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건강보험심사평가원 자료를 이용한 국내 비결핵항산균 감염증의 역학적 특성분석
전병우,이혜원,명우재,고원중 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0
목적: 비결핵항산균 감염증은 전세계적으로 증가하고 있고, 지역과 국가에 따라서 다양한 역학적 특성을 보인다. 본 연구는 국내에서 발생하는 비결핵항산균 감염증의 역학적 특성에 대해서 분석하였다. 방법: 2007년부터 2016년도까지 건강보험심사평가원 자료에서 상병코드(ICD10th, A31)를 이용하여 비결핵항산균 감염증을 선별하였고, 유병률, 발생률, 그리고 지역 분포 및 인구통계적 특성을 분석하였다. 성적: 연구기간 동안 비결핵항산균 감염증의 유병률(/100,000명)은, 2007년 6.7명, 2012년 24.5명, 그리고 2016년에 39.6명으로 5배 이상 증가함을 보였다. 발생률(/100,000명/년)은 2008년 6.0명, 2012년 12.3명, 그리고 2016년 19.0명으로 3배이상 증가하였다. 전체 기간유병률(/100,000명, 2007-2016)은 연령에 따라서 증가하였고, 20-29세에서 9.3명, 50-59세에서 107.1명, 그리고 70-79명에서 306.9명 이었다. 기간유병률의 성별비교 결과, 여성이 73.9명으로, 남성(61.3명)보다 높았다. 또한, 기간유병률의 지역별비교 결과, 서울특별시와 광역시 (부산, 대전, 광주, 대구, 인천, 울산)들이, 도 지역에 비해서 높은 경향을 보고, 제주도가 가장 낮은 값을 보였다. 가장 흔한 호흡기 동반질환은, 천식(53.0%), 기관지확장증(43.6%), 그리고 만성 폐쇄성 폐질환(32.3%)이었고, 악성질환은 23.0%에서 동반되었다. 결론: 국내 비결핵항산균 감염증은 증가하고 있는 추세이며, 성별, 연력, 지역별로 다양한 분포를 보인다.
전병우,문성미,전경만,권오정,유희진,조금희,( Charles L. Daley ),고원중 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
We investigated the prognostic factors associated with long-term mortality in nontuberculous mycobacterial pulmonary disease (NTM-PD) patients with data on radiological type and etiologic organisms. In total, 1,445 patients diagnosed with treatment- naïve NTM-PD between July 1997 and December 2013 were included. The distribution of NTM etiology was as follows: Mycobacterium avium (n=655), M. intracellulare (n=487), M. abscessus subspecies abscessus (M. abcessus, n=129), or M. abscessus subspecies massiliense (M. massiliense, n=174). Factors associated with mortality were analyzed using a multivariable Cox model adjusted for demographic, radiographic, and etiologic data. The overall 5-, 10-, and 15-year cumulative mortality rates of NTM-PD were 12.4%, 24.0%, and 36.4%, respectively. The multivariable analysis showed that old age, male, low body mass index, chronic pulmonary aspergillosis, pulmonary or extra-pulmonary malignancy, and chronic heart or liver disease were significantly and negatively associated with mortality. Causative NTM organism (reference M. avium) was significantly associated with mortality: M. intracellulare (adjusted hazard ratio [aHR]=1.42; 95% confidence interval [CI]=1.04-1.95), M. abscessus (aHR=2.12; 95% CI=1.32-3.41), and M. massiliense (aHR=0.97, 95% CI=0.59-1.6). Mortality was also significantly associated with the radiological type of NTM-PD, especially in cavitary diseases (log-rank test; p<0.0001). In conclusion, NTM organisms and cavitary disease as well as demographic characteristics were associated with long-term mortality in NTM-PD.
전병우,허희재,고원중 대한의사협회 2019 대한의사협회지 Vol.62 No.1
The incidence and prevalence of pulmonary tuberculosis (TB) in South Korea remain high despite the fact that South Korea is a high-income country, and pulmonary TB is an important public health issue in terms of both morbidity and mortality. Thus, rapid diagnosis and management of active pulmonary TB are crucial for effective TB control, which can help to prevent the transmission of TB and the occurrence of new TB cases. However, because the clinical and radiological presentations of pulmonary TB may occasionally be nonspecific, identification of causative microorganisms using laboratory tests is the most important diagnostic method. Recently-developed microbiological and molecular techniques are commonly employed in current clinical practice. In particular, advances in liquid culture system, line probe assays, and Xpert MTB/RIF assay have reduced the identification time and facilitate the identification of drug-resistance TB. However, as various tests have both advantages and limitations, physicians should be aware of the principles underpinning the tests when interpreting the results. Thus, the clinical and radiological characteristics of pulmonary TB and several diagnostic laboratory tests that we describe below will aid physicians in diagnosing pulmonary TB efficiently
전병우 대한의사협회 2024 대한의사협회지 Vol.67 No.1
Background: Nontuberculous mycobacteria are mycobacteria other than those that cause tuberculosis and leprosy and can cause infections in various parts of the body, predominantly the lungs. Of approximately 200 species of nontuberculous mycobacteria, only about 10 are linked to pulmonary infections, with Mycobacterium avium complex (MAC) being the most common. Current Concepts: The standard treatment for pulmonary diseases caused by the MAC is combination therapy, including macrolide antibiotics and other antibiotics such as ethambutol and rifampin. Among macrolide antibiotics, azithromycin and clarithromycin are commonly used for managing MAC pulmonary diseases, and in cases with extensive lesions, amikacin injections are administered concurrently during the initial stages of treatment. Ensuring an overall treatment duration of an additional 12 months after negative culture conversion is recommended in affected patients. However, despite an extended treatment period, the cure rate remains at 60~70%. Recently, an inhalable liposomal form of amikacin, marketed as ARIKAYCE, has been developed. It has been approved by the US Food and Drug Administration as an effective treatment for refractory MAC pulmonary diseases. When ARIKAYCE was used for an additional 6 months or more in patients with refractory MAC pulmonary diseases, approximately 29% of patients achieved additional treatment success. However, it has yet to be officially imported into South Korea, and a high monthly cost restricts its practical use in the country. Therefore, the treatment of MAC pulmonary disease in South Korea will remain a challenge, unless a more effective treatment emerges. Discussion and Conclusion: MAC pulmonary disease requires long-term combination antibiotic therapy, usually with macrolides, ethambutol, and rifampin, and amikacin injections are recommended for cases with extensive lesions. The lack of effective drugs hampers treatment, increasing the burden of antibiotic side effects. Therefore, more research is urgently needed for better treatment of MAC pulmonary disease.