1987년 및 1988년에 한국에서 발생한 발진열의 혈청역학 조사

장우현(W.H. Chang),김익상(I.S. Kim),최명식(M.S. Choi),최인학(I.H. Choi),기선호(S.H. Kee),김석용(S.Y. Kim),이우곤(W.K. Lee),최강원(K.W. Choe),최두혁(D.H. Choi),이증훈(J.H. Lee),윤태영(Y.T. Yoon),김우열(W.Y. Kim),기정일(J.I. Kee),박영수(Y.S. Pa 大韓微生物學會 1989 大韓微生物學會誌 Vol.24 No.4

1986년부터 1988년사이에 우리나라에서 발생한 신증후 출혈열의 혈청역학 조사

장우현(W.H. Chang),이범구(B.G. Lee),최성배(S.B. Choi),김익상(I.S. Kim),최명식(M.S. Choi),최인학(I.H. Choi),기선호(S.H. Kee),김석용(S.Y. Kim),이우곤(W.K. Lee),최강원(K.W. Choe),최두혁(D.H. Choi),이증훈(J.H. Lee),윤태영(T.Y. Yoon),김우열(W.Y. K 大韓微生物學會 1989 大韓微生物學會誌 Vol.24 No.5

1987년 및 1988년에 한국에서 발생한 쭈쭈가무시병의 혈청역학적 조사

장우현(W.H. Chang),최명식(M.S. Choi),박경희(K.H. Park),이우곤(W.K. Lee),김석용(S.Y. Kim),최인학(I.H. Choi),기선호(S.H. Kee),김익상(I.S. Kim),최강원(K.W. Choe),우준희(J.H. Woo),송영욱(Y.W. Song),최두혁(D.H. Choi),이증훈(J.H. Lee),김우열(W.Y. K 大韓微生物學會 1989 大韓微生物學會誌 Vol.24 No.2

한국 농촌거주 정상인의 Leptospira Interrogans에 대한 항체보유율 현황

최강원,최성배,국윤호,장우현,우준희,박경희,강재승,차창룡,김양수,김석용,윤종구,김익상,이우곤,최명식,송영욱 대한감염학회 1988 감염 Vol.20 No.3

It has been well known that leptospiroisis is a one of the prevailing acute febrile diseases in Korea. In order to find out the incidence of past infection of L. interrogans among normal population, a total of 1,171 sera obtained from rural residents and tested by microscopic agglutination test. All of normal resident's sera were collected during July in 1987, just before epidemic season, at Keochang county(248 sera), at Wanju county(145 sera), at Wonseoung county(255 sera), at Cholwon county(411 sera) and at Kongju county(112 sera). Seropositive rate against L. interrogans among rural residents was 12.0% and ranged from 2.7% in Kongju county to 18.5% in Cholwon county. There was a higher seropositive rate in males and the majority of seropositives occurred in the age group over 30 yesrs. Icterohaemorrhagiae was a most commonly reacting serotype of L. interrogans and followed by CH-48 and Canicola. The sera reacted with Cynopteri, Ballum, Australis, and Pyrogenes were present also.

한국에서의 Human T-Cell Leukemia Virus Type-1(HTLV-1)에 대한 혈청학적 및 역학에 관한 연구

이영열,이성열,김은실,이홍복,김병국,이문호,박선양,김노경,서철원,규경채,최강원,조한익,고월청,야마구찌이찌세이 대한내과학회 1986 대한내과학회지 Vol.31 No.2

Type-C retrovirus, human T-cell leukemia virus type-l(HTLV-1), has been shown to be associated etiologically with adult T-cell leukemia, which is an endemic disease in southwestern parts of Japan. We examined the seroepidemiological characteristics of antibody to adult T-cell leukemia virus associated antigen (anti-ATLA-antibody) by the indirect immunofluorescent assay and ELISA from the healthy individuals and various diseased patients in the Republic of Korea, a country adjacent to Japan in which HTLV-1 is endemic. The results were as follows. 24 out of 9,603 individuals(0.25%) were seropiositive. The positve rate was 0.17% in males and 0.36% in females, the sex difference was female predominent relatively. HTLV-1 carriers were found 16 individuals in Seoul, 5 in Kyonggi area, 1 in Chungnam and Jonbuk, respectively, but found only 1 individual in Busan city and Jaejoo area close to southwestern parts of Japan. Positive rate to anti-ATLA-antibody seemed to be high in older age, especially at the 50s(0. 4Yo). In conclusion the prevalence rate of anti-ATLA- antibody seemed to be very low in the Republic of Korea adjacent to Japan in which HTLV-1 is endemic and no patient with adult T-cell leukemia has been found as yet. Also we noted that the Republic of Korea is not an endemic area to HTLV-1.

