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B형 간염바이러스 양성인 공여자와 수여자 간의 사체 신이식
한혁준 ( Han Hyeog Jun ),허우성 ( Heo U Seong ),이현희 ( Lee Hyeon Hui ),윤수진 ( Yun Su Jin ),김윤구 ( Kim Yun Gu ),김대중 ( Kim Dae Jung ),오하영 ( O Ha Yeong ),김성주 ( Kim Seong Ju ),조재원 ( Jo Jae Won ) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6
B형 간염 환자의 신이식은 이식 후 투여된 면역억제제의 직·간접적인 영향으로 간염의 악화또는 간부전으로 인한 사망률이 높다는 연구가 꾸준히 보고되고 있으나, 최근 연구에서는 간염 양성군과 음성군간의 이식신 거부반응, 감염증, 이식신 및 환자 생존율에 차이가 없으며, 다만 수술 후 간질환이 발생할 가능성만이 더 높다는 주장이 증가하고 있다. 여기에 간염 바이러스 증식억제제인 라미부딘이 신장이식에 도입됨으로써 B형 간염환자에 대한 이식이 새로운 국면을 맞이하였다. 하지만 이러한 연구들에서도 수여자는 B형 간염 양성이나, 신장을 제공하는 공여자는 모두 간염 바이러스 음성인 경우가 대부분으로, 문헌고찰 결과 현재까지 B형 간염 양성 공여자와 수여자간의 신이식 보고를 찾기가 어려웠다. 저자들은 1997년부터 2000년까지 삼성서울병원에서 이루어진 B형 간염바이러스 양성인 뇌사자와 B형 간염바이러스 양성인 만성신부전 환자 사이의 사체 신이식 9례를 분석하였다. 공여자는 모두 뇌사자로 총 6명(남5, 여 1, 연령 : 15-52세) 이었고, 수여자는 총 9명(남 4, 여 5, 연령 :23-52세)이었다. 수여자의 이식 전 투석기간은 중앙치 23개월(범위 : 7-76개월)이었고, 이식 후42에서 12개월의 경과를 관찰하였다(중앙치 24개월). 3예에서 급성거부반응을 경험하였으나 성공적으로 치료되었고 만성거부반응은 없었다. 마지막추적관찰에서 혈청 크레아티닌이 1.5 mg/dL인 1예 외 나머지 8예는 정상 혈청 크레아티닌을보이고 있다. 전격성 간부전이나 간경화의 사례는 없었고, 4예에서 간기능 장애가 있었다. 그 중1예는 CyclosporineA hepatotoxicity로 진단되었고, 1예는 6개월 이상의 간기능장애를 보였으나 이후 간기능수치가 안정되었다. 1예는 급성간염의 소견을 보였고 나머지 1예는 재발성간염이 있었다. 나머지 5예는 지속적으로 안정적인 alanine aminotransferase(ALT) 수치를 보이고 있다. 현재 ALT 60 IU/L인 1례를 제외한 8례에서 정상적 간기능 수치를 보이고 있으며 전예에서 라미부딘 치료가 시행되고 있다. 신이식 수여 대상자가 제공자에 비해 월등히 많은 실정에서 신제공자의 범위를 B형 간염바이러스 양성자에게까지 넓히는 시도는, 특별히 우리나라와 같이 간염보균자와 만성간염 환자가 많은 상황에서는 임상적으로 큰 의미가 있다고 판단되며 장기적인 경과 관찰을 통한 비교 분석이 필요할 것으로 사료된다. There has been studies constantly reporting on high rate mortality of renal transplantation of hepatitis B virus(HBV)-positive subject because the direct and indirect effect of immunosuppressive agent which was administrated after a transplantation worsens hepatitis or causes hepatic failure. But recent studies have reported that there is no difference in graft rejection, infection and survival rate of the graft or the host between hepatitis positive and negative groups. And, after lamivudine which suppresses HBV replication is introduced into renal transplantation, transplantation of HBV-positive subjects has taken on a new aspect. But it has been hard to find the reports about renal transplantation between donor and recipient both are hepatitis B virus positive in documents, because, in most cases of those reports, the recipient was hepatitis B virus positive but the donor who offers kidney was hepatitis virus negative. This study selected all 9 cases of cadaveric renal transplantation between HBV-positive cadaveric donor and HBV-positive chronic renal failure(CRF) patient who were operated at Samsung medical center from March of 1997 to August of 2000, then analyzed the medical records of five donors and nine recipients retrospectively. Six cadaveric donors(5 male, 1 female, age 15-52) and nine recipients(4 male, 5 female, age 23-52, median dialysis period 23 months) were included. During following up periods of 42 to 12 months (median 24 months) after renal transplantation with HBV DNA, serum ALT and serum creatinine change of hepatic function and renal function were observed and a development of infection and other complication were also investigated. Any case didn`t come out fulminant