소변검사에 이상을 보인 류마티스양 질환에서 사구체기저막의 변화에 관한 연구

염주협(Ju Hyup Yum),홍은경(Eun Kyung Hong),박문향(Moon Hyang Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

류마티스 관절염을 포함한 류마티스양 질환에서 병의 경과 중 여러 종류의 신 질환이 나타난다. 본원에서 39명의 환자에서 시행한 40예의 신생검 진단은 막성 사구체신병증 10예, IgA 신병증 6예, 혈관간부증식성 사구체신염 4예, 유전분증 3예 간질성 신염 2예, 미세변화신질환 2예, 초점성 분절성 사구체경화증과 현미경적 다발성 혈관염이 각각 1예씩이었다. 또한 광학현미경(LM)상 정상이면서 현미경적 혈뇨를 보인 경우가 11예였다. 모든 예의 임상 및 약물 치료의 병력을 검토하였으며, 이중 전자현미경(EM) 표본에 사구체가 포함된 30예를 영상분석기로 사구체기저막(GBM)의 두께를 형태계측하여 비교하였다. 대조군으로는 류마티스양 질환이 없는 미세변화신질환(MCD)과 초박기저막병(TBMD)의 2개의 대조군을 이용하여 GBM의 두께를 측정 비교하였다. 미세사구체이상(Minor glomerular abnormalities, MGA)군 8예의 GBM의 평균 두께는 334.5±76nm로 MCD 대조군(390.6±39.3nm)보다 얇았으나 통계적으로 유의한 차이가 없었다 (p>0.01). 8예 중 EM상 각각 TBMD와 정상으로 판정된 2예을 제외한 6예의 GBM의 평균 두께는 344.7±31.6nm로 정상범위였으나, GBM이 300nm 미만으로 얇아진 부분의 비율은 측정부위의 30.3-40.5%(평균35.2%)로 MCD 대조군(11.4%)에 비행 유의하게 분절성으로 얇아져 있었다(p=0.02). MGA군 8예 중 EM상 TBMD로 진단된 1예는 GBM의 두께가 평균 175.1±27.0nm로 미만성으로 얇아져 있었으며, 다른 1예는 300nm 미만인 부분이 2%로 정상이었다. 다른 질환군에서도 GBM이 얇아진 분절의 비율이 증가되어 있었다. 분절성으로 얇아진 범위는 IgA 신병증이나 혈관간부증식성 사구체 신병증 군에서는 23.8%, MCD/FSGS 군은 22.1%, 막성 사구체신병증 군은 30.3%, 유전분증은 25.5%, 1예의 현미경적 다발성 맥관염의 예는 79.1%가 300nm이하로 분절성 변화를 나타내었다. 이러한 GBM의 변화는 류마티스양 질환에서 사용하는 다양한 치료약물에 의한 영향으로 생각되나, 본 연구에서 약물사용과의 연관성은 발견하지 못하였다. 이상의 결과로 류마티스양 질환을 가진 환자의 경과 중 나타나는 신장의 이상은 형태학적으로 다양하며 특히 LM상 정상으로 보이지만 세뇨관 내강에 적혈구가 있는 경우 EM상 GBM두께의 변화가 있을 수 있으므로, EM검사로 GBM의 변화를 세밀하게 검사하고 분절성으로 GBM두께가 감소하는지 확인하는 것이 필요하며, 이러한 사구체 질환이나 GBM의 초미세변화가 질병에 의한 것인지, 약물에 의한 것인지 확인하기 위하여서는 더 많은 예를 대상으로 한 전향적 연구가 필요하다. We reviewed forty renal biopsies from 39 patients of rheumatoid disease with urinary abnormalities. Pathologic findings were as follows: 11 cases with normal or minor glomerular abnormalities(MGA), 10 with membranous glomerulonephropathy, 6 with IgA nephropathy, 4 with mesangial proliferative glomerulonephritis, 3 with renal amyloidosis, 2 with interstitial nephritis, 2 with minimal change disease(MCD), 1 with focal segmental glomerulosclerosis, and 1 with microscopic polyangiitis. Among 11 cases with MGA both in light and immunofluorescent microscopy, 8 cases were analyzed morphometrically with electron micrographs to determine the variation of thickness of the glomerular basement membrane. The mean GBM thickness was 334.5±76nm and was not statistically significantly different to that of control(391±39 nm, p>0.05). Of these, one case showed diffuse attenuation of GBM(175.1±27.6nm) to meet the criteria of thin basement membrane disease. Also, another case showed normal finding. Mean GBM thickness of the remaining 6 cases, excluding these 2 cases, was 344.7±31.3nm. The proportion of attenuated foci (less than 300nm) was increased ranging from 30.3% to 40.5% of total measurements of GBM(control 11.4%, p<0.02). Another cases with distinct renal dis- eases also showed segmental attenuation of GBM (22-30.3%). In conclusion, the renal manifestations were variable in patients with rheumatoid disease and segmental thinning of GBMs was noted in most cases, which may evoke idiopathic hematuria during the course of RA. The renal morphologic lesion in RA patients with isolated proteinuria and those with hematuria can not be accurately predicted on the ba- sis of clinical symptoms and signs. Prospective longterm studies are necessary to determine the nature and consequences of the condition.