각종 갑상선질환에서의 항Thyroglobulin 항체 및 항Microsome 항체의 출현빈도에 관한 연구

이문호,고창순,이홍규,이권전,김병국,최강원,박성회,지제근,이상국 대한핵의학회 1979 핵의학 분자영상 Vol.13 No.1

저자들은 각종 갑상선질환에서 갑상선자가항체의 출현빈도를 조사하여 이들 항체가 갖는 진단적 가치를 관찰하고저, 1978년 4월부터 1979년 4월사이에 서울대학교병원 내과에 내원하였던 각종 갑상선질환환자 108명과 정상인 15명을 대상으로 하여, 감작혈구응집반응을 이용하여 항 thyroglobulin 항체와 microsome 항체를 측정하여 다음과 같은 결론을 얻었다. 1) 정상인 15명에서의 항 thyroglobulin 항체는 모두 음성이었는데, 항 microsome 항체는 1명(6.7%)에서 양성이었다. 각종 갑상선질환환자 108명에서의 결과는 각각 34명(31.5%) 및 40명(37.0%)이 양성이었다. 2) Graves병 환자 25명에서는 항 thyroglobulin 항체는 7명(28.0%)이 양성이었으나 항 microsome 항체는 9명(36.0%)에서 양성이었고, 음성인 군과 양성군 사이에 임상소견 및 검사소견이 특별한 차이를 볼 수 없었다. 3) Hashimoto병 환자는 18명으로 이들은 모두 침생검소견으로 확진된 예들로서, 두가지 항체가 각각 16명(88.9%)과 17명(94.4%)에서 양성이었다. 4) Familial goiter 환자는 7명이었는데 각각 4명(57%) 및 6(85%)명에서 양성이었다. 5) 양성갑성선종 35명에서는 각각 2명(5.7%) 및 3명(8.6%)이 양성의 소견을 보였으며, 갑상선암종 16명에서는 각각 3명(18.8%)이 양성이었다 6) 2명의 아급성갑상선염환자는 두가지가 모두 음성이었던데 반하여, 원발성점액수종환자 1명은 수검검사에서 양성이었다. 7) 1:802 이상의 고력가를 보인 예는 항 thyroglobulin 항체의 경우는 16명(14.8%)이었고, 이중 10명(62.5%)이 Hashimoto병이었으며, 항 microsome항체의 경우는 20명중 13명(65.0%)이 Hashimoto병이었다. 8) Tg Ab와 Mc Ab의 상관계수는 0.76으로 상관관계가 비교적 높으며 Mc Ab의 양성빈도가 약간 높았다. 이상의 결과를 종합하면 감작혈구응집반응은 간편하고 예민하며 신뢰도 및 재현성이 높은 검사로 생각되며 이 방법으로 측정한 항 thyroglobulin 항체 및 항 microsome 항체는 Hashimoto병에서 그 검출빈도가 높고 그 역가도 높아 Hashimoto병의 진단에 유용하다고 사료된다. The authors investigated the incidence of antithyroglobulin antibodies and antibodies and antimicrosomal antibodies measured by tanned red cell hemagglutination method in subjects suffering from various thyroid disorders. 1) In 15 normal patients, neither suffering from any thyroid diseases nor from any other autoimmune disorders, the antithyroglobulin antibodies were all negative, but the antimicrosomal antibody was positive only in one patient(6.7%). 2) The antithyroglobulin antibodies were positive in 31.5%(34 patients) of 108 patients with various thyroid diseases, and the antimicrosomal antibodies were positive in 37.0%(40 patients). 3) of the 25 patients with Graves' diseases, 7 patients(28.0%) showed positive for the antithyroglobulin antibodies, and 9(36.0%) for the antimicrosomal antibodies. There was no definite differences in clinical and thyroid functions between the groups with positive and negative results. 4) Both antibodies were positive in 16(88.9%) and 17(94.4%) patients respectively among 18 patients with Hashimoto's thyroiditis, all of them were diagnosed histologically. 5) Three out of 33 patients with thyroid adenoma showed positive antibodies, and 3 of 16 patients with thyroid carcinoma revealed positive antibodies. 6) TRCH antibodies demonstrated negative results in 2 patients with subacute thyroiditis, but positive in one patient with idiopathic primary myxedema. 7) The number of patiencs with high titers($gt;l:802) was 16 for antithyroglobulin antibody, and 62.5%(10 patients) of which was Hashimoto's thyroiditis. Thirteen(65.0) of 20 patients with high titers($gt;l:802) for antimicrosomal antibody was Hashimoto's thyroiditis. TRCH test is a simple, sensitive method, and has high reliablity and reproducibility. The incidences and titers of antithyroglobulin antibody and antimicrosomal antibody are especially high in Hashimoto's thyroiditis.

