단일 2차 기관에서 소아 마이코플라스마 폐렴 환자의 치료를 위한 스테로이드 사용 현황과 효과

유수지 ( Susie Yoo ),최성은 ( Seong Eun Choi ),전지영 ( Jiyoung Chun ),안요한 ( Yo Han Ahn ),조기영 ( Ky Young Cho ),이용주 ( Yong Ju Lee ),성태정 ( Tae Jung Sung ),이건희 ( Kon Hee Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Purpose: Steroids can be used as an adjuvant therapy in the management of mycoplasma pneumonia, but no definite guidelines for the use of steroids have been established. The purpose of this study was to analyze the current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital in Korea. Methods: We retrospectively reviewed the medical records of 152 patients who were admitted due to mycoplasma pneumonia. The patients were divided into 3 groups as follows: those who did not use steroids (81 patients, 53%), those who used steroids after their fever subsided (42 patients, 28%) and those who used steroids during fever (29 patients, 19%). Results: In decreasing order of values, the duration of fever during hospitalization (60.0±40.2 hours vs. 37.3±28.5 hours vs. 29.7±29.5 hours, P=0.006) and duration of hospitalization (5.9±1.7 days vs. 5.0±1.4 days vs. 4.0±1.5 days, P<0.001) were reported in the group which received steroids during fever, the group which received steroids after the fever subsided and the group which did not receive steroids. In the group which received steroids during fever, patients with early steroid use (within 24 hours) had a shorter fever duration in the hospital (12.0 hours vs. 73.5 hours, P<0.001) and a hospitalization duration (5.0 days vs. 6.5 days, P=0.007) than those with late steroid use (after 24 hours). Conclusion: Steroids were used in 47% of patients with mycoplasma pneumonia. The patients who received early steroids had a shorter fever duration and a shorter hospital stay than those who received late steroids. (Allergy Asthma Respir Dis 2018;6:122-127)

