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기관지 천식 환자에서 혈청 IL - 6 , ICAM - 1 , RANTES 농도 측정의 임상적 의의
최재선(Jae Sun Choi),이병훈(Byung Hoon Lee),안창혁(Chang Hyuk Ahn),유지훈(Ji Hoon Yoo),나문준(Moon Jun Na),김재열(Jae Yeol Kim),박인원(In Won Park),최병휘(Byung Whui Choi),허성호(Sung Ho Hue) 대한내과학회 1998 대한내과학회지 Vol.55 No.5
N/A Bronchial asthma is a chronic airway inflammation disorder involving lymphocyte activation and various cytokines secretion by lymphocyte. The inflammatory response results from a complex network of interactions between inflammatory cells (mast cells, eosinophils, macrophages) and resident cells belonging to the lung structure itself like EC, fibroblasts, or bronchial epithelial cells. IL-6 which is known to up-regulate the endothelial cell expression of adhesion molecules participating in the development of the inflammatory reaction in bronchial asthma is produced by alveolar macrophage. ICAM-1 is produced by bronchial epithelial cell and expression by endothelial cell, which is known to enhance of the influx of various cells, RANTES which is known to a potent chemoattractant for eosinophils, lymphocytes, and monocytes, a member of the CC chemokine family, is expressed by bronchial epithelial cell. To evaluate whether markers of lymphocyte activation are useful markers of disease activity in bronchial asthma, we measured slL-6, sICAM- 1, sRANTES in 42 patients with mild to moderate bronchial asthma and in 26 normal controls and con the result with other disease activity markers in asthma(pulmonary function, blood eosinophil counts). The mean level of sIL-6 was higher than that of normal control and correlated significantly with sICAM-1, FEV1% to predicted value. The mean level of sICAM-1 was higher than that of normal control and correlated significantly with FEV1%, FEV1% to predicted value. The mean level of sRANTES showed the tendency to be higher than that of normal control, but not significant statistically, and did not correlated with sIL-6, sICAM-1, FEV1%, FEV1% to predicted value, blood eosinophil counts. It appeared that sIL-6 and sICAM-1 could be a disease marker in bronchial asthma. But, clinical application of the measurement of these markers needs to be studied further.
기관지천식 환자의 혈중 eosinophil cationic protein 치와 기관지과민성과의 관계
유지훈,최재선,안창혁,이병훈,나문준,김재열,박인원,최병휘,허성호 ( Ji Hoon Yoo,Jae Sun Choi,Chang Hyuk Ahn,Byung Hoon Lee,Moon Jun Na,Jae Yul Kim,In Won Park,Byung Whui Choi,Sung Ho Hue ) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.3
Background: Serum eosinophil cationic protein(ECP) level has been proposed as a indirect marker of eosinophilic inflammation of the airway in bronchial asthma. Objective'. To evaluate serum ECP against indirect clinical markers of disease, we compared bronchial obstruction, bronchial hyperresponsiveness and peripheral blood eosinophil counts, total IgE with serum ECP levels in patients with bronchial asthma and normal controls. Method: Fourty-two patients with bronchial asthma and twenty-six normal controls were enrolled. Measurement were made by spirometry, inhalation challenge with methacholine, peripheral blood eosinophil counts, total IgE and FEIA(fluoroenzymatic immunoassay) of serum ECP Result. Serum ECP levels were significantly higher in asthmatic patients than normal controls(p<0.0,5). Serum ECP levels were correlated with peripheral blood eosinophil counts(p<0.01, r=0.544) and bronchial hyperresponsiveness(PC,)(p<0.01, r=-0.456) in patients with bronchial asthma. Serum ECP levels were correlated with degree of bronchial obstruction(FEV, % to predicted value, FEV1/FVC%) in total subjects, but not in asthmatic patients. Conchcsion.' Serum ECP level may be used as indicator of disease activity in bronchial asthma and be helpful in differentiation between normal person and asthmatic patients on simple serological method. Further studies on the changes of serum ECP levels according to disease course and therapeutic responses are needed.
