간경변 환자에 발생한 비외상 횡문근융해증의 임상 특성

김민정 ( Min Jeong Kim ),이홍식 ( Hong Sik Lee ),김경진 ( Kyung Jin Kim ),정록선 ( Rok Son Choung ),임형준 ( Hyung Joon Yim ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hyun Choi ),김창덕 ( Chang Duck Kim ),류호상 ( Ho Sang Ryu ),현진해 대한소화기학회 2005 대한소화기학회지 Vol.46 No.3

목적: 횡문근융해증은 다양한 비외상 원인에 의해 발생할 수 있고 급성신부전 등의 합병증이 동반될 수 있는 질환이다. 그러나 간경변 환자들에서 발생한 비외상 횡문근융해증은 몇몇 산별적인 보고가 있을 뿐이고 임상 특성은 잘 알려져 있지 않은 상태이다. 저자들은 알코올 및 비알코올 간경변 환자들에게 병발된 비외상 횡문근융해증의 임상 특성을 알아보았다. 대상 및 방법: 2001년 10월부터 2004년 9월까지 고려대학교 안산병원 소화기내과에 간경변으로 입원한 환자 중 외상 없이 자발적인 횡문근융해증의 소견을 보인 19예를 대상으로 임상 특성, 검사 소견 및 치료 성적을 분석 하였다. 결과: 대상 환자 19예 중 남자 14예, 여자 5예였고, 평균연령은 49.6세(32-74세)였다. 알코올 간경변에 병발한 횡문근융해증군은 알코올(50.0%)이, 비알코올 간경변에 병발한 횡문근융해증군은 분명한 원인이 없는 자발적인 경우(69.2%)가 주된 원인이었다. 알코올 간경변에 병발한 횡문근융해증군은 대체로 비특이 증상을, 비알코올 간경변에 병발한 횡문근융해증군은 전형적인 증상을 호소하는 경우가 많았다. 대상 간경변군에서는 사망한 환자가 없었으나, 비대상 간경변군에서는 8명(57.1%)이 사망하여, 비대상 변화 유무에 따른 사망률의 유의한 차이를 보였다(p=0.04). 핍뇨는 8예(42.1%), 급성신부전은 12예(63.2%)에서 발생하였고, 전체 사망 환자 수는 8예(42.1%)였다. 핍뇨와 급성신부전이 발생하였을 때 사망률이 유의하게 증가하였다. 결론: 간경변 환자에서 비외상 횡문근융해증은 치명적인 결과를 초래할 수 있는 질환으로 특히 비대상 간경변 환자와 경과 중 핍뇨와 급성신부전이 발생한 경우에서 사망률이 높았다. 따라서, 간경변증 환자에서 횡문근 융해증의 발생 가능성을 항상 염두에 두고 의심될 경우 신속히 진단하여 적극적인 치료를 시행해야 한다. Background/Aims: Rhabdomyolysis is a serious and lethal condition that can be induced not only by traumatic causes but also by a variety of nontraumatic causes. However, there are few reports about rhabdomyolysis developed in patients with liver cirrhosis. We carried out this study to elucidate the clinical characteristics and courses of rhabdomyolysis in patients with liver cirrhosis. Methods: We analyzed 19 cases of nontraumatic rhabdomyolysis in patients with liver cirrhosis who had admitted at Korea University Ansan Hospital between October 2001 and September 2004. Results: Alcohol (50%) was the main etiology of rhabdomyolysis in alcoholic liver cirrhosis patients, and the precipitating factors were not apparent (69.2%) in majority of nonalcoholic liver cirrhosis patients with rhabdomyolysis. Nonalcoholic liver cirrhosis patients had complaints of pain referable to the musculoskeletal system, but alcoholic liver cirrhosis patients had no typical complaints. Mortality of rhabdomyolysis in liver cirrhosis patients was high (42.1%), especially in decompensated liver cirrhosis patients (p=0.04). In nonalcoholic liver cirrhosis patients, the development of oliguria (p=0.007) and acute renal failure (p=0.049) in the course of rhabdomyolysis increased the mortality significantly. Conclusions: In cirrhosis patients, rhabdomyolysis showed a poor prognosis, especially in nonalcoholic liver cirrhosis with oliguria, acute renal failure, or decompensated liver cirrhosis. It is believed that a high clinical suspicion for the occurrence of rhabdomyolysis in liver cirrhosis patients can lead to quicker recognition and better patient care. (Korean J Gastroenterol 2005;46:218-225)

