만성 간질환 환자에서 순간탄성측정법(transient elastography, FibroscanⓇ)에 의한 간탄력도에 영향을 줄 수 있는 임상요소

배락천,조한진,오종택,이응갑,허준,신근영,박수영,정민규,전성우,조창민,탁원영,권영오 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: Transient elastography as performed using the FibroscanⓇ is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (LSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the LSM value obtained by the FibroscanⓇ is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the LSM value obtained using transient elastography as performed using the FibroscanⓇ in patients with chronic liver disease. Methods: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the FibroscanⓇ, laboratory test, ultrasound, and/or abdominal computed tomography. Results: The 298 patients were aged 47.8±12.9 years (mean±SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had LSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that LSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). Conclusions: This study reveals that age, GGT, and albumin are clinical factors influencing LSM values. This reinforces the need to interpret LSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings. 목적: 최근 사용되고 있는 순간탄성측정법(FibroscanⓇ)은 비침습적 방법으로 간섬유화를 측정하는 데 유용하다고 알려져 있지만, 급성 간염의 경우나 만성 간염에서의 급성 악화를 보이는 경우에는 간탄력도가 실제의 간섬유화도보다 높게 측정된다는 연구결과를 보여주고 있다. 그로 인하여 만성 간질환 및 간경변을 가진 환자에서 순간탄성측정법으로 측정한 간탄력도(kPa)의 해석에 대한 한계성이 제시되었고, 이에 저자 등은 임상적으로 간경변까지 진행되지는 않았다고 판단되는 만성 간질환 환자에게서 높은 간탄력도와 상관관계를 보이는 임상 요소를 알아보고자 하였다. 대상 및 방법: 만성 간염 혹은 간경변으로 본원에서 추적 중인 환자 중 2007년 11월부터 2008년 3월까지 순간탄성측정법을 시행한 298명을 대상으로 하였다. 만성 간염은 6개월 이상 지속적으로 원인에 노출되는 경우로 하였고, 간세포암 또는 복수를 가진 대상은 연구에서 제외하였다. 바이러스표지자 및 혈청학적 검사를 포함한 혈액검사, 순간탄성측정법을 통해 측정한 간탄력도, 복부초음파검사 또는 컴퓨터단층촬영 등을 조사하였고, 간경변의 진단은 영상학적으로 표면결절이 있고 비장종대에 의한 150×103/μL이하의 혈소판감소증이 있는 경우, 혹은 내시경상 정맥류가 있는 경우 또는 간성혼수 병력이 있는 경우로 하였다. 결과: 다변량 분석을 시행한 결과, 만성 간질환 환자에서 고령(P=0.007), GGT 증가(P= 0.022), 알부민 감소(P=0.015), 총 빌리루빈이 증가(P=0.009)된 경우에 비정상적으로 높은 간탄력도를 나타내었다. 결론: 기존의 연구에 추가하여 연령, GGT, 알부민 역시 간탄력도에 영향을 주는 임상 요소에 관여할 수 있다는 것을 확인하였고, 병력, 혈청학적 검사 및 영상학적 검사 등을 통한 제반의 임상적 요소를 고려하여 간탄력도를 해석하여야 할 것이다.

만성 간질환 환자에서 순간 탄성도와 간조직 검사에 의한 간섬유화 비교

정민규 ( Min Kyu Jung ),조한진 ( Han Jin Cho ),이호철 ( Ho Chul Lee ),박관식 ( Kwan Sik Park ),서은희 ( Eun Hee Seo ),전성우 ( Sung Woo Jeon ),조창민 ( Chang Min Cho ),탁원영 ( Won Young Tak ),김성국 ( Sung Kook Kim ),최용환 ( Yon 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4

