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HBeAg 양성 만성 활동성 간염의 치료에 있어 α2b-Interferon의 효과 및 안정성에 관한 연구
신동현 ( Sin Dong Hyeon ),김신묵 ( Kim Sin Mug ),한상우 ( Han Sang U ),김세종 ( Kim Se Jong ) 대한내과학회 1993 대한내과학회지 Vol.44 No.1
연구배경 : B형 만성 활동성간염에서 B형 간염바이러스와 지속적인 증식은 만성 활동성간염의 간경변증과 원발성 간암으로 천이하는데 중요한 요인으로 알려져 B형 만성 활동성간염의 치료에 B형 간염바이러스의 증식을 억제할려고 하는 노력들이 진행되었었다. 그러나 최근에는 면역기능조절 장애가 만성 활동성 간염의 발생에 중요한 요인임을 감안하여 면역조절기능과 항바이러스 작용을 동시에 갖고 있는 interferon으로 만성 활동성간염을 치료해 보려는 연구들이 시도되고 있다. 방법 : 저자는 HBeAg 양성인 만성 활동성간염 환자 28예를 대상으로 합성 interferon 인 Intron-A^(R)을 1회에 300만 단위로 1주에 3회씩 12주간 피하주사하고 B형 간염 바이러스 증식의 표지자인 HBV DNA 및 HBeAg의 음전율과 간기능의 변화, 말초 혈액소견의 변화, BUN, 혈청 Creatinine, 요검사소견의 변화 및 부작용들을 2년간 추적 관찰하였기에 그 결과를 보고하는 바이다. 결과 : 1) 6주이상 지속적으로 음전된 HBeAg음전율은 HBeAg양성인 27예중 10예로 37% 이었다. 2) 6주이상 지속적으로 음전된 HBV DNA 음전율은 HBV DNA 양성인 187예중 16예로 88% 보였다. 3) 혈청 AST 및 ALT치는 투여 2주째부터 감소하기 시작하여 2년까지 투여 시작전에 비해 유의하게 감소된 상태를 유지하고 있었다(p<0.05). 4) 말초 혈액소견은 투여 2주째부터 백혈구, 과립백혈구 및 혈소판수의 감소가 관찰되었으나 6주내지 8주부터 증가하기 시작하여 24주경부터는 투약전의 상태로 정상화 되었다. 5) BUN, 혈청 creatinine 및 요검사 소견은 2년간 추적관찰에서 이상없이 모두 정상이었다. 6) a_2b-interferon 투여로 인한 부작용은 발열(89%), 근육통(89%), 피로감(67%), 두통(57%), 식욕부진(50%), 오심(35%), 주사부위 피부발진(25%), 설사(17%), 탈모증(7%), 불면증(3%), 극심한 전신 근무력중(3%)등의 순이었으나 전례에서 경미한 정도였고 6주째 극심한 근무력증을 호소한 1예에서는 투여를 중단하였다. 결론 : B형 만성 활동성 간염 환자에서 300만 단위 IFN를 주3회, 12주간 피하투여하는 방법은 HBV DNA와 HBeAg을 소실시키며 aminotransferase를 감소 또는 정상화 시키고, 조혈기관이나 신기능에 장애를 일으키지 않고, 심한 임상적 부작용을 나타내지는 않는 비교적 안전한 치료방법으로 생각되었다. Background : It was Known that the persistent replication of hepatitis B virus in chronic active hepatitis was an important cause of developing liver cirrhosis and hepatocellular carcinoma and several antiviral agents was tried in protecting viral replication. But recently, interferon functioning as an immune modulator and antiviral agents has been tried in treating chronic active hepatitis B. Methods : The efficacy and safety of recombinant interferon a_2b (Intron-A^(R) was studied in twenty eitght cases with HBeAg positive chronic active hepatitis (CAH). Three million units of interferon were administrated subcutaneously three times a week for 12 weeks. The negativity of HBV DNA and HBeAg,m activities of aminotransferase, BUN, serum creatinine and urinalysis were followed up for 2 years in 28 cases with HBeAg positive CAH. The peripheral blood white blood cell, granulocyte and platelet count were followed-up for 2 years. The negativity of HBV DNA and HBeAg was regarded as persistent negativity more than 6 weeks in follow up period. Results : the result were as follows 10 HBeAg negativity more than 6 weeks for 2 years were observed in 10 cases (37%) out of 27 cases. 2) HBV DNA negativity more than 6 weeks for 2 years were observed in 16 cases(88%) out of 18 cases with HBV DNA positive cases. 3) During administration of interferon, serum aspartate aminotransferas (AST) and allanin aminotransferase (ALT0 were decreased significantly from the 2nd week after th initial injection to the 116th week (p<0.05). 4) The peripheral white blood cell, granulocyte and platelet counts were decreased from the 2nd week but recovered from the 6th to the 8th week in 28 cases. These were within normal limits within 24 weeks. 5) There were no specific changes in BUN, serum creatinine and urinalysis by a_2b-interferon administration. 6) Fever(89%), myalgia(89%), fatigue(67%), headache(57%), anorexia(50%), nausea(35%), skin eruption at injected site (21%), diarrhea(17%), alopecia(7%), insomnia(3%) and severe generalized muscle weakness (3%) were noted in the first few weeks as adverse effects. But these were mild in all cases and subsided within first few weeks. We stopped the injection in a case with uncontrollable severe generalized muscle weakness at the 6th week. Conclusion : In chronic active hepatitis B, a subcutaneous administration of three million units of interferon at interval of theree times a week for 12 weeks can be used safely without a significantly adverse effects. Also it may cause a loss of HBV DNA and HBeAg and reduce or normalize the titers of aminotransferase.