1987년 한국에서 발생한 렙토스피라병의 혈청역학적 조사

이증훈,박영수,이우곤,김석용,정선식,우준희,박성광,박경희,송영욱,김선영,기정일,최두혁,강성귀,김주완,최강원,김우열,최명식,최인학,장우현,윤성열 대한감염학회 1988 감염 Vol.20 No.3

Human leptospirosis was an unfamiliar disease in Korea until 1984 that outbreak of leptospirosis occurred among farmers and soldiers after field works for harvesting rice. During that time, Lee and Jo confirmed the first Korean cases of leptospirosis by serological test, isolation of causative agent and autopy findings. Afterward several outbreaks occurred also during autumn especially after flood in every years and some characterisitcs of leptospirosis in Korea such as clinical manifestations, serotypes and seroepidemiological features has been revealed by many investigators. Because of the major mode of transmission between rodents and human is by direct contact with leptospiral urine of rodents or contaminated soil by the urine, leptospirosis in Korea has been primarily a disease of person in occupations heavily exposed to contaminated soil or infected urine such as farmer, army and etc. Therefore it seems that leptospirosis is one of the main communicable diseases to be controlled urgently in Korea, for an agricultural people account for almost half of total Korean people. For clarifying the seroepidemiological patterns of human leptospirosis in Korea by sex, month region and main reacting serovars of L. interrogans among acute febrile disease occurred in 1987, 1,773 patient's sers with acute febrile episodes were tested by microagglutination test using 19 representative strains of leptospiral serogroup as antigen. All of those sera were collected from 10 collaborative clinics located in Kyunggi, Kangwon, Chungbuk, Chungnam, Chonbuk, Chonnam province and Seoul. The results wee summerized as follows. 1) Among 1,773 sera of patients with acute febrile episodes, 219 (12.4%) were seropositive to L. interrogans, 487(27.5%) to R. tsutsugamushi, 241(13.6%) to R.typhi and 160(90.0%) to Hantaan virus. 2) Among seropositives to L.interrogans, the male outnumbered the female, 65% and 35%. 3) For age distribution, 26.9% of seropositives to L.interrogans were fifties, 19.6% were forties, 9.1% were sixties, 5.9% were thirties and 4.1% were twenties. 4) Eighty three percent of seropositives had occurred between September and October in 1987 with a peak in September. 5) Main leptospiral serovars reactive to patient's sera were Icterohaemorrhagiae(54.3%), Canicola(31.0%), CH-48(13.2%), Tarassovi(0.9%)and Cynopteri(0.5%). 6) For regional distribution, 65.8% of seropositives to L.interrogans were residents from Chonbuk, 12.3% were Chonnam, 7.3% were Chungnam, 5.5% were Kyunggi and 1.4% were Kangwon.

