한국에서 원인 미상의 급성간염 환자와 건강인에서의 E형 간염 표지자의 발현상

변관수(Kwan Soo byun),연종은(Jong Eun Yeon),권오상(Oh Sang Kwon),박영태(Young Tae Bak),김진호(Jin Ho Kim),권소영(So Young Kwon),이창홍(Chang Hong Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Recently hepatitis E virus(HEV) has been cloned and the enzyme immuno- assay(EIA) for anti-HEV has been useful in diagnosis and epidemiological studies for HEV infection. Hepatitis E has not still been reported in Korea, therefore the clinical significance of anti-HEV detected in the population is uncertain. This study was performed to investigate the clinical HEV infection in Korea and to evaluate the reliability of anti-HEV for the diagnosis and epidemiological study of HEV infection. Methods: Sera were collected from the patients with acute hepatitis(31 non-A, non-B, non-C, 20 toxic or drug induced, 9 fulminant hepatitis), 199 healthy adults and 30 patients with acute hepatitis B as control groups. Testing for IgG and IgM anti-HEV was done by EIA. Results: IgG anti-HEV was detected in 9.7% of non-A, non-B, non-C hepatitis, 15% of toxic hepatitis and none of fulminant hepatitis. IgG anti-HEV was also detected in 9.5% of healthy adults and in 3.3% of acute hepatitis B and the detection rates among acute hepatitis groups were not significantly different from controls. Only 1 case among acute hepatitis groups was positive for both IgG and IgM anti-HEV and the IgM antibody was sustaindly detected but IgG antibody was not detected within 2 months follow up. 2 cases of healthy adults were positive for IgM anti-HEV without IgG anti-HEV. Conclusions: Sporadic hepatitis E seems to be rare in Korea. Anti-HEV EIA is incomplete for the diagnosis of HEV infection and IgM anti-HEV might be nonspecific for the diagnosis of acute hepatitis E. Therefore, careful interpretation of anti-HEV is needed in the diagnosis or epidemiological study of HEV infection. (Korean J Gastroenterol 1996; 28:661 - 668)

임신중의 생리적 피부변화에 대한 임상적 관찰

서대헌,안종성,윤상호,권오상,정진호,전종관,윤재일 ( Dae Hun Suh,Jong Seong Ahn,Sang Ho Youn,Oh Sang Kwon,Jin Ho Chung,Jong Kwan Jun,Jai Il Youn ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.5

Background: The skin shows many physiological changes during pregnancy. Although these physiological skin changes do not usually impair the health of the mother or the fetus, some can be cosmetically significant and of importance to the dermatologist. Objective : The aim of our study was to determine the incidence and clinical findings of these skin changes during pregnancy. Methods : We made a prospective study of 157 women in the third trimester of pregnancy who visited the prenatal care clinic at Seoul National University Hospital from January 1996 to June 1996. Women with pathological pregnaneies were excluded. Results : The results of the study are summarized as follows. 1. Various skin changes occurred such as pigmentary alteration, vascular changes, striae, abnormalities in hair growth, and nail changes. In all subjects, one or more of these changes were found. 2. The incidence of hyperpigmentation was highest among the skin changes. The incidence of hyperpigmentation of areola and nipple was 100%. Linea nigra were observed in 81.5%. 3. Palmar erythema, suprapubic hirsutism, and abdominal striae were observed in 36.3%, 14.0%, and 40.1 %, respectively. Conclusion : Physiological skin changes during pregnancy were various and observed with high frequency. The incidences of vascular changes, hair and nail changes in Korean pregnant women were reported for the first time. (Korean J Dermatol 1997;35(5): 902-908)

Battery SOC(State of Charge)측정을 통한 태양광발전 시스템 운영 방안 연구

송정용(Song Jung-Yong),서유진(Seo Yu-Jin),권오상(Kwon Oh-Sang),정관철(Jeoung Kwan-Chul),허창수(Huh Chang-Su) 한국태양에너지학회 2004 한국태양에너지학회 논문집 Vol.24 No.2

