한국인에서 류마티스 관절염과 비타민 D 수용체 유전자 다형성과의 연관성에 관한 연구

윤원찬(Wern Chan Yoon),김채기(Chae Gi Kim),송용호(Yong Ho Song),김상경(Sang Gyung Kim),전창호(Chang Ho Joen),김옥동(Ok Dong Kim),최정윤(Jung Yoon Choe) 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background : The purpose of this study was to determine whether the distribution of vitamin D receptor (VDR) polymorphisms in rheumatoid arthritis (RA) patients group is different from that of the control group and whether there is a relationship between VDR genotype and radiographic severity or bone mineral density (BMD) of RA patients. Methods : The VDR genotype was determined by polymerase chain reaction and digestion with three restriction enzymes Taq I, Apa I and Bsm I in 78 healthy women and 97 female RA patients. Hand X-rays were scored by Larsen's method and bone mineral density was measured by dual energy X-ray absorptiometry (DEXA) in RA patients. Results: VDR genotypic distributions in Koreans were much different from Caucasians in each control and RA patient groups. Especially, tt allele and BB allele were very rare, prominently differentiating from Caucasians. But within Koreans, no significant difference of VDR genotypic frequency was observed between control group and RA patients group. And there was no significant relationship of VDR genotype with radiographic scores, nor with BMD scores in RA patients. Conclusion: The distribution of VDR polymorphisms in Korean RA patients was not different from controls. The VDR polymorphisms correlate neither with the radiographic severity of RA, nor with BMD scores in Korean RA patients.(Korean J Med 62:209-217, 2002)

류머티스 관절염과 골관절염 환자에서 Transforming growth factor β의 발현 양상

김채기,윤원찬,송용호,김상경,최정윤,Kim, Chae-Gi,Yoon, Wern Chan,Song, Yong-Ho,Kim, Sang-Gyung,Choe, Jung-Yoon 대한면역학회 2001 Immune Network Vol.1 No.3

The transforming growth $factor-{\beta}$ ($TGF-{\beta}$) is a multifunctional cytokine modulating the onset and course of autoimmune disease as shown in experimental models. In synovial inflammation, there is a potential role for $TGF-{\beta}$ in repairment, the inhibition of cartilage and bone destruction, and the down-regulation of immune response. The biologic effects of $TGF-{\beta}$ depend on the cell type, the isoform and the availability of active $TGF-{\beta}$. We investigated $TGF-{\beta}$ expression in patients with rheumatoid arthritis (RA) and compared to those of osteoarthritis (OA). And we determined a correlation between $TGF-{\beta}1$ and $TGF-{\beta}2$, and also the relationships between each $TGF-{\beta}$ isoform and the parameters for disease activity of RA. Methods: The study population consisted of 20 patients with RA and 20 patients with OA. The commercial ELISA kit was used to study $TGF-{\beta}1$ and $TGF-{\beta}2$ levels in peripheral blood (PB) and synovial fluids (SF). Results: 1) While PB $TGF-{\beta}1$ level was of no difference between RA and OA patient groups, SF $TGF-{\beta}1$ level was higher in RA group than OA group. Similarly, PB $TGF-{\beta}2$ levels of RA and OA groups was not different, but SF $TGF-{\beta}2$ levels was higher in RA group than OA group. 2) In patients with RA, the $TGF-{\beta}1$ levels were higher than $TGF-{\beta}2$ in both the PB and SF, while in patients with OA, there showed higher readings for $TGF-{\beta}1$ than $TGF-{\beta}2$ in SF but no difference between $TGF-{\beta}1$ and $TGF-{\beta}2$ levels in PB. 3) In patients with RA, there were no correlations between PB $TGF-{\beta}1$ and PB $TGF-{\beta}2$ levels, nor between SF $TGF-{\beta}1$ and SF $TGF-{\beta}2$ levels. At the same way, there was no correlation between PB $TGF-{\beta}1$ and SF $TGF-{\beta}1$ levels, nor between each levels of $TGF-{\beta}2$ in patients with RA. 4) There was also no correlation between each $TGF-{\beta}$ isoform and the parameters for disease activity such as ESR, CRP, tender joint count, swollen joint count, rheumatoid factor, and the duration of morning stiffness except between in PB $TGF-{\beta}1$ and disease duration of RA (r=0.637, p<0.01). Conclusion: Each $TGF-{\beta}$ isoforms were higher in synovial fluid of patients with RA than that of patients with OA. The data from the RA patients demonstrated different patterns of expressions of the isoforms depending on which compartment (PB or SF) was investigated. The quantification of different $TGF-{\beta}$ isoform is thought to be important when $TGF-{\beta}$ is measured under disease conditions of RA.