반복적 부동화 스트레스가 신경활성 Steroid의 GABAА 수용체 조절작용에 미치는 영향

강헌구,강병조,하정희 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.2

신경활성 steroid들은 중추신경계의 말초성 benzodiazepine 수용체에서 합성되고, GABAA 수용체 복합체상의 독립적인 인지부위에 작용하여, GABAA 수용체에 대하여 효현활성을 나타내며, 스트레스에 대응하여 유리되는 내인성 조절자로 시사되고 있다. 그러나 신경활성 steroid의 신경전달조절 활성을 스트레스에 대한 반응도(reactivity)와 연관시켜 연구한 것은 아직 미흡한 실정이다. 이에 본 연구에서는 Sprague-Dawley rat에 2주간의 반복적인 부동화 스트레스를 부하한 후 반복적 스트레스에 의한 신경활성 steroid 활성의 변화를 검색하고자 하였다. 그리고 스트레스에 대하여 과도한 반응성을 보일 것으로 보고된 borderline-hypertensive rat을 대상으로 신경활성 steroid의 억제성 신경전달계인 GABA성 신경전달 조절활성을 비교 관찰함으로써, 반복적 부동화 스트레스에 대한 실험동물의 반응성에 대한 연구의 일환으로 신경활성 steroid의 신경조절작용을 검색하고자 하였다. 이를 위하여 Sprague- Dawley rat의 대뇌피질세포막에 있는 GABAA-benzodiazepine 수용체 복합체에서 대하여 신경활성 steroid인 pregnanolone의 [³H]flunitrazepam 결합반응을 항진효과를 비교, 검색하였다. 본 실험결과, Sprague-Dawley rat의 대뇌피질세포막에 있는 GABAA-benzodiazepine 수용체 복합체에서 신경활성 steroid인 pregnanolone은 [³H]flunitrazepam 결합반응을 항진시킴으로써 GABAA 수용체에 대하여 효현 활성을 나타내었으며, 2주간의 반복적인 부동화 스트레스에 의해 이러한 pregnanolone의 활성은 증강되었다. 한편, 스트레스에 대하여 과도한 반응성을 보인다고 알려진 borderline-hypertensive rat의 뇌조직에서도 Sprague-Dawley rat에 비하여 항진된 GABA성 신경조절활성이 관찰되었으며, 스트레스 부하에 대해서도 유사한 반응성을 나타내었다. 이상의 결과로부터 반복적인 부동화 스트레스는 스트레스에 대한 반응성의 일환으로 신경활성 steroid인 pregnanolone의 GABA성 신경전달 항진작용을 증강시킨다고 생각되었으며, 스트레스 유발 고혈압의 질환모델로 보고된 BHR에서는 동일한 스트레스에 대하여 과도한 반응성을 나타냄으로써 스트레스 관련 말초질환에서의 중추성 병인인자의 참여 가능성을 시사해주었다. Pregnanolone[5β-pregnan-3α-ol-one(pregnanolone)] is one of neuroactive steroids that are reduced metabolites of progesterone. Pregnanolone synthesis in the neuron or glia was regulated by peripheral benzodiazepine receptor agonist, which was consistently observed to be upregulated in the acutely stressed animals and humans. Pregnanolone is a potent positive modulator of the γ-aminobutyric acid(GABA) response that enhance the binding of [³H] flunitrazepam to the GABAA receptor. Recently, it was reported that chronic treatment with pregnanolone uncouples allosteric interactions between steroid and benzodiazepine recognition sites in cultured neurons. The present study was designed to assess the effect of repeated stress on the modulation of neuroactive steroid on the GABAA receptor. The effect of steroid on the ligands binding to GABAA receptor was investigated using cerebral cortices of unstressed and repeatedly immobilized Sprague-Dawley rats and borderline-hypertensive rats. Pregnanolone enhanced the binding of [³H]flunitrazepam to GABAA receptor in both of unstressed and repeatedly stressed Sprague-Dawley rats. However, repeatedly stressed rats showed significantly lower values in EC50 and higher values in Emax of enhancement binding of [³H] flunitrazepam than those of unstressed rats. Borderline-hypertensive rats, which are known to be overreactive to stress, showed higher basal binding of [³H]flunitrazepam to GABAA receptor, similar to those of stressed Sprague-Dawley rats. Borderline-hypertensive rats, in both control and stressed groups, showed similar pharmacological activity of pregnanolone with Sprague-Dawley rats. From these findings, it can be concluded that repeated immobilization stress enhanced the positive modulation of neuroactive steroid on the GABAA-receptor complex, and these pharmacological activity of neuroactive steroid might be a defensive reactivity to stress of individuals.

Intratympanic Steroid Therapy for Sudden Sensorineural Hearing Loss

Yong-Soo Park,Eun-Ju Jeon 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.2

