신공여자특이수혈에 따른 면역학적변화가 Cyclosporine - A 를 사용한 이식신의 예후에 미치는 영향

박능화(Neung Wha Park),지상근(Sang Keun Ji),최현묵(Hyun MOok Choi),김영우(Young Woo Kim),이신화(Sin Wha Lee),양상호(Sang Ho Yang),임학(Hark Rim),이재우(Jae Woo Lee),이승도(Seung Do Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.5

N/A Objectives: Donor specific transfusion (DST) prior to kidney transplantation has been widely accepted due to its beneficial effect on the graft survival. The mechanisms of protective effect of DST are not clearly understood, although several hypotheses have been suggested including alterations of cell mediated immunity. The significance of DST, however, tends to be decreased following introduction of cyclosporine. Therefore, we investigated the prognostic effect of mixed lymphocyte culture (MLC) an<i other cell mediated immunological changes induced by DST. Methods: 98 HLA-haploidentical renal transplants operated during the period of 1985 through 1991 were evaluated. Among these 48cases were DST group and the remainder was control group. Immunological indices including MLC were examined and graft survivals were analyzed. Graft loss was de- fined as a loss of its function requiring dialysis. Results: 1) Following DST, stimulation index of MLC was significantly suppressed from 4.0.0.4 (mean±S.E.) to 2.6±0.1 (p<0.(E), Relative response appeared to be decreased after DST from 61.1±6.0% to 49.9±3.1%, although thc difference was not statistically significant. 2) No significant changes in CD3, CD4, CD8, DR' cell, T-cell stimulation test by PHA and spontaneous lymphocyte transformation were found after DST. For all indices there was no significant difference between the post DST and control groups. 3) The actuarial graft survival rates for 1 and 5 years were 94±4% and 75±57%, respectively, in DST group and 904Fo and 69±14%, respectively, in control group. The graft survivals of DST and control groups were not significantly different. 4) The 1- and 5-year graft survival rates were 94±4% and 71±8%, respectively, in the DST group with the SI value over 2.0, and 92±7% and 85±10%, respectively, in the DST group with SI value lesser than 2.0. 5) The 1- and 5-year graft survival rates were 91±5% and 72±8%, respectively, in the DST group with RR value greater than 40%, and 100% and 85±105, respectively, in the DST group with RR value lesser than 40% Conclusion: These results suggest that although DST suppresses stimulation index, it could not improve graft survival in HLA-haploidentical renal transplants treated with cyclosporine.

위내 담즙산의 농도와 위점막의 장상피화생과의 연관성

김도하(Do Ha Kim),박능화(Neung Wha Park),주광로(Kwang Ro Joo),이선호(Seon Ho Lee),김성률(Sung Ryul Kim),유철인(Cheol In Yoo),서재희(Jae Hee Suh),박재후(Jae Hoo Park) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.4

Background/Aims: Enterogastric reflux of bile has been suspected as a risk factor of foregut cancer. Thus, we measured total intragastric bile acid to determine association between duodenogastric reflux and development of intestinal metaplasia known as premalignant gastric mucosal change. Methods: One hundred and three patients with a functional dyspepsia underwent endoscopy. Subsequently, samples of fasting gastric juice were taken from all patients for analysis of total bile acid. With the specimens from 5 sites of the antrum and body, the degree of intestinal metaplasia was evaluated by the update Sydney System and H. pylori infection was evaluated also by Warthin-Starry staining. Results: There was a significant correlation between the total bile acid level and the degree of intestinal metaplasia (r=0.278, p=0.005). Moreover, multiple linear regression test showed that the concentration of total bile acid was one of the independent risk factors for intestinal metaplasia regardless of age and H. pylori infection. Conclusions: These results suggest that intragastric bile acid may affect histologic premalignant changes of the gastric mucosa and thus, duodenogastric reflux may play a role in gastric carcinogenesis. (Korean J Gastroenterol 2002;39:248-253)

경정맥을 통한 간생검의 유용성과 안전성

김도하(Do Ha Kim),김홍자(Hong Ja Kim),박능화(Neung Hwa Park),이근찬(Geun Chan Lee),정영화(Young Wha Chung),이영상(Young Sang Lee),구동억(Dong Erk Goo),윤현기(Hyeon Ki Yoon),성규보(Kyu Bo Sung),유은실(Eun Sil Yu),서동진(Dong Jin Suh) 대한내과학회 1998 대한내과학회지 Vol.54 No.2

N/A Objectives : Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in Korea. Methods : We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. Results : The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4±1.1 per case and the mean size of specimen was 1.8±0.7mm Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. Conclusion: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.

자가면역성 담관염(Autoimmune Cholangitis)의 임상상

이영상,서동진,정영화,박능화,이근찬,유은실,강경훈,김형건 대한소화기학회 1997 대한소화기학회지 Vol.30 No.6

Background/Aims: Autoimmune cholangitis is a disease with clinical and pathologic features of primary biliary cirrhosis(PBC) but with negative antimitochondrial antibody(AMA) and positive antinuclear antibody(ANA) tests. The terms such as AMA negative PBC, immunocholangitis, autoimmune cholangiopathy, or autoimmune hepatobiliary overlap syndrome(AH-OS) type 1 have been suggested. Autoimmune cholangitis may be immunologically distinct from PBC because an antibody to carbonic anhydrase II in the bile duct epithelium, which is uncommon in PBC, is frequently detected in the sera. The aim of this study is to assess the clinical characteristics and pathologic features of 7 cases with autoimmune cholangitis. Methods: We retrospectively analyzed 7 cases whose clinical and pathologic features were suggestive of PBC but serum antimito-chondrial antibody(AMA) was absent and antinuclear antibody(ANA) was present. Age and sex, initial symptoms and signs, associated diseases, biochemical and serologic data, and liver biopsy features were studied. Results: All 7 patients were women ranging in age from 40 years to 57 years(mean, 48.7 years). Of 7 patients, 5 were symptomatic: pruritus and chronic fatigue were common(4 cases respectively). All patients were negative for AMA by immunofluorescence studies. HBs Ag and anti-HCV were negative. Radiological studies including ultrasonography and ERCP revealed no abnormality in biliary tree. All patients were positive for antinuclear antibody: five at a titer of 1: 640, one at 1: 320, and one at 1: 80. Speckled ANA pattem was noted in 4 patients while a homogenous pattern in 3. All the patients had marked elevation of alkaline phosphatase(means: 777 IU/L) and gamma glutamyl transferase(means: 217 IU/L) with only modest elevation of aminotransferases. Serum IgM values were normal in three patients studied. Anti- smooth muscle antibody was found positive in 1 among 5 patients studied. Associated diseases were adenomatous goiter(1 case), Hashimoto's thyroiditis(1 case), and sicca syndrorne(1 case). All 7 liver biopsy specimens showed interlobular bile ductopenia, portal inflammatory infiltration and piecemeal necrosis. Bile ductular proliferation and portal fibrosis were noted in six cases. Piecemeal necrosis, granuloma, and fibrosis were commonly found. Conclusions: It is suggested that autoimmune cholangitis can be found in Korea. It should be considered in AMA-negative patients with clinical and pathologic features of PBC. Further studies are needed to assess the causes, pathogenesis, and treament of autoimmune cholangitis.