류마티스 관절염의 관절액 Total Fibronectin의 임상적 의의

김학준 ( Hak Jun Kim ),박정기 ( Jeong Ki Park ),여동근 ( Dong Geun Yoe ),윤원찬 ( Wern Chan Yoon ),정의달 ( Ye Dal Jung ),조선주 ( Sun Joo Cho ),김상경 ( Sang Gyung Kim ),전창호 ( Chang Ho Jeon ),김채기 ( Chae Ki Kim ),송용호 ( Yo 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3

목적: 류마티스 관절염에서의 염증 자극에 대한 활막 또는 관절액의 fibronectin에 관한 연구는 염증 기전이나 RA의 병인을 규명할 수단이 될 수 있다. 최근에 단클론성 항체의 개발로 체액중 total fibronectin의 측정이 가능하게 되어 RA와 OA의 관절액의 그 농도를 측정하였고, RA 환자를 대상으로 하여 이 측정값의 임상적 가치를 살펴 보고자 하였다. 방법: 무릎 관절 종창을 보이는 RA 및 OA 환자 68명을 대상으로 하여 약 2mL의 관절액을 채취하고 total fibronectin을 단클론성 항체를 이용하여 측정하였고, RA 환자 38명을 대상으로 6가지 기존의 질병활성도를 횡단면연구로 조사하였다. 결과: 1. RA 환자와 OA 환자의 관절액내 total fibronectin의 농도(mean±SD)는, RA가 148.4±72.6μg/ml, OA가 39.5±16.9μg/ml로 OA 환자에 비하여 RA 환자에서 유의하게 증가되어 있다 (p<0.001). 2. RA 환자의 관절액내 total fibronectin의 농도는 질병이환 기간(r=-0.272, p=0.199), 조조강직 기간(r=0.252, p=0.313), ESR (r=0.082, p=0.711), Ritchie index (r=0.217, p=0.359), CRP (r=0.131, p=0.550), 류마티스 인자(r=-0.010,p=0.963)와는 유의한 연관성을 보이지 못했다. 결론: 이상에서 RA 환자에서 관절액 중 total fibronectin의 농도는 OA 환자에서 보다 명확히 높기 때문에 원발성 OA 환자의 그것과 병인론적으로 구별됨을 알 수 있었으나, 임상적으로는 RA의 활성도를 나타내는 지표로 쓰일 수는 없다고 생각된다. Objective: A study on fibronectin, which is synthesized in response to inflammatory process of joint destruction, can be of great value in identifying the mechanism of inflammation or disease activity of rheumatoid arthritis (RA). This study attempts to measure the concentrations of total fibronectin in synovial fluid of patients with RA and osteoarthritis (OA), and compare it with the clinical disease activity parameters of RA available. Methods: A total 68 patients suffering from knee pain and joint effusion was examined. Synovial fluids of thirty-eight RA patients and thirty OA patients were measured by using monoclonal fibronectin antibody. Cross-sectional analysis was undertaken to correlate the fibronectin levels of the RA patients with the clinical disease activity parameters available. Results: 1. Mean synovial fibronectin level of RA (148.4±72.6㎍/ml) was significantly higher than that of OA (39.5±16.9㎍/ml)(p<0.001). 2. The fibronectin levels in RA do not seem to have significant relationship with the parameters such as disease duration, the duration of morning stiffness, Ritchie index, ESR, CRP, and rheumatoid factor. Conclusion: In conclusion, the synovial total fibronectin concentration can clearly distinguish RA from OA. However, it would be unlikely to be used as a parameter of disease activity.

