behcet`s disease, which suggested injury of vascular endothelium. Levels of HDL cholesterol, apolipoprotein A-1 and antithrombin III were decreased in Behcet`s disease. APC resistance was not found.

한국인의 유증상 무릎 골관절염의 위험요인에 관한 연구

김진현 ( Jin Hyun Kim ),송영욱 ( Yeong Wook Song ),이정찬 ( Jung Chan Lee ),신동혁 ( Dong Hyuk Sheen ),박남규 ( Nam Gyu Park ),이윤종 ( Yun Jong Lee ),이은봉 ( Eun Bong Lee ),김현아 ( Hyun Ah Kim ),김윤근 ( Yun Keun Kim ),박병주 ( 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.2

Objective: To investigate the risk factors for symptomatic knee osteoarthritis (OA) in Koreans Methods: A total of 1,194 persons consisting of 588 men and 606 women (mean age±SD, 48.9±14.0 years) were enrolled in rural and urban areas or in a hospital of Korea between september 2000 and august 2001. All participants were interviewed about symptoms of knee OA and possible risk factors including age, sex, occupation, body mass index (BMI), smoking, age of menarche, menopause and hormone replacement therapy and examined. Knee radiograph was obtained in all participants with knee symptoms. Symptomatic knee OA was defined according to clinical criteria or clinical and radiographic criteria for classification of osteoarthritis of the knee by Altman. Results: Of 1,194 participants, symptomatic knee OA was found in 189 persons (15.8%) and multivariate analysis showed that female (OR=5.66, 95% CI 3.42∼9.38), aging (OR=1.10, 95% CI 1.08∼1.12), living in rural area (OR=3.83, 95% CI 2.27∼6.45) and BMI over 25 kg/m2 (OR=2.26, 95% CI 1.42∼3.59) were risk factors. Age (older than 70 years, OR=1.08, 95% CI 1.04∼1.12) and living in rural area (OR=5.39, 05% CI 1.94∼14.96) were associated with symptomatic knee OA in men and age (older than 40 years, OR=1.11, 95% CI 1.07∼1.16), living in rural area (OR=2.46, 95% CI 1.17∼5.17), and BMI over 25 kg/m2 (OR=3.45, 95% CI 1.63∼7.29) in women. Conclusion: The risk factors for symptomatic knee OA were aging, female, living in rural area and high BMI in Koreans.

면역성병인에 의한 혈관손상이 혈관내피세포의 혈액응고 조절기전에 미치는 영향에 관한 연구 ; Tissue - Type Plasminogen Activator , Plasminogen Activator Inhibitor - 1 및 von Willebrand Factor 의 변동에 관하여

박선양(Seon Yang Park),송영욱(Yeong Wook Song) 대한내과학회 1991 대한내과학회지 Vol.40 No.2

N/A To elucidate the pathophysiologic mechanisms for hemorrhagic or thrombotic conditions induced by immune-mediated vascular injury, changes of the plasma levels of tissue-type plasminogen activator (t-PA) and type 1 plasminogen activator inhibitor (PAI-1), and von Willebrand factor ristocetin cofactor (vWf:RCo) activities were evaluated in seven patients with Henoch-Schonlein purpura (HSP) and 18 patients with systemic lupus erythematosus (SLE) with or without thrombotic complications. 1) Plasma PA activities and t-PA concentrations were not changed significantly in patients with HSP or SLE compared to those in normal controls. 2) Plasma PAI activities were increased significantly in HSP (57.7±5.1%, p<0.001) and SLE (51.6±8.6%, p=0.039) compared to those in normal controls (45.7±5.6%). In patients with SEL, thrombotic complications had no effect on the activities of plasma PAI-1. 3) PAI-1 concentrations were significantly elevated in patients with SLE (44.3±31.2AU/ml, p=0.015) compared to those in normal controls (23.4±8.8AU/ml). However, no difference in PAI-1 concentrations were found between the patients with or without thrombosis. PAI-1 concentrations were not significantly changed in HSP. 4) On fibrin autographic analysis of euglobulin fractions after SDS-PAGE, the intensity of 97K and 72K bands were increased. 5) vWf:RCo activities were greatly increased in patients with SLE (373.5±141.2%) with or without thrombosis. However, no significant difference was observed between the two groups. In conclusion, the increase of plasma PAI activities in patients with HSP appeared to be a compensatory mechanism for the hemorrhagic tendency characteristic of the disease, whereas, the increases of PAI activities, PAI-1 concentrations, t-PA-PAI-1 complexes and vWf:RCo activities might be a pathogenetic mechanism for the thrombotic conditions often complicated in patients with SLE.

