치명적 기관지천식 환자의 임상상

이종명(Jong Myung Lee),황윤근(Youn Keun Hwang),윤종수(Jong Soo Yun),강천일(Cheon Il Kang),서영익(Young Ik Seo),김능수(Nung Soo Kim),구성모(Seong Mo Koo),조봉기(Bong Kee Cho),강영모(Young Mo Kang),이중기(Choong Ki Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A The number of persons with HIV infection in Korea have increased steadily, total number of HIV infection in Korea were 478 on August, 1995. To investigate the clinicoimmunologic manifestation of AIDS in Korea, we reviewed complete blood counts (CBC), CD4 counts, serum β2-microglobulin level, opportunistic infections and cause of death for 19 AIDS patients who had been admitted or visited at Pusan national university hospital during the period of January, 1990 to August, 1995. 1) The predominant mode of HIV transmission was heterosexual contact(18), other modes of transmission were homosexual contact(1). Clues of diagnosis of HIV infection were routine occupational health examination(14), and opportunistic infection symptoms such as fever, coughing(4). 2) Mean CD4 cell counts(/mm3) were 53±72 totally, 22±27 for 8 dead patients at mean 2 month before, 91±87 for 7 living patients. There were not significant difference(p>0.05). 3) Serum β2-microglobulin(MG;ug/ml) was measured at 12 patients, mean serum β2-MG level was4.8±7.3 totally, 7.1±10.3 for 6 dead patients at mean 1.3 month before, 2.5±0.4 for 6 living patients. There were not significant(p>0.05). 4) At CBC examination, WBC(/mm3) was 5,932±2,899 totally, 5,452±3,436 for 10 dead patients, 6,500 ±2,221 for 9 living patients(p>0.05). Hb(g/dl) was 11,4±2.8 totally, 9.4±1.8 for dead patients, 13.6±1.8 for living patients(p<0.05). Lymphocyte count(/mm) was 1,255±800 totally, 731±424 for dead patients, 1,838716 for living patients(p<0.05). ESR(mm/h) was 72±47 totally, 97±33 for dead patients, 47±47 for living patients(p<0.05). 5) Opportunistic infections had developed at 14 patients, candidiasis 7, pneumocystis carinii pneumonia 5, tuberculosis 3, cytomegalovirus infection 2, herpes zoster 3, toxoplasmosis 1, cryptococcal infection 2, bacterial pneumonia 5, and herpes simplex l. Malignant lymphoma had developed in 1 patient. 6) Mean survival interval from diagnosis of HIV infection to death was 32.8±19.1 months, and the most common cause of death was pneumocystis carinii pneumonia, and other causes of death were meningitis, bacterial pneumonia and AIDS-wasting syndrome. Based on these results, We concluded that CD4 counts, serum β2-microglobulin level, Hb, total lymphocyte count and ESR in AIDS patients are specific laboratory markers of progression and prognosis of AIDS, the most common opportunistic infection was candidiasis, and the most common cause of death in AIDS patients was pneumocystis carinii pneumonia.

연구논문 : 남강유역 지류,지천별 영향도 평가

이재운 ( Jae Woon Lee ),권헌각 ( Heon Gak Kwon ),곽인수 ( In Soo Kwak ),윤종수 ( Jong Soo Youn ),천세억 ( Se Uk Cheon ) 한국환경영향평가학회 2012 환경영향평가 Vol.21 No.5

The relations between tributaries and mainstream were identified with the water qualities measurements in the field. Parameters of water qualities were BOD, T-N, T-P and measurements were performed by 4 events of rainfalls for 2011. The precipitation data influenced on pollutants loads. Pollutants loads were fluctuations with the seasonal variation. Gajoacheon contributed in 18.39% of BOD, 23.79% of T-N, 15.23% of T-P and Nabulcheon contributed in 13.54% of BOD, 13.05% of T-N and 13.66% of T-P in the region from Nam River_C to Nam River_D. In case of the region from Nam River_C to Nam River_D, Yongacheon river inflowed to main stream as 23.65% of BOD, 20.74% of T-N, and 15.05% of T-P.