hepatitis or liver cirrhosis. Four cases came out hepatic dysfunction. Among these, one case was diagnosed to CsA hepatotoxicity. One case came out a transient increase of ALT more than six months, since then was normilized. One case came out acute hepatitis and one case recurrent hepatitis. The rest constantly came out normal hepaitc function. In all the cases lamivudine treatment was practiced and the major indication were positive HBV DNA and a increase of ALT. In the recent test the eight cases came out a normal ALT and the only one case came out a little increase of ALT, 60 IU/L. Renal function was relatively well maintained. Three cases came out acute rejection, but it was successfully recovered. Chronic rejection didn`t occur. In the recent test the eight cases came out a normal serum creatinine except one case(28 month after transplantation) which 1.5 mg/dL of serum creatinine appeared. When we consider our situation possessing much more recipients than donors of renal transplantation, this trial to expand the scope of donor to HBV- positive patients as well as the activation of cadaveric renal transplantation is a clinically meaningful effort especially in Korea and Asian countries which have a plenty of hepatitis carriers and chronic hepatitis patients. And we consider this new trial needs to continue comparative analyzation through long term observation.
경피적 관상동맥 확장술 전후의 QT 간격분산 ( QT dispersion ) 비교
한혁준(Hyeok Jun Han),노태호(Tai Ho Rho),이만영(Man Young Lee),김희열(Hee Yeol Kim),윤호중(Ho Joong Youn),김종진(Jong Jin Kim),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1997 대한내과학회지 Vol.52 No.6
N/A Objectives: QT dispersion(QTd) is defined as the difference between the maximum and minimum average QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. It was reported previously that QTd was dependent on the degree of reperfusion in myocardial infarction. The purpose of this study is to investigate the effects of percutaneous transluminal coronary angioplasty(PTCA) on QTd. Methods: We studied in 21 patients(15 men and 6 women: mean age, 53±7.5 years: 14 acute myocardial infaction, 4 angina pectoris and 3 unstable angina). All standard 12-lead ECGs were recorded at a paper speed of 25mm/sec and examined retrospectively by single observer. QT interval was measured from 11.3±1.1 leads using a computerized program interfaced with digitizer. QTd corrected for heart rate(QTcd) was calculated by Bazett`s formula. Each cases were divided to 2 stages, before and after PTCA(mean obsevation duration, 16.8±9.7 days vs. 22.5±21.9 hours). The difference of QT dispersions was assessed by comparing by paired t-test. Results: There were significant difference in QTd (mean 110.2±37.4 vs. 90.4±37.6 msec, p<0.05). Results did not change when Bazett`s QTc was substituted for QT(QTcd: mean 125.5±38.3 vs. 97.9±29.8 msec, p<0.05). Conclusion: Successful PTCA is associated with less QTd after PTGA. The results are equally significant when either QT or QTc is used for analysis. In our limited study, measurement of QT dispersion, an easily accessible, resonably accurate, noninvasive method, may be a valuable tool in assessment of patients before and after PTCA. However, this study must be confirmed in prospective trial.