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홍성표(Sung Pyo Hong),이선주(Sun Ju Lee),이영식(Young Sik Lee),이상인(Sang In Lee),한지숙(Jee Sook Hahn),고윤웅(Yun Woong Ko),한상순(Sang Soon Hahn),윤홍섭(Hong Sup Yoon),이삼열(Samuel Y . Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.4
N/A Spur cell anemia is intense hemolytic anemia associated with alcoholic liver cirrhosis characterized by spiculated erythrocytes due to a striking increase in cholesterol content and in cholesterol to phospholipid ratio. Several attempts including splenectomy, plasmapheresis and calcium antagonists, have been tried to correct this anemia. Presented here is a case of a 60-year-old man with alcoholic liver cirrhosis who revealed jaundice and severe hemolyic anemia. The peripheral blood smear demonstrated spurred erythrocytes which are caused by serum factor. The cross incubation test, that is, spur cells with normal serum and normal red blood cells with the patient's serum, revealed reversability of the spur cells. The benefits of plasmapheresis were equivocal, while a calcium antagonist, flunarizine, was administered with discernible benefits. The authors suggest that spur cell anemia should be suspected in alcoholic liver cirrhosis with severe jaundice and anemia refractory to transfusion and that the calcium antagonist, flunarizine, is useful to treat it.
각종 간질환 환자에서 섬유소용해 활성도 ( Fibrinolytic Activity ) 에 관한 연구
최흥재(Heung Jai Choi),문영명(Young Myoung Moon),정재복(Jae Bock Chung),한광협(Kwang Hyub Han),전재윤(Chae Yoon Chon),박준용(Joon Yong Park),윤홍섭(Hong Sup Yoon) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
N/A To assess the fibrinolytic activity and coagulation defects in various liver diseases, antithrombin III, fibrin degradation products and prothrombin time were measured in the plasma of 49 patients with various liver diseases including liver cirrhosis, hepatoma, acute viral hepatitis and obstructive jaundice. Also antithrombin III was measured in the plasma of 29 normal controls. The results were as follows: 1) The antithrombin III level was significantly lower in liver cirrhosis and hepatoma than in controls. 2) The fibrinogen was significantly higher in obstructive jaundice than in the others. 3) Small amounts of FDP were found in some patients with liver cirrhosis and hepatoma. 4) In the cirrhotic patients, a significant difference in antithrombin III level was found between patients with FDP (+) and those with FDP (-). 5) The prothrombin time was significnatly more prologned in liver cirrhosis than in the others. 6) A significant correlation was found between antithrombin III and prothrombin time (r=0.48). 7) Comparing cirrhotic patients classified as Child A, B and C, the antithrombin III level was lower in Child C and the prothrombin time was more prolonged than in Child A and B. FDP was found in all but one of the patients classified as Child C.
각종 간질환에 있어서 이상 Prothrombin (des-γ-Carboxyprothrombin)에 관한 연구
이혁우,정경섭,김원호,한광협,정재복,이상인,박인서,최홍재,도윤정,윤홍섭 대한내과학회 1990 대한내과학회지 Vol.38 No.4
The absence of vitamin K or the ingestion of vitamin K antagonists inhibits vitamin K-dependent carboxylase activity in the liver, and an abnormal prothrombin, known as des-y-carboxyprothrombin(DCP) or PIVKA -Ⅱ(a protein induced by vitamin K absence or antagonists-Ⅱ), is released into the blood. In order to evaluate whether abnormal prothrombin levels can be clinically used as an index of hepatocellular dysfunction or as a tumor marker of hepatocellular carcinoma(HHC), DCP levels were determined by a latex agglutination test in 20 normal subjects and in patients with various liver diseases, including 70 hepatocellular carcinoma, sever metastatic liver disease, 45 liver cirrhosis, 13 acute viral hepatitisB, six chronic active hepatitis B, three fatty liver and one liver abscess. The usefulness of the combination assay of DCP and alpha-fetoprotein(AFP) levels to improve the diagnostic value and the effects of vitamin K administration on DCP levels were assessed in the present study. The results obtained were as follows: 1) DCP was detected in 42 out of 70 patients with HCC(60.0%), in three seven patients with metastatic liver disease(42.9%), in 23 out of 45 patients with liver cirrhosis(51.1%), and in one out of six patients with chronic active hepatitisb(16.7%), but there was no detectable DCP among the 20 healthy control subjects or in the 13 acute viral hepatitis B, three fatty liver and one liver abscess cases. 2) The detection rates of DCP according to the size of the HCC were 66.7% in the larger-than 5㎝ size and 44.4% in the 3~5㎝ size, but there was no detection in four patients with smaller-than 3㎝ size. The detection rates of DCP according to Child’s classification of liver cirrhosis were 60% in class C and 25% in class B, but there was no detection in two patients in class A. 3) There was no significant correlation between DCP and AFP levels. However, DCP was also detected 62.5% in less than 400ng/㎖ of AFP, and the positive rates were 91.0% in higher than 400ng/㎖ of AFP or higher than 1:10(+) of DCP in patients with HCC. 4) The detection rate of DCP was 56.8% in liver cirrhosis patients with prolonged prothrombin time(PT). However, 61.4% was detected in HCC patients with normal levels of prothrombin time(PT). 5) On observation of the effectiveness of vitamin K administration on DCP level, are was no effectiveness of vitamin K administration in all patients with 13 HCC, but the DCP level decreased or was not detected in seven out of nine patients with liver cirrhosis after vitamin K administration (p<0.05). Based on these results, DCP determined by a latex agglutination test may be useful as an index of hepatocellular dysfunction. However, due to the lower sensitivity and specificity of the latex agglutination test, it is doubtful whether DCP is a definite tumor marker of HCC. But the combination assay of AFP and DCP is helpful for obtaining an increased diagnostic rate of HCC. We recommended comparison of the effectiveness of vitamin K administration on DCP concentrations during the follow-up observation of chronic liver disease, such as liver cirrhosis, for increasing the diagnostic rate of HCC. Further study utilizing methods such as RIA or ELISA might be needed to evaluate the usefulness of DCP as a tumor marker for HCC.