중증 재생불량성빈혈에서 타인 혹은 HLA 불일치 혈연간 골수이식을 위한 cyclophosphamide와 antithymocyte globulin전처치 요법

이정희,이제환,김신,설미이,이정신,김우건,김상희,지현숙,박찬정,이규형 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: Cyclophosphamide와 ATG의 전처치 요법은 HLA가 일치하는 형제간 골수이식에서는 매우 효과적인 것으로 알려져 있으나, 타인 혹은 HLA 불일치 혈연간 골수이식에서는 전처치 요법으로서 불충분한 것으로 보고되었는데, 주요 문제는 착상 부전이었다. 우리나라를 포함하는 극동아시아 지역의 국가들에서 발표되는 보고에 의하면 타인이식을 포함하여 골수이식 후 착상 부전과 이식편대숙주질환의 발생이 서구 국가들로부터의 보고에서보다 적은 것으로 알려져 있다. 저자 등은 6예의 중증 재생불량성빈혈 환자들에서 질병 초기에 Cyclophosphamide와 ATG만을 이용하여 전처치를 한 후에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행하였다. 방법: 1999년 5월부터 2000년 4월까지 서울중앙병원에서 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 성인 중증 재생불량성빈혈 환자들을 대상으로 하였다. 골수이식을 위한 전처치 요법으로 cyclophosphamide (50 mg/kg/d x 4)와 ATG (30 mg/kg/d x 3)를 투여하였는데, 골수이식 전에 ATG에 대하여 과민 반응을 보였던 한 예 (UPN 120)에서는 ATG 대신에 fludarabine (30 mg/m2/d x 3)을 투여하였다. 이식편대숙주질환의 예방을 위하여 cyclosporine과 methotrexate를 투여하였다. 결과: 연구 기간 중에 모두 6예가 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받았는데, 5예는 타인으로부터 골수를 공여 받았으며, 1예는 HLA의 표현형이 하나의 유전자좌에서 일치하지 않는 형제로부터 골수를 공여 받았다. 타인 골수이식을 받은 5예 중에서 3예의 공여자는 HLA의 표현형이 일치하였으며, 1예는 하나의 유전자좌가 major mismatch였고, 1예는 하나의 유전자좌가 minor mismatch였다. 추적기간의 중앙값은 406일 (범위, 328-643일)인데, 6예 모두에서 착상된 상태를 유지하면서 생존해있다. 2예에서 3도의 급성 이식편대숙주질환과 전신성 만성 이식편대숙주질환이 발생하였다. 결론: Cyclophosphamide와 ATG의 전처치 요법은 재생불량성빈혈의 초기에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 한국인 환자들에서 충분히 착상을 가져올 수 있는 요법으로 생각된다. 비록 본 연구의 대상 환자 수가 적지만 결과는 매우 고무적이다. HLA가 일치하는 형제가 없는 중증 재생불량성빈혈 환자의 경우에 타인 골수 공여자에 대한 검색을 조기에 시행해야 하며, 타인 혹은 HLA 불일치 혈연간 골수이식을 질병 초기에 적극적으로 고려해야 할 것으로 생각된다. Background: Cyclophosphamide (CY) and ATG regimen was reported to be insufficient for alternative donor BMT in SAA patients due to high incidence of graft rejection. The rates of graft rejection and GVHD after allogeneic BMT including unrelated donor transplants seemed to be lower in reports from Asian countries of Far East. We applied CY/ATG regimen to six patients with early stage of SAA transplanted with marrow from alternative donors other than HLA-identical siblings. Methods: Three patients were transplanted from HLA-phenotypically identical unrelated donors, two from one-locus mismatched unrelated donors, and one from an one-locus mismatched sibling donor. Four patients received no previous therapy for SAA, and two received one course of immunosuppressive therapy with ATG. Preparative regimen was CY (200 mg/kg) plus ATG (90 mg/kg) in all patients except one who had had an anaphylactic reaction to ATG prior to BMT and received fludarabine (90 mg/m2) in place of ATG. Cyclosporine plus methotrexate were given for GVHD prophylaxis. Results: All six patients engrafted and all are alive with durable engraftment at a median follow-up of 406 days (range, 328 to 643). Two patients developed grade III acute GVHD and extensive chronic GVHD. Conclusions: CY/ATG regimen may be sufficient in Korean patients with early stage of SAA transplanted with marrow from alternative donors. Although the number of patients in present study is small, results are encouraging. Stem cell transplantation using alternative donors may be considered at early stage of aplastic anemia.