용혈성 요독 증후군이 합병된 출혈성 장염 1예

김능수,이원길,김기연,이종명,윤종수,김성한,전정훈 대한감염학회 1997 감염 Vol.29 No.3

저자들은 쇠고기에 의해 매개된 것으로 추정되는 출혈성 장염 및 이에 합병된 용혈성 요독 증후군 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report case of hemolytic uremic syndrome(HUS) associated with hemorrhagic colitis. A 35-year0old man was admitted to a local hospital because of abdominal pain and watery diarrhea which had developed about 6 hours after taking roast beef. He was treated with intravenous fluids and antibiotics, but watery diarrhea changed to bloody in nature from the next day. He was transferred to our hospital due to progressive ascites and jaundice on his 8th day of illness. Examinations revealed ascites, jaundice, microangiopathic hemolytic anemia, thrombocytopenia and uremia. Sorbitol-negative Escherichia coli was isolated from his stool, which proved as Shiga-like toxin-negative E. coli, serotype O25. His conditions improved markedly after three times of plasmapheresis and intravenous fluids therapy, and the organism was not isolated from the follow-up stool culture.

전신성 홍반성 낭창환자에서 혈청 면역글로불린치의 변화

황윤근,윤종수,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.3

목적 : SLE환자에서 혈청 면역글로불린치와 연령별, 질병 이환기간, 임상적 활동도 및 신증후군 유무와 혈청 면역글로불린치에 대한 상관관계를 알아보기 위하여 본 연구를 시행하였다. 재료 및 방법 : SLE로 진단된 54례(남자 3례, 여자 51례)의 환자를 대상으로 이들의 병력, 이학적 검사, 및 검사실 소견 등을 조사하였다. 혈청 IgG, IgA, IgM치는 RID(radial immunodiffusion)법으로, IgE치는 EIA(enzyme immuoassay)법을 이용하여 측정하였다. 결과 : 54명의 환자중 남녀비는 1:17이었고 환자의 평균연령은 29.1±11.6세, 평균 질병이환 기간은 3.0±2.7년이었다. 혈청 면역글로불린의 평균치는 IgG, IgA, IgM의 경우 정상범위내에 있었고 IgE치는 정상보다 높았다. 연령 또는 질병 이환기간과 혈청 면역글로불린 IgG, IgM, IgE치 사이에는 유의한 상관 관계가 없었으나 연령과 이환기간 사이에는 유의한 상관관계가 있었다. 임상적 활동도와 혈청 면역글로불린치 사이에는 IgG와 IgM의 평균치의 경우 활동군 및 비활동군사이에 유의한 차이가 없었으나 IgE치는 활동군에서 유의하게 높았다. 신증후군 유무와 혈청 면역글로불린치 사이에는 유의한 관계가 없었다. 결론 : SLE환자에서 혈청 면역 글로불린 중 IgE의 평균치가 정상범위보다 높았으며 임상적으로 활동군인 경우가 비활동군보다 IgE치가 유의하게 높았다. SLE환자에서 IgE의 증가와 기전 및 역할에 대해서는 추가적인 연구가 필요할 것으로 생각된다. To determine the factors influencing serum immunoglobulin levels, the effects of age, duration of disease, clinical activity and the presence of nephrotic syndrome on serum immunoglobulin level were investigated in 54 patients with SLE. Of 54 cases with SLE, 51 cases were females and 3 cases were males. The mean age of parients was 29.1 ± 11.6 years(range: 11-64) and the mean duration of disease was 3.0 ± 2.7 years with a range of 1-12 years. The mean IgG concentration was 16.54 ± 7.32 g/L, the mean IgA was 2.81 ± 1.13 g/L, the mean IgM was 1.56 ± 0.86 g/L and the mean IgE was 246.46 ± 286.04 IU/mL. The mean values of IgG, IgA and IgM was within the normal ranges but the mean IgE concentrations was higher than normal reference values. In view of relationships among age, disease duration and serum immunoglobuline concentrations, IgG, IgM and IgE levels were not correlated with age or disease duration. But age and disease duration were significantly correlated(r=0.457, p < 0.01). With regard to the effect of clinical activity on serum immunoglobulin levels, there was no significant difference in mean IgG and IgM levels between active and inactive group. But patients with active group had significantly higher mean IgE levels than inactive group(p < 0.05). In the study of determining the relationship between nephrotic syndrome and serum immunoglobulin levels, the mean values of IgG, IgM and IgE levels revealed no significant difference between the SLE patients with nephrotic syndrome and those without nephrotic syndrome. Further prospective studies are needed to evaluate the relationships among age, disease duration, clinical activity, nephrotic syndrome and serum immunoglobulin levels. And additional studies to clarify the clinical significance of altered immunoglobulin levels in patients with SLE might be needed