목적: 최근 새롭게 개발된 순간 탄성도는 간경도를 측정하여 빠르고 간단하면서도 비침습적으로 간섬유화 정도를 측정하는 방법이다. 몇몇 연구 결과들에 의하면 Fibroscan을 이용한 간경도 측정으로 C형 간염 환자의 간섬유화 정도를 비교적 정확히 예측할 수 있었다. 이 연구의 목적은 HCV 외 다양한 병인을 가진 국내 만성 간질환 환자의 간섬유화 정도를 측정하는 데 순간 탄성도의 정확성 및 임상적인 유용성을 간조직 검사 결과와 비교하여 알아보고자 하였다. 대상 및 방법: 최근 6개월 이내에 간조직 검사를 시행한 54명의 만성 간 질환 환자를 대상으로 하였다. 만성 간질환의 원인은 HBV, HCV, 자가면역, 비알코올 지방간염이었다. 간섬유화 등급은 대한병리학회 소화기병리연구회가 제안한 간조직 기술지침에 따라 섬유화 4등급으로 나누어 판독하였다. 결과: Fibroscan의 간경도 측정치는 F0는 5.10 kPa, F1 이 9.72 kPa, F2가 8.48 kPa, F3는 16.96 kPa, F4에서는 19.86 kPa를 보여주었다. 간섬유화 등급이 높아질수록 간경도 측정치도 증가하였으며, 이들의 상관관계는 spearman 상관상수가 0.614로 유의하였다. 결론: Fibroscan을 사용한 간경도 측정법은 통증을 동반하지 않고 검사 시간이 짧으며 합병증이 없다는 점에서 만성 간질환 환자의 간섬유화 정도를 측정하는데 있어 간조직 검사에 비해 간편한 검사법이나 그 진단적 가치를 확인하기 위해서는 다양한 원인질환을 대상으로 다른 섬유화의 혈청표지자들과 함께 많은 수의 환자들을 대상으로 전향적인 연구가 필요할 것으로 생각한다. Background/Aims: Transient elastography (Fibroscan, Echosens, France) is a new, simple, and non-invasive method to assess the degree of hepatic fibrosis by measuring liver stiffness. Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C. The aim of this study was to evaluate accuracy of Fibroscan for the detection of hepatic fibrosis in Korea with various etiologies of chronic liver disease by comparison with fibrosis assessed by histologic examination. Methods: Fifty-four patients with chronic liver diseases, which were histologically confirmed within recent 6 months were enrolled. Etiologies were HBV, HCV infection, autoimmune hepatitis, and non alcoholic steatohepatitis. Hepatic fibrosis was graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. Results: Fibroscan values were significantly higher in F3 (16.96 kPa) and F4 (19.86 kPa) than others (p=0.003). Liver stiffness measurement was significantly correlated to the fibrosis stage (r=0.614, p<0.0001). Conclusions: Liver stiffness measurement by Fibroscan is a promising method for the assessment of hepatic fibrosis in chronic liver disease because it accompanies no complication. (Korean J Gastroenterol 2008;51:241-247)

간섬유화 진단에서 순간탄성측정법(Transient Elastography)과 간조직검사의 비교 연구

김현진(Hyeon-jin Kim),정양화(Yang-hwa Chung),진미경(Mi-kyeong Jin),이원홍(Won-hong Lee),서대건(Dae-keon Suh) 대한초음파의료영상학회 2015 대한초음파의료영상학회지 Vol.6 No.1

