소아에서 흔한 신장 질환에서 Lp(a)의 양상과 영향을 미치는 인자에 대한 평가

오종권,임인석,O Chong-Gwon,Lim In-Seok 대한소아신장학회 2003 Childhood kidney diseases Vol.7 No.2

Purpose : Lipoprotein(a) is a genetically determined risk factor for atherosclerotic vascular disease and is elevated in patients with renal disease. Especially the patients with nephrotic syndrome exhibit excessively high Lp(a) plasma concentrations. Also the patients with end-stage renal disease have elevated Lp(a) levels. But the mechanism underlying this elevation is unclear. Thus, in this study, by measuring the level of serum Lp(a) in common renal diseases in children, we hoped to see whether there would be a change in Lp(a) in renal diseases other than nephrotic syndrome. Then, we figured out its implications, and looked for the factors that affect the Lp(a) concentrations. Methods : A total of 75 patients(34 patients with hematuria of unknown etiology, 10 with hematuria and hypercalciuria, 8 with IgA nephropathy, 8 with poststreptococcal glomerulone phritis, 3 with $Henoch-Sch\"{o}nlein$ nephritis, 7 with urinary tract infection, and 5 with or- thostatic proteinuria) were studied. The control group included 20 patients without renal and liver disease. Serum Lp(a), total protein, and albumin levels, 24-hour urine protein and calcium excretions, creatinine clearance and the number of RBCs and WBCs in the urinary sediment were evaluated. Data analysis was peformed using the Student t-test and a P-value less than 0.05 was considered to be statistically significant. Results : LP(a) was not correlated with 24-hour urine calcium and creatinine. Lp(a) level had a positive correlation with proteinuria and negative correlation with serum albumin and serum protein. Among the common renal diseases in children, Lp(a) was elevated only in orthostatic proteinuria (P<0.05). Conclusion : Lp(a) is correlated with proteinuria, serum protein, and serum albumin, but not with any kind of specific renal disease. Afterward, Lp(a) needs to be assessed in patients with orthostatic proteinuria and its possible role as a prognostic factor could be confirmed.

소아 요로감염에서 배뇨성 방광 요도 조영술의 결정

김동운,최응상,임인석,Kim, Dong-Woon,Choi, Eung-Sang,Lim, In-Seok 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.2

Purpose : We attempted to compare the independent factors such as age, sex, C-reactive protein(CRP), and white blood cell count(WBC) in children with radiologic studies and assess the necessity of performing voiding cystourethrography(VCUG). Method : 98 children who have been diagnosed their first time febrile urinary tract infection from Janurary 2002 to Januray 2005 were enrolled. In all patient, the duration of fever which occurred before and after treatment was recorded, and CRP, WBC, $^{99m}Tc$-2,3-dimercaptosuccinic acid($^{99m}Tc$-DMSA) renal scans, renal ultrasound and VCUG were analyzed. Results : Of the 98 children diagnosed with urinary tract infection(UTI), 52 were male and 46 were female. 18 had abnormalities in VCUG, 17 had abnormalities in kidney ultrasound, and 20 had partial defects or diffuse uptake decrease in $^{99m}Tc$-DMSA renal scans. There were no significant relationship between incidence of radiologic abnormalities and age. The risk of renal scar was significantly higher in children who had a longer febrile period before treatment than in those with shorter period. Both CRP and WBC were significantly elevated in children with the radiological abnormalities. A positive of $^{99m}Tc$-DMSA renal scans and renal ultrasound were highly associated with vesicoureteral reflux(VUR). Conclusion : If there are abnormalities in the kidney ultrasound and $^{99m}Tc$-DMSA renal scan of a child with initial UTI, a VCUG is recommended. Even in cases without abnormal findings in $^{99m}Tc$-DMSA renal scan and renal ultrasound, clinical data such as CRP and WBC should be assessed, and VCUG should be Performed for the undetected VUR.

가와사끼병에서 Matrix metalloproteinase 9과 Tissue inhibitor of metalloproteinase 1, 2의 임상적 중요성

윤기욱,윤신원,이정주,채수안,임인석,최응상,유병훈,이미경,Yun, Ki-Wook,Yun, Sin-Weon,Lee, Jung-Ju,Chae, Soo-Ahn,Lim, In-Seok,Choi, Eung-Sang,Yoo, Byoung-Hoon,Lee, Mi-Kyung 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