다중 검출 유도결합 플라즈마 질량분석기를 이용한 납 및 카드뮴안정동위원소비 분석의 질량 편향 보정방법 비교

김지영 ( Jee Young Kim ),김명진 ( Myung Jin Kim ),유은진 ( Eun Jin Yoo ),이강현 ( Kang Hyun Lee ),이경석 ( Kyoung Seok Lee ),이원석 ( Won Seok Lee ),최종우 ( Jong Woo Choi ),권오상 ( Oh Sang Kwan ) 한국환경분석학회 2014 환경분석과 독성보건 Vol.17 No.3

To obtain precise and accurate isotope ratios with a multi-collector ICP-MS, three methods such as interelementalinternal calibration, sample-standard bracketing (SSB), and log-log linear regression correction model were applied to isotope ratio measurement of lead (Pb) and cadmium (Cd) for the correction of instrumental mass discrimination. Certified reference materials including NIST SRM 981 (Pb), NIST SRM 3108(Cd), and BAM I012 (Cd) were used as reference materials for the isotope ratios of lead and cadmium to compare the corrected results obtained from the respective correction models. The accuracies of lead isotope ratio measurements were in the range of -0.002 (207/206Pb) to -0.035 (208/204Pb) % when the inter-elemental internal calibration applied. The same range of -0.002 (207/206Pb) to -0.035 (208/204Pb) % was also found with the SSB method. The log-log linear regression correction model, on the other hand, showed a different range of -2.160 (207/206Pb) to 0.219 (208/204Pb) %. The precisions of lead isotope ratios with these three correction methods ranged from 0.027 (206/204Pb) to 0.127 (208/204Pb), 0.025 (206/204Pb) to 0.124 (208/204Pb), and1.265 (207/204Pb) to 1.367 (207/206Pb), respectively. Therefore, both of the inter-elemental internal calibration and the SSB method were selected as good methods for mass bias correction of lead isotope ratios. Theε114/110Cd values obtained from the application of the three different correction models were -14.5±0.7 (Agas an internal standard), -13.0±2.1 (SSB), and -15.2±1.8 (log-log linear regression correction model), respectively. For ε114/110Cd values, the inter-elemental internal calibration showed the best precision among the three correction methods. Isobaric interferences with cadmium were also corrected when correction coefficients were applied to each isotope of cadmium. The difference of correction coefficients between the isotope ratios with natural abundances and the empirical ratios in the isobaric interferences reached up to 11%. The heavier isobaric interferences (106, 108, 110Pd vs. 105Pd) were underestimated in the application of the natural ratios, while the lighter isobaric interferences (112,114,116Sn vs. 118Sn and113In vs. 115In) were overestimated. In conclusion, the inter-elemental internal calibration and the SSB method can properly correct the isotope ratios of interest in the isotope ratio measurement using the MC-ICP-MS. Further research on the isotope ratio analysis of environmental samples should follow to improve precision and accuracy.

다발성 결절로 전신에 나타난 간세포암의 피부전이 1예

권오상,김지훈,박상훈,연종은,변관수,이창홍,서연석,김윤홍,손수민,공휘,김경오 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.4

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Frequent sites of extrahepatic metastasis are the lung, adrenal gland, bone, etc. But, cutaneous metastasis from HCC is rare event. Several cases of subcutaneous seeding after percutaneous transhepatic biopsy or aspiration of liver were reported, however, most of these cases had solitary nodular lesion which was located at the biopsy site. We experienced a case of multiple cutaneous metastasis on whole body from HCC which was not related to percutaneous transhepatic biopsy of liver in a 34-year-old male patient. Thus, we report a case of multiple cutaneous metastasis from HCC with brief review of related literature. (Korean J Hepatol 1999;5:338-342)

만성 B형 간염환자에서 인터페론 치료후 장기적 관찰

권오상,김윤홍,연종은,변관수,이창홍,서연석,김윤홍 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.1