장티프스에서 효소면역측정법의 진단적 가치

차창용,김윤원,황응수,정문현,오명돈,최강원 대한감염학회 1985 감염 Vol.17 No.2

The diagnostic value of ELISA for typhoid fever was tested with 43 sera from patients with enteric fever and 27 sera from patient who had no known history of enteric fever. IgG antibody was most commonly elevated (in 97.6%), followed by IgA (in 38.3%) and IgM antibody (in 65.1%). On the other hand, IgM and IgA antibody were found to be elevated in 40.7% of various infectious (notably due to M, tbc and gram negative enteric bacteria) and noninfectious conditions. On the contrary, IgG antibody was elevated only occasionally. (7.4%). IgG antibody was most sensitive and specific indicator for the S. typhi and S. paratyphi A infection.

만성신부전의 고혈압에서 Furosemide 정주에 대한 Renin 반응

최강원 대한핵의학회 1978 핵의학 분자영상 Vol.12 No.1

Furosemide 정주에 대한 만성신부전환자의 Renin 반응을 관찰하고, 이것이 고혈압발생 유지와 가지는 관계를 밟히기 위하여 46명의 정상혈압 및 신기능을 가진 대조군과 51예의 고혈압을 수반한 만성신부전 및 악성고혈압 환자에서 기저 및 furosemide 정주 1시간후의 PRA를 측정하였다. 1) 대조군에서는 자극전후의 PRA가 각각 2.5±1.95, 4.5±2.51 ng/ml/hr였으며, 전예에서 증가를 보였다. 2) 악성고혈압군에서는 5.1±2.36, 5.8±2.25 ng/ml/hr으로 여타고혈압환자의 1.9±1.70, 1.9±1.63 ng/ml/hr에 비해 자극전후에 PRa가 현저하게 증가되어 있었으나, 양군 모두 furosemide자극에 유의한 PRA증가반응을 나타내지 않았다. 3) 항압제치료에 반응하였던 항압반응군은 자극전후의 PRA가 2.5±2.21, 2.9±2.46으로 증가반응을 나타내지 않았고 비반응군은 4.9±1.96, 6.4±1.71 ng/ml/hr로서 PRA가 자극전후에 있어서 반응군보다 현저히 높고, furosemide 투여에 대해 상당한 증가를 보였다. 자극후 PRA가 4ng 이상 PRA에서는 양군이 각각 7예씩 있었다. 따라서 항압제치료에 반응이 적은 환자나 악성고혈압에서는 높은 PRA와 PRA 반응을 나타내는데 비해, 항압반응군에서는 PRA가 낮고, 대체로 furosemide에 대해서 PRA의 증가가 없다. 4) 24시간 요중 Na 양과의 관계에서 기저 PRA를 관찰하면 대부분의 만성신부전이나(68.6%), 악성고혈압(71.43%)에서 Na-PRA의 관계는 정상범위에 있었다. 그러나 상당수에서 PRA의 이상증감이 있고, 또 대게의 경우 임상적으로 Na 저유가 의심되기 때문에 많은 PRA는 이상증가되어 있음과 Na에 의한 renin-angiotensin 활성의 조절에 이상이 있음이 시사되었다. It has been suggested that plasma renin activity (PRA) and its response to volume depletion may be abnormal in that it shows little or exaggerated change in patients with chronic renal failure and hypertension. Intravenous furosemide stimulation test was performed in 46 control subjects and 51 patients with chronic renal failure and/or malignant hypertension in order to evaluate PRA response. In contrast to the consistent increase in PRA in control subjects (from 2.5±1.95 to 4.5±2.51 ng/m1/hr), no consistent increase was observed in patients with chronic renal failure, especially in those who showed favorable response to antihypertensive therapy (from 2.5±2.21 to 2.9±2.46 ng/ml/hr). But poor responder to antihypertensive treatment showed considerably higher PRA before and after furosemide stimulation (from 4.9±1.96 to 6.4±1.71 ng/ml/hr) than the responder group did. Moreover, this group seemed to retain the ability to increase PRA in response to intravenous furosemide stimulation. Thus it became apparen responder group was unable to increase PRA normally in response to furosemide as well as volume depletion, while poor responder seemed to retain that ability. Thus intravenous furosemode may serve as a convenient way to differenfiate those who might be benefited by conservative antihypertensive measures from those who would require more drastic measures such as bilateral nephrectomy for their optimal blood pressure control. $quot;