Introduction Sudden sensorineural hearing loss (SSHL) is defined as a hearing loss of 30 dB or more, affecting at least 3 consecutive frequencies, occurring within 3 days without any identifiable cause. It is relatively common disease, affecting 5 to 20 per 100,000 persons per year. The cause, pathophysiology, and management of SSHL are still not known. Spontaneous recovery in untreated patients has been reported as ranging from 38% to 65%.1,2,3,4)At this time, systemic administration of steroid is most commonly accepted treatment for SSHL. The use of systemic steroid for SSHL is originally based on the study by Wilson, et al.4) In their prospective, double-blind, clinical trial, they showed that patients with idiopathic sudden SNHL treated with systemic steroid had a statistically better recovery (78%) than patients receiving placebo or no treatment (38%). Moskowitz, et al.5) in 1984 showed similar response rate: 89% of steroid group showed recovery, while 44% of untreated patients showing recovery. On the contrary, Cinamon, et al.6) reported no significant differences between steroid and placebo in their prospective, placebo-controlled study, questioning the efficacy of steroid in SSHL. Systemic steroid has many side effects: immune suppression, weight gain, osteoporosis, avascular necrosis of the hip, mood swings, and skin and endocrine changes. The use of systemic steroid is contraindicated in patients with peptic ulcer, glaucoma, diabetes, tuberculosis, and those are pregnant. Intratympanic administration delivers medication into the inner ear through round window membrane. In 1996, Silverstein, et al.7) reported on the use of intratympanic steroid therapy for a refractory cases of SSHL and demonstrated a modest improvement in small number of patients. Since there had been no treatment option for the cases that are refractory to systemic steroid, the idea of topical administration of steroid via transtympanic route ignites numerous clinical trials for refractory cases and animal studies regarding the pharmacokinetics of steroid in the inner ear. An online search for the PubMed databases using the following terms "sudden hearing loss, intratympanic steroid" resulted in 81 listings. After excluding animal studies and review articles, we found 47 publications concerning clinical evaluation of the efficacy of intratympanic steroid injection (ITS) in SSHL patients since 1996 (Table 1). Among these, 15 articles have been published in 2011, showing an otologist's high interest on this subject in recent period. Many advantages of this procedure explains the enthusiasm for ITS. It can be done under local anesthesia at the office setting with relatively low cost, exerts its effect only at the affected ear, and bypasses systemic side effects of steroid. The technique is minimally invasive, easily to perform, and well tolerated by patients. Furthermore, through the animal study, it was proven that the perilymphatic concentration of corticosteroid is much higher when the medications were administered through a transtympanic route compared with systemic administration.8,9)Although many clinical studies have been performed enthusiastically, well-designed, prospective randomized controlled studies on this subject are relatively few. Thus, the optimum protocols including the time to start ITS, types and doses of steroid, and administration method are still in controversial. Here, we conducted a literature review regarding published researches on ITS to date to provide update information of this valuable treatment tool for SSHL. Mechanism of Action Intratympanically injected steroid enters the scala tympani through the round window membrane, while most of them is lost through the eustachian tube to the pharynx. Round window membrane is a semi-permeable membrane with outer squamous epithelial layer faces middle ear cavity and inner mesothelial layer continuous with the lining of the scala tympani.10) The lack of a continuous basem... Background and Objectives: Firefighters face serious risks to their health and safety in the performance of their duties. In addition to the diverse occupational hazards well-known to the public, firefighters are also occasionally exposed to high levels of noise, such as sirens, horns, and electronic alerting signals. Materials and Methods: We first measured the noise emitted by two fire trucks and one ambulance. Next, we enrolled 171 firefighters (164 males, seven females). We designated the employees of a private school as controls for the firefighter group. After selecting workers, including audiometric testing at 1,000 and 4,000 Hz, the groups were age- and gender-matched. Both groups were included separately for the right and left ears at pure-tone test frequencies at 1,000 and 4,000 Hz. We chose the better ear thresholds and analyzed the differences in hearing levels at each frequency and each age group between the firefighters and controls. Results: The sound pressure levels of the siren in and out of an ambulance, the first fire truck, and the second fire truck were 99.3 dB (A) and 108.9 dB (A), 92.3 dB (A) and 108.3, and 78.8 dB (A) and 99.0 dB (A), respectively. At 4,000 Hz, the hearing threshold was significantly increased by work period (p<0.01). Each hearing threshold level was significantly higher than controls (p<0.01). Conclusions: Many of the noise sources produce sounds exceeding 90 dB (A), and some firefighters may be exposed for brief periods to levels that exceed 105-110 dB (A). The hearing threshold level in firefighters is higher than the general population and noise-induced hearing loss in firefighters is possible. In the future, consistent, effective, and long-standing implementation of hearing conservation programs are needed, and special health examinations for hearing levels in firefighters must be conducted.

P022 : Topical steroid phobia among parents of children with atopic dermatitis in Korea

