류마티스 섬유모세포양 활막세포에서 저산소증이 시토카인 생산에 미치는 영향

안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),고재현 ( Jae Hyun Koh ),김진희 ( Jin Hee Kim ),최화정 ( Hwa Jung Choi ),안광성 ( Kwang Sung Ahn ),차훈석 ( Hoon Suk Cha ),유석희 ( Suk Hee Yu ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2003 대한류마티스학회지 Vol.10 No.1

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased production of cytokines, proliferation of fibroblast-like synoviocytes (FLS) and joint destruction. It is well known that the involved joints in RA are hypoxic. Hypoxia may play a role in the pathogenesis of RA. We thought that hypoxia might alter the production of cytokines by FLS and these changes could affect the biologic behaviors of FLS. Based on that, we investigated whether hypoxia affects the production of cytokines in FLS and the effect of these changes on matrix metalloproteinases (MMPs) expression. Methods: Fibroblast-like synoviocytes from human rheumatoid synovial tissue obtained duringjoint replacement surgery were cultured in vitro. Hypoxic culture was performed by incubating cells in BBL(R) Gaspak pouch(TM) anaerobic system. After incubation under hypoxic condition for 24 hr, the concentrations of various cytokines in culture supernatants were determined by ELISA. To determine the effect of highly expressed cytokines on MMP expression, we performed ELISA of MMP-1, MMP-2 and MMP-3 in cultured FLS, after stimulation with respective cytokines. Results: In hypoxic state, IL-6, IL-8 and vascular endothelial growth factor (VEGF) concentrations were significantly increased compared to those in normoxic condition. However, there were little differences in IL-1, IL-2, IL-4, TNF-α and TGF-β. Stimulation of FLS with IL-6 and IL-8 showed the increased concentrations of MMP-1, MMP-2 and MMP-3. Conclusion: Hypoxic environment of rheumatoid synovium might affect FLS to produce proinflammatory and proangiogenic cytokine such as IL-6 and IL-8. These cytokines again could stimulate MMPs production in FLS leading to joint destruction.

전신성 홍반성 루푸스에서의 위장관 가성폐색증

안중경 ( Joong Kyung Ahn ),고재현 ( Jae Hyun Koh ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),김영호 ( Young Ho Kim ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

Intestinal pseudo-obstruction is an uncommon and poorly understood complication of systemic lupus erythematosus. It is characterized by acute or chronic symptoms suggestive of the obstruction of small or large intestine without any radiologic, surgical or endoscopic evidence of mechanical obstruction. Although the exact pathogenesis of intestinal pseudo-obstruction in SLE remains unknown, it can be caused by derangement of the visceral smooth muscle, enteric nerves or visceral autonomic nervous system. Concomitant involvement with dilatation of gastrointestinal and genitourinary tract highly suggests of intestinal pseudo-obstruction in systemic lupus erythematosus. There is an apparent association between lupus-related intestinal pseudo-obstruction and ureterohydronephrosis. The management of intestinal pseudo-obstruction consists of high dose corticosteroid, adequate nutrition, hydration and prokinetics. Early recognition of intestinal pseudo-obstruction in systemic lupus erythematosus and the use of adequate dose of corticosteroid are important. We report a case of systemic lupus erythematosus presenting as intestinal pseudo-obstruction.

결체 조직 질환에서 조직학적으로 확진된 통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상상과 흉부 HRCT 소견의 비교 및 방사선학적 변화와 임상적 지표와의 연관성

안중경 ( Joong Kyong Ahn ),고은미 ( Eun Mi Koh ),이유선 ( You Sun Lee ),차훈석 ( Hoon Suk Cha ),정만표 ( Man Pyo Chung ),한정호 ( Jung Ho Han ),오대근 ( Dae Kun Oh ),이경수 ( Kyung Soo Lee ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.3

Objective: The purpose of this study is to assess the clinical characteristics and the serial changes of high resolution CT (HRCT) findings and to correlate those with the results of clinical parameters in biopsy proven nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) with connective tissue diseases (CTD). Methods: Retrospective analysis was made of forty patients with CTD diagnosed of NSIP and UIP from a single tertiary hospital between January 1996 and February 2006. Results: UIP was common in rheumatoid arthritis, systemic sclerosis and Sjogren`s syndrome, while NSIP was frequent in polymyositis/dermatomyositis. No significant difference was found in the clinical characteristics of patients with NSIP and UIP. In initial HRCT findings, extents of honeycombing and reticulation pattern were significantly more in UIP-CTD than in NSIP-CTD. In bronchoalveolar lavage (BAL) results, proportion of alveolar macrophages was significantly higher in NSIP-CTD than in UIP-CTD. In NSIP-CTD, significant increment in the extent of reticulation and honeycombing was noted in the serial HRCT findings despite the aggressive treatment. Significant correlation was found between leukocytosis and honeycombing change in NSIP-CTD. Despite no significant difference of survival between two groups, patients with UIP-CTD seem to have a higher mortality than those with NSIP-CTD. Conclusion: It is suggested that chest HRCT and BAL fluid analysis may be helpful in the differential diagnosis of NSIP- and UIP-CTD and leukocytosis in initial blood test might be predictive of honeycombing progression in NSIP-CTD. Further study will be required to compare with the prognosis of NSIP- and UIP-CTD.