Patients with Underlying Liver Disease without “Fibro-Cirrhosis” Should Be Carefully Managed to Improve the Survival Outcome in Pediatric Liver Transplantation: A Single Center Experience

( Suk Kyun Hong ),( Nam-joon Yi ),( Kwangpyo Hong ),( Eui Soo Han ),( Jeong-moo Lee ),( Kwang-woong Lee ),( Kyung-suk Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Although liver transplantation (LT) has become the standard for treatment of end-stage liver disease in children, there are still some complications that adversely affect the post-transplant outcome. The aim of this study is to identify the risk factors affecting the outcomes in pediatric LT. Methods: Data from pediatric patients who underwent primary LT at Seoul National University Hospital from March 1988 to December 2018, were retrospectively analyzed. Liver disease without “fibro-cirrhosis” was defined as explanted liver showing fibrosis regardless of grade or cirrhosis, or as underlying disease causing progressive liver injury and eventually leading to fibrosis or cirrhosis. Results: There were 255 pediatric LT patients and their 1-, 5-, and 10-year overall survival rates were 90.5%, 88.4%, and 87.8%, respectively and the 1-. 5-, and 10-year graft survival rates were 87.8%, 86.2%, and 84.9%, respectively. Multiple variate analysis identified that liver disease without fibro-cirrhosis as underlying disease (P=0.024) and PELD≥30 (P=0.036) were risk factors of overall survival and body weight <6kg (P=0.028), liver disease without fibro-cirrhosis as underlying disease (P=0.041), and postoperative hepatic artery complication (P<0.001) were risk factors of graft survival. Liver disease without fibro-cirrhosis was the only factor independently associated with hepatic artery complication (P=0.003). Conclusions: More caution is recommended in pediatric LT patients liver disease without fibro-cirrhosis to improve the survival outcome as well as patients with high PELD or low body weight. Hepatic artery complication was the only surgical complications affecting on the graft survival outcome especially in patients having liver disease without fibro-cirrhosis.

만성 간질환 및 간경변증에 동반된 간세포암 환자에서 혈청 보체치 측정의 의의

신창록(Chang Rok Shin),전용철(Yong Cheol Jeon),함준수(Joon Soo Hahm),이종철(Jong Chul Rhee),이민호(Min Ho Lee),이동후(Dong Hoo Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park) 대한내과학회 1991 대한내과학회지 Vol.40 No.2

N/A Serum complement levels were evaluated retrospectively in 68 patients with chronic liver diseases: 21 patients with chronic active hepatitis, 25 patients with liver cirrhosis, and 22 patients with hepatocellular carcinoma in liver cirrhosis. There was no significant difference in serum complement levels between the chronic active hepatitis patients and the control group. Serum complement levels were significantly reduced in the liver cirrhosis group compared with the chronic active hepatitis and normal control groups, while hepatocellular carcinoma in the liver cirrhosis group showed significantly high serum complement levels compared with the liver cirrhosis only group. Serum C3 levels correlated well with the serum albumin levels and prolonged prothrombin times in chronic active hepatitis and liver cirrhosis patients but not in the hepatocellular carcinoma patient group. The cutoff values of the complements for detection of hepatocellular carcinoma in patients with liver cirrhosis were set according to a retrospective study. Based on these data, a prospective study was performed to detect hepatocellular carcinoma in 58 patients with liver cirrhosis. The positive predictive values, negative predictive values, and accuracies of the complements were as follows: 83.3%, 79.4%, and 81.0% for C3, 87%, 80.0%, and 82.8% for C4 respectively. Thus, these data suggest that measuring serum complement levels may be helpful in the follow-up evaluation of patients with chronic liver diseases, and the combination of complements tests and α-fetoprotein test could be useful in the early detection of hepatocellular carcinoma in liver cirrhosis patients.

바이러스성 및 알코올성 간질환에서의 장투과성의 변화

김정욱 ( Kim Jeong Ug ),전우규 ( Jeon U Gyu ),윤중원 ( Yun Jung Won ),박동일 ( Park Dong Il ),조용균 ( Jo Yong Gyun ),성인경 ( Seong In Gyeong ),박창영 ( Park Chang Yeong ),손정일 ( Son Jeong Il ),김병익 ( Kim Byeong Ig ),김은정 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.2