체외배양한 인제대정맥혈관내피세포에서 R. tsutsugamushi 감염이 Tissue Factor와 Type 1 Plasminogen Activator Inhibitor의 발현에 미치는 영향에 관한 연구

김미란,기선호,배현주,장우현,박선양,최강원 대한감염학회 1995 감염 Vol.27 No.4

목적:쯔쯔가무시질환시 생기는 전신혈액응고장애의 병인 기전이 rickettsia의 침투에 의한 혈관내피세포의 손상, 그에 따른 tissue factor의 발현, 뒤이은 tissue type plasminogen activator(tPA)의 분비와 보상기전으로 type 1 plasminogen activator inhibitor(PAI-1)이 분비되는 과정으로 생각하고 이를 보고자 연구를 시행하였다. 방법:체외배양한 혈관내피세포에 순수분리한 Rickettsia tsutsugamushi를 감염시킨후 상층액에서 ELISA법으로 tPA와 PAI-1을 측정하였고 혈관내피세포 단층배양에서 면역형광법으로 tissue factor를 측정하였으며 PAI-1 유전자의 발현을 확인하고자 Northern blot analysis로 PAI-1 mRNA를 확인하였다. 결과: 1) PAI-1 R. tsutsugamushi를 감염시킨후 24시간에 가장 높은 농도를 보이며 그 증가량은 정상대조군에 비해 2.5배에서 4.7배까지 증가 하였다. 2) R. tsutsugamushi를 감염시킨후 혈관내피세포에서 분비되는 tPA의 분비는 정상대조군에 비해 유의한 차이를 보이지 않았다. 3) Northern blot analysis에 의한 PAI-1 mRNA의 발현 검색 결과 정상대조군에 비해 R. tsutsugamush가 감염된 혈관내피세포에서는 PAI-1의 발현이 2.5배 정도 증가하였다. 4) 혈관내피세포 단층배양에 R. tsutsugamushi를 감염시킨후 24시간에 tissue factor단일클론 항체와 FITC-conjugated anti mouse IgG를 이용한 간접 면역형광항체법으로 tissue factor를 측정한 결과 혈관내피세포 표면에서 tissue factor의 존재를 확인할 수 있었다. 결론:단층배양한 혈관내피세포에 R. tsutsugamushi를 감염시켰을 때 tissue factor가 발현되었고 PAI-1의 분비가 증가하여 24시간에 가장 많이 분비되었다. 그러나 tPA의 분비는 정상대조군에 비해 유의한 차이를 보이지 않았다. Nothern blot analysis를 통한 PAI-1 mRNA의 발현 검색 결과 PAI-1이 새로이 생성되어 분비됨을 확인하였다. Background:Tissue type plasminogen activator(tPA), type 1 plasminogen activator inhibitor (PAI-1), and von Willebrand factor are known to be released into the sera of patients in disseminated intravascular coagulation(DIC). The main pathologic mechanism of tsutsugamushi disease is the vasculitis by direct endothelial cell invasion by R. tsutsugamushi which dosen't have endotoxin. It is suspected that the mechanisms of DIC and activation of plasminogen activation system are different from those of sepsis by other organisms. which is caused by endotoxin. We suspect that direct rickettsial invasion of endothelial cells causes endothelial cell damage, tissue factor release, which is followed by DIC, and tPA and PAI-1 are released as compensatory mechanism. Methods:We cultured endothelial cells from human umbilical cord vein, infected them with purified R. tsutsugamushi Gilliam strain, checked tPA and PAI-1 by ELISA in culture supernatant. Then we observed the tissue factor expression on cultured endothelial cell monolayer by indirect IF stain. PAI-1 gene expression was evaluated by northern blot analysis. Results: 1) PAI-1 level showed gradual increase up to 240ng/ml (2.5-4.7 fold increase) in 24 hours. 2) tPA level showed no significant change with time. 3) PAI-1 gene expression increased 2.5 fold by northern blot analysis. 4) Tissue factor was expressed on the endothelial cells infected with R. tsutsugamushi. Conclusion: R. tsutsugamushi infection induces expression of tissue factor on endothelial cells and PAI-1 synthesis and it would contribute to DIC mechanism in tsutsugamushi disease in part. But it has no direct effect on tPA release.