기관지 천식 환자에서 단기간의 부신피질호르몬제 투여가 뇌하수체 및 부신피질 기능에 미치는 영향
김옥란(Ok Lan Kim),서승천(Seung Cheon Seo),허성호(Sung Ho Hue),최병휘(Byung Hue Choi),배혜상(Hae Sang Bae),성천모(Cheon Mo Seong),이재용(Jae Yong Lee),최민석(Min Seok Choi),이원돈(Won Don Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.1
N/A Short-term, high dose corticosteroid therapy is often required for control of acute asthma episodes. To evaluate possible Hypothalamic-Pituitary-Adrenal (HPA)-axis suppression and recovery after such therapy, we studied 7 patients with adult acute asthma before and at 1, 3 and 7 days after completion of a 12 day course of corticosteroid. Corticosteroid was administered as a loading dose (methylprednisolone which was equivalent to 4 mg of hydrocortisone/kg body weight) and maintenance dose (equivalent to 3mg of hydrrcortisone/kg body weight/6 hours) for 3 days, followed by prednisolone (usual start dose was prednisolone 60 mg as a single daily morning dose). The dose was then reduced in half every 3 days. The function and reserve of the HPA-axis were evaluated with basal plasma cortisol, ACTH and short corticotropin stimulation tests. The results obtained were as follows: 1. Baseline plasma cortisol, ACTH, and cortisol responses to corticotropin before corticosteroid treatment were 10.3±5.6 ㎍/dl, 25.4±8.4 /㎍/ml, and 17.7±6.2 ㎍/dl, respectively. 2. One day after corticosteroid therapy, plasma cortisol and ACTH levels (3.9±2.4 ㎍/dl, 9.2±9.0 pg/ml) were significantly reduced compared to pretreatment levels (p<0.01. p<0.01), but the cortisol responses to corticotropin were preserved. 3. Three days after concluding the corticosteroid therapy, plasma cortisol and ACTH levels had returned to 68.9% and 71.7% of the pretreatment levels respectively, and were restored to near pretreatment baseline levels 7 days after treatment. These data suggest that a brief course of high dose corticosteroid treatment may limit the adrenal component of HPA responses for up to 7 days and patients may be at risk if they encounter major surgery or infection during this time.
결핵성 흉막염에서 프레드니솔론의 치료효과 -흉막유착 발생에 대한 전향적 연구-
이병훈 ( Byoung Hoon Lee ),지현석 ( Hyun Suk Jee ),최재철 ( Jae Chul Choi ),박용범 ( Yong Bum Park ),안창혁 ( Chang Hyeok An ),김재열 ( Jae Yeol Kim ),박인원 ( In Won Park ),최병휘 ( Byung Whui Choi ),허성호 ( Sung Ho Hue ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.4
늑막액에서 Cholesterol 측정의 진단적 의의에 관한 연구
이원돈(Won Don Lee),김옥란(Ok Ran Kim),이재용(Jae Young Lee),성천모(Chun Mo Sung),배혜상(Hae Sang Bae),서승천(Seung Cheon Seo),최병휘(Byung Hue Choi),허성호(Sung Ho Hue) 대한내과학회 1989 대한내과학회지 Vol.36 No.1
N/A The cholesterol of pleural fluids was measured in 30 patients various diseases with pleural effusion to investigate the utility of differential diagnosis of exudates from transudates. Six cases were pleural transudates and 24 cases were pleural exudates as by classified predefined criteria. The results were as follows: 1) Mean protein level in group 1 (transudates) was l.9±0.8 g/dl and 4.8±0.9 g/dl in group 2 (exudates). Mean pleural fluid to serum ratio in group 1 was 0.30±0.11 and 0.80±0.48 in group 2. 2) Mean LDH level was 40X29 IU in group 1 and 325+271 IU in group 2. Mean pleural fluid to serum ratio was 0.20±0.11 in group 1 and 2.01±1.90 in group 2. 3) Mean cholesterol level was 37±14 mg/dl in group 1 and 97±42 mg/dl in group 2. Mean pleural fluid to serum ratio was 0.18±0.06 in group 1 and 0.71±0.32 in group 2. 4) A protein level of 3.0 g/dl, LDH level of 200 IU, cholesterol level of 60 mg/dl and their pleural fluid to serum ratios of 0.5, 0.6 and 0.3 respectively were used as dividing lines separating transudates from exudates, and 0% was misclassified in group 1. Misclassified effusions in group 2 for each single parameter were: protein 0%, protein ratio 4%, LDH 29%, LDH ratio 20%, cholesterol 20%, cholesterol ratio 0%, and Light criteria 4%. We found the use of cholesterol level to be superior to the measurement of LDH level and inferior to protein level. The ratio of pleural fluid to serum cholesterol markedly improved the result. On the basis of the above results, it is suggested that pleural fluid cholesterol is a useful index in differentiating exudative from transudative pleural effusions.