Background/Aims: Increased intestinal permeability has been possible contributing factors to the pathogenesis of alcoholic liver disease. Moreover, it can contribute to the development of bacterial infection and intestinal endotoxemia in patients with liver cirrhosis. This study aimed to examine the difference of intestinal barrier dysfunction between alcoholic and viral liver disease patients through the comparison of the intestinal permeabilities of patients with clinical characteristics. Methods: Intestinal permeabilities were measured in 18 healthy controls, 41 patients with alcoholic liver disease (17 cases of alcoholic liver disease without cirrhosis and 24 cases of alcoholic liver cirrhosis) and 46 patients with viral liver disease (14 cases of chronic viral hepatitis and 32 cases of viral liver cirrhosis) by measuring 24 hour urine excretion of 51Cr-EDTA. Results: The intestinal permeability was significantly increased in the patients with alcoholic liver disease without cirrhosis (5.62±80%), alcoholic liver cirrhosis (5.29±48%) and viral liver cirrhosis (3.15±39%) compared with that in control subjects (1.99±53%). On the contrary, it was not increased in the patients with chronic viral hepatitis (2.05±57%) versus controls. The significant correlation was not found between intestinal permeability and clinical and laboratory findings. Conclusions: The intestinal permeability was elevated in patients with alcoholic liver disease compared to those with viral liver cirrhosis. The pathophysiology of liver injury secondary to intestinal epithelial damage may be different between alcoholic and viral liver diseases. (Korean J Gastroenterol 2004; 43:104-111)

Changes in Characteristics of Patients with Liver Cirrhosis Visiting a Tertiary Hospital over 15 Years: a Retrospective Multi-Center Study in Korea

Jang Won Young,정우진,장병국,황재석,이헌주,Hwang Moon Joo,Kweon Young Oh,Tak Won Young,Park Soo Young,Lee Su Hyun,Lee Chang Hyeong,Kim Byung Seok,Kim Si Hye,Suh Jeong Ill,Park Jun Gi 대한의학회 2020 Journal of Korean medical science Vol.35 No.29

Background: Liver cirrhosis has become a heavy burden not only for patients, but also for our society. However, little is known about the recent changes in clinical outcomes and characteristics of patients with cirrhosis-related complications in Korea. Therefore, we aimed to evaluate changes in characteristics of patients with liver cirrhosis in Daegu-Gyeongbuk province in Korea over the past 15 years. Methods: We retrospectively reviewed the medical records of 15,716 liver cirrhotic patients from 5 university hospitals in Daegu-Gyeongbuk province from 2000 to 2014. The Korean Standard Classification of Diseases-6 code associated with cirrhosis was investigated through medical records and classified according to the year of first visit. Results: A total of 15,716 patients was diagnosed with cirrhosis. A number of patients newly diagnosed with cirrhosis has decreased each year. In 2000, patients were most likely to be diagnosed with hepatitis B virus (HBV) cirrhosis, followed by alcoholic cirrhosis. There was a significant decrease in HBV (P < 0.001), but alcohol, hepatitis C virus (HCV), and non- alcoholic fatty liver disease (NAFLD) showed a significant increase during the study period (alcohol, P = 0.036; HCV, P = 0.001; NAFLD, P = 0.001). At the time of initial diagnosis, the ratio of Child-Turcotte-Pugh (CTP) class A gradually increased from 23.1% to 32.9% (P < 0.001). The most common cause of liver-related hospitalization in 2000 was hepatocellular carcinoma (HCC) (25.5%); in 2014, gastrointestinal bleeding with esophageal and gastric varices (21.4%) was the most common cause. Cases of hospitalization with liver-related complication represented 76.4% of all cases in 2000 but 70.9% in 2014. Incidence rate of HCC has recently increased. In addition, HCC-free survival was significantly lower in CTP class A than in classes B and C. Finally, there was significant difference in HCC occurrence according to causes (P < 0.001). HBV and HCV cirrhosis had lower HCC-free survival than alcoholic and NAFLD cirrhosis. Conclusion: In recent years, the overall number of cirrhosis patients has decreased. This study confirmed the recent trend in decrease of cirrhosis, especially of cirrhosis due to HBV, and the increase of HCV, alcoholic and NAFLD cirrhosis. Targeted screening for at-risk patients will facilitate early detection of liver diseases allowing effective intervention and may have decreased the development of cirrhosis and its complications.

