만성 C 형 간질환에서 혈청 히아루론산 및 PIIINP 농도와 간조직 소견의 비교

이준성 ( Jun Sung Lee ),김태헌 ( Tae Hun Kim ),임영석 ( Young Suk Lim ),이효석 ( Hyo Suk Lee ),김정룡 ( Chung Yong Kim ),윤정환 ( Jung Hwan Yoon ),우광훈 ( Gwang Hoon Woo ),김경아 ( Kyung Ah Kim ),장자준 ( Ja Jun Jang ) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4

Background/Aims: In chronic liver disease type C, there have been no clinically useful serum markers to reflect histological findings such as hepatic necroinflammation and fibrosis except for an invasive liver biopsy. In an attempt to find out serum markers predicting these histological degree of progression in patients with chronic liver disease type C, we compared the histological findings with the levels of serum hyaluronate and N-terminal peptide of procollagen III (PIIINP) which are produced during the metabolism of extracellular matrices. Methods: Thirty-seven patients with antibody to HCV were enrolled in this study. Histological findings were scored for degree of piecemeal necrosis, lobular inflammation and fibrosis according to Ludwig's score. Then, serum concentrations of hyaluronate and PIIINP were measured by enzyme immunoassay and radioimmunoassay, respectively. Results: Hyaluronate at the concentration of 100 ng/mL had a positive predictive value of 80% and a negative predictive value of 100% for diagnosis of stage 3, 4 fibrosis. The positive and negative predictive values of PIIINP at the level above 1.5 U/mL were 100% and 89.3% for the diagnosis of grade 3, 4 piecemeal necrosis, and 100%, 85.7% for the diagnosis of grade 3, 4 lobular inflammation, respectively. Conclusions: Serum hyaluronate may be a useful serum marker of liver fibrosis compared with PIIINP. However, PIIINP may be a useful marker for detecting grade 3, 4 necroinflammation in patients with chronic liver disease type C. (Korean J Gastroenterol 2001;38:254-261)

결핵성 복막염 진단을 위한 복수

이준성 ( June Sung Lee ),김경아 ( Kyung Ah Kim ),이우진 ( Woo Jin Lee ),전영빈 ( Young Bin Jeon ),이정환 ( Jung Whan Lee ),김유선 ( You Sun Kim ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.2

Backgrounds/Aims: The diagnosis of tuberculous peritonitis, particularly in patients with chronic liver disease, is usually difficult since liver cirrhosis obscures the clinical features and alters the biochemical characteristics of ascites. The aim of th

아토피성 천식 환자에서 특이적 면역요법이 말초혈액 단핵구의 IL-10 과 IL-13 mRNA 발현에 미치는 영향

이준성(Joon Sung Lee),이수중(Soo Jung Lee),이경수(Kyong Su Lee) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1999 소아알레르기 및 호흡기학회지 Vol.9 No.1