Purpose : Kawasaki disease (KD) is a systemic vasculitis, a leading cause of pediatric acquired heart disease. Histopathological findings of coronary artery lesion (CAL) in KD indicate destruction of the coronary artery wall with diffuse vasculitis. Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) might play central roles in this process. Special attention to MMP-9 has recently been emerging. This study was performed to investigate the clinical significance of MMP-9 and its inhibitors, TIMP-1 and TIMP-2, in KD. Methods : We compared 47 KD patients with 14 febrile controls. Serum MMP-9 and TIMP-1, TIMP-2 were measured by ELISA and compared according to clinical stages and coronary involvement. Results : In acute stage, MMP-9 and TIMP-1 were significantly higher, whereas TIMP-2 was lower, in KD than those in febrile controls ($P$<0.05). The elevated MMP-9 levels in acute phase significantly decreased during the subacute and convalescent phases ($P$<0.05). During acute phase, the MMP-9, TIMP-1, and MMP-9/TIMP-2 levels in the CAL group were lower than those in the non-CAL group, but they increased significantly in the subacute phase ($P$<0.05). MMP-9 has a positive correlation with TIMP-1 in the acute and subacute phases, and negative correlation with TIMP-2 in the subacute and convalescent phases ($P$<0.05). Conclusion : These results suggest that MMP-9, TIMP-1, and the imbalance in MMP-9 and TIMP-2 might play important roles on the pathophysiology of KD and especially on the development of CAL. However, further larger studies are needed.

Comparison of the Head-up Tilt Test in the Children and Adult

류나리 ( Na Li Yu ),이나미 ( Na Mi Lee ),이대용 ( Dae Yong Yi ),윤신원 ( Sin Weon Yun ),채수안 ( Soo Ahn Chae ),임인석 ( In Seok Lim ) 중앙대학교 의학연구소 2017 中央醫大誌 Vol.42 No.1

Objective: To compare the difference of children (under 18 year-old) and adult (over 40 year-old) in head-up tilt test (HUTT) positive patients. Methods: All patients diagnosed as vasovagal syncope in HUTT from January 2005 to December 2015 in Chung-Ang university hospital. Any patients with underline disease excluded. Results: The mean age was 13.5 years (from 7 to 17 years) and 59.3 years (from 40 to 85 years) in children and adult respectively in HUTT positive patients. There was no sex differences in children and adult [male: 57 (35.4%) vs 65 (43%) (p =0.167)]. The positive rate of passive test was statistically different in two groups [54 patients (33.5%) vs 23 patients (15.2%) (p <0.001)]. The highest heart rate (HR) and delta HR in Type I positive in passive test was statistically different in two groups [highest HR: 107.8 bpm vs 91.0 bpm (p <0.05); increase delta HR: 35.8 bpm vs 22.5 bpm (p <0.001); decrease delta HR 38.0bpm vs 25.6 bpm (p <0.05)]. The HR values except at baseline in Type I positive in provocation test were statistically different in two group [highest HR: 138.4 bpm vs 113.5 bpm (p <0.001); lowest HR: 88.7 bpm vs 77.3 bpm (p <0.05); increase delta HR: 64.5 bpm vs 44.4 bpm (p <0.001), decrease delta HR: 49.7 bpm vs 36.1 bpm (p <0.001)]. Conclusion: The positive rate of passive test and HR differences in HUTT were statically different in two groups. Chung-Ang J Med 2017; 42(1): 17-23

임상 ; 우리나라 저체중출생아와 이에 관계된 인자의 변화양상, 1995-2007

김상원 ( Sang Won Kim ),이정주 ( Jung Ju Lee ),김지현 ( Ji Hyun Kim ),이재희 ( Jae Hee Lee ),윤신원 ( Sin Weon Yun ),채수안 ( Soo Ahn Chae ),임인석 ( In Seok Lim ),최응상 ( Eung Sang Choi ),유병훈 ( Byung Hoon Yoo ) 대한주산의학회 2010 Perinatology Vol.21 No.3

Objective: Low birth weight (LBW) infants are known to be at the risk of increased morbidity and mortality, and also of developing adult or metabolic diseases later in their life. Recently, the number of LBW infants has increased in Korea. Therefore, we examined the changing patterns of LBW infants and associated risk factors. Methods: Data from the Korean National Statistical Office during 13 years (1995-2007) were used. We analyzed the changing mean gestational age, mean birth weight, mean maternal age, and the changing incidence of premature infant, LBW infant, multiple births, the proportion of first baby, and sex of the baby. Also, we analyzed the incidence of unmarried mother, old aged mother (>35 years), young aged mother (<20 years), high school graduated mother. In addition, we analyzed the relationship between LBW infants and risk factors. Results: The incidence of LBW infants was 2.99% in 1995, and 4.66% in 2007. The proportion of premature infant, multiple birth, first baby, unmarried mother, old aged mother, female baby increased. The increase in premature infant, multiple birth, old aged mother, unmarried mother, and female infant were found to be the important factors regarding increase in LBW infants in Korea. Conclusion: In Korea, an increase in the prevalence of LBW infants and prematurity from 1995 to 2007 was observed. The increase in premature infants, multiple birth, old aged mother, unmarried mother, and female infant are associated with the increase in LBW infants.