정신분열병 환자에서 얼굴 영상의 작동기억 장애 : 기능자기공명영상연구

이창욱,김태석,주라형,박주미,박여진,김종진,전신수,배치운,김정진,이수정,이철,백인호 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : Impaired processing of facial information is one of the broad ranges of cognitive deficits seen in patients with Schi-zophrenia. We aimed to elucidate the differences in brain activities involved in the process of facial working memory between schizophrenic patients and healthy comparison subjects. Methods : Twelve patients with schizophrenia were recruited along with twelve demographically matched healthy volunteers as a comparison group. Functional magnetic resonance imaging (fMRI) was used to assess cortical activities during the Perfor-mance of a 2-back working memory paradigm using images of neutral faces as mnemonic content. Rcsults : The patient group performed the tasks with reduced accuracy. Group analysis revealed that the left fusiform gyrus, the right superior frontal gyrus, the bilateral middle frontal gyri/insula, the left middle temporal gyrus, the precuneus, the quadrangular lobules and the vermis of cerebellum showed decreased cortical activities in the patient group. On the other hand, an increased level of activation in the lateral prefrontal cortex and the pahetal lobule was observed from the patient group, all in the right hemisphere. Conulusion : A decreased level of activity in the left fusiform gyrus among the patient group implicates inefficient processing of facial information. An increased level of activation in prefrontal and parietal neural networks from the patient group confirms earlier findings on the impaired working memory of patients with schizophrenia.

주요 우울장애가 동반된 혈액 종양 환자에서 Paroxetine의 효과 및 안정성

배치운,이혁재,김정진,이창욱,이수정,이철,백인호 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.4

Objectives : The efficacy and safety of paroxetine in the treatment of depressive disorders are well known, however its efficacy and safety for the treatment of depression in patients with cancer has been poorly studied. This study therefore aimed to evaluate the efficacy and safety of paroxetine in treatment of depressed patients with hematological malignancy (HM). Methods : Fifty-two patients with major depressive disorder (MDD) based on DSM-IV criteria along with comorbid HM were allotted to 8 weeks trial with a flexible-dose regime of paroxetine in combination with their chemotherapy or supportive pharmacotherapy. Treatment response was assessed at baseline, week 2, week 4, and week 8 with 17-item Hamilton Rating Scale for Depression (HAM-D17), Montgomery A sberg Depression Rating Scale (MADRS), and Clinical Global Impression-severity (CGI-S). Side effects were collected with the reported adverse events and laboratory test throughout the study period. Results : 44.2% of 52 patients completed the eight weeks trial. Scores on the HAM-D17, MADRS, and CGI-s (last Observation carried forward, LOCF) at baseline were significantly reduced with mean reduction of 30.5%, 32.8%, and 39.1%, respectively, after 8 weeks treatment with paroxetine. Forty-six patients (88.5%) reported at least one adverse event. The most common adverse event observed in this study was nausea and no serious adverse event was found. Conclusion : In this preliminary study, overall results showed paroxetine could be used for the treatment of depressed patients with HM, but more controlled study is needed to confirm the efficacy and safety of paroxetine in this area.

Fluoxetine 투여와 관련된 양측 측두하악관절 손상 1예

배치운,김연주,김태석,김정진,이창욱,이수정,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

We hereupon present a case of injured temporomandibular joint (TMJ) associated with fluoxetine monotherapy-inducedrepeated yawning. Further information is needed regarding the relationship between fluoxetine administration and clinically significant yawning. Clinicians should be more careful to listen to their patients when they describe unexpected reactions to medications.

정신분열병 환자에서 올란자핀과 연관된 체중 증가에 대한 니자티딘과 효과 : 예비 연구 A Pilot Study

배치운,정유경,이창옥,이수정,이철,백인호 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.1

본 연구는 올란자핀을 투여 후 체증 증가가 관찰된 정신분열병 환자들을 대상으로 nizatidine의 효과를 조사하고자 시도되었다. 올란자핀을 처으 투여 받은 환자들 중 체중 증가가 발생된 10명을 대상으로 하였다. 모든 환자에게 nizatidine을 300mg/day로 투여하였으며 임상 증상에 미치는 영향을 배제하기 위하여 PANSS와 BPRS를 기저 시점과 nizatidine 투여 후 4주 및 8주 시점에 측정하여 임상 증상의 변화를 평가하였다. 연구 시작 후 4주 및 8주 시점에서 체중 변화는 각각 1.1kg(1.5%)와 2.5kg(3.5%)이었으며 BMI의 경우 4주와 8주 시점에서 각각 0.4(1.6%)와0.9(3.7%)로 연구 기간동안 모두 유의한 감소를 보였다. 올란자핀을 복용하여 체중 증가가 관찰되었던 10명의 정신분열병 환자를 대상으로 하여 8주간 nizatidine을 투여한 결과, 연구 방법상의 제한점이 있으나 nizatidine은 올란자핀 관련 체중 증가의 치료에 효과적인 약물로 생각된다. Objectives:This pilot study was conducted to evaluate the effect of nizatidine on olanzapine-associated weight gain(OAWG) in schizophrenic patients in Korea. Methods:Ten subjects with OAWG from outpatients clinic who were diagnosed with schizophrenia and schizophreniform disorder in accordance with DSM-IV criteria. Positive and Negative Syndrome Scale(PANSS) and Brief Psychiatric Rating Scale(BPRS) were measured at baseline, week 4 and week 8 as were weight and Body Mass Index(BMI). A flexible dose of olanzapine plus fixed 150mg(b.i.d) dose of nizatidine was administered to all patients. Weight and BMI(kg/m^2) were recorded at each visit. Results:A combination of nazatidine resulted in significant reversal of OAWG without worsening the psychopathology. In the with studies of Western populations, an add-on therapy of nizatidine could be an effective option for the control of weight gain in olanzapine-treated patients in Korea. Conclusion:Our finding call for further evaluation of the effect of this drug on schizophrenics, with randomized placebo-controlled studies, in Asian populations.

