그레이브스병에서 치료에 따른 폐동맥압의 변화

남택만,조한수,이진서,송영림,김두만,두영철,박철영,정인경,홍은경,이성진,오기원,김현규,유재명,최문기,유형준,박성우 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경: 갑상선기능항진증에 의한 갑상선중독증 환자들은 호흡곤란을 호소하며, 그 원인으로 호흡근의 근력 약화, 좌심실부전으로 인한 폐모세혈관의 울혈, 기도저항의 증가, 갑상선종으로 인한 기관의 압박, 호흡기능 이상 등이 거론되고 있다. 폐동맥고혈압이 동반된 그레이브스병 환자가 여러 증례가 보고되었으며, 폐동맥고혈압 환자에게서 갑상선 자가항체와 갑상선기능저하증의 빈도가 높음이 알려지면서 갑상선중독증이 동반된 그레이브스병 환자에게서 관찰되는 호흡곤란의 한 원인으로 폐동맥압 증가가 작용할 가능성이 제시되고 있다. 이에 저자 등은 그레이브스병 환자를 대상으로 폐동맥압을 측정하고 치료 전후의 폐동맥압의 변화를 전향적으로 연구하였다. 방법: 갑상선중독증이 동반된 그레이브스병 환자와 정상 갑상선기능을 나타낸 대조군을 대상으로 갑상선기능검사 및 갑상선 자가항체를 측정하고, 심초음파를 이용하여 치료 전후로 폐동맥압을 측정하여 폐동맥압과 갑상선기능 및 갑상선 자가항체와의 관계, 폐동맥압의 변화 등을 관찰하였다. 결과: 1. 연구대상은 대조군 10명 (남녀비 1:9, 관해 상태의 그레이브스병 3명, 갑상선종 3명, 정상인 4명), 그레이브스병 환자 26명 (남녀비 7:19)이었다. 2. 대조군과 치료 전 그레이브스병 환자의 폐동맥압은 각각 23.5±2.32 mmHg, 29.6±10.3 mmHg이었고, 치료 전의 폐동맥압과 혈청 갑상선자극호르몬 결합억제 면역글로불린 (TBII) 농도는 유의한 양의 상관관계를 보였다. 3. 26명의 그레이브스병 환자 중에서 10명 (38.5%)이 폐동맥고혈압 (기준: 폐동맥압 > 30 mmHg)으로 진단되었다. 4. 치료 전후로 폐동맥압을 측정한 13명은 폐동맥압이 치료 전 29.6±10.3 mmHg에서 치료 후 폐동맥압 22.2±6.48 mmHg로 의미있게 감소하였다. 결론: 갑상선중독증을 보이는 그레이브스병 환자의 약 40% 정도에서 폐동맥고혈압이 발견되어 폐동맥고 혈압은 그레이브스병에 흔하게 동반하는 질환으로 생각된다. 향후 그레이브스병 환자에서 관찰되는 폐동맥압의 증가와 관련한 병인, 발생기전 및 임상적 의의 등에 대한 연구가 필요할 것으로 생각된다. Background: Exertional symptoms, dyspnea and impaired effort tolerance are common in patients with Graves' disease. Proposed explanations include: high-output left heart failure, ineffective oxygen utilization and respiratory muscle weakness. In addition, pulmonary hypertension has also been reported in patients with Graves' disease. A high prevalence of hypothyroidism and positive thyroid autoantibody were also observed in patients with pulmonary arterial hypertension. Therefore, the pulmonary artery pressure in patients with Graves' disease was evaluated. Methods: Two-dimensional and Doppler echocardiographic examinations (Hewlett Packard Sonos 2500) were performed to determine the pulmonary artery (PA) pressure in 26 Graves' disease patients, both before and after treatment (23 patients with propylthiouracil and 3 with RAI), and in 10 euthyroid controls. The changes in the PA pressure after treatment were evaluated in 13 patients with Graves' disease, who became euthyroid after treatment. Results: The pulmonary artery pressure was increased in the untreated Graves' disease patients compared to the normal controls (23.5±2.32 vs. 29.6±10.3 mmHg). 38.5% of the Graves' disease patients (10/26) showed pulmonary arterial hypertension (PA>30 mmHg) and the serum TBII level was higher in the Graves' disease patients with pulmonary arterial hypertension than in those with normal PA pressure (P<0.05). In the Graves' patients who became euthyroid after treatment, the PA pressure was significantly decreased. Conclusion: 38.5% of the untreated Graves' disease patients showed pulmonary arterial hypertension, and the pulmonary artery pressure was significantly decreased in those who became euthyroid after treatment. The pathogenesis and clinical importance of pulmonary arterial hypertension in Graves' disease requires further studies (J Kor Soc Endocrinol 18:465∼472, 2003).