전신성 홍반성 낭창의 임상적 고찰

황윤근,윤종수,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.3

목적 : 전신성 홍반성 낭창(systemic lupus erythematosus; 이하 SLE라 함)은 전신 주요장기의 결체조직을 침범하여 다양한 증상을 일으키는 자가면역질환으로 알려져 있다. 저자들은 최근 10년간 경북대학교 병원에서 경험한 SLE 환자를 대상으로 그 임상 증상과 검사 소견을 알아보기 위하여 본 연구를 시행하였다. 재료 및 방법 : SLE로 진단된 58례의 환자를 대상으로 이들의 병력, 이학적 검사 및 검사실 소견 등을 후향적으로 분석 조사하였다. 결과 및 결론 : 1) SLE의 호발 연령은 20대로 37.9%의 빈도를 나타내었고 이중 10∼39세사이의 환자가 전체의 93.0%를 차지하였으며 평균 연령은 26.2세 였다. 남녀비는 1:13.5로 여자에게서 월등히 많았다. 2) 1982년 미국 류마티즘 학회가 규정한 각 항목의 양성율은 항핵항체 양성 반응이 91.4%로 가장 높았으며 그 다음으로 관절통 혹은 관절염(84.5%), 신장 이상소견(82.8%), 혈액 이상소견(75.9%), 피부발진(72.4%), 면역학적 이상소견(67.2%), 장막염(41.4%), 광과민성(39.7%), 구강궤양(27.6%) 그리고 신경학적 이상소견(13.8%)의 순서를 보였다. 3) 환자들이 호소하는 첫 증상으로 관절통 흑은 관절염이 47.3%로 가장 많았고 주요 임상상으로서 가장 흔히 관찰된 증상은 전신증상으로 96.6%를 차지하였다. 4) 피부점막 병변중에서는 피부발진(72.4%)이 가장 많았고, 근골격계 증상에서는 관절통 혹은 관절염(85.2%)이, 심폐계 증상 중에서는 늑막염(32.8%)이, 신경정신학적 증상 중에서는 psychosis(10.3%)가 가장 않았다. 5) 신장 병변 중에서는 혈뇨 및 casts(75.9%)가 가장 많았고 신장 조직검사를 시행한 21례 중에서는 미만성 증식성 신염(38.1%)이 가장 많았다. 6) 일반 혈액정사상의 이상 소견으로 빈혈이 74.1%로 가장 많았으며 백혈구 감소증과 혈소판감소증이 각각 62.1%, 48.3%의 순이었다. 7) 면역학적 검사 소견에서는 항핵항체가 91.4%로 가장 많았으며 C_3 감소 및 C_4감소가 각각 77.2%, 75.0%였고, 항 ds DNA 항체 양성이 57.9%등의 순이었다. 8) SLE와 동반된 질환으로 결핵 6례, 갑상선 질환 5례(갑상선 기능 저하증 3례, 갑상선 기능항진증 2례), 혈액계 질환 4례(Evans' syndrome 3례, 특발성 혈소판 자반증 1례), 교원 질환 3례(류마치스성 관절염 2례, Sjo¨gren's syndrome 1례), 대상 포진 3례 등이 관찰되었다. 9) SLE의 사망원인으로 뇌출혈 3례, 중추신경계 루푸스 1례 및 폐렴이 합병된 신부전 1례 등이 있었고 원인 미상의 경우가 1례 있었다. Systemic lupus erythematosus(SLE) is an autoimmune disease characterized by multisystem involvement and various clinical and laboratory findings. During a 11-year period from Feb. 1983 to Feb. 1994, 58 cases of SLE were observed retrospectively at the department of Internal Medicine, Kyungpook National University Hospital The results were as follows: 1) In 58 patients with SLE, 22 cases(37.9%) were diagnosed to have SLE in the 3rd decade. The male to female ratio was 1:13.5 and the mean age was 26.2 years(range 11-59) 2) The sensitivities of 1982 revised ARA criteria for SLE showed that positive antinuclear antibody(ANA) was 91.4%, arthralgia or arthritis 84.5%, renal disorder 82.8%, hematologic disorder 75.9%, mucocutaneous disorder 72.4%, immunologic disorder 67.2%, serositis 41.4%, photosensitivity 39.7%, oral ulcer 27.6% and neuropsychiatric disorder 13.8%. 3) The most common major clinical manifestation was constitutional symptom such as fever, weight loss or fatigue sense. 4) The initial manifestation and their incidences of 55 patients with SLE revealed that arthralgia or arthritis was 47.3%, mucocutaneous disorder 41.8%, fever 20.0%, renal disorder 14.5%, myalgia or myositis 5.5%, pericarditis, pleritis, gum bleeding, headache and generalized weakness 1.8% each other. 5) The facial rash was the most common feature in mucocutaneous disorder, arthralgia or arthritis in musculoskeletal disorder, pleuritis and pericarditis in cardiopulmonary disorder and psychosis in neuropsychiatric disorder. 6) Abnormal urinary sediments was the most common finding in renal discorder. In 21 cases performed renal biopsy, the most common histologic type was diffuse proliferative glomerulonephritis (38.1%) 7) In hematologic abnormalities, anemia(74.1%) was the most common manifestation. 8) The most common immunologic disorder was positive ANA(91.4%), then hypocomplementemia, positive anti-dsDNA antibody in order. 9) The diseases associated with the patients with SLE were tuberculosis(6 cases), thyroid diseases (hypothyroidism 3 cases, hyperthyroidism 2 cases), hematologic disease (Evans' syndrome 3 cases, Idiopathic thrombocytopenic purpura 1 case), connective tissue diseases(Rheumatoid Arthritis 2 cases, Sjo¨gren's syndrome 1 case), herpes zoster(3 cases). 10) Number of death confirmed was 6 cases. Causes of death included 3 of intracerebral hemorrhage associated with thrombocytopenia, 1 of renal faiure complicated by pneumonia and 1 of CNS lupus. In another 1, the cause of death was not defined.