목적 : 순간탄성측정법(Transient elastography, TE)를 통한 간섬유화 결과 값과 간조직 생검의 결과 값을 분석하여 간섬유화 진단에 대한 TE의 정확도와 유용성을 알아보고자 한다. 대상 및 방법 : 2013년 8월부터 2014년 8월까지 간조직생검을 통해 간섬유화 정도를 확인한 환자들 중에서 간조직검사 시행 전후에 TE를 시행한 304명을 대상으로 후향적 분석을 하였다. 간조직검사 결과는 대한병리학회에서 제시한 간조직 기술지침에 의거하여 F0, F1, F2, F3, F4의 단계로 나누었고, TE는 fibroscan을 사용하여 F2≥, 7.2 kPa; F3≥, 9.6 kPa; F=4, 14.5 kPa 단계로 구분하였다. 결과 : 간경화도에 대한 TE의 민감도는 94.80%, 특이도 77.08%, 정확도 90.95%, 양성예측도 93.71%, 음성예측도는 80.43%였다. TE의 근사 95% 신뢰구간은 0.786에서 0.933, cut-off value은 0.859였고, TE의 근사 유의확률은 각각 0.000으로 나타났다(p<0.05). 일치측도 카파 값은 0.730, 유의확률 0.000으로 두 진단법은 유의한 일치성이 있는 것으로 나타났다 (p<0.05). 결론 : 간경화도 진단에 사용되는 침습적인 방법의 간조직검사는 간 일부 조직만을 통한 간경화도 진단의 대표성 문제와 조직검사 과정에서 부작용 등이 발생하므로 조직검사 결과에 일치성을 보이는 TE로 간경화도 측정을 대체하여 사용하는 것이 더욱 효과적이라고 생각한다. Purpose: Transient elastography by analyzing the results of liver fibrosis and liver biopsy to evaluate the results with accuracy and usefulness of the TE for diagnosing liver fibrosis. Materials and Methods: 304 patients who underwent biopsies before and after the TE among patients who underwent liver fibrosis confirmed by liver biopsy between approximately August 2013 to August 2014 was a retrospective analysis in this study. Liver biopsy on the basis of the results presented in liver tissue technical instructions for Pathology F0, F1, F2, F3, divided into steps of F4. TE uses Fibroscan F2≥, 7.2 kPa; F3≥, 9.6 kPa; F = 4, were separated by 14.5 kPa step. Statistical analysis SPSS ver. 18.0 was processed using the software for, the P-value for each statistical significance level was defined as less than 0.05. Results: The sensitivity of the TE to cirrhosis of the liver also is 94.80%, a specificity of 77.08%, 90.95% accuracy, positive predictive value of 93.71% and the negative predictive value was 80.43%. Approximate 95% confidence interval of the TE is 0.933, cut-off value was 0.859 at 0.786, respectively approximate significance probability of TE was 0.000(p<0.05). Match measure kappa value 0.730, 0.000, significant probability of two diagnostic methods was found to have a significant correspondence (p<0.05). Conclusion: cirrhosis of liver biopsy is also used in the diagnosis of invasive methods such side effects occur in the course of representation issues and biopsy diagnosed with cirrhosis of liver, some organizations only. Therefore, the correspondence with TE looks to cirrhosis of the liver biopsy results also think that it would be more effective to use a substitute measure.

비보강받침접합의 용접강도와 설계도표

최선규,유정한,이강민,박재우,Choi, Sun-Kyu,Yoo, Jung-Han,Lee, Kang-Min,Park, Jai-Woo 한국강구조학회 2012 韓國鋼構造學會 論文集 Vol.24 No.2

Unstiffened seated connections (USC) ensure easy installation and safety during erection, thereby making the process more economical. USCs consist of a seat angle for carrying the beam's reactions and a top angle to provide beam stability. These angles are bolted or welded to the beam and supporting member. This paper sought to propose a design table for the weld strength of such connections obtained from the elastic vector method (EVM) and the instantaneous center-of-rotation method (ICM) in terms of calculating the eccentricity. Also, the proposed design table is compared with both AISC and KBC specifications. 비보강받침접합(Unstiffened Seated Connection, USC)은 시공의 편의성과 설치시의 안정성 및 경제성이 있는 단순접합의 한 종류이다. 비보강받침접합은 하부ㄱ형강과 상부ㄱ형강으로 구성되며 하부ㄱ형강은 보의 단부반력전체를 지지하며, 상부ㄱ형강은 보의 안정을 위하여 설치한다. 상부와 하부ㄱ형강은 볼트 또는 용접에 의해 보와 지지부재에 접합된다. 본 연구에서는 비보강받침접합의 용접강도에 대한 실용적인 설계절차와 함께 용접부의 편심계산시 탄성벡터법(EVM)과 순간회전중심법(ICM)으로 소요지압길이에 근거한 설계도표를 제안하였다. 또한 제안한 설계방법에 의한 용접강도를 AISC와 KBC기준에 따라 비교하였다.