( Young Her ),( So Eun Park ),( Jin Yong Lee ),( Soo Jung Shin ),( Chang Sun Yoo ),( Chul Woo Kim ),( Sang Seok Kim ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Topical steroids are effective therapeutic agent for treatment of atopic dermatitis (AD). However, there is a vague phobia when using topical steroids among parents of children with AD due to lacking correct information about this subject. Objectives: The purpose of this study is to assess the current state of steroid phobia and the relationship of these concerns with level of adherence with treatment among parents of atopic children in Korea. Methods: 127 parents of atopic children were interviewed using structural questionnaire. Results: Overall, 67% of the parents were exposed to steroid phobia. There were statistically significant difference of steroid phobia according to awareness of side effects, application of topical steroids and relationship between topical steroid phobia and adherence (p<0.05). The most recognized side effects of topical steroids is skin atrophy and thinning (71.9%). The most prevalent source of information about steroid phobia is internet (49.2%). Degree of AD severity (odds ratio[OR]=5.332(moderate),9.040(severe) vs mild; p=0.001) and awareness of side effects of topical steroids (OR=2.658; p=0.021) were predictive factors for steroid phobia. Conclusion: Our study showed the prevalence of inaccurate information about topical steroids through other sources, not through a doctor, can lead to steroid phobia. Therefore, we emphasized the important role of dermatologists as a provider of appropriate information and education when using topical steroids.

근육병 모델에서 스테로이드가 HSP70 발현에 미치는 영향

임정훈,방문석 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.1

Objective: To investigate the effect of steroid administration on the apoptosis and heat shock protein 70 (HSP70) expression after exercise in the animal model of Duchenne muscular dystrophy. Method: We measured Bcl-2, BAX and HSP70 expression by western blotting. 20 control and 20 mdx mice were divided into free-living (n=10) and exercise (n=10) groups. Free-living and exercise groups were further divided into steroid-treated and sham-treated groups to evaluate the effect of steroid administration. Results: Apoptosis was most prominent in the sham-treated exercise group, while apoptosis was significantly reduced in the steroid-treated exercise group. HSP70 expression was maximized in sham-treated exercise group, whereas steroid administration inhibited HSP70 expression after exercise in muscular dystrophy animal model. Exercise loading was found to cause severe apoptosis but steroid administration alleviated apoptotic damage in mdx mice. Conclusion: HSP70 expression was suppressed in the steroid-treated exercise group, which suggests steroid might have major preventive effect in exercise-induced apoptosis of muscular dystrophy animal model. Objective: To investigate the effect of steroid administration on the apoptosis and heat shock protein 70 (HSP70) expression after exercise in the animal model of Duchenne muscular dystrophy. Method: We measured Bcl-2, BAX and HSP70 expression by western blotting. 20 control and 20 mdx mice were divided into free-living (n=10) and exercise (n=10) groups. Free-living and exercise groups were further divided into steroid-treated and sham-treated groups to evaluate the effect of steroid administration. Results: Apoptosis was most prominent in the sham-treated exercise group, while apoptosis was significantly reduced in the steroid-treated exercise group. HSP70 expression was maximized in sham-treated exercise group, whereas steroid administration inhibited HSP70 expression after exercise in muscular dystrophy animal model. Exercise loading was found to cause severe apoptosis but steroid administration alleviated apoptotic damage in mdx mice. Conclusion: HSP70 expression was suppressed in the steroid-treated exercise group, which suggests steroid might have major preventive effect in exercise-induced apoptosis of muscular dystrophy animal model.

국소 스테로이드 제제 사용에 관한 대학 병원 피부과외래 환자의 인식도 및 행태 설문 조사

김세연 ( Sei Yeon Kim ),이승동 ( Seung Dong Lee ),김형옥 ( Hyung Ok Kim ),박영민 ( Young Min Park ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.4

Background: Topical steroids are a widely used therapeutic agent in dermatology. However, little objective data has been collected in order to assess the awareness, knowledge and behavior of patients regarding the use of topical steroids. Objective: The goal of this study was to investigate the current state of awareness, knowledge, and behavior of patients regarding topical steroid use. Methods: A written questionnaire was distributed to 570 outpatients who visited the dermatologic clinics of the University Hospital. Of these, 504 were appropriate and thus were included in this study for further statistical analysis. The questionnaire consisted of 26 items concerning the overall evaluation of the awareness, and behavior of outpatients regarding their use of topical steroids. Results: The results demonstrated that of 504 patients included in the analysis, 53.8% bought topical steroids with a dermatologist`s prescription, whereas 33.6% obtained their topical steroids without prescription. The patient recognition rate of brand name, therapeutic effects, and side effects of topical steroids was 58%, 77% and 26%, respectively. Twenty percent of patients who have used topical steroids complained of side effects, the most common of which being pruritus (7.5% of cases). More than half of the patients said they obtained their information about topical steroids from sources other than the dermatologist. More than three quarters of patients (77%) applied topical steroids 1-2 times per day, whereas the overusers (4%) and the long-term users (16%) were applying topical steroids more than 5 times a day and longer than 16 weeks, respectively. Conclusion: The results indicate that topical steroids have been used without sufficient information and guidelines. Taken together, it is suggested that dermatologists should more thoroughly explain the therapeutic effects, indications, and side effects of topical steroids to their patients. (Korean J Dermatol 2008;46(4):473~479)