성윤업(Yun Up Sung),김상훈(Sang Hoon Kim),강윤정(Yun Jung Kang),신종욱(Jong Wook Shin),임성용(Seong Yong Lim),고형기(Hyoung Gee Koh),박인원(In Won Park),최병휘(Byung Whi Choi),허성호(Sung Ho Hue) 대한내과학회 1995 대한내과학회지 Vol.49 No.4
N/A Background: The cervical injuries may impose a fatal result or permanent neurologic damage with multiple severe complications. Moreover most early deaths following acute cervical injury are due to pulmonary complications in spite of recent improvements in respiratory management. Objectives: With a comprehensive evaluation of pulmonary complications, the cervical injured patients with pulmonary dysfunction have a proper opportunity to be treated. Therefore it is important to know the incidence and the sorts of pulmonary complications in patients with cervical cord injury and to assess the important factors affecting on the development of pulmonary complications after cervical cord injury. Methods: The authors reviwed 84 patients who had visited Chung-Ang University Hospital due to cervical injury from 1988 to 1933. And the clinical data were analyzed according to the etiology of injury, injury level, presence or absence of pulmonary complications, neurologic status of the patients, associated trauma and multiple cervical fractures. Results: 1) The pulmonary complications occurred in 25 (28.6%) of the 84 patients with cervical injury. 2) The most common pulmonary complication was pneumonia (59.4%). Atielectasis and acute respiratory failure occurred in 5 patients respectively (15.6%). 3) Without complete neurolgic deficit, the development of pulmonary complications was primarily not dependent on the level of cervical cord injury. 4) The inportant factors affecting on the development of pulmonary complications were as follows Age over 50 years, initial neurologic status above grade C on Frankel classification, previous pulmonary diseases, associated trauma or head trauma and multiple cervical fractures. 5) There was significant difference in the patient distribution between the survivors (31.2%) and the non-survivors (62.5%) among the patients with pulmonary complications whose initial neurologic status was grade A. 6) The most common cause of death was pneumonia Conclusion: In patients with cervical cord injury the incidenc rate of pulmonary complication would be increased in patients with poor neurologic status, old age, previos underlying pulmonary diseases, associated trauma and multiple cervical fractures. Therefore in these patients, especially with pneumonia, intensive respiratory management is required.
원저 : 만성 폐쇄성 폐질환에서 급성 호흡부전 발생시 Simplifed Acute Physiology Score에 따른 단기예후의 평가
이상표 ( Sang Pyo Lee ),성윤업 ( Yun Up Sung ),김상훈 ( Sang Hoon Kim ),김봉식 ( Bong Sik Kim ),김영준 ( Young Jun Kim ),박인원 ( In Won Park ),최병휘 ( Byung Whui Choi ),허성호 ( Sung Ho Hue ) 대한결핵 및 호흡기학회 1993 Tuberculosis and Respiratory Diseases Vol.40 No.5
악성 , 결핵성 및 비특이성 흉막염 환자의 임상적 특성
김봉식(Bong Sik Kim),김상훈(Sang Hoon Kim),성윤업(Yun Up Sung),이상표(Sang Pyo Lee),박인원(In Won Park),최병휘(Byung Whui Choi),허성호(Sung Ho Hue),서승천(Seung Chun Seo) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
N/A Objectives: The role of pleural biopsy in the evaluation of unexplained exudative pleural effusion has been well established. Although repeat pleural biopsy will increase the diagnostic yield in patients ultimately proven to have malignant or tuberculous pleuritis, it will increase the expense and morbidity of patients with nonspecific pleuritis. The identification of patients who should undergo additional diagnostic procedures is a difficult but important clinical problem. The purpose of this study was to determine if patients with nonspecific pleuritis could be distinguished from those with malignant or tuberculous pleuritis by clinical criteria. Methods: The medical records and chest roentgenograms of 93 patients who had pleural tapping and pleural biopsy performed during the five-year period from January 1986 to December 1990 at the department of Internal Medicine, Chung-ang University Hospital were reviewed. Results: The five clinical criteria, ie, fever, weight loss, pleurtitic chest pain, above moderate amount of pleural effusion, lymphocytosis of greater than 90 percent in pleural fluid, were observed significantly more often in the patients who were diagnosed to have either malignant or tuberculous pleuritis. The positive predictive value of the criteria, ie, the probability of the patient having tuberculous or malignant pleural disease, was 89 percent when one criterion was present and increased to 95 percent if two criteria were present. Conclusions: Based on our observations, we recommend the following diagnostic approach to the evaluation of an unexplained exudative pleural effusion. If the initial pleural biopsy reveals nonspecific pleuritis only in a patient without any of the above five criteria, further pleural biopsies are not needed, and the patient is followed up clinically. When two or more criteria are present, an aggressive diagnostic approach including repeat pleural biopsy is recommended.