Background/Aims : Several randomized controlled studies have shown that responders who had treated with interferon alpha for chronic hepatitis B had better rate of sustained loss of HBeAg and HBV DNA than non-responders. These studies also showed that non-responders had higher rates of liver related complication and mortality. But there is very little data on how well sustained responders are and whether the responders eventually lose HBsAg in Korea. The aims of this study were to better define the long term remission of chronic hepatitis B induced by interferon alfa therapy and compare the clinical outcome among the interferon responders and non-responders in Korea. Methods : Sixty-eight patients with chronic hepatitis B who were treated with interferon alfa between 1987 and 1998 were followed up for serologic status (HBsAg, HBeAg, HBV DNA), biochemical tests and liver related complication or mortality. Results : Among 68 patients with chronic hepatitis B who were treated with interferon alfa, 28 (41%) responded to treatment with loss of HBeAg within 1 year of starting treatment. Up to 129 months (mean 58 months) after therapy, responders had higher rate of cumulative clearance of HBeAg at five years than non-responders (100% vs 35.1%, p$lt;0.05). Responders had maintained the normal serum ALT than nonresponders at five years (94% vs 55.6%, p$lt;0.05). Loss of HBsAg was not different between responders and non-responders (5% vs 4%, NS). The rates of liver related complication and mortality did not differ between both groups. Delayed clearance of HBeAg occured in twelve out of forty non-responders (30%). There were no differences in age, baseline ALT, histologic finding of liver biopsy, HBV DNA at the end of first year after study with IFN therapy between the non-responders with and without delayed clearance of HBeAg. Conclusion : Remission in chronic hepatitis B induced by alfa interferon maintained in long duration. But clinical outcomes such as liver related complication, mortality and the elimination of HBV infection have no differences between responders and non-responders. Further studies are needed for the role of interferon therapy in long-term clinical outcome for chronic hepatitis B. (Korean J Hepatol 1999;5:12-21)

한국인 A 형 간염 환자에서 A 형 간염 바이러스의 유전자형에 관한 연구

권오상,송기준,박상훈,송진원,김재선,김종헌,변관수,이창홍,연종은,백락주,박영태 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.3

$quot;목적: 한국에서 과거 A형 간염은 낙후된 개인위생 및 자연환경으로 유소아기에 불현성 감염으로 앓고 지나가게 되어 청소년 및 성인에서 HAV에 대한 항체 보유율이 매우 높고 성인에서의 급성 A형 간염은 매우 드물게 보고되었다. 그러나 고도의 경제성장과 더불어 식생활, 위생상태의 개선, 상하수도의 보급 등으로 유소아기의 A형 간염 이환율이 현격히 감소하면서 청소년 및 성인에서 HAV 항체가 없는 인구집단 즉 HAV에 감염되면 현증 간염이 발생할 수 있는 인구 집단이 증가되어 최근 수 년 사이에 현증 A형 간염이 폭발적으로 증가하게 되었다. 이에 저자는 HAV의 유전자형을 알아보고 이미 보고된 각국의 HAV와 연관성을 알아보고자 본 연구를 시행하였다. 대상과 방법: 1994년부터 1998년까지 한국에서 산발적으로 발생한 18예의 A형 간염 환자의 혈청에서 HAV RNA를 추출, 역전사-중화효소 연쇄반응법(RT-PCR)으로 증폭하여 직접 염기서열의 분석을 통해 국내 HAV 사이에 염기서열, 아미노산의 차이 등을 알아보고 세계 각국에서 보고되었던 HAV 분리주들과 비교하였다. 결과: HAV 게놈의 특정부위인 VP1/2A 연결부위 168 bp 길이에서 시행한 염기서열 분석 결과 한국에서 분리된 18예의 HA이러스는 최근 해외에서 유입된 바이러스일 가능성은 적으며 따라서 장기간 국내에서 토착화된 바이러스일 것으로 생각된다. $quot;Background/Aims: Studies of genotypes and changes in nucleotide and amino acid sequences of hepatitis A virus (HAV) may provide valuable information on the epidemiological aspects of a particular region. In Korea the prevalence of anti-HAV in the 1 - 20 year age group declined from 60% in 1980 to 9% in 1995. As a result this age group has a high risk of HAV infection. Actually over 1,500 cases of clinically overt hepatitis A occurred in 1998 while few cases of clinical hepatitis A had been reported until the early 1990s. The aims of this study are to determine the genotypes of HAV which have been circulating in Korea and to define the phylogenetic relationships of geographically defined isolates. Method: From 1994 - 1998 a total of 18 serum specimens was obtained from patients in Korea with sporadic form acute hepatitis A. The HAV nucleic acid from serum specimens was subjected to genomic sequence analysis following viral RNA extraction, reverse transcription and amplification of the cDNA by PCR. DNA sequencing was performed in both directions of each PCR product. Results: All isolates clustered within the subgenotype IA irrespective of the geographic locations and timing of the clinical hepatitis. Among 18 Korean isolates, 9 isolates had 2 amino acid sequence changes and 2 isolates had 1 amino acid sequence change. These changes in the amino acid sequences are unique and have never been reported in HAV subgenotype IA. Conclusions: All isolated HAV had genotype (IA). Eleven of 18 isolates had unique changes in amino acid sequences. These data indicate that the endemic HAV has been circulating in Korea over a long period of time.