목 적 : 알레르기 질환의 치료에서 특이적 면역요법이 임상적인 치료효과를 가저오는 면역학적 작용기전은 명확하지 않다. 본 연구에서는 집먼지진드기 항원으로 특이적 면역요법를 받고 있는 천식환자들의 말초혈액 단핵구를 집먼지진드기 항원으로 자극하였을 때 발현되는 cytokine mRNA 양상을, 정상 대조군과 집먼지진드기에 대한 알레르기가 있으나 면역요법를 받지 않은 천식환자들에서의 양상과 비교하여 cytokine의 발현과 면역요법의 임상적인 치료반응과의 상관관계를 알아보고자 하였다. 방 법 : 알레르기 병력이 없는 정상 대조군 8명, 집먼지진드기 알레르기에 의한 천식 증상을 보이나 면역요법을 받지 않은 비면역요법군 25명, 그리고 일년 이상 집먼지진드기 백신으로 면역요법을 시행하여 임상적으로 호전을 보이지 않은 면역요법 무반웅군 19명과 증상의 호전을 보인 면역요법 반응군 20명의 말초혈액 단핵구를 분리하여 집먼지진드기 항원으로 18시간 자극배양하고 RNA를 분리한 다음 RT-PCR을 시행하여 전기영동 한 후 IL-10, IL-13, IFN-γ, IL-4 mRNA 함량을 densitomet로 측정하였다. 결 과: 1) 면역요법을 받지 않은 천식환자에서 정상 대조군에 비해 IL-10 mRNA의 발현이 유의하게 낮고, 면역요법시 IL-10 mRNA의 발현이 증가되었다. 임상적 호전을 보인 면역요법 반웅군이 무반응군보다 유의하게 IL-10 mRNA 발현이 증가되며, 정상 대조군 수준으로 IL-10 mRNA의 발현이 증가되었다. 2) 면역요법을 받지 않은 천식환자에서 정상 대조군에 비해 IL-13 mRNA의 발현이 유의하게 높고, 면역요법시 IL-13 mRNA의 발현이 감소되었다. 임상적 호전을 보인 면역요법 반응군이 무반응군보다 유의하게 IL-13 mRNA 발현이 감소되며, 정상 대조군 수준으로 IL-13 mRNA의 발현이 감소되었다. 3) 면역요법을 받지 않은 천식환자에서 정상 대조군에 비해 IFN-γ mRNA의 발현이 유의하게 낮고, 면역요법시 IFN-γ mRNA의 발현이 증가되었다. 임상적 호전을 보인 면역요법 반응군이 무반응군보다 유의하게 IFN-γ mRNA 발현이 증가되며, 정상 대조군 수준으로 IFN-γ mRNA 발현이 증가되었다. 4) 면역요법을 받지 않은 천식환자에서 정상 대조군에 비해 IL-4 mRNA의 발현이 유의하게 높고, 면역요법시 IL-4 mRNA의 발현이 감소되었다. 임상적 호전을 보인 면역요법 반응군이 무반응군보다 유의하게 IL-4 mRNA 발현이 감소되며, 정상 대조군 수준으로 IL-4 mRNA의 발현이 감소되었다. 결 론 : 집먼지진드기 알레르기에 대한 특이적 면역요법은 T_H2(IL-4, IL-狀)에서 T_H1(IFN-γ)으로 cytokine 발현의 변화를 유도하며 또한 IL-10의 생성을 증가시킴을 알 수 있었다. 이러한 cytokine 발현의 변화가 면역요법의 임상적 효과를 초래하는데 일부 기여할 것으로 생각된다. Purpose : Allergen-specific immunotherapy(IT) has been shown to be effective in the treatment for allergic diseases. But the immunologic mechanism of IT effect has not been fully elucidated. We studied house dust mite(HDM)-specific cytokine mRNA expression in peripheral blood mononuclear cells(PBMC) from patient with HDM-sensitive asthma and determined whether alterations in cytokine mRNA expression correlated with the clinical outcome of IT. Methods : PBMC were obtained from 64 children with mite-sensitive asthma : 25 had never received HDM-IT(NIT), 39 had been receiving HDM-IT for more than 12 months. The 39 patients were divided into two groups according to the clinical response based on the asthma scores(symptom and medication scores) before and after IT. Good responders were those patients who showed an improvement greater than 50%, whereas poor responders were those who showed an improvement less than 50%. After a 18 hr culture with HDM, cytokine mRNA expression was analysed by RT-PCR and densitometry. Results : 1) IL-10 mRNA expression in NIT was significantly lower than that in the normal controls and was significantly increased by IT. IL-10 mRNA expression in the good responders was significantly higher than that in the poor responders and NIT. 2) Little or no IL-13 mRNA were detected in the good responders and the normal controls. IL-13 mRNA expression in the good responders was significantly lower than that in the poor responders and NIT. 3) IFN-γ mRNA expression in NIT was significantly lower than that in the normal controls and was significantly increased with IT. IFN-γ mRNA expression in the good responders was significantly higher than that in the poor responders and NIT. 4) Little IL-4 mRNA were detected in the good responders and the normal controls. IL-4 mRNA expression in the good responders was significantly lower than that in the poor responders and NIT. Conclusion : These results show that IT not only induces a shift in cytokine expression from T_H2(IL-4 and IL-13) to T_H1 cytokines(IFN-γ), but also leads to induction of the antiinflammatory cytokine IL-10. These changes in cytokine expression may be responsible for clinical effects by immunotherapy.

BCG 접종후 Mantoux 검사의 반응도와 임상인자들의 영향

이준성(Joon Sung Lee),이현정(Hyun Jung Lee),김영훈(Young Hoon Kim),황경태(Kyung Tai Whang),김종완 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1997 소아알레르기 및 호흡기학회지 Vol.7 No.2