위점막에서 Helicobacter pylori 분포의 내시경적 진단
주영은(Young Eun Joo),김신묵(Sin Mook Kim),김태두(Tae Du Kim),신동현(Dong Hyun Sin),성종호(Jong Ho Seong),안영주(Young Joo Ahn),정용환(Yong Hwan Jeong),양대현(Dae Hyun Yang),유종선(Chong Sun Rew),윤종만(Chong Mann Yoon) 대한내과학회 1994 대한내과학회지 Vol.46 No.1
N/A Background: Since the successful isolation of Helicobacter pylori from the human gastric mucosa by Warren and Mashall, biosy studies have shown that this organism is closely related to chronic gastritis and peptic ulcer. However the distribution of this organism has been proved to be uneven and patchy on the gastric mucosa. The aim of this paper is to assess the distribution of this organism on human gastric mucosa in vivo by endoscopy. Method: To control the gastric pH around 4.0 to 6.0, premedication by the intravenous injection of ranitidine 50mg one hour before the endoscopy, was performed. And thereafter, 0.1% phenol red solution containing 0.5M urea was sprayed onto the mucosal surface of the stomach through the endoscope. A red color change was observed in a few seconds after spraying the phenol red solution. The red color change pattern was classified into three types: diffuse, regional and patchy type. Two biopsies were taken from the red color changed area and the unstained area for hitological and bacteriological study. Results: l) In 26 out of 33patients with chronic gastritis, the red color change was observed after spraying the phenol red solution. The diffuse, regional and patchy type in chronic gastritis patients were observed in 17, 5, 4 patients respectively. In peptic ulcer group, the diffuse type was observed in 6 and the regional and patchy type were observed in 3, 1 patients. 2) The bacteriological and histological identification of Helicobacter pylori was observed in 17 of 26patients (65.4%) With Chronic gastritis and 7 Of 10patiCIltS (70%) with peptic ulcer in the biopsy materials taken from the gastric mucosa showing a red color change with phenol red solution. But the organism was not found in the unchanged and unstained mucosa except for one case of chronic gastritis. Conclusion: These results suggest that this endoscopic spraying technique may be useful to determining the distribution of Helicobacter pylori in human gastric mucosa.
만성간염 환자의 혈청에서 중합효소연쇄반응을 이용한 HBV DNA 및 HCV RNA 검출소견
박용욱(Yong Uk Park),서강석(Kang Suk Suh),한상우(Sang Woo Han),김신묵(Sin Mook Kim),최성규(Sung Kyu Choi),서순팔(Soon Pal Suh),김세종(Sei Jong Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.5
N/A Objectives: It is well-known that chronic hepatitis can be caused by hepatitis viral infection, drugs and toxins, inborn errors of metabolism, and autoimmume disease. Hepatitis B (with or without superimposed hepatitis D) and hepatitis C viral infections are known as the common causes of chronic viral hepatitis. Recently there have been several reports that chronic hepatitis and chronic liver disease can be caused by the superinfection or co-infection of HBV and HCV. We detected HBV DNA and HCV RNA in patients with chronic hepatitis using polymerase chain reaction and compared polymerase chain reaction with enzyme immunoassay in evaluating the presence of a superinfection or co-infection of HBV and HCV. Methods : Using sera from 61patients with histologically proven chronic hepatitis (chronic active hepatitis' 51cases, chronic persistent hepatitis: 10cases), we checked the HBV DNA and HCV RNA using polymerase chain reaction. We also checked the HBV and HCV markers using enzyme immunoassay. Results: 1) Only HBV DNA could be detected in 37patients (60.7%). HBV DNA and HCV RNA were detected in 11patients (18%). Only HCV RNA was dectected in 4patients (6.6%). Neither HBV DNA nor HCV RNA was found in 9patients (14.8%). 2) HBV DNA and HCV RNA were detected in 11patients (18%) whereas HBsAg or anti-HBe and anti-HCV were seropositive in 4patients (6.5%). 3) The positive rates of HBsAg and HBV DNA were 83.6% and 78.7%, respectively, and the positive rates of HBV DNA in HBsAg-positive cases and in HBeAg-positive cases were 90.2% and 93.0%, respectively. 4) The positive rates of anti-HCV and HCV RNA were 11.5% and 24.6%, respectively, and the positive rates of HCV RNA in anti-HCV positive cases and in anti-HCV negative eases were 85.7% and 14.8%, respectively. Conclusion: It has been suggested that hepatitis B viral infection is the most common cause of chronic hepatitis in Korea, and that hepatitis C virus might also play an etiological role. In this study, we found that 18% of chronic hepatitis patients were superinfected or co-infected with HHV and HCV, and that polymerase chain reaction was more sensitive than enzyme immunoassay to detect HBV and HCV infection when superinfection or Qo-infection was suspected.