정신분열병과 Glutathione S-Transferase M1유전자 다형성

배치운,조자현,김연주,김태석,김정진,이창욱,이수정,전태연,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.5

Objectives : This study aimed to test the possible association between Glutathione S-Transferase Ml gene (GSTMl) variants and schizophrenia. Methods : One hundred and eleven inpatients with schizophrenia and 130 healthy controls were recruited. Genotyping was performed by polymerase chain reaction-based method. Results : The GSTMl null genotype was significantly more frequent in patients with schizophrenia than in controls (p=0.014, odd ratio=1.93, 95% confidence interva1=1.115-3.351), while GSTMl genotype vahants were not associated with either tardive dyskinesia (TD) or total Abnormal Involuntary Movement Scale (AIMS) scores. Conclusion : The present study suggests that the GSTMl polymorphism may confer susceptibility to the development of schizophrenia but not to TD, at least in Korean population.

Monocyte Chemoattractant Protein-1[MCP1] -2518 유전자 다형성과 주요 우울장애

배치운,이지현,신윤경,김태석,김정진,이창욱,이수정,전태연,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Object : This study was designed to examine the association between monocyte chemoattractant protein-l (MCPl) -2518poly morphism and major depressive disorder (MDD). Methods : Ninety patients with MDD and 114 healthy controls participated in this study. Genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism method. Results : Genotype and allele distributions in patients with MDD were significantly different from those of the controls, In particular, subjects with the allele A were found to have an increased risk of MDD. Conclusion : The present study suggests that the MCPl -2518 polymorphism may have a potential role for susceptibility to MDD in the Korean population and thus calls for consecutive studies in order to pile up the data with larger different ethnic background.

양극성 장애와 Monocyte Chemoattractant Protein-1 유전자 다형성

배치운,김태석,장우영,김정진,이창욱,이수정,전태연,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.5

Objectives : Several studies suggested that cytokines could be involved in the pathogenesis of mood disorders, while data for bipolar disorder is relatively deficient (BD). BD, Knowned to have a inherited tendency, has been considered to be related with T-helper cell system. This study was designed to investigate the association between polymorphism of monocyte chemoattractant protein-1 (MCP1) gene at promoter-2518 and BD. Methods : Patients with BD (n=92) in accordance with DSM-FV criteria and control subjects (n=114) participated in this study. DNA was extracted from whole blood and the MCP-1 gene promoter region was amplified by polymerase chain reaction-based method. Results : Genotype and allele distributions in patients with BD were not different from those of control subjects (p=0.587 ; p=0.384). Genotype and allele distributions in accordance to presence or absence of suicide attempt (p=0.423), family history (p=0.733) and psychotic feature (p=0.436) were not different between the two groups. Conclusion : Present study suggests that the MCP1 promoter -2518 polymorphism may not affect the susceptibility and clinical diversity of the development of BD.

절수에 의한 Mongolian Gerbil 장기중량변화에 관한 분석연구

김무강,이기훈,이강이,송치원,이경열,권효정,박미선,정승혁,이행연,김명철 충남대학교 수의과대학 동물의과학연구소 2000 動物醫科學硏究誌 Vol.8 No.-

In this study, authors measured the each organ weight of the long term water deprived Mongolian gerbil, after then we calculated the mean, standard deviation, variance coefficient of the real measured organ weight and induced the organ weight change quantity, rate of quantity, deviation between measured and theological organ weight, deviation rate, sum of deviation rate, organ weight change rate, rate of organ weight by the mathematical formula. The results obtained as follow 1. The weight of the brains, lung, and testis were abruptly decreased after water deprived until the 5th day, after then slowly decreased until the 20th day. 2. The weight of the heart was decreased gradually from the first day until the 20th day. 3. The weight of the liver was abruptly decreased until the 10th day, after then the more slowly decreased until the 20th day. 4. The weight of the thymus, spleen, kidney, and pancreas were abruptly decreased until the 15th day, after then increased slowly until 20th day but the weight of the kidney was abruptly increased from the 10th day. 5. The organ weight change rate and the rate of the each day organ weight were very diversified.

리스페리돈과 올란자핀이 투여된 정신과 환자들에서 간 효소 변화에 대한 후?적 연구

임현국,배치운,박석준,김정진,이창욱,이수정,이철,백인호 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.3