목 적 : 소아에서 Mantoux 검사는 결핵 감염의 유무를 판단하는 데 널리 사용되는 방법으로, BCG 접종후 면역 상태를 알아보는 데도 유용하다. 그러나 그 반웅의 정도 및 양전율은 백신접종시 연령, 백신의 용량, 백신접종후 시간경과 및 검사횟수 등에 영향을 받는 것으로 알려져 있다. 저자들은 BCG 접종후 시간경과, 재태기간, 성별 및 수유방법에 따라 Mantoux 검사의 반옹정도와 양전율에 차이가 있는지를 알아보기 위하여 이 연구를 시행하였다. 방 법 : 1994년 7월부터 1996년 6월까지 강남성모병원에서 출생한 신생아 85명(만삭분만아 71명, 미숙분만아 14명)을 대상으로 하였다. BCG백신은 국립보건원에서 제조한 것으로 생후 4주 이내에 0.05ml를 피내주사하였고, 접종후 3개월, 9개월, 15개월에 Mantoux 검사를 시행하였다. 검사시약은 PPD(5TU)를 사용하였다. BCG백신 접종과 Mantoux 검사의 결과 판독은 모두 동일인에 의하여 시행되었다. 결 과: 1) BCG 접종후 3개월, 9개월 및 IS개월에 Mantoux 검사에서 양전을은 만삭분만군 26.8%, 53.5%, 및 60.6%이었으며, 미숙분만군 14.3%, 28.6%, 50%로 만삭분만군에 비하여 미숙분만군에서 전반적으로 낮은 경향을 보였고 생후 3개월에 유의한 차를 나타내었다. 2) BCG 접종후 3개월, 9개월 및 15개월에 시행한 Mantoux 검사에서 경결의 평균 크기는 만삭분만군 7.2㎜, 8.5㎜, 9.4㎜를, 미숙분만군 5.0㎜ 6.6㎜, 8.2㎜를 보였으며 3개월에 검사한 경결의 크기는 두 군간에 통계학적으로 유의한 차가 있었다(P<0.05). 3) 만삭분만군 및 미숙분만군 모두에서 성별 및 수유방법에 따른 Mantoux 검사의 양전율은 유의 한 차가 없었다. 4) BCG백신의 합병증은 만삭분만군에서 9.9%로 림프절염, 지축적 궤양 및 열성 농양의 순이었으며 미숙분만군에서는 합병증이 한 예도 없었다. 결 론 : 이상의 결과에서 Mantoux 검사의 반응은 시간이 경과함에 따라 경결의 크기가 증가하고 양전율이 증가함을 알 수 있었으며 3개월 Mantoux 검사에서 미숙분만군에서 경결의 크기가 만삭분만군보다 작은 것은 미숙분만아의 면역학적 미성숙과 관련이 있을 것으로 생각되었다. Purpose : During the childhood, Mantoux test is very popular for detecting tuberculous infection and also useful for evaluating the immunity against tuberculosis after BCG vaccination. But the response and conversion rate is affected by the age of vaccination, the quality of vaccine, the duration after vaccination and the frequency of the test. This study was performed to investigate the difference of the response and conversion rate, according to duration after vaccination, gestational age, sex and feeding type. Methods : The subject was included 85 of infants (71 of full term infants, 14 of preterm infants) and was followed up 3 months, 9 months, 15 months after vaccination, from July, 1992 to June, 1994 in Kangnam St. Mary`s Hospital. We injected intradermally the BCG vaccine (0.05m1) which was produced by National Institute of Health and PPD (5TU) was used as a testing material of Mantoux test. Injecting BCG and interpreting the result of the Mantoux test was done by the same person. Results : 1) The positive conversion rates of Mantoux test which was done 3 month, 9 month and 15 month after vaccination were 26.8%, 53.5% and 60.6% in the full-term infant group, and 14.3%, 28.6%, and 50% in the preterm infant group. The conversion rate was significantly lower in preterm infant group as compared with that of the full-term infant group 3 months after vaccination. 2) The sizes of induration in Mantoux test, which was done 3 month, 9 month and 15 month after vaccination, are 7.2㎜, 8.5㎜, 9.4㎜ in the full-term infant group and 5.0mm, 6.6mm, 8.2mm in the preterm infant group. The size of induration was significantly lower in the preterm infant group as compared with that of the full-term infant group. 3) There is no difference in conversion rate of Mantoux test according to the sex, feeding type in both groups. 4) Complication rate for BCG vaccine is 9.9%, which is leaded by lymphadenitis, persistent ulcer, and febrile abscess as the order, in the full-term infant group and there are no complications in the preterm infant group. Conclusions : In those results, the size of induration and conversion rate is increased as the duration after vaccination, then lower conversion rate in the preterm infant group 3 months after vaccination may be due to immunological immaturity of preterrn infant.