9∼12개월 영아에서 철 결핍성 빈혈의 조기 검진 필요성

조양환 ( Yang Hwan Cho ),김수영 ( Su Yeong Kim ),이대용 ( Dae Yong Yi ),윤신원 ( Sin Weon Yun ),채수안 ( Soo Ahn Chae ),임인석 ( In Seok Lim ),이나미 ( Na Mi Lee ) 한국정맥경장영양학회 2019 Annals of Clinical Nutrition and Metabolism(한국정맥경장 Vol.11 No.2

Purpose: Growth and development of infants can be periodically assessed through health screening, but iron deficiency anemia, which is common in infants, is difficult to detect by conducting only infant health screening. This study evaluated the prevalence of iron deficiency anemia in infants who visited Chung-Ang university hospital between 9 and 12 months of age. The study also determined the difference of anemia between term and preterm infants. Methods: The subjects of this study were infants aged 9 to 12 months who visited outpatient clinics of Chung-Ang University Hospital from January 2006 to August 2018 for the purpose of infant health screening and immunizations. We divided the subjects as the term group and the preterm group, and their medical records were retrospectively analyzed. Results: One hundred and fifty-two infants were included in the study. There were 51 in the preterm infant group and 101 in the term infant group. Thirteen infants were diagnosed with iron deficiency anemia, and 12 infants of these infants were in the term group and one infant was in the preterm group, which was statistically significant (P<0.001). There are significant differences in the hemoglobin (12.0±1.1 g/dL, 12.6±1.2 g/dL), hematocrit (35.8%±2.7%, 36.7%±3.2%), serum iron (60.8±25.4 μg/dL, 73.5±40.9 μg/dL), and unsaturated iron binding capacity (279.1±67.7 μg/dL, 252.0±47.5 μg/dL) between the term infant group and the preterm infant group, respectively (P<0.05). Conclusion: Iron deficiency anemia was significantly more often diagnosed in term infants than that in preterm infants. Preterm infants may have a lower prevalence of iron deficiency anemia than do term infants because the preterm infants are taking iron supplements prophylactically. Therefore, iron deficiency anemia should be prevented in term infants, and it is important to confirm the presence of iron deficiency anemia by conducting blood tests during the first 9 to 12 months of life.

산전 초음파 검사를 이용한 거대아 및 견갑난산 예측의 유용성

윤성준(Sung Jun Yoon),강규현(Kue Hyun Kang),박형무(Hyoung Moo Park),허민(Min Hur),임인석(In Seok Lim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.5

Objective : To determine if birth weight greater than 4000gm can be predicted by ultrasound measurement of abdominal circumference(AC) and if shoulder dystocia in macrosomic infants can be predicted by ultrasound measurement of the difference between the abdominal diameter(AD) and biparietal diameter(BPD). Methods : A Retrospective study was performed of births occuring from March, 1998 to August, 1999 at department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University. Among neonates of birth weight greater than 4000 gm, 50 cases in that ultrasound examination was done within 2 weeks before delivery were selected for macrosomic group and 50 cases were selected for control group during the same period, among neonate of birth weight from 3100gm to 3900gm. Results : 1) Normal spontaneous vaginal delivery(NSVD) was 41 cases in control group and 30 cases in macrosomic group. Among NSVD, shoulder dystocia was 1 case in 41 cases of control group and was 7 cases in 30 cases of macrosomic group. 2) On ultrasound measurement, 6 cases had AC greater than 35 cm in control group and 45 cases in macrosomic group. Among 30 cases in NSVD was done in macrosomic group, difference between AD and BPD was 2.9 0.271 cm when shoulder dystocia was existed and was 2.1 0.409 cm when shoulder dystocia was not existed. Between the two groups, statistically significant difference was detected. 3) When AC(cutoff value of 35cm) was used for screening of macrosomia, sensitivity for macrosomia was 88.2% and specificity was 89.8% and when AD-BPD difference(cutoff value of 2.6cm) was used for prediction of shoulder dystocia, sensitivity for shoulder dystocia was 66.6% and specificity was 95.2%. Conclusion : In prenatal ultrasound measurement, AC measurement at third trimester of pregnancy will be a valuable indicator for macrosomia screening. The AD-BPD difference of shoulder dystocia group was greater than uncomplicated group in macrosomia and the AD-BPD difference cutoff value of 2.6cm was significant value statistically.