십이지장궤양환자에서의 (十二指腸潰瘍) 위배출속도 (胃排出速度)

송인성(In Sung Song),김정용(Chung Yong Kim),이효석(Hyo Suk Lee),송영욱(Yeong Wook Song),이영상(Young Sang Lee) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1

N/A Gastric emptying rate was studied with the acetaminophen method in 21 normal volunteers and 17 active duodenal ulcer patients. As an indicator of gastric emptying rate, the serum acetaminophen concentration was measured by dye method at 0, 30, 60 90, 120, 180 minutes after ingestion of 50 ml of water with l. 5g of acetaminophen. In normal subjects, the serial mean serum concentrations of acetaminophen were 16.6, 19.3, 20.5, 16.8, 13.0 ug/ml, respectively, and in the active duodenal ulcer patients the concentrations were 19.1, 20.2, 18.9, 16.4, 11.1 ug/ml, respectively. The peak serum concentretion seemed to appear earlier in the ulcer patients, and mximum serum concentrations were 24.2+-4.3 ug/ml in the normal subjects and 24.1+-8.9 ug/ml in the active duodenal ulcer patients, both of which, however, were neither statistically significant, indicating that there was no significant acceleration of gastic emptying rate in patients with active duodenal ulcer.

증례 : 전신홍반루푸스에 동반된 장기종 1예

박준원 ( Jun Won Park ),송영욱 ( Yeong Wook Song ),신기철 ( Ki Chul Shin ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2

본 증례처럼 면역억제제 치료를 받고 있는 전신홍반루푸스 환자에서 복부 팽만, 복통이나 구토, 설사 등의 소화기 증상이 나타날 경우 장기종을 감별 진단에 포함시키는 것이 필요하다고 생각된다. 장기종은 흔하게 발생하는 합병증은 아니나, 혈관염을 동반하거나 고용량의 스테로이드를 장기간 사용한 환자에서 병발할 수 있으며, 대부분의 경과는 양호하여 보존적 치료만으로 호전된다. 그러나 일부 장기종의 경우 응급 수술이 필요한 장괴사나 복막염으로 진행할 수 있어 주의가 필요하다. Pneumatosis cystoides intestinalis, which is characterized by multiple air-filled cysts in the intestinal mucosa, submucosa, and subserosa, is associated with autoimmune disorders, including systemic sclerosis, inflammatory myopathy and, rarely, systemic lupus erythematosus (SLE). Here, we report the case of a 57-year-old female with a 2-year history of SLE who developed pneumatosis cystoides intestinalis. The patient`s symptoms were improved with conservative management. Although pneumatosis cystoides intestinalis is an uncommon manifestation of SLE, and follows a mainly benign course, it can be associated with vasculitis, which has a poor prognosis.

Churg-Strauss 증후군에서 동반된 심근내막섬유증

김혜원 ( Hye Won Kim ),송영욱 ( Yeong Wook Song ),장성혜 ( Sung Hae Chang ),류한희 ( Han Hee Ryu ),송란 ( Ran Song ),이은봉 ( Eun Bong Lee ),손대원 ( Dae Won Son ),김유영 ( You Young Kim ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.3

Cardiac involvement is an important cause of mortality in patients with Churg-Strauss syndrome. The typical cardiac presentation of Churg-Strauss syndrome includes pericarditis, myocarditis, and cardiomyopathy. Endomyocardial fibrosis has rarely been described in patients with Churg-Strauss syndrome. We experienced a patient with Churg-Strauss syndrome who exhibited exertional dyspnea and endomyocardial fibrosis visualized as delayed enhancement on cardiac magnetic resonance imaging (MRI). After glucocorticoid treatment, the patient`s symptom resolved, and the eosinophil count decreased to normal. Nine months later, the delayed-enhanced lesion on the cardiac MRI nearly disappeared. Here, we report a case of endomyocardial fibrosis in a patient with Churg-Strauss syndrome with a literature review.