당뇨병 환자에서 고위험 관상동맥 중재술시 혈소판 당단백 IIb / IIIa 수용체 차단제 ( Abciximab : ReoPro ) 의 장기 임상 효과

심두선(Doo Sun Sim),정명호(Myung Ho Jeong),김원(Weon Kim),류제영(Jay Young Rhew),염주협(Ju Hyup Yum),김주한(Ju Han Kim),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),안병희(Byoung Hee Ahn),김상형(Sang Hyung Ki 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background: High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate, especially in diabetics. We sought to observe whether diabetes affects long-term clinical outcomes after Abciximab (ReoPro) therapy in Korean patients undergoing high-risk PCI. Methods: One hundred nineteen patients with 152 lesion sites were administered ReoPro out of 2,231 patients who underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2001. They were divided into two groups, 30 in diabetic group (Group I, 57.7±8.2 years, 22 male) and 89 in non-diabetic group (Group II, 59.6±10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. Results: In clinical diagnosis the number of acute myocardial infarction was 25 in Group I (83.3%) and 76 in Group II (85.4%). As for risk factors and target lesion artery, ACC/AHA types, there were no differences between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%) and thrombus-containing lesion 28 (93.3%) and 88 (98.9%) in Group I and II respectively. Procedure was successful in 27 (90.0%) in Group I and 80 (89.9%) in Group II and there were no differences in bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death were observed in Group I, but there were 8 cases of MACE in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) during 18.5±6.7 (5∼28) months. The number of overall MACEs were 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). Conclusion: ReoPro used in high-risk PCI in diabetics was effective in early clinical outcome, but long-term clinical benefits were not warranted.(Korean J Med 62:171-181, 2002)

성인병 검진을 위해 내원한 60세 이상 노인에게서 연령증가에 따른 질환의 분포

김용훈(Yong Hoon Kim),곽현진(Hyun Jin Kwak),정홍배(Hong Bae Jeong),안명수(Myoung Soo Ahn),염주협(Ju Hyup Yum),조대경(Dae Kyoung Cho),남홍우(Hong Woo Nam),이홍순(Hong Soon Lee),유수웅(Soo Wong Yoo) 대한내과학회 1999 대한내과학회지 Vol.56 No.2

N/A With increasing life expectance and improvement of the overall health of the elderly, the understanding of geriatric disease becomes an important aspect of medical services. In the elderly, the frequencies of hypertension, DM, & anemia are increased according to aging and renal function is decreased progressively. As screening test for cervical cancer Papanicolaou smear is recommended due to its cost-effective benefits in females. In age-adjusted elderly male and female study populations, authors investigated the alterations of the above diseases, hypercholesterolemia, liver disease, obesity, & proteinuria distributions. Methods : This study included 1,181 aged 40 years (600 males, 581 females) visitors between January 1, 1997 and December 31, 1997 in National Medical Center, Seoul, South Korea. Authors divided these populations into two large groups such as group A and B. Group A was composed of 40-59 years, group B 60 years and older. Group A and B were subdivided into 4 subgroups each other, such as A-1, A-2, A-3 and A-4, B-1, B-2, B-3 and B-4 by means of age-adjusted dividing scale. We used our inclusion criteria to define each disease. Results : Hypertension was the most common disease in males of group B, but obesity was in females. The age-adjusted frequencies of hypertension, anemia, obesity & proteinuria were increased according to aging in the elderly aged 60 years and older. Though hypercholesterolemia revealed non-specific distribution in each group, increased frequency was observed in females compared to males in group B. With increasing their age, abnormal findings of Papanicolaou smear were found in females of group B. Conclusions : As the frequencies of hypertension, anemia, obestiy, proteinuria & abnormal findings of Papanicolaou smear were increased in the elderly aged 60 years and older as increasing their age. Much more attentions and follow up plans for these disease should be needed in the elderly.