전신성 홍반성 낭창 환자에서 항 cardiolipin항체와 루프스 항응고인자의 출현 빈도와 임상적 의의

강문수,윤종수,강천일,서영익,황윤근,이종명,김능수 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.3

목적 : 전신성홍반성낭창으로 확진된 환자들을 대상으로 항 cardiolipin,항체와 루프스 항응고인자의 출현 빈도와 임상 증상, 검사 소견 및 치료약제와의 관계를 분석하고 임상적 의의를 조사하였다. 대상 및 방법 : 전신성홍반성낭창으로 확진된 21예를 대상으로 하였으며 임상 및 검사소견을 분석하였고 항 cardiolipin항체는 ELISA법으로 측정하였고 루프스 항응고인자는 Kaolin clotting time 및 Platelet neutralization procedure를 함께 시행하여 측정하였다. 결과 : 전신성홍반성낭창 21예에서 항 cardiolipn항체는 6예(28.5%)에서 양성이었으며, 루프스 항응고인자는 단 1예(4.7%)에서 양성이었다. 항 cardiolipin항체 양성군과 음성군 사이에 연령, 성별 및 질병기간은 차이가 없었으며 광 과민성, 레이노 현상, 혈관염, 근관절증상, 심폐계증상, 신장병변 등의 임상소견도 차이가 없었다. 자연유산의 경험은 양성군에서 2예(40%), 음성군에서 1예(12.5%)에서 있었으며, 혈전증은 양성군 1예에서만 발생하였다. 양성군과 음성군사이에 빈혈, 백혈구감소증, 혈소판감소증, prothrombin time의 연장, 항핵 항체, 항 dsDNA항체, 혈청 보체감소 등의 검사 소견은 통계학적으로 차이가 없었다. 항 cardiolipin항체 양성군과 음성군사이에 IgG와 IgA치는 차이가 없었으나 IgM과 IgE치는 양성군에서 음성군보다 통계학적으로 유의하게 높았다. (P<0.05) 결론 : 항 cardiolipin항체와 혈전중, 자연유산, 혈소판감소증 및 혈관염 사이에는 별다른 상관관계를 발견할 수 없었으며 항 cardiolipin항체 양성군의 IgM및 IgE치의 증가가 질병의 활성도에 따른 변화 때문으로 생각되나 항 cardiolipin항체와의 직접적인 상관관계가 있을 가능성도 배제할 수 없을 것으로 생각된다. 전신성홍반성낭창환자에서 항 cardiolipin항체 양성군의 임상적 의의에 대해서 논란의 여지가 있으나 앞으로 더 많은 환자를 대상으로 이들의 임상적 의미에 대한 연구가 필요할 것으로 생각되며 또한 cardiolipin 이외의 각종 인지질에 대한 연구가 요구된다고 사료된다. We evaluated the prevalence of anti-cardiolipin antibodies and lupus anticoagulant in 21 patients with systemic lupus erythematosus(SLE) and investigated whether the presence of anti-cardiolipin antibodies was associated with paticular clinical or laboratory features. The prevalence of anti-cardiolipin antibodies was 28.5% and that of lupus anticoagulant was 4.7% in patients with SLE. No statistically significant association could be found between anti-cardiolipin antibodies and recurrent abortion, thrombosis, thrombocytopenia, and false positive VDRL. But there were significant association between anti-cardiolipin antibodies and serum immunoglobulin M, immunoglobulin E levels. Also, Various therapeutic regimens, including corticosteroids or antimalarial agents had no effect on the presence of anti-cardiolipin antibodies. Further studies are needed to clarify the pathogenetic role and clinical significance of anticardiolipin antibody, lupus anticoagulant.