증례 : 류마티스 ; Etanercept으로 치료한 류마티스관절염 환자에서 발생한 악성 림프종 1예

정상경 ( Sang Kyung Jung ),이주현 ( Ju Hyun Lee ),이준성 ( June Sung Lee ),이혜란 ( Hye Ran Lee ),장선희 ( Sun Hee Chang ),윤보영 ( Bo Young Yoon ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

1998년 이래로 TNF-α 길항제는 중증 류마티스 관절염의 치료에 탁월한 치료 효과와 함께 비교적 안전하게 널리 치료제로 이용되고 있다. 그러나 악성 림프종 발생 위험을 높인다는 많은 보고들과 함께, 악성 림프종 발생이 치료제 자체보다는 류마티스관절염의 질병 활성도와 더 큰 상관관계가 있다는 주장도 제기되고 있는 상태이다. 본 저자들은 아직까지 국내에 보고가 드문 etanercept로 치료한 류마티스관절염 환자에서 발생한 악성 림프종을 경험하여 참고문헌과 함께 보고하는 바이다. Rheumatoid arthritis (RA) is a chronic inflammatory polyarthritis that is associated with an increased risk of coronary artery disease, infection, lymphoma, and life expectancy. Several studies have shown that patients with RA have a 2~3x increased risk of developing lymphomas as compared with the general population. TNF-α antagonist therapy might be independently associated with an increased risk of lymphoma; however, other studies have shown that the risk of lymphoma is increased in RA patients with severe disease activity rather than the treatment per se. We experienced a 65-year-old woman who developed Etanercept-associated malignant lymphoma with rheumatoid arthritis. (Korean J Med 77:S1342-S1346, 2009)

상복부 증상이 있는 환자에서 식도 - 위 접합부 장상 피화생의 빈도 및 발생 관련 인자

이우진(Woo Jin Lee),이준성(June Sung Lee),김경아(Kyung Ah Kim),이혜란(Hye Ran Lee),백현욱(Hyun Book Baik),전영빈(Young Bin Jeon),이정환(Jung Whan Lee),김유선(You Sun Kim),우광훈(Gwang Hoon Woo),문정섭(Jeong Seop Moon),윤세진(Sei Jin 대한소화기학회 2002 대한소화기학회지 Vol.40 No.1

N/A

거치상 선종의 조직학적 및 대장내시경적 특징과 p53 단백의 과발현

김상균(Sang Gyune Kim),이문성(Moon Sung Lee),김진오(Jin Oh Kim),천갑진(Gab Jin Cheon),정인섭(In Seop Jung),천영국(Young Koog Cheon),조주영(Joo Young Cho),이준성(Joon Seong Lee),진소영(So Young Jin),심찬섭(Chan Sup Shim) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.5

Background/Aims: Serrated adenomas (SA) is a distinct form of colorectal neoplasia, in which adenomatous glands have a serrated epithelial arrangement observed in hyperplastic polyps. SA is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in a serrated glandular architecture. The aims were to clarify colonoscopic and histologic features, p53 protein overexpression of SA. Methods: One hundred and five SAs were obtained from 50 patients. We examined the location, size, colonoscopic findings, dysplasia, combined lesions. Twenty randomly selected cases of SA were compared with 24 cases of hyperplastic polyp and 21 cases of tubular adenoma for p53 protein overexpression. Results: Twenty-five patients (50%) had a single SA. The most common site was the sigmoid colon (30.5%). Out of 105 SAs, 83 (79%) were less than 5 mm in diameter. The endoscopic appearance showed that 52 cases of (49.5%) SAs were sessile type. The p53 protein overexpression was noted in none of hyperplastic polyps, in 55% of SAs (11/20), and in 76.2% of tubular adenomas. Conclusions: According to this study, SAs are generally sessile type sized less than 5 mm and commonly observed in the sigmoid colon. Moreover, SAs show higher overexpression rate of p53 protein than hyperplastic polyps. Thus, the careful observation is required considering its malignant potential. ( Korean J Gastroenterol 2002; 39: 350-355)

내시경 역행 췌담관조영술 중 경췌중격절개술 후 발생한 벽내 십이지장 혈종 및 문헌고찰

김정곤 ( Jung Gon Kim ),백우현 ( Woo Hyun Paik ),김재형 ( Jae Hyung Kim ),김정욱 ( Jong Wook Kim ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Transpancreatic septotomy is known to improve the success rate of selective bile duct cannulation in endoscopic retrograde cholangiopancreatography. Recent retrospective study reported that transpancreatic septotomy is more effective and safer than needle knife sphincterotomy. Herein, we report a case of patient with gallstone pancreatitis who suffered from intramural duodenal hematoma after transpancreatic septotomy that caused obstruction of the duodenum and hypovolemic shock. The intramural hematoma improved after conservative management. The rare adverse event such as intramural duodenal hematoma seems to be considered after transpancreatic septotomy, especially when acute pancreatitis is accompanied.