Pulmonary embolism with massive hemoptysis from pulmonary artery aneurysm in patient with Behçet’s disease : a case report

장준용,김양기,어수택,김기업,구소미,이보영 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Objective: Behçet’s disease(BD) is an idiopathic systemic vasculitis with variable clinical manifestation. Diagnosis of BD of a patient initially presented with vascular complication such as pulmonary embolism can be challenging and the exact role of anticoagulation therapy is still debated. So we report the case of a 27-year-old man with Behcet’s disease who initially presented with pulmonary embolism. Case Report: A 27-year-old Ethiopian male with no medical history presented with complaint of chest pain. A computerized tomography (CT) showed pulmonary thromboembolism with pulmonary infarctions in the both mid to lower lungs and Budd-Chiari syndrome due to thrombus in IVC and hepatic veins. Anti-coagulant therapy with rivaroxaban was started, and four months later, he was readmitted for massive hemoptysis. CT showed multifocal aneurysms in the both pulmonary arteries, diffuse alveolar hemorrhage, and resolution of previously seen pulmonary. Further examination revealed that the patient have BD. Anticoagulant therapy was stopped and high dose intravenous corticosteroid with cyclophosphamide was given. After 3 month, CT showed improvement of pulmonary aneurysm and recurrence of pulmonary embolism. Conclusion: We present a case of pulmonary embolism and pulmonary artery aneurysm associated with BD. Pulmonary aneurysm was successfully treated with immunosuppressant with steroid but pulmonary embolism was not. Further studies are needed about the role of anticoagulation therapy.

광범위한 폐정맥 폐쇄와 동반된 원발성 폐동맥 고혈압 1 예

서홍석(Hong Seog Seo),강경호(Kyeong Ho Kang),김혜경(Hye Kyeong Kim),임도선(Do Sun Lim),박창규(Chang Kyu Park),김영훈(Young Hoon Kim),심완주(Wan Joo Shim),오동주(Dong Joo Oh),박정의(Jeong Euy Park),노영무(Young Moo Ro),진동규(Dong Kyu 대한내과학회 1993 대한내과학회지 Vol.45 No.3

Primary pulmonary hypertension has been subdivided into several subsets, including plexogenic, theromoembolic, pulmonary veno-occlusive disease, and others. Pulmonary veno-occlusive disease (PVOD) is one of the least cause of clinical pulmonary hypertension, with approximately 100 patients reported in would medical literature, and no case reported in Korea. Here we report on a 35-year-old woman had primary pulmonary hypertension presenting with massive hemoptysis and secondary atelectasis. Her simple chest x-ray, C-T scan, pulmonary angiogram and cardiac catheterization findings were compatible with typical primary pulmonary hypertension, except elevated pulmonary capillary wedge pressure up to 26 mmHg. that was pathognomonic feature of pulmonary veno-occlusive disease subset of primary pulmonary hypertension. The laboratory findings were compatible with primary pulmonary hypertension and could rule out the secondary pulmonary hypertension and other cardiac diseases. Left lingular segment atelectasis due to massive hemoptysis clots was resolved by removal of large blood clots by bronchoscopy. Her pulmonary artery pressure was not response to the vasodilator trials including nifedipine and captopril. We report a case of PVOD with a review of the literature.

우리나라 성인의 제한성 및 폐쇄성 폐질환 유병률과 위험요인 : 2019 국민건강영양조사 자료분석

이도연 한국콘텐츠학회 2024 한국콘텐츠학회논문지 Vol.24 No.2

본 연구의 목적은 국내 40세 이상 성인의 폐질환 발생율과 질환의 위험요인을 파악하고, 이에 대한 관리를 통하여 폐질환 발생 예방을 위한 기초자료를 제공하는 것이다. 국민건강영양조사 2019년도 자료를 바탕으로 40세 이상 성인 중 폐기능 검사와 건강설문조사 등에 참여한 3,280명을 대상자로 선정하였다. 복합표본 다중로지스틱 회귀분석을 이용하여 폐질환 발생 위험요인을 분석하였다. 분석결과 본 연구대상자의 제한성 폐질환 발생율은 12.9%로 나타났고, 폐쇄성 폐질환은 10.0%로 나타났다. 제한성 폐질환에서는 남성일수록, 연령대가 높을수록, BMI와 허리둘레를 기준으로 비만인 경우에 발생 위험률이 높게 나타났다. 폐쇄성 폐질환에서는 남성인 경우, 연령대가 높은 경우, 과거흡연 및 현재 흡연자인 경우에 발생 위험률이 높았다. 따라서, 폐질환 발병을 감소시키기 위하여 질환별 위험요인을 가진 대상자를 위한 예방 중재 및 교육이 필요하다. The purpose of this study was to identify the incidence rate and risk factors of pulmonary disease in korean adults. Based on the data from the Korea National Health and Nutrition Survey 2019, 3,280 adults over 40 years of age who participated in lung function tests and health surveys were selected as subjects. Risk factors for lung disease were analyzed using complex sample multiple logistic regression analysis. As a result of the analysis, the incidence of restrictive pulmonary disease of the cases of this study was 12.9%, and obstructive pulmonary disease was 10.0%. The risk of developing restrictive pulmonary disease was high in men, in the high age group, and in the case of obesity based on body mass index and waist circumference. Obstructive pulmonary disease had a high risk of occurrence in men, high age group, past and current smokers. Therefore, in order to reduce the incidence of pulmonary disease, preventive intervention and education are needed for subjects with risk factors for each disease.

저산소성 폐질환에서 폐동맥압의 비관혈적 측정에 관한 연구

이진구(Jin Goo Lee),인광호(Kwang Ho In