미만성 기관, 기관지 침범으로 발현한 재발다발연골염 1예

유경모 ( Kyung Mo Yoo ),황지원 ( Jiwon Hwang ),안중경 ( Joong Kyong Ahn ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.6

Relapsing polychondritis is a rare autoimmune disease involving the cartilaginous structures of the whole body. Its diagnosis can be difficult when the typical clinical features such as auricular chondritis are absent. Here, we report on a case of a 51-year-old female who presented with cough, dyspnea, and polyarthritis. Chest computed tomography showed the diffuse involvement of tracheobronchial cartilage. According to Damiani`s criteria, she was diagnosed as relapsing polychondritis even though there was no unique involvement of auricular cartilage, and high dose steroid and immunosuppressive therapy were then started. This case indicated that patients who have tracheobronchial cartilage involvement without definite auricular chondritis should be considered for relapsing polychondritis as a differential diagnosis. (J Rheum Dis 2015;22:374-377)

쇼그렌증후군에서 폐를 침범한 MALT 림프종 2예

이유선 ( You Sun Lee ),고은미 ( Eun Mi Koh ),안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),채지영 ( Ji Young Chai ),차훈석 ( Hoon Suk Cha ),정만표 ( Man Pyo Chung ),한정호 ( Joung Ho Han ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.3

Sjogren`s syndrome is an autoimmune exocrinopathy characterised by decreased lacrymal and salivary gland function, resulting in keratoconjunctivitis sicca and dry mouth. The occurrence of malignant lymphoma is the most serious complication of Sjogren`s syndrome. Recent reports have found that MALT lymphoma accounts for 46~56% of the malignant lymphoma that develop in patients with Sjogren`s syndrome. The most common site of MALT lymphoma in patients of Sjogren`s syndrome is parotid gland, but we experienced two cases of MALT lymphoma of lung in patients with Sjogren`s syndrome. We report these cases with review of literature.

염증성 근병증에서 자기공명영상의 임상적 의의

고재현 ( Jae Hyun Koh ),홍석주 ( Suk Joo Hong ),안홍준 ( Hong Joon Ahn ),안중경 ( Joong Kyung Ahn ),전찬홍 ( Chan Hong Jeon ),차훈석 ( Hoon Suk Cha ),안중모 ( Joong Mo Ahn ),김현숙 ( Hyun Sook Kim ),서연림 ( Yeon Lim Seo ),고은미 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.3

Objective: The purpose of the study is to describe the magnetic resonance imaging (MRI) findings and to investigate useful sequences of MRI in inflammatory myopathies. A third goal is to correlate MRI findings with the grade of histopathologic severity. Methods: Sixteen patients (13 women, 3 men), aged 21~74 years (median age of 49) with inflammatory myositis (examined with both MRI and muscle biopsy) were studied. Ten patients were diagnosed with polymyositis and 6 with dermatomyositis. Conventional T1-weighted (SE 366/12) and T2-weighted (SE 4766/90) fast spin-echo and fat-suppressed T1-weighted MR images with contrast enhancement (FSAT T1 CE) were obtained. Ratios between the signal intensities of a muscle and the signal intensities of subcutaneous fat in the same tomographic sections were calculated to objectively represent the degree of signal intensities. Semi-quantitative grading of severities in muscle biopsy specimen was examined based on invasion of inflammatory cells and necrosis, degeneration and regeneration of muscle fiber by a neuromuscular pathologist. Results: FSAT T1 CE could objectively describe the severity of involvement in inflammatory myopathies. The quadriceps muscle group, especially the vastus muscle tended to be most severely and frequently involved in inflammatory myositis with FSAT T1 CE (statistically insignificant). The vastus intermedius muscle was more severely involved in dermatomyositis than polymyositis. The signal intensity of abnormal muscle sampled by biopsy correlated positively with the grade of muscle biopsy. Conclusion: MRI shows promise in identifying pathologic muscle in patients suspected of having one of the inflammatory myopathies. The degree of signal intensity on MRI may reflect the severity of grade in muscle biopsy.