만성 간질환에서 혈중 Gelatinase (Matrix Metalloproteinase-2와 9)의 측정 의의

권오상,임도윤,권광안,정문기,박동균,김선숙,김연석,권소영,구양서,김유경,최덕주,김주현,황유진,변관수,이창홍 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3

목적: Gelatinase (MMP-2와 9)는 기저막의 주구성요인 type IV collagen을 분해하는 효소로, MMP-2는 간경변과 MMP-0은 간세포암의 진행과 연관이 있는 것으로 알려져 있다. 본 연구에서는 만성 간질환과 MMP-2와 9의 관계를 알아보고자 하였다. 대상과 방법: 간기능이 정상이고 간질환이 없는 건강 대조군 10예, 만성 간염 15예, 간경변 18예, 그리고 간세포암 25예를 대상으로 혈장을 채취하여 MMP-2와 9의 활성을 보기 위해 zymography를 시행하였다. 결과: 혈장 MMP-2의 활성은 간경변군에서 건강 대조군(p=0.009)과 만성 간염군(p=0.011)에 비해 증가되어 있었으나 간세포암군과는 차이가 없었다. 혈장 MMP-9의 활성은 간경변군에서 건강 대조군에 비해 증가되어 있었으나(p=0.035), 만성 간염군과 간세포암군과는 차이가 없었다. 간세포함이 없는 간경변군 15예와 간세포암을 동반한 간경변군 23예를 합친 총 간경변군 38예에서 MMP-2의 활성은 total bilirubin이 높을수록 (r=0.323, p=0.048) 그리고 Child-Pugh 점수가 높을수록(r=0.414, p=0.012) 증가되어 있었다. 총 간경변군에서 MMP-2와 MMP-9의 활성은 알코올 성 간경변군에서 HBV에 의한 간경변군 보다 현저히 증가되어 있었다(각각 p=0.009, p=0.002). 결론: 혈장 MMP-2의 활성은 간경변의 진단과 중증도에 유용한 표지자로 사용될 수 있을 것이다. 혈장 MMP-9의 활성은 간세포암에서의 유용성은 적으리라 생각되나 알코올성 간경변의 진단적 표지자로는 유용하리라 생각된다. MMP-2와 MMP-9의 활성은 간경변의 원인 별로 차이가 나는 것으로 생각되며 그 이유에 대한 연구가 필요하리라 생각된다. Background/Aims: Gelatinase (matrix metalloproteinase (MMP) -2 and 9) has an important role in the pathogenesis of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In this study, we evaluated the relationship of gelatinase to chronic liver disease. Methods: Four groups of subjects were examined; healthy control (10 cases), chronic hepatitis (18 cases), LC (15 cases), and HCC (28 cases). The plasma of each subject was obtained, and the equal quantification of plasma protein was done. The plasma activities of MMP-2 and 9 were measured by zymography. Results: The activities of plasma MMP-2 in patients with LC were significantly higher than those in controls (p=0.009) and in patients with chronic hepatitis (p=0.011), but not different from those in patients with HCC. The activities of plasma MMP-9 in patients with LC were significantly higher than those in controls, but not different from those in patients with chronic hepatitis or HCC. In patients with LC (regardless of having HCC), the activities of MMP-2 correlated with total bilirubin (r=0.323, p=0.048) and Child-Pugh score (r=0.414, p=0.012). The activities of MMP-2 and 0 were higher in patients with LC (regardless of having HCC) caused by alcohol than caused by HBV (p=0.009 and 0.0002 for each one). Conclusions: The plasma activity of MMP-2 may be a useful marker for the diagnosis and determination of the severity of LC. The plasma activity of MMP-9 was not useful for HCC, but may be a marker for alcoholic LC. Further study is needed to determine why the plasma activity of gelatinase was higher in patients with LC caused by alcohol than by HBV.(Korean J Hepatol 2003;9:222-230)