Physician education can minimize inappropriate steroid use in patients with inflammatory bowel disease: the ACTION study

박예현,최창환,김현수,문희석,김도현,김진주,Dennis Teng,박동일 대한장연구학회 2022 Intestinal Research Vol.20 No.4

Background/Aims: Epidemiological data on steroid use in South Korean patients with inflammatory bowel disease (IBD) are limited. We documented the steroid use patterns in these patients, and whether physician education on appropriate steroid use affected these patterns.Methods: ACTION was an observational cohort study conducted in adults (≥19 years) with IBD. A retrospective chart review was performed at baseline (cohort 1) and 1 year after physician training (cohort 2). Eligible cases with excessive or inappropriate steroid use were identified, along with any associated risk factors.Results: Data were collected during May 2018-July 2019 from patients with Crohn’s disease (CD) and ulcerative colitis (UC) in cohort 1 (n=1,685) and cohort 2 (n=1,649). At baseline, 155 patients (9.2%) had received steroids within the previous 12 months, 46 (29.7%) of whom had used steroids excessively, 16 (34.8%) of these having inappropriately used excessive steroids. Although steroid exposure was similar in cohort 1 (9.2%) and cohort 2 (9.7%), the latter comprised fewer excessive steroid users (20.0% vs. 29.7%). Severe disease was associated with excessive steroid use in cases with UC, but not with CD.Conclusions: Although, overall steroid use was relatively low in South Korean patients with IBD, one-third of steroid users used them excessively, and one-third among these used excessive steroids inappropriately. High disease activity was the main risk factor for excessive steroid use which may potentially be reduced by physician education, especially in cases with UC. Active screening to minimize excessive and inappropriate steroid use through physician education should be considered.

피부과 의사의 스테로이드 외용제 처방에 대한 설문조사

주혜영 ( Hye Young Ju ),김혜성 ( Hye Seung Kim ),임숙희 ( Sook Hee Lim ),이승동 ( Seung Dong Lee ),강훈 ( Hoon Kang ),김형옥 ( Hyung Ok Kim ),박영민 ( Young Min Park ) 대한피부과학회 2009 大韓皮膚科學會誌 Vol.47 No.9

Background: A recent survey on dermatology outpatients, which assessed their knowledge and behavior for topical steroid use, showed that topical steroids were often used without sufficient information or guidelines. Objective: Our study aimed to evaluate the general pattern of which dermatologists prescribe topical steroids, the prevalence of topical steroid phobia among the dermatology outpatients and the way dermatologists managed such patients. Methods: 236 dermatologists, including those in private clinics and those in the secondary and tertiary hospitals, were asked via mail or e-mail to fill in a questionnaire on their topical steroid prescription. Results: About sixty percent of the total respondents answered that they prescribed topical steroid to more than half of their outpatients, with excluding those patients who came to the office for cosmetic purposes. Most respondents informed their patients about their prescription of topical steroids (85.61%), they explained the mechanism of its action and the clinical effects (65%), the potency and duration of application (70%), and the side effects (82%). But most respondents forgot or did not tell their patients about their steroid formulation (46%), the optimal amount to apply (74%) and the means and duration of optimal storage (82%). 45% of the respondents assumed that more than half of the outpatients to have topical steroid phobia. Yet 80% of the respondents replied that less than 10% of their outpatients had experienced side effects of topical steroids. 73% of the respondents in private clinics and 62% in secondary and tertiary hospitals were influenced by the patients` negative attitude on topical steroid prescription. Conclusion: The results show that the information on topical steroids, in terms of formulation, the optimal amounts to apply and the means and duration of optimal storage, were not sufficiently provided by dermatologists. The topical steroid phobia of patients has been exaggerated despite the low incidence of side effects. (Korean J Dermatol 2009;47(9):1004∼1011)