살모넬라 Group C 감염에 동반된 횡문근융해증 및 급성신부전

안기성(Ki Sung Ahn),박정기(Jeong Ki Park),여동근(Dong Keun Ye),윤원찬(Wern Chan Yoon),김학준(Hak Jun Kim),정의달(Ye Dal Jeong),조선주(Sun Ju Jo) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

Rhabdomyolysis is a syndrome characterized by muscle necrosis and release of intracellular muscle constituents into the circulation. Rhabdomylosis can be precipitated by different causes, such as trauma, extraordinary physical exer- tion, metabolic disorder, drugs, toxins, infection, or endocrinopathy. Salmonellosis is another rare cause of rhabdomyolysis. We report a 62-year-old male who developed severe diarrhea and vomitting, one day after boiled pork & raw octopus ingestion. The diagnosis of rhabdomyolysis was established primarily by the elevated serum CPK and myoglobin level. There were no other traumatic, metabolic, toxic, or enzymatic causes for the rhabdomyolysis. Stool cultures received at the first day of hospitalization yielded Salmonella Group C. Salmonella sp. is suggested to cause muscle damage by direct bacterial invasion as well as by decreasing the oxidative and glycolytic enzyme activity of skeletal muscles and by activating lysosomal enzymes. We wish to draw attention to these serious complication of salmonella gastroenteritis, and to institute of prompt measures for preventing the development of ATN. We report a case of acute renal failure associated with rhabdomyolysis and gastroenteritis caused by salmonella Group C with review of literatures.

한국인 폐경 후 여성에서 골관절염과 비타민 D 수용체의 다형성과의 연관관계의 부족

임경진 ( Gyung Jin Lim ),김무곤 ( Moo Gon Kim ),배종석 ( Jong Seok Bae ),유길종 ( Kil Jong Yu ),조유리 ( You Lee Cho ),윤현대 ( Hyun Dae Yoon ),김은영 ( Eun Young Kim ),윤원찬 ( Wern Chan Yoon ),김채기 ( Chae Gi Kim ),송용호 ( Yon 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.1

Objective: To determine whether polymorphisms of the Vitamin D receptor (VDR) gene, known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians, might also relate to the risk of OA and osteoporosis in Korean postmenopausal women Methods: A population of 130 postmenopausal women, including 76 healthy controls and 54 knee OA patients, were studied using anteroposterior radiographs of the knee, which were graded for OA according to the Kellgren classification system. The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I, Bsm I, and Apa I. Femoral neck bone mineral density (BMD) was assessed in all participants by dual energy X-ray absorptiometry. Results: VDR genotype frequency distributions in Koreans were much different from Caucasian`s both in the OA group and the control group. Especially, tt, BB and AA genotype were very rare, prominently differentiating from Caucasians. But within Koreans, no significant differences in VDR genotype frequencies were observed between OA cases and controls. VDR genotype was not significantly associated with the radiographic grades of OA. And there were no significant relationships of VDR genotype with BMD scores in each group. Conclusion: In Korean postmenoposal women, the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD. VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because: (1) there is no correlation of VDR genotypes with the radiographic severity of OA; and (2) there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian`s.

전신성 홍반성 루푸스 환자에서 Total Anti-oxidant Capacity와 질병활성도의 상관성

정원태 ( Won Tae Chung ),이성원 ( Sung Won Lee ),김경희 ( Kyung Hi Kim ),김정만 ( Jung Man Kim ),김채기 ( Chae Gi Kim ),윤원찬 ( Wern Chan Yoon ),류재근 ( Jae Kean Ryu ),장성국 ( Sung Gug Chang ),송용호 ( Yong Ho Song ),최정윤 ( J 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.3

