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허지회 대한뇌졸중학회 1999 Journal of stroke Vol.1 No.1
〈서론〉인체내에서 세포가 다른 세포 또는 세포외기질( extracellular matrix)과 같은 세포 밖의 다른 물질과 부착하는 것은 아주 기본적인 생리적 현상이다[1]. 이러한 부착은 발생, 분화, 발달, 상처재생 등의 생리적현상에 필수적일 뿐만 아니라, 암, 염증, 지혈( hemostasis)이나 혈전생성( thrombosis )을 비롯한 여러 질환의 병적 현상에도 중요한 역할을 하고 있다. 이렇게 세포와 세포 또는 세포와 세포외기질의 부착에 관여하는 물질을 부착분자(adhesion molecule) 라고 한다. 부착분자에는 크게 integrin, immunoglobulin superfamily, selectin, 그리고 cadherin의 네가지 군이 있다[2]. Integrin은 α와 β의 이질이량체( hetero-dimer )의 결합으로 이루어져 있는 세포막의 당단백물질( glycoprotein )로 세포와 세포, 그리고 세포와 세포외기질의 부착 및 신호전달에 관여하며 부착물질중 대표적인 물질군이라 할 수 있다[3]. Immunoglobulin superfamily와 cadherin은 세포와 세포를 부착해준다. 그리고 selectin은 다른 부착분자 군과는 달리 백혈구나 혈관내피세포( endothelium )에 있는 당(carbohydrate)에 부착을 하여 혈관 및 혈액의 생리적 또는 병적 현상에 중요한 역할을 한다. 최근 이들의 신체내 작용기전이 밝혀지기 시작하면서, 여러 질환에서 이들의 변화가 연구되기 시작하였고 일부 질환에서는 부분적으로는 이들을 이용한 치료가 시작되기 시작하였다. 뇌경색에서도 예외는 아니어서 이들을 이용한 치료가 벌써 시도되었거나 시도되고 있는 중이다. 본 종설에서는 부착분자를 이용하여 뇌경색에서 현재 임상연구가진행중인 부분인 항염증 및 항혈소판제 치료에 대하여 논의하고자 한다.
Effect and Safety of Rosuvastatin in Acute Ischemic Stroke
허지회,송동범,남효석,김응엽,김영대,이경열,이기정,유준상,김윤남,이병철,윤병우,Jong S. Kim 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.1
Background and Purpose The benefit of statins in acute stroke remains uncertain. Statins may prevent stroke recurrence during the acute stage of stroke via pleiotropic effects. However, statins may increase the risk of intracerebral hemorrhage. We investigated the effect and safety of rosuvastatin in acute stroke patients. Methods This randomized, double-blind, multi-center trial compared rosuvastatin 20 mg and placebo in statin-naïve stroke patients who underwent diffusion-weighted imaging (DWI) within 48 hours after symptom onset. The primary outcome was occurrence of new ischemic lesions on DWI at 5 or 14 days. Results This trial was stopped early after randomization of 316 patients due to slow enrollment. Among 289 patients with at least one follow-up imaging, the frequency of new ischemic lesions on DWI was not different between groups (rosuvastatin: 27/137, 19.7% vs. placebo: 36/152, 23.6%) (relative risk 0.83, 95% confidence interval 0.53–1.30). Infarct volume growth at 5 days (log-transformed volume change, rosuvastatin: 0.2±1.0 mm3 vs. placebo: 0.3±1.3 mm3; P=0.784) was not different, either. However, hemorrhagic infarction or parenchymal/subarachnoid hemorrhage on gradient-recalled echo magnetic resonance imaging occurred less frequently in the rosuvastatin group (6/137, 4.4%) than the placebo group (22/152, 14.5%, P=0.007). Among 314 patients with at least one dose of study medication, progression or clinical recurrence of stroke tended to occur less frequently in the rosuvastatin group (1/155, 0.6% vs. 7/159, 4.4%, P=0.067). Adverse events did not differ between groups. Conclusions The efficacy of rosuvastatin in reducing recurrence in acute stroke was inconclusive. However, statin use was safe and reduced hemorrhagic transformation.
허지회,김견섭,유준상,김영대,남효석,김응엽 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.1
The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2*-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography. The determination of thrombus size may be predictive of successful recanalization/non-recanalization after intravenous thrombolysis and endovascular treatment. However, cut-offs of thrombus size for predicting recanalization/non-recanalization are different among studies, due to different methods of measurements. Thus, a standardized method to measure the thrombus is necessary for thrombus imaging to be useful and reliable in clinical practice. Software-based measurements may provide a reliable and accurate assessment. The measurement should be easy and rapid to be more widely used in practice, which could be achieved by improvement of the user interface. In addition to prediction of recanalization, sequential measurements of thrombus volume before and after the treatment may also be useful to determine the efficacy of new thrombolytic drugs. This manuscript reviews the diagnosis of thrombus, prediction of recanalization using thrombus imaging, and practical considerations for the measurement of thrombus burden and density on CT