증가된 C - Reactive Protein 은 관상동맥 중재술 후 재협착에 대한 유일한 예측인자

정우곤(Woo Kon Jeong),정명호(Myung Ho Jeong),김계훈(Kye Hun Kim),이상록(Sang Rok Lee),박옥영(Ok Young Park),염주협(Ju Hyup Yum),김원(Won Kim),김주한(Ju Han Kim),류제영(Jae Young Rhew),안영근(Youn Keun Ahn),조정관(Jeong Gwan Cho),안병희 대한내과학회 2002 대한내과학회지 Vol.62 No.4

연구배경: 최근에 동맥경화 및 관상동맥 질환의 발생의 중요한 역할을 하는 감염 및 염증인자에 대한 연구가 활발히 이루어지고 있다. 본 연구에서는 관상동맥 중재술 후 발생하는 재협착과 염증인자의 상관관계 및 CMV, C. pneumoniae, H. pylori 등의 감염과 상관관계에 대해서 전향적 조사를 하였다. 대상 및 방법: 1999년 9월부터 2001년 3월까지 처음으로 관상동맥 질환으로 진단된 후 관상동맥 중재술을 시행한 후 추적 관상동맥 조영술을 시행받았던 272예 중 재협착이 발생하였던 재협착군 (99명, 134병변, 59.5±10.8세)과 재협착이 발생하지 않았던 비재협착군 (173명, 211병변, 58.8±10.2세)으로 나누어, 양군간의 세 가지 감염항체의 양성률 및 역가와 CRP를 측정하여 재협착과 연관성 등을 전향적으로 분석하였다.결과: 재협착군과 비재협착군에서 C. pneumoniae, H. pylori, CMV의 항체 양성률은 각각 27.3%와 26.0%, 61.6%와 63.6%, 100%와 100%로서 양군간에 유의한 차이는 없었다. CRP의 양성률은 재협착군과 비재협착군에서 각각 57.6%와 36.4%로서 재협착군에서 유의하게 높았고 (p=0.001), CRP의 측정치는 3.38±5.80 mg/dL와 1.36±2.62 mg/dL로서 재협착군에서 유의하게 높았다 (p=0.001). 관상동맥 재협착 예측인자에 대한 다변량 회귀 분석에서 CRP는 상대위험도 2.1169, 95% 신뢰구간 1.2062∼3.7154 (p=0.009)로서 재협착 발생에 대한 유일한 독립적인 위험인자이었다. 결론: 추적 관상동맥 조영술상 재협착군과 비재협착군에서 C. pneumoniae, H. pylori, CMV의 항체 양성률은 양군간에 유의한 차이는 없었고 CRP의 양성률, 측정치 모두 유의하게 높았고, CRP는 재협착 발생을 예측할 수 있는 유일한 인자이었다. Background: Current techniques of percutaneous coronary interventions (PCI) remain limited by the restenosis. Recent studies provide evidence that inflammation plays a role in the pathogenesis of cardiovascular disease. Methods: We prospectively tested whether inflammatory markers are predictors of subsequent restenosis in 272 consecutive patients with angiographically proved coronary artery disease. The patients who underwent PCI at Chonnam National University Hospital between Sep. 1999 and Mar. 2001 were divided into two groups according to the occurrence of restenosis on follow-up coronary angiogram: patients with restenosis (Group I: n=99, 59.5×10.8 years, M:F=77:22) and patients without restenosis (Group II: n=173, 58.8×10.2 years, M:F=131:42). IgG seropositivity and titer of CMV, C. pneumoniae, H. pylori, levels of C-reactive protein (CRP) were compared between two groups. Results: There were no statistical differences in the seropositivity of CMV IgG, C. pneumoniae IgG, H. pylori IgG between two groups (Group I vs. II: 100% vs. 100%, 24.7% vs. 25.7%, 62.2% vs. 63.7% in group I vs. II respectively). Among angiographic parameters, low TIMI flow (TIMI 0 or I) was more common in Group I than in Group II (p=0.038). The patients with elevated CRP (>0.5 mg/dL) were more common in Group I than those in Group II (57.6% vs. 36.4%, p=0.001) and the value of CRP was higher in Group I than in Group II (3.3±5.8 mg/dL vs. 1.3±2.6 mg/dL, p=0.001). According to multiple logistic regression analysis, CRP was the only predictor of restenosis with odd ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). Conclusion: The value of CRP is the most important predictor of restenosis after PCI. (Korean J Med 62:405-414, 2002)