내시경적 활막제거술을 시행하여 활막염 증상이 호전된 일차성 비후성 골관절증

이재준 ( Jae Joon Lee ),김형진 ( Hyung Jin Kim ),황지원 ( Ji Won Hwang ),노정원 ( Jung Won Noh ),안중경 ( Joong Kyung Ahn ),고은미 ( Eun Mi Koh ),차훈석 ( Hoon Suk Cha ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.3

일차성 비후성 골관절증(Primary hypertrophic osteoarthropathy) 혹은 경피골막증(pachydermoperiostosis)은 곤봉형 수지, 골막주변 비후 그리고 피부와 두피가 두꺼워지는 연조직의 변화를 특징으로 하며 남자에게서 좀더 흔한 매우 드문 질환이다. 이차성 비후성 골관절증(secondary hypertrophic osteoarthropathy)은 원발성에 비해 비교적 흔하며 악성종양, 선천성 심질환 또는 소화기 질환과 같은 다양한 기저질환과 동반되어 나타나는 것이 특징이다. 저자들은 곤봉형 수지, 깊은 주름이 잡힌 이마, 다한증과 활막염의 특징적인 임상증상을 보인 26세 남자에서 일차성 비후성 골관절증을 진단하였으며 우측 슬관절의 지속적인 활막염과 관절종창으로 인해 내시경적 활막제거술을 시행하여 증상이 호전되었으므로 이를 문헌고찰과 함께 보고하는 바이다.

조혈모세포이식 환자에서의 기계 환기의 위험 인자 : Assessment of Risk Factors

안중경,이홍기,황정혜,박세훈,이효락,송서영,이순일,박준오,김기현,김원석,정철원,임영혁,강원기,박근칠 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.1

연구배경: 조혈모세포이식을 시행한 환자에서 집중 치료 시 예후가 매우 나쁜 것으로 알려져 있고, 기계 환기는 강력한 사망 예측 인자로서 보고되고 있다. 그러나 현재까지 이식 환자에서 기계 환기의 위험 인자를 밝힌 연구는 매우 드물다. 따라서 기계 환기를 시행한 조혈모세포이식 환자의 임상적 특징을 살펴보고 기계 환기에 대한 위험 인자를 알아보고자 하였다. 방법: 삼성서울병원에서 조혈모세포이식을 시행한 환자 중 기계 환기를 시행한 23명과 기계 환기를 시행하지 않은 142명을 대상으로 후향적 연구를 시행하였다. 기계 환기에 대한 위험 인자의 여부에 관해서는 chi-square 또는 Fisher's exact 검정을 시행하였으며 기계 환기에 대한 각 위험 인자의 영향에 관해서는 다중로지스틱 회귀분석을 시행하였다. 결과: 기계 환기를 시행한 23명의 환자 중 30일째 생존자는 1명이었고 6개월째 생존율은 0%였다. 생존자와 사망자 모두에서 다기관 기능부전이 관찰되었으며, APACHE II 점수와 SAPS II 점수에 의한 예측 사망률은 각각 56%, 59%였다. 조혈모세포이식 후 기계 환기의 위험 인자로는 선행 질환이 혈액질환, 부분불일치 동종이식, 간정맥폐색성질환, 이식 전 질병 상태가 재발하였거나 약물에 반응하지 않는 경우였다. 다중로지스틱 회귀분석 결과 기계 환기의 위험 인자로 통계적으로 유의한 차이를 나타낸 것은 단지 부분불일치 동종이식을 시행한 경우였다. 결론: 현재까지 조혈모세포이식 환자에서 집중 치료의 역할에 대해서는 확실히 정립되어 있지는 않으며, 이식 환자에서 기계 환기는 강력한 사망 예측 인자이다. 따라서, 조혈모세포이식을 시행한 환자에서 기계 환기의 위험 인자와 불량한 예후 인자를 고려하여 기계 환기 여부에 대한 신중한 결정을 내려야 한다. Background: Respiratory failure requiring mechanical ventilation is a frequent, critical complication of hematopoietic stem cell transplantation (HSCT). Patients who require mechanical ventilatory support after HSCT generally have a very poor prognosis. Mechanical ventilation in HSCT recipients is a strong predictive factor of mortality. The objectives of this study are to describe clinical characteristics of HSCT recipients undergoing mechanical ventilation and to identify the risk factors for mechanical ventilatory support after HSCT. Methods: We performed a retrospective chart review of all patients >15 yrs old who received HSCT at Samsung Medical Center and subsequently required mechanical ventilatory support between 1996 and 2001. Results: Thirty-day mortality rate in HSCT recipients undergoing mechanical ventilation was 95.6%. The mean predictive mortality rates of APAHCE II score and SAPS II score were 56% and 59%, respectively. Reasons for mechanical ventila-tion were sepsis (47.8%) followed by fungal infection (13%) and diffuse alveolar hemorrhage (8.7%). Univariate analysis identified relapsed or refractory diseases at HSCT, hematologic disease, hepatic venoocclusive disease and allogeneic or HLA-mismatched transplant as significant risk factors for mechanical ventilation. On multivariate logistic regression analysis, only allogeneic mismatched transplant remained significant. Conclusion: Overall outcome of HSCT recipients undergoing mechanical ventilation is very poor. Therefore, the risk factors and the poor prognostic factors for mechanical ventilation should be taken into account in making further treatment decision for HSCT recipients requiring mechanical ventilation.