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한국인에서 D-Dimer의 위양성과 관련된 인자와 검사의 정확도 향상을 위한 Cut-Off Value
홍만용 ( Man Yong Hong ),이창근 ( Chang Kun Lee ),유상용 ( Sang Yong Yoo ),신대희 ( Dae Hee Shin ),정상식 ( Sang Sig Cheong ),권장훈 ( Jang Hoon Kwon ),장우성 ( Woo Sung Jang ),유승진 ( Seung Jin Yoo ),오광훈 ( Kwang Hoon Oh ) 대한내과학회 2013 대한내과학회지 Vol.84 No.3
목적: 폐동맥 색전증과 심부 정맥 혈전증 이외에 D-dimer 검사의 양성 결과를 나타내는 여러 질환들이 보고되고 있으나, 현재까지 한국인에서 위양성을 유발하는 인자에 대해서는 명백하게 알려진 바가 없다. 따라서 한국인에서 위양성을 초래하는 인자들을 확인하고, 정확도를 향상시키기 위한 새로운 cut-off value를 제시하고자 한다. 방법: 2009년 1월부터 12월까지 본원에 방문한 환자 중 다양한 이유로 D-dimer 검사를 시행 받은 2,047명의 환자를 대상으로 분석하였고, 위양성을 유발하는 인자들을 확인하기 위해 오즈비와 95% 신뢰구간을 로지스틱 회귀분석을 이용하여 분석하였다. 새로운 cut-off value는 ROC curve를 이용하여 구하였다. 결과: 연령의 증가, 외상, 수술의 기왕력, 급성 감염, 결핵, 뇌혈관 질환, 악성종양, 만성 신부전, 급성 관동맥 증후군, 심부전, 호흡기 질환 등이 D-dimer 검사의 위양성을 유발하는 인자로 확인되었다. 또한 민감도와 특이도를 향상시키기 위해 ROC curve를 이용하여 구한 새로운 cut-off value는 0.68mg/L였다(65세 이하에서는 0.58 mg/L, 65세 이상에서는 0.77mg/L). 결론: 여러 인자들이 D-dimer 위양성과 관련이 있었으며, 임상에서 D-dimer 검사를 시행하고 임상에 적용할 때에는 이러한 인자들이 결과치에 영향을 줄 수 있음을 충분히 고려하여야겠다. Background/Aims: The D-dimer value is a simple blood test used to evaluate venous thromboembolism (VTE). However, due to its low specificity, another test is needed for a definite diagnosis, such as a radiographic test. We evaluate the factors associated with a false positive D-dimer test and propose a new cut-off value for detecting VTE more effectively in Koreans. Methods: This was a retrospective, observational study. From January 2009 to December 2009, 2,047 patients (988 men, 63 ± 15 years) had the D-dimer value checked to evaluate VTE. The main outcome of interest was a positive D-dimer test. Odds ratio and 95% confidence intervals were determined using logistic regression analysis. The new D-dimer cut-off was evaluated using receiver operating characteristics (ROC) curves. Results: The result was positive in 1,093 patients (53%), for a false positive percentage for VTE of 95% and a false negative percentage for VTE of 1%. Significant false positive predictors for a positive D-dimer were increasing age, trauma, postoperative, acute infection, tuberculosis, stroke, malignancy, chronic renal failure, acute coronary syndrome, heart failure, and lung disease. The discriminative value of the D-dimer test was assessed using ROC curve analysis. A D-dimer value of 0.68 mg/L on admission was the best cut-off value for predicting the development of VTE with a sensitivity of 95% and specificity of 57%. Conclusions: Many factors affect the D-dimer value and we must consider these factors before using the D-dimer value to evaluate VTE. A D-dimer value of 0.68 mg/L appears to be a good cut-off value for evaluating VTE more effectively in Koreans. (Korean J Med 2013;84:372-378)
아급성형 Gaucher 씨 병에서의 동종골수이식과 유세포 분석기를 이용한 Glucocerebrosidase 활성화 추적 1 예
김현수,김덕기,박준성,하만준,유상용,김효철,김현주,정철권 대한내과학회 2001 대한내과학회지 Vol.61 No.2
Gaucher's disease (GD) is the most common inherited lysosomal storage disease, manifested by generalized accumulation of glucocerebroside in macrophages of the reticuloendothelial system due to a deficient lysosomal β-glucocerebrosidase (GC). It is inherited by an autosomal recessive pattern in which three clinical phenotypes have been described based on the presence and severity of neurologic involvement. GD is treated possible by GC enzyme replacement therapy, allogeneic bone marrow transplantation (BMT), and gene therapy. We here report the experience of successful allogeneic BMT in a 16-year-old female patient with GD type III which was demostrated markedly increased Gaucher cells in bone marrow and absence of GC activity in peripheral blood monocytes by FACS using 5'- pentafluorobenzoylaminofluorescein-di-β-D-glucoside (PFBFDGlu) as substrate. Donor marrow engraftment was confirmed by chromosome analysis using microsatellite and by bone marrow examination. Assay of GC activity using FACS revealed normalevel of enzyme activity. She remains alive and well after 12 months of BMT.(Korean J Med 61:195-200, 2001)
IgG1 및 IgG3 아형 결핍이 동반된 중증 아스피린 : 과민성 천식 환자에서 intravenous immunoglobulin 치료 1 례
박해심,김희연,한동석,남동호,안성균,유상용 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.4
Common complications in a patient with IgG subclass deficiency include recurrent respiratory infections and concomitant inflammatory lung disease. The most effective therapy in these patients is the administration of intravenous immunoglobulin. The authors report a case of severe aspirin-sensitive asthma and recurrent pneumonia with combined IgG1, and IgG3 subclass deficiency in a 19-year-old man. The patient was treated with 0.4g/kg at monthly intervals for 6 months, and is still receiving 0.2g/kg every 2 weeks at our clinic. After the replacement of in- travenous immunoglobulin, the patient has clinically improved.
재발성 구강내 진균감염증이 동반된 IgG3 아형 결핍증 1례
최정희,박해심,송정엽,이수걸,남동호,유상용,김선신 대한알레르기학회 2000 천식 및 알레르기 Vol.20 No.4
Common clinical manifestations in patients with IgG subclass deficiency include recurrent respiratory tract infection, recurrent otitis media and sinopulmonary infection by virus or bacteria. The administration of intravenous immunoglobulin(IVIG) has been regarded as the most effective therapy in these patients. We experienced a 22-year-old patient with IgG3 subclass deficiency and recurrent fungal infection of oral cavity and lips. IVIG was given at 0.2g/kg/dose twice a month for 6 months. After treatment with IVIG, the patient improved clinically.