Helicobacter pylori Infection and Peptic Ulcer Disease in Patients with Liver Cirrhosis

( Dong Joon Kim ),( Hak Yang Kim ),( Sung Jung Kim ),( Tae Ho Hahn ),( Myoung Kuk Jang ),( Gwang Ho Baik ),( Jin Bong Kim ),( Sang Hoon Park ),( Myung Seok Lee ),( Choong Kee Park ) 대한내과학회 2008 The Korean Journal of Internal Medicine Vol.23 No.1

Background/Aims: We investigated the prevalence and relationship of peptic ulcer disease and Helicobacter pylori infection to liver cirrhosis. Methods: We examined 288 patients with liver cirrhosis, 322 patients with non-ulcer dyspepsia, and 339 patients with peptic ulcer disease. Rapid urease test and Wright-Giemsa staining were used for diagnosis of H. pylori infection. Results: The prevalence of peptic ulcer disease in patients with cirrhosis was 24.3%. The prevalence of peptic ulcer disease in patients with cirrhosis divided into Child-Pugh classes A, B, and C was 22.3%, 21.0%, and 31.3%, respectively (p>0.05). The prevalence of H. pylori infection in the patients with cirrhosis, non-ulcer dyspepsia, and peptic ulcer without chronic liver disease were 35.1%, 62.4%, and 73.7%, respectively (p<0.001). The prevalence of H. pylori infection did not differ depending on whether there was peptic ulcer (35.6%) or not (34.9%) in patients with liver cirrhosis (p>0.05). The prevalence of H. pylori infection in patients with hepatitis virus-related liver cirrhosis and in the patients with alcohol-related liver cirrhosis was 42.5% and 22.0%, respectively (p<0.001). The prevalence of H. pylori infection in patients with Child-Pugh classes A, B, and C liver cirrhosis was 51.5%, 30.5%, and 20.0%, respectively (p<0.001). Conclusions: Factors other than H. pylori may be involved in the pathogenesis of peptic ulcer disease in the setting of liver cirrhosis.

포스터 전시 : 간경변증에서 잔존 간기능을 나타내는 지표: 아포지단백 A-1

이승룡,이호경,권혁진,문병식,이승옥,김대곤 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

Background/Aims: Apolipoprotein A-I(Apo A-I) is synthesized mainly by hepatocytes. It is decreased in alcoholic patients with liver fibrosis and cirrhosis. The mechanisms of serum apo A-I decrease in liver cirrhosis are unknown, but it has been shown that serum apo A-I measurement alone or in correlation with other biological data such as prothrombin time and r-glutamyl transferase, albumin and total bilirubin can serve as a marker of liver cirrhosis in alcoholic patients. The goal of this study was to to describe the changes of apo A-I according to the different stages of the liver cirrhosis, to correlate the changes to serum liver tests and to estimate its diagnosis, prognotic valuse and functional reserve of injuried liver. Mathods: We examed the value of apo A-I in 201 patients of liver cirrhosis and 138 patients of hepatocellular carcinoma in Korea. Results: The results showed that apo A-I concentration is highly related to the degree of liver injury, reaching a minimum in patients with severe cirrhosis. And apo A-I is correlated with biological marker of liver function such as albumin, prothrombin time, total bilirubin, α- macroglobulin. Apo A-I had an independent and discriminative value for the diagnosis of cirrhosis. This result was also observed not only in patients of alcoholic liver cirrhosis but also in patients of hepatocellular carcinoma due to hepatitis B. Conclusions: Our results suggest that serum Apo A-I is index for functional reserve in the irreversible liver disease such as cirrhosis of liver and hepatocellular carcinoma.

LC : Effects of Oral Branched Chain Amino Acid on Serum Albumin Concentration in Patients with Liver Cirrhosis

( Do Seon Song ),( Sang Hyun Hong ),( Jaemin Lee ),( Hee Yeon Kim ),( Sung Won Lee ),( Myeong Jun Song ),( Si Hyun Bae ),( Jong Young Choi ),( Seung Kew Yoon ),( Jin Mo Yang ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Patients with liver cirrhosis often develop hyperdynamic circulation, characterized by decreased systemic vascular resistance and increased cardiac output. We investigated the clinical factors predictive of hyperdynamic circula tion in patients with liver cirrhosis. Methods: Seventy-six consecutive patients who underwent living donor liver transplantation (LDLT) were included. Among these patients, 59 had liver cirrhosis and 17 had fulminant hepatitis. Hemodynamic markers were measured after induction of anesthesia during LDLT, and the relationships between these markers and the pre-transplantation clinical parameters were analyzed. Results: There were no significant differences in the median cardiac output (CO), systemic vascular resistance index (SVRI), or cardiac index (CI) between fulminant hepatitis and liver cirrhosis. In liver cirrhosis, the Model for End-Stage Liver Disease (MELD) score was negatively correlated with the SVRI (P=0.035). The median CI value of the patients with systemic inflammatory response syndrome (SIRS) was significantly higher than that of patients without SIRS (P=0.002) in those with liver cirrhosis. On multivariate analysis, a low SVRI less than 1500 dyne?s/cm5/m2 was associated only with a high MELD score above 15 [OR 7.43 (95% CI 1.25-44.12); P=0.027], and the presence of SIRS was the only factor predictive of high CI over 4 L/min/m2 [OR 6.44 (95% CI 1.01-41.30); P=0.049] in patients with liver cirrhosis. No clinical factors were significantly predictive of hyperdynamic circulation in the fulminant hepatitis patients. Conclusions: High MELD score and SIRS appeared to be predictive of a low SVRI and high CI in liver cirrhosis patients.