소아 신장질환에서 요 β₂-microglobulin검사의 분석

김동운,임인석,Kim, Dong Woon,Lim, In Seok 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.4

Purpose : There have been numerous researches on urine ${\beta}_2$-microglobulin (${\beta}_2$-M) concerned with primary nephrotic syndrome and other glomerular diseases, but not much has been done in relation to pediatric age groups. Thus, our hospital decided to study the relations between the analysis of the test results we have conducted on pediatric patients and renal functions. Methods : Retrospective data analysis was done to 102 patients of ages 0 to 4 with renal diseases with symptoms such as hematuria, edema, and proteinuria who were admitted to Chung-Ang Yongsan Hospital and who participated in 24-hour urine and urine ${\beta}_2$-M excretion test between January of 2003 and January of 2006. Each disease was differentiated as independent variables, and the statistical difference of the results of urine ${\beta}_2$-M excretion of several groups of renal diseases was analyzed with student T-test by using test results as dependent variables. Results : Levels of urine ${\beta}_2$-M excretion of the 102 patients were as follows : 52 had primary nephrotic syndrome [MCNS (n=45, $72{\pm}45{\mu}g/g$ creatinine, ${\mu}g/g-Cr$), MPGN (n=3, $154{\pm}415{\mu}g/g-Cr$), FSGS (n=4, $188{\pm}46{\mu}g/-Cr$], six had APSGN ($93{\pm}404{\mu}g/g-Cr$), seven had IgA nephropathy ($3,414{\pm}106{\mu}g/g-Cr$), 9 had APN ($742{\pm}160{\mu}g/g-Cr$), 16 had cystitis ($179{\pm}168{\mu}g/g-Cr$), and 12 had HSP nephritis ($109{\pm}898{\mu}g/g-Cr$). IgA nephropathy (P<0.05) and APN (P<0.05) were significantly higher than in other renal diseases. Among primary nephrotic syndrome, FSGS with higher results of ${\beta}_2$-microglobulin test had longer treatment period (P<0.01) when compared to the lower groups, but no significant differences in Ccr, BUN, or Cr were observed. Conclusion : IgA nephropathy and APN groups showed significantly higher level of ${\beta}_2$-M excretion value than other groups. Although ${\beta}_2$-microglobulin value is not appropriate as an indicator of general renal function and pathology, it seems to be sufficient in the differential diagnosis of the UTI and in the prediction of the treat-ment period of nephrotic syndrome patients.

생후 90일 미만 영아의 요로 감염에서 세균성 수막염의 동반 가능성

황준호,김수영,이나미,이대용,윤신원,채수안,임인석,박지영,Hwang, Jun Ho,Kim, Su Yeong,Lee, Na Mi,Yi, Dae Yong,Yun, Sin Weon,Chae, Soo Ahn,Lim, In Seok,Park, Ji Young 대한소아감염학회 2022 Pediatric Infection and Vaccine Vol.29 No.2

Purpose: Urinary tract infections (UTIs) are the most common serious bacterial infections in young infants. Lumbar puncture (LP) has been used to diagnose coexisting meningitis in infants under 90 days of age with suspected UTI in many hospitals. However, the incidence of bacterial meningitis associated with UTIs is low. We aimed to describe the prevalence of concomitant bacterial meningitis in young infants with UTIs. Methods: The medical records of infants with the first episode of UTI admitted to the Chung-Ang University Hospital from January 2010 to December 2019 were retrospectively reviewed. Infants aged < 90 days who underwent LP with initial evaluation were included. Demographic and clinical features, laboratory findings, and imaging findings were collected and analyzed. Results: Eighty-six infants with UTIs were enrolled in the study. The median age was 61.5 days (interquartile range, 42.3-73.8 days) and boys (90.7%) were predominant. Escherichia coli was the most common pathogen (n=80, 93.0%) and followed by Klebsiella species (n=5, 5.8%). Fifteen (18.1%) specimens produced extended spectrum β-lactamase (ESBL). Five (5.8%) infants had positive blood culture results. Seven (8.1%) infants showed pleocytosis in the cerebrospinal fluid, but none had coexisting bacterial meningitis. Twenty-four (30.8%) infants showed renal dilatation or hydronephrosis on ultrasonography. Dimercaptosuccinic acid (DMSA) scans revealed cortical defects in 17 (21.3%) infants while voiding cystourethrography revealed vesicoureteral reflux in 6 (46.2%) infants. Conclusion: Co-existing bacterial meningitis was not observed in young infants with UTIs. LP could not be routinely performed considering the clinical condition of <90 days old UTI patients.

Urine endothelin-1의 소아 요로 감염 환아에서의 진단적 유용성

기형민,이대용,윤기욱,임인석,하태선,Kee, Hyung Min,Yi, Dae Yong,Yun, Ki Wook,Lim, In Seok,Ha, Tae-Seon 대한소아신장학회 2014 Childhood kidney diseases Vol.18 No.1

Purpose: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. Method: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. Results: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group ($1.41{\pm}0.35$ pg/mL vs. $0.33{\pm}0.07$ pg/mL, P =0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P =0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). Conclusion: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.