골다공증성 척추 압박 골절 후에 발생된 새로운 압박 골절의 위험 인자

김성수(Sung Soo Kim),이동현(Dong Hyun Lee),김정훈(Jung Hoon Kim),임동주(Dong Ju Lim),최병완(Byung Wan Choi),김진환(Jin Hwan Kim),김진혁(Jin Hyok Kim),이준성(Jun Seung Lee) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.6

목적: 골다공증성 압박 골절 후 새롭게 나타나는 압박 골절을 조사하여 위험인자를 알아보고자 하였다. 대상 및 방법: 다기관 후향적 연구로, 세 개의 병원에서 골다공증성 급성 압박 골절에 대한 치료를 시행하고, 1년째 척추 영상을 얻을 수 있었던 135명을 조사하였다. 1년째 새롭게 발생된 척추 골절의 유무를 조사하여 골절이 발생한 군과 발생하지 않은 군으로 나누어 각각 군별로 대상 환자들의 연령, 성별, 동반 질환 여부, 골밀도, 급성 압박 골절의 부위, 기존 척추 골절의 유무, 골다공증 약물복용률, 치료방법의 차이에 대해서 조사하였다. 결과: 1년째 새로운 척추 골절은 총 25명(18.5%)에서 발견되었으며, 새로운 척추골절이 발생한 군과 그렇지 않은 군 간의 비교에서 연령, 성별, 동반 질환 여부, 급성 압박 골절 부위, 기존 압박 골절의 빈도에는 유의한 차이는 없었다. 새로운 척추 골절은 성형술을 시행한 경우(p=0.003, odds ratio=4.71)와 대퇴 경부의 T-score가 -2.5 이하인 경우에 유의하게 높은 빈도를 보였다(p=0.013, odds ratio=3.47). 결론: 골다공증성 압박 골절 후에 발생된 새로운 척추 골절의 위험 인자는 척추 성형술이나 풍선 성형술, 대퇴 경부 T-score -2.5 이하였다. Purpose: To evaluate the risk factors for subsequent vertebral fracture following acute osteoporotic vertebral compression fracture. Materials and Methods: This was a multicenter retrospective study. We recruited 135 patients treated for acute osteoporotic compression fracture with available spine image taken at the 1-year follow-up mark in 3 different hospitals. The patients were divided into 2 groups in accordance with the occurrence of subsequent vertebral fracture. Variables including age, sex, bone mineral density, medical comorbidity, acute fracture level, presence of prior vertebral fracture, osteoporosis medication, and treatment method were analyzed and compared between the 2 groups. Results: The new subsequent vertebral fractures were detected in 25 patients (18.5%). There were no significant differences between the 2 groups with respect to age, sex, medical comorbidity, presence of prior vertebral fracture, and acute fracture level, as shown by univariate analysis. However, in the group with subsequent vertebral fracture, more patients were treated by vertebroplasty or kyphoplasty and had a femur neck T-score of ≤-2.5, as well as poor compliance of osteoporosis medication with significant difference (p<0.05). According to the multivariate analysis, subsequent vertebral fractures were significantly influenced by vertebroplasty or kyphoplasty (p=0.003, odds ratio=4.71) and femur neck T-score of ≤-2.5 (p=0.013, odds ratio=3.47). Conclusion: Subsequent vertebral fractures were found in 19% at the 1-year mark after the treatment of acute osteoporotic compression fracture. The two risk factors for subsequent vertebral fractures were vertebroplasty or kyphoplasty and femur neck T-score of ≤-2.5.

아칼라지아 환자에서 보툴리늄 독소주입 치료 후 미만성 식도경련 , 호두까기 식도로의 이행에 관여하는 인자에 대한 연구

차상우(Sang Woo Cha),이준성(Joon Seong Lee),임희혁(Hee Hyuk Im),황경란(Kyung Ran Hwang),정인섭(In Sup Jung),천갑진(Gab Jin Cheon),김진오(Jin Oh Kim),조주영(Joo Young Cho),이문성(Moon Sung Lee),심찬섭(Chan Sup Shim),김부성(Boo Sung Ki 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2

N/A Backgroud/Aims: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin inj ection to lower esophageal sphincter (LES). Methods: This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with Ph monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. Result: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31mmHg vs 23 mmHg, p<0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p<0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups. Conclusion: Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body. (Korean Journal of Gastrointestinal Motility 2001;7:188-196)