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정현철 ( Hyun Chul Jung ),이수봉 ( Soo Bong Lee ),곽임수 ( Ihm Soo Kwak ),나하연 ( Ha Yeon Rha ) 대한내과학회 2003 대한내과학회지 Vol.64 No.3
목적 : 혈청 칼륨 측정 검사는 임상에서 흔히 시행되는 검사이며, 심한 저칼륨혈증은 사망률이 높고, 즉각적인 칼륨의 보충이 필요한 위험한 전해질 장애이지만 내과 입원환자에서 이에 대한 유용한 정보는 부족한 실정이다. 본 연구는 내과 입원 환자에서 저칼륨혈증의 빈도와 심한 저칼륨혈증 환자의 임상적 특징을 알아보고자 하였다. 방법 : 1999년 12월 2000년 6월까지 부산대학교 병원 내과에 입원하여 전해질 검사를 시행한 환자 3,124명 중 입원 기간 Background: Serum potassium level asses nt is one of the commonly requested laboratory tests, Hypokalemia is defined as a serum potassium level of less 3.5mEq/L, It can be potentially life-threatening when severe, due to its association with cardiac arrhy
신기능 저하 환자에서 99mTc - DMSA 신장 스캔을 이용한 신 섭취율과 사구체 여과율의 상관성
이수봉(Soo Bong Lee),정현철(Hyun Chul Jung),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),안승재(Seoung Jae An),정유석(Yoo Suck Jung) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.4
배 경 : 신기능 저하 환자에서 신기능을 정확히 평가하는 것은 중요하고, 다양한 방법으로 사구체 여과율(GFR)을 구하고 있다. 임상에서 흔히 ^99mTc-DTPA 신장 스캔과 99mTc-DMSA 신장 스캔이 개별 신기능의 평가에 많이 이용되고 있다. 본 연구에서는 99mTc-DMSA 신장 스캔을 이용하여 신피질 영상을 위한 1시간 상대적 신 섭취율과 사구체 여과율 사이의 상관성을 검토하고자 하였다. 방 법: 1998년 1월부터 2001년 3월까지 부산대학교병원 신장내과에 내원한 환자들 중 ^99mTc-DMSA 신장 스캔, ^99mTc-DTPA 신장 스캔, 혈청 크레아티닌, 24시간 요 중 크레아티닌을 검사한 65명의 환자들 중에서, 중증 및 중등도 신기능 저하 환자 42명을 대상으로 하였다. ^99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPA-GFR)에 따라 중증 신기능 저하군(A)과 중 등도 신기능 저하군(B)으로 나누었다(A군 : ≤20 mL/min/1.73㎡, n=20명, B군 : 20-50 mL/min/1.73㎡, n=22명). 99mTc-DMSA 신장 스캔을 이용하여 1시간 상대적 신 섭취율(DMSA-%uptake, TRUR)을 구하고, 이것을 99mTc-DTPA 신장 스캔을 이용한 사구체 여과율(DTPAGFR), 내인성 크레아티닌 청소율(Ccr), Cockcroft와 Gault가 고안한 추정 크레아티닌 청소율(C & G Ccr)과 Spearman rank correlation test를 이용하여 상관성을 비교하였다. 결 과 : 전체 42명의 대상 환자들 중에서 15명은 남자였고, 27명은 여자였다. 평균 나이는 54 세(28-80세)였다. 두 군에서 평균 DTPA-GFR과 평균 TRUR은 각각 통계적으로 유의한 차이 를 보였다(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p< 0.05). 그러나 TRUR의 DTPA-GFR에 대한 상관성을 보았을 때, A군에서는 유의한 상관관계는 없었으나, B군에서는 유의한 상관관계를 보였다(0.263, p>0.05 vs 0.731, p<0.01). 또한 TRUR의 혈청 크레아티닌, Ccr, C & G Ccr에 대한 상관성을 보았을 때, 두 군 모두에서 통계적으로 유의한 상관관계를 보였다. 결 론 : ^99mTc-DMSA 신장 스캔에서 신피질 영상으로 사용되는 1시간 상대적 신 섭취율은 실제 사구체 여과율을 정확하게 측정할 수는 없지만, 신기능이 중증이하로 감소되지 않은 경우에는 사구체 여과율을 간접적으로 반영하였다. Background : Glomerular filtration rate(GFR) is an important parameter for the evaluation and monitoring of renal function. The aim of this study was to investigate the correlation between the relative 1 hour uptake of 99mTc-DMSA renal scan(DMSA-%uptake, TRUR) and GFR which was estimated by 99mTc-DTPA, serum creatinine and 24 hour-urinary creatinine excretion. Methods : Between January 1998 and March 2001, 65 patients had undergone ^99mTc-DMSA renal scan, ^99mTc-DTPA renal scan, serum creatinine and 24 hour-urinary creatinine excretion. Of them, 42 patients had moderately or severely reduced renal function(DTPA-GFR ≤50 mL/min/1.73㎡). According to the DTPA-GFR level, patients were divided into two groups : Group A(n=20) with DTPA-GFR ≤20 mL/min/1.73㎡(mean±S.D. 14.8±4.7), Group B(n=22) with DTPA-GFR 20-50 mL/min/1.73㎡(mean±S.D. 34.9±8.4). Between the TRUR and other methods to estimate renal function such as DTPA-GFR, 24 hour-urinary creatinine clearance(Ccr) and Cockcroft & Gault`s formula(C & G Ccr), the correlation coefficient was measured by Spearman rank correlation test. Results : Of 42 patients, 15 were men and 27 