돌발성 난청에서 스테로이드 투여 방법에 따른 치료 결과의 차이

정재호,김인식,김동환,윤형준,박철원,이승환 대한이비인후과학회 부산,울산,경남 지부회 2017 임상이비인후과 Vol.28 No.1

The aims of the study was to compare the treatment outcomes associated with the steroid administration routes in unilateral sudden sensorineural hearing loss. Methods:From January 1998 to December 2014, three hundred and eighteen patients with unilateral sudden sensorineural hearing loss were assessed. Among them, 34 patients received the intravenous dexamethasone (16 mg/day)while the others 284 patients received 1mg/kg prednisolone daily with a subsequently tapered dose. We performed a propensity score matching analysis using previously known prognostic factors including initial hearing level, presence of vertigo and duration of onset of treatment to compare treatment outcome of IV and oral steroid. The hearing recovery between the IV steroid group and propensity score matched oral steroid group was assessed according to the AAO-HNS guideline and Siegel’s criteria. Results:In the comparison between oral and IV steroid group, mean age, the initial hearing level was significantly higher in the oral steroid group than in IV steroid group (p=0.002, p=0.003) After propensity score matching, initial hearing level, age, sex and other clinical parameters were not significantly different between IV steroid and matched oral steroid group. In the treatment outcome, the complete recovery rate in IV steroid and the oral steroid group were 64.7% and 47.1% respectively. Although the recovery rate of the IV steroid group was higher than that of the oral steroid group, statistical significance was not identified. Conclusions:The administration route of systemic steroid did not affect the clinical outcomes of idiopathic sudden sensorineural hearing loss.

Clinical Characteristics of COVID-19: Use of Steroids in Mostly Unvaccinated COVID-19 Patients Before the Omicron Variant

Oh Sang-Min,Ham Sin Young,Suh Hyeon Jeong,Lee Eunyoung,Park Sang-Won 대한의학회 2022 Journal of Korean medical science Vol.37 No.29

Background: Glucocorticoids are one of the current standard agents for moderate to severe coronavirus disease 2019 (COVID-19) treatment based on the RECOVERY trial. Data on the real clinical application of steroids for COVID-19 are scarce and will help guide the optimal use of steroids. We described the current prescription pattern of steroids for COVID-19 and investigated the factors related to specific practices. Methods: All adults aged ≥ 19 years who were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction and admitted to one of 3 study hospitals from 8 December 2020 to 30 June 2021 were enrolled. Demographic and clinical data, including medications and oxygen therapy, were retrospectively collected from electronic medical records. The severity of comorbidities and COVID-19 were measured. The subjects were divided into steroid and nonsteroid groups, and the steroid group was then subdivided into standard and higher/longer groups. Results: Among a total of 805 patients, 217 (27.0%) were treated with steroids. The steroid group showed a higher rate of oxygen therapy (81.1% vs. 2.7%), more concomitant use of remdesivir (77.4% vs. 1.4%) or antibiotics (79.3% vs. 4.3%), and a higher proportion of high risk according to National Early Warning Score-2 score (30.0% vs. 0.9%) or severe risk according to National Institute of Allergy and Infectious Disease Ordinal Scale score (81.1% vs. 2.7%) than the nonsteroid group. The mortality of the steroid group was 4.6%. In the steroid group, 82.5% received a standard or lower dose of steroids within ten days, and 17.5% (38/217) received a higher or longer dose of steroids. Multivariate analysis showed that initial lymphopenia (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.89–0.99) and high level of lactate dehydrogenase (LDH) (aOR, 1.00; 95% CI, 1.00–1.01) were independent risk factors for higher doses or longer steroid use. Conclusion: The dose and duration of steroids were in line with current guidelines in 82.5% of COVID-19 patients, but the outliers may need tailored therapy according to surrogate markers, such as initial lymphopenia or high level of LDH.