Objective: To determine the correlation between total anti-oxidant capacity (TAOC) and lipid peroxidase (LPO) levels in serum and disease activity in systemic lupus erythematosus (SLE). Methods: The study population consisted of 99 patients with SLE according to the 1982 revised ACR criteria and 83 healthy controls. The serum TAOC levels in 99 patients with SLE and 83 healthy controls by the ABTS(R) inhibition method (Randox Ltd, Antrim, UK) and serum malondialdehyde (MDA) levels in 37 out of 99 patients with SLE were measured. Anti-dsDNA antibody (anti-dsDNA), albumin, AST, ALT, cholesterol, uric acid and creatinine were measured to determine the association with the serum TAOC levels. The correlation between the serum TAOC levels and nephritis in 27 cases with nephritis out of 99 SLE patients was also investigated. The SLE disease activity was determined by the SLE disease activity index (SLEDAI) at the time of sample collection. Results: Compared to the controls (1.37±0.127mmol/L), serum TAOC levels were significantly decreased (1.29±0.124mmol/L) in SLE patients (p=0.001). And there was a negative correlation between serum TAOC levels and SLEDAI total scores in the SLE patients (r=-0.388, p=0.0001), but no significant correlation between TAOC levels and C3 and anti-dsDNA. Further, a significant difference (p<0.04) in TAOC levels was found in SLE patients with and without nephritis. In comparison with other parameters such as AST, ALT, and cholesterol which might change anti-oxidant level, there was no correlation between the serum TAOC levels and them, except for serum uric acid (r=0.387, p=0.0001), creatinine, and albumin (r=0.507, p=0.0001). Additionally, we couldn`t find significant correlation between the serum TAOC levels and MDA. Conclusions: The serum TAOC levels correlate significantly with SLE disease activity and are associated with nephritis. Also, this study showed a significant correlation with serum albumin levels in these patients. Conclusively, the measurement of the serum TAOC levels in patients with SLE will provide useful information on SLE disease activity.

엡스타인-바 바이러스와 연관되어 발생한 성인형 스틸병

유길종 ( Kil Jong Yu ),배종석 ( Jong Seok Bae ),서영진 ( Young Jin Seo ),이준엽 ( Juhn Yeob Lee ),임경진 ( Kyung Jin Lim ),조유리 ( You Lee Joh ),윤원찬 ( Wern Chan Yoon ),김채기 ( Chae Gi Kim ),송용호 ( Yong Ho Song ),최정윤 ( Ju 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.4

Adult onset Still`s disease (AOSD) is a rare, distinct clinical entity which affects predominantly young adults aged 16-35. It affects multiple organs, and at present, the etiology is still unclear. Because this disease has few diagnostic or confirmative test, the diagnosis is made by the differential diagnosis and by excluding other diseases. Several reports have suggested a viral trigger in the pathogenesis of this disease. It has some common clinical features; abrupt onset, high fever, sore throat, transient maculopapular rash, lymphadenopathy, and hepatosplenomegaly. We describe a 17-year-old man who fulfilled the proposed diagnostic criteria of AOSD and had evidence of acute Epstein-Barr virus infection. He complained of intermittent high fever and myalgia for a week. He also had maculopapular rash, sore throat, multiple right cervical lymphadenopahty, and right ankle pain and swelling. After admission, intermittent fever persisted for a month, but diffuse myalgia and migrating arthralgia fluctuated.

류마티스 관절염 환자에서 Methotrexate 사용 중 발생한 악성 림프종

김무곤 ( Moo Gon Kim ),이준엽 ( Juhn Yeob Lee ),배종석 ( Jong Seok Bae ),서영진 ( Young Jin Seo ),임경진 ( Kyung Jin Lim ),정승혜 ( Seung Hie Chung ),윤현대 ( Hyun Dae Yoon ),김은영 ( Eun Young Kim ),윤원찬 ( Wern Chan Yoon ),류 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.1

Rheumatoid arthritis (RA) is a multisystemic inflammatory disease with a prevalance of approximately 1% of the population. The use of disease modifying anti-rheumatic drug (DMARD) is an essential regimen for the treatment of RA. Among DMARDs, methotrexate (MTX) is used worldwide with confirmed effectiveness. However, cytopenia, pulmonary injury, and hepatic toxicity are a few side effects limiting its use. In addition, although the oncogenic potential of MTX is low, several cases have been reported. Recently an increased risk of developing lymphoproliferative disorders has been reported in patients with RA. The incidence is higher in elderly individuals with severe longstanding seropositive RA, those with Sjoren`s or Felty`s syndrome, and in patients with RA treated with prolonged low dose MTX. We describe a case of RA who developed non-Hodgkin`s lymphoma during low dose MTX therapy.

Phenylpropanolamine에 의해 유발된 심근손상 1예

윤원찬,여동근,김학준,박정기,도준형,류재근,최지용,장성국 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.3

류머티스 관절염과 골관절염 환자에서 Transforming grwoth factor β의 발현 양상

김채기,윤원찬,송용호,김상경,최정윤 Official Journal of the Korean society for immunol 2001 Immune Network Vol.1 No.3