급성 심근경색증 환자에서 장기 임상경과에 대한 C - Reactive Protein 의 역할

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),박형욱(Hyung Wook Park),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),염주협(Ju Hyup Yum),김원(Weon Kim),김주한(Ju Han Kim),류제영(Jay Young Rhew),안영근(Young Keun A 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. Methods: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9±9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43±0.14 mg/dL) on admission and Group II (n=122, 59.1±10.4 years, male 83.6%) with elevated CRP ( ≥1.0 mg/dL, mean value=3.50±0.93 mg/dL) on admission. Results: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4±10.5 to 52.0±9.0%, 1.52±1.13 to 2.77±0.55, p<0.001 vs Group II; 50.1±11.2 to 52.7±9.7, 1.55±1.11 to 2.76±0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). Conclusion: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.(Korean J Med 61:606-615, 2001)

유방암과 동반된 피부근염에서 발생한 횡문근융해증 및 급성 신부전 1예

김용훈,손진희,염주협,정예경,안병진,정성오,전용덕 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.

노인 심방세동 환자의 원인기저 질환 분석

조대경,위준환,염주협,고재민,이태호,정성오,김태훈,정봉기,남홍우,이홍순,유수웅,문언수 대한노인병학회 2000 Annals of geriatric medicine and research Vol.4 No.3

당뇨병 교육 방법이 당뇨병 환자의 식사요법 수행과 당화혈색소에 미치는 영향

김을상,문현경,이영남,이태훈,김성곤,고재민,손진희,유형준,송오금,남흥우,정성오,위준환,염주협,조대경 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.5

Background: Diet control plays an important role in diabetic management, but it is often hard for diabetic patients to follow the dietary control program. Poor dietary compliance leads to metabolic derangements in patients with diabetes and it may derive mainly from defects in dietary education program rather than from patients themselves. Therefore, we performed a randomized prospective study to compare the effects of three different teaching methods for diet control. Methods: Forty eight diabetic patients with poor glycemic control (mean HbA1c 11.4±1.5%) were enrolled during hospitalization and allocated at random to three different teaching methods i.e. Conventional diet sheet instruction (Group 1), Food recording on every meal (Group 2), and Meal time demonstration (Group 3). For evaluation, knowledge about DM diet and barriers to diet control were assessed by a questionnaire. Consistency in carbohydrate intake (Coefficient of variation) and serial HbA1C measurements were used for the estimation of dietary compliance and glycemic control respectively. Results: During five months' follow-up period, there was no remarkable improvement in knowledge about diabetic diet control, dietary compliance and glycemic control in Group 1 patients. But both dietary compliance and glycemic control improved in Group 2 and 3 patients during follow-up period. In Group 2 CV (Coefficient of Variation) fell from 36.4±15.2% to 27.7±17.3% and in Group 3 from 32.1±9.6% to 23.2±10.5% (p$lt;0.05). In Group 2 HbA_(1c) fell from 12±2.2% to 8.3±2.0% and in Group 3 from 11.5±2.0% to 7.5±1.9%(p$lt;0.01). The change of HbA1c level showed an appreciable correlation with dietary compliance (r= 0.75). Among the perceived barriers to dietary practice in patients of Group 2 and Group 3, extrinsic factors related to knowledge lowered during the intervention (p$lt;0.05). Even though Group 3 patients had good dietary compliance, they still felt that intrinsic factors related to motive and attitude were the major barriers at the end of the study (p$lt;0.05). Conclusion: We found that meal time demonstration teaching method may improve dietary compliance and glycemic control compared with the conventional diet sheet instruction method.