were women(mean age 54 years; range 28-80 years). there were significant differences between mean DTPA-GFR and mean TRUR in both groups(14.8±4.7 vs 34.9±8.4 mL/min/1.73㎡, p<0.05; 8.9±3.7 vs 16.3±7.4%, p<0.05). In group A, TRUR(mean±S.D. 8.9±3.7%) was not significantly correlated with DTPA-GFR(r=0.263, p>0.05). In group B, TRUR (mean±S.D. 16.3±7.4%) was significantly correlated with DTPA-GFR(r=0.731, p<0.01). In both group, serum creatinine, Ccr and C & G Ccr were significantly correlated with TRUR. Conclusion : Although the relative 1 hour uptake of the ^99mTc-DMSA renal scan, as a method of renal cortical image could not estimate the true GFR, it showed a good correlation with GFR in patients with moderately reduced renal function. 99mTc-DMSA renal scan seems to be helpful to evaluate the renal function in patients with moderately reduced renal function.
패혈증에 의한 급성 신부전의 예견인자로서의 APACHE III prognostic system과 Liano system의 유용성
신호진(Ho Jin Shin),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),송상헌(Sang Heun Song),정현철(Hyun Chul Jung),배우형(Woo Hyung Bae),안승재(Seung Jae Ahn) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2
N/A Uncontrolled infection quite often 1eads to systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite advances in medical knowledge and technology, the mortality of patient with sepsis is still 35-60%, and even reach up to 50-90% in septic patients having acute renal failure. The purpose of this study was to examine the characteristics and predictive factors of progression to acute renal failure(ARF) in sepsis. We analyzed the bacteriologic and laboratory data of 54 admitted patients with SIRS(systemic inflam-matory response syndrome) at Pusan National University Hospital from July 1997 to July 1999(ARF 23 vs non-ARF 31). Multiple factor which may influence mortality and progression to AEK in sepsis, were evaluated and measured on admission day. The following of results, 1) Of the 54 patients, 23 were ARF group and 31 were non-ARF group. Mean age were,52 years and 51 years. The mortality of ARF group and non-ARF group were 78% and 23%, Urine output, albumin, cholesterol, mean arterial blood pressure and evidence of underlying disease were not statistically different in each group. 2) Although the sources of sepsis could not identified in 9%(ARF), 23%(non-ARF), the others had the primary site of infections ' gastrointestinal tract(35% vs 29%), lung(30% vs 19%), genitourinary tract(9% vs 13%), skin(17% vs 16%). 3) Although statistically not different, gram-posi-tive bacterial infection was more common in ARF group(mainly staphylococcus aureus). Culture negative results were 4 patients(ARF), 1 patient(non- ARF). 4) APACHE III score in ARF group was higher than non-ARF group(48.1±16.5 vs 30.2±15.6). Liafio score in ARF group was higher than non-ARF group(39.1±13.0 vs 28.9±8.3). 5) APACHE III score and Liailo score in non- survivors were higher than survivors(APACHE III score:48.6±15.3 vs 28.1±14.0, Liaho score:37.9±12.0 vs 29.4±9.2) 6) APACHE lII system was positively correlated with Liaho system(r=0.512, p=0.001). In conclusion, APACHE III system and Liaho system were significant predictors of progression to ARF and mortality in sepsis. In the future, prospec-tive and multicenter studies are required to improve the method of treatment and the prognosis in sepsis.