간경변증에서 잔존 간기능을 나타내는 지표: Apolipoprotein A-I

이승룡 ( Seung Young Lee ),김소영 ( So Young Kim ),안득수 ( Deuk Soo Ahn ),이수택 ( Soo Teik Lee ),김대곤 ( Dae Kon Kim ) 전북대학교 의과학연구소 2005 全北醫大論文集 Vol.29 No.2

Background: Apolipoprotein A-I (Apo A-I), a 28 kd protein, is synthesized mainly by hepatocytes. It is decreased in alcoholic patients with liver fibrosis and cirrhosis. The mechanisms of serum apo A-I decrease in liver cirrhosis are unknown, but it has been shown that serum apo A-I measurement alone or in correlation with other biological data such as prothrombin time and r-glutamyl transferase, albumin and total bilirubin can serve as a marker of liver cirrhosis in alcoholic patients. Material and prupose: This study of apo A-I has been undertaken in 201 patients of liver cirrhosis and 138 patients of hepatocelluar carcinoma in order to describe the change of apo A-I according to dfferent stages of the liver cirrhosis, to correlate the changes to serum liver function tests and to estimate its diagnosis, prognostic values and functional reserve of injuried liver. Results: Results showed that apo A-I concentration is highly related to the degree of liver injury, reaching a minimum in patients with severe cirrhosis (Child-Pugh classification C). And apo A-I is correlated with biological marker of liver function such as albumin, prothrombin time, total bilirubin, a2-macroblobuiln. This is showed that apo A-I had an independent and discriminative value for the diagnosis of cirrhosis. This result was showed not only in patients of alcoholic liver cirrhosis but also in patients of hepatocelluar carcinoma due to hepatitis B. Conclusion: Our results suggest that serum Apo A-I is index for functional reserve in the irreversible liver disease such as cirrhosis of liver and hepatocelluar carcinoma.

간경변증 환자에서 체내 나트륨 대사변화와 그 기전에 대한 연구

채현기(Hyun Kim Chae),윤영무(Young Moo Yun),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Sohn),김호중(Ho Joong Kim),함준수(Joon Soo Hahm),박경남(Kyung Nam Park),기춘석(Choon Suhk Kee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4

N/A This prospective study was performed to evaluate the concentration of the serum sodium and its pathogenesis in 16 patients of liver cirrhosis without ascites and 8 patients with ascites who were admitted to Hanyang University Hospital from November 1992 to January 1993. In order to evaluate the pathogenesis of the hyponatremia, we measured the level of serum sodium, serum albumin, serum creatinine, creatinine clearance, 24 hour urinary sodium excre- tion, plasma renin activity(PRA), aldosterone and sympathetic activity in cirrhotic patients without ascites(Group I, n=16) and with ascites(Group II, n=8). Serum Na level and ex cretion of Na in 24 hour urine were decreased significantly in patients with decompensated liver cirrhosis(liver cirrhosis with ascites)(P=0.006). And the frequency of patients with hyponatrernia was high in liver cirrhosis with ascites(Group I:13%, Group II: 50% ). The serum albumin and creatinine clearance were significantly decreased in liver cirrhosis with as- cites(P=0.000, P=0.012). The PRA and serum norepinephrine were also significantly in- creased in liver cirrhosis with ascites(P=0.000, P=0.018). During hospital 10 days, the serum sodium concentration was significantly more decreased(P = 0.04, 136 + 1.9mEq/1132+ 2.6mEq/ 1) with significant weight loss and decreased creatinine clearance in liver cirrhosis with asci- tes. The serum concentration of sodium showed positive correlation with serum albumin(R=O. 6, P=0.004) and negative correlation with PRA(R=0.7, P=0.001) in all patients with liver cirrhosis. These findings indicate that the hyponatremia in liver cirrhosis is associated with de- creased creatinine clearance and disturbance of frea water excretion due to hypoalbuminemia, decreased effective circulatory volume, increased PRA and increased sympathetic activity. (Korean J Gastroenterol 1994; 26: 662 668)