혈소판 감소증을 보이는 간경변증 환자에서 간질환의 중증도에 따른 혈청 thrombopoietin의 의의

권오상,김지훈,박상훈,연종은,변관수,이창홍,서연석,공휘 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.3

Background/Aims: Thrombopoietin (TPO) is an important cytokine for megakaryocyte maturation and platelet production. Because the main site of its production is liver, the failing liver may have a role in thrombocytopenia in chronic liver disease. The aims of this study were to determine the serum TPO levels in cirrhotic patients with thrombocytopenia and clarify the relation between the serum TPO levels and liver function impairment. Method: Cirrhotic paitents with thrombocytopenia (LC, n=57, Child class A/B/C; 20/13/24), chronic hepatitis patients (CH, n=24), oncologic patients with thrombocytopenia induced by chemotherapy (HO, n=7), acute viral hepatitis patients (AVH, n=5) and healthy controls (HC, n=5) were enrolled. Serum TPO was measured by an ELISA method. Results: Although the mean platelets counts of LC (69±32, ×103/ul: mean±SD) were lower than those of HC (229±29, ×103/ul), serum TPO levels in LC (108±63 pg/ml: mean±SD) were not significantly different from HC (122±24 pg/ml). In HO, serum TPgnificantly higher than LC (623±746 vs 108±63 pg/ml, p$lt;0.05) inspite of comparable platelets counts. In LC, serum TPO level was not significantly different among Child class groups. It was not correlated with serum ALT, serum albumin levels, prothrombin time, serum bile acid, Child class, Child score and partial thromboplastin time, but weakly correlated with serum total bilirubin (p=0.038, r=0.288) and platelet counts (p=0.041, r=0.287). Conclusions: Although impaired hepatic production of TPO seems to be the main cause of low serum TPO levels in thrombocytopenic cirrhotic patients, there was no correlation between serum TPO level and the severity of liver dysfunction. The role of other factors such as megakaryocyte mass in bone marrow, portal hypertension and hypersplenism may be necessary to explain the putative mechanism between TPO and platelet numbers in liver cirrhosis with thrombocytopenia. (Korean J Hepatol 1999;5:208-216)

담낭 담석으로 인한 복강경 담낭절제술시 총수담관결석 동반 유무의 예측인자

최상용,김진호,권오상,김재선,최창원,변관수,박영태,김종극,임형준,정길만 대한소화기학회 1998 대한소화기학회지 Vol.30 No.3

Background/Aims: Accurate preoperative prediction of cho]edocholithiasis is essential in order to minitnize patients risk and to avoid unnecessary procedures. We preforme 1 this study identify independent risk factors for choledocholithiasis in patients who had undergone cholecystectomy for symptomatic cholelithiasis. Methods: The medical records of patients who had undergone cholecystectomy between Septernber, 1993 and December, ]996 were reviewed. Patients who were already found to have either extrahepatic or intrahepatic hiliary stones on sonogram were excluded. 79 of these patients in whom the presence or absence of choledocholithiasis had been confirmed(preoperative ERCP in 69, operative choangiography in 10) were eligible for analysis. Candidate predictor variables included age, sex, presence of fever, and maximum preoperative values for each of the followings: common bile duct(CBD) diarneter, white blood cell counts, AST, ALT, alkaline phosphatase, total bilirubin, and amylase. The analysis was conducted using SPSS(V 5.0.2). Results: Choledocholithiasis was confirmed in 16(20.3%) of the 79 eligible patients. Univariate analysis identified age, alkaline phosphatase, and CBD diameter as predictors. Multivariate analysis subsequently identified alkaline phosphatase and CBD diameter as independent predictors of choledocholithiasis. The probability of choledocholithiasis was 86% when two independent predictors were present, but was 3% when all two predictors were absent. Conclusions: ERCP or operative cholangiography is not thought to be necessary for patients with symptomatic cholelithiasis who have both normal biliary tree on sonogram and normal serum alkaline phosphatase. However patients with syrnptomatic cholelithiasis who have both dilated CBD on sonogram and elevated serum alkaline phosphatase, or are found to have CBD stone on abdominal sonogram, do necessarily require do not necessarily reqine what? RCP? To confirm the presence of CBD stone.