Interleukin-17이 배양된 류마티스관절염 활막세포에서 vascular endothelial growth factor 생성에 미치는 영향
곽임수 ( Ihm Soo Kwak ),남태수 ( Tae Soo Nam ),나하연 ( Ha Yeon Rha ),서정탁 ( Jeung Tak Suh ),김유선 ( Yoo Sun Kim ),김성일 ( Sung Il Kim ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.3
Objective: To investigate the the effects of interleukin-17 (IL-17) on the production of vascular endothelial growth factor (VEGF) from cultured rheumatoid arthritis synoviocytes. Methods: Fibroblast-like synovial cells(FLS) were prepared from the synovial tissues of rheumatoid arthritis patients and cultured in the presence of IL-17, IL-17 with or without transforming growth factor-β(TGF-β), tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β). VEGF levels were determined in the culture supernatants by sandwitch ELISA. Results: Stimulation of FLS by serial concentration of IL-17, TGF-β, TNF-α, IL-1β increased the production of VEGF by 2.1-2.7, 2.2-3.0, 2.0-2.9, 2.3-3.1 fold over the constitutive levels of unstimulated FLS. Stimulation of FLS by IL-17 with TGF-β or TNF-α or IL-1β also increased the production of VEGF according to culture periods by 1.6-1.8, 1.1-1.9, 1.5-1.7 fold over the levels stimulated with TGF-β or TNF-α or IL-1β, respectively. This results indicated that IL-17 increased the effect of TGF-β, TNF-α, IL-1β on FLS, leading synergistic enhancement of VEGF production. Conclusion: IL-17 may be involved in the neovascularization in rheumatoid synovitis by enhancing the production of VEGF.
초기 류마티스 관절염 환자에서 폐 질환 발생의 빈도와 연관인자
김성일 ( Sung Il Kim ),곽임수 ( Im Soo Kwak ),박순규 ( Soon Kew Park ),나하연 ( Ha Yeon Rha ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
Objective: To determine the frequency and associated factors of physiologic abnormalities indicative of lung disease in early rheumatoid arthritis (RA). Methods: Thirty-six early RA patients(mean age 43±12 years, 30 females, disease durations less than 12 months, mean duration 5±3 months), who had not been treated with disease modifying antirheumatic drugs (DMARDs), were studied. Clinical, laboratoy and radiologic variables such as age, sex, smoking history, past lung disease history, drug medication history, rheumatoid factor positivity, erythrocyte sedimentation rate (ESR), CRP and chest radiography, were undertaken. Pulmonary function tests (PFTs) were performed in all patients and results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height. Lung disease was defined as one or more of the followings should be present, 1) forced vital capacity (FVC) <80% for predicted, 2) diffusing capacity of carbon monoxide (DL(CO)) <80% for predicted, 3) forced expiratory flow from 25% and 75% of vital capacity (FEF 25-75%) <80% for predicted. Statistical comparisons were made using Student`s t test or chi-square test as appropriate. Results: All patients had normal chest radiography. Rheumatoid factor was positive in 21 patients (58%), smokers were 5 patients (14%), ESR and CRP were increased in 16 (44%) and 17 patients (47%). Ten patients (28%) had lung disease and included FVC<80% in 4, DL(CO)<80% in 4 and FEF 25-75%<80% in 6 patients. There was no significant predictor of lung disease. Conclusion: The frequency of lung disease in early RA by PFTs was 28% and there was no significant predictor of lung disease.