사례보고 : 칡즙 복용 후 발생한 독성간염 2예

김승영 ( Seung Young Kim ),임형준 ( Hyung Joon Yim ),안재홍 ( Jae Hong Ahn ),김정한 ( Jeong Han Kim ),김진남 ( Jin Nam Kim ),윤익 ( Ik Yoon ),김동일 ( Dong Il Kim ),이홍식 ( Hong Sik Lee ),이상우 ( Sang Woo Lee ),최재현 ( Jai Hyu 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

건강에 대한 관심 증가와 함께 대체요법의 사용이 늘어나면서 각종 식물제제를 포함한 건강보조식품으로 인한 부작용들이 나타나고 있다. 저자들은 칡즙을 복용한 후 발생한 독성간염 두 예를 경험하여 보고한다. 환자들은 구역, 구토 등으로 내원하였으며, 입원 후 혈액생화학검사, 혈청검사 및 간조직검사를 시행받았고 RUCAM 점수체계를 기준으로 독성간염으로 진단되었다. 이들은 보존적치료 후 검사실 소견 및 순간탄성도검사 등에서 빠른 호전을 보였다. 칡즙의 복용으로도 독성간염이 생길 수 있다는 점을 염두에 두고, 건강보조식품에 대한 경각심을 가져야겠다. Herbal remedies and health foods are widely used, and their side effects have been reported. We describe two cases of symptomatic toxic hepatitis that developed in middle-aged women after ingesting arrowroot juice. The clinical manifestations were nausea, vomiting, and jaundice. The diagnosis of toxic hepatitis was made using the Roussel Uclaf Causality Assessment Method score on the basis of the patient`s history and laboratory data. After supportive care, the patients showed rapid improvements of clinical symptoms, laboratory findings, and liver stiffness. Clinicians should be aware that the consumption of arrowroot juice can cause toxic hepatitis. (Korean J Hepatol 2009;15:504-509)

연구논문 : 만성 간질환 환자에서 순간탄성측정법(transient elastography, Fibroscan(R))에 의한 간탄력도에 영향을 줄 수 있는 임상요소

배락천 ( Rack Cheon Bae ),조한진 ( Han Jin Cho ),오종택 ( Jong Taek Oh ),이응갑 ( Eung Kap Lee ),허준 ( Jun Heo ),신근영 ( Keun Young Shin ),박수영 ( Soo Young Park ),정민규 ( Min Kyu Jeong ),전성우 ( Seong Woo Jeon ),조창민 ( Ch 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: Transient elastography as performed using the Fibroscan? is a useful noninvasive method for evaluating hepatic fibrosis. However, recent studies have found that liver stiffness measurement (lSM) values are inappropriately elevated in acute hepatitis or in the acute flare state of chronic hepatitis, suggesting that the lSM value obtained by the Fibroscan? is not a reliable marker for fibrosis. We retrospectively evaluated the clinical factors influencing the lSM value obtained using transient elastography as performed using the Fibroscan? in patients with chronic liver disease. Methods: A total of 298 patients who were followed in Kungpook National University Hospital from November 2007 to May 2008 due to previously established liver cirrhosis or chronic liver disease were investigated using the Fibroscan?, laboratory test, ultrasound, and/or abdominal computed tomography. Results: The 298 patients were aged 47.8±12.9 years (mean±SD). The cut-off value for a diagnosis of liver cirrhosis was 12.5 kPa (as used in previous studies). Thirty-six patients (15%) and 202 patients (85%) with chronic liver disease without clinical manifestation of cirrhosis had lSMs of >12.5 kPa and <12.5 kPa, respectively. Multivariate analysis revealed that lSM values were unusually increased in patients with chronic liver disease who were older (P=0.007) or who had increased gamma gultamyltranspetidase (GGT) (P=0.022), decreased albumin (P=0.015), or increased total bilirubin (P=0.009). Conclusions: This study reveals that age, GGT, and albumin are clinical factors influencing lSM values. This reinforces the need to interpret lSM values in the context of a defined diagnosis, biochemical data, radiologic examination, and other clinical findings.

포항분지 제3기 두호층 이암의 크리프 거동

김광식 ( Kwang Shik Kim ),김교원 ( Gyo Won Kim ) 대한지질공학회 2003 지질공학 Vol.13 No.2

FibroScan(R)을 이용한 간탄력도 검사

한광협 ( Kwang Hyub Han ),김승업 ( Seung Up Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5

Progressive liver fibrosis is a similar feature of all chronic liver diseases and eventually develops liver cirrhosis. The prognosis and treatment plans of chronic liver diseases depend strongly on the degree of liver fibrosis. These facts raise clinical interests in quantifying liver fibrosis. Although liver biopsy has been the gold standard for assessment of liver fibrosis, it has some technical limitations and risks. Accordingly, an increasing need for alternative non-invasive method to quantify liver fibrosis has been a major challenge that has stimulated search for new non-invasive methods. Such methods for diagnosing liver fibrosis have progressed significantly over the last few years notably with the appearance of several serological markers which have been reported to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. However, complicated calculation, cost problems, and influences of extrahepatic conditions make it less accessible to clinicians. Recently, liver stiffness measurement using FibroScan(R) is emerging as a new diagnostic method for liver fibrosis. It is totally non-invasive and reproducible and gives an immediate result without intra- and inter-observer variability. Its clinical use in comparison with liver biopsy and several available serologic markers is now intensively being investigated. Here, we review the currently available data on FibroScan(R).(Korean J Med 74:463-471, 2008)

춘계학술대회 발표 : 포스터전시 ; 무증상 대상자에서 순간 탄성 측정법에 의한 간조직 섬유화 및 지방 침착 정도의 진단: 생체 간이식 공여 대상자에서의 전향적 연구

김강모,박성호,유은실,이승규,임영석,이한주,정영화,이영상,서동진 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.3(S)

식도정맥류의 발생과 출혈 예측에 있어서 순간 탄성 측정법(Fibroscan(R))의 유용성

이시형 ( Si Hyung Lee ),은종렬 ( Jong Ryul Eun ),이헌주 ( Heon Ju Lee ),김태년 ( Tae Nyeun Kim ),장병익 ( Byung Ik Jang ),최재원 ( Jae Won Choi ),박윤선 ( Youn Sun Park ),김경옥 ( Kyung Ok Kim ),이규형 ( Gyu Hyung Lee ),문희정 ( H 대한내과학회 2008 대한내과학회지 Vol.74 No.5

Background/Aims: This study was conducted to evaluate the efficacy of transient elastography (Fibroscan(R)) for predicting esophageal varices and esophageal variceal hemorrhage in patients with chronic liver diseases. Methods: We studied 245 patients (mean age: 50.1 years, male/female: 181/64) with chronic liver diseases to determine the relation between the clinical or serologic markers associated with liver fibrosis and tissue elastography, and these tests were performed in Feb 2007. The causes of chronic liver diseases were hepatitis B virus in 139 (56.7%), hepatitis C virus in 30 (12.2%), alcohol in 38 (15.5%), nonalcoholic fatty liver disease in 23 (9.4%), autoimmune liver disease in 3 (1.2%), and unknown 12 (4.9%). Results: Transient elastography was correlated with APRI (r=0.712) and the grades of esophageal varices (r=0.635). The AUROC values of transient elastography were 0.916 (95% CI: 0.838-0.954) for the presence of esophageal varices, 0.875 (95% CI: 0.819-0.931) for the esophageal varices grade ≥2, and 0.895 (95% CI: 0.846-0.945) for esophageal variceal hemorrhage. The cutoff values for 90% specificity were 15.3 kPa for esophageal varices, 20.7 kPa for esophageal varices grade ≥2 and 34.8 kPa for esophageal variceal hemorrhage, while the negative predictive values were 90%, 94% and 97%, respectively. Conclusions: Transient elastography was correlated with the presence of esophageal varices, the grades of esophageal varices and the presence of esophageal variceal hemorrhage. Therefore, this data may help to screen those patients how might undergo upper gastrointestinal endoscopy.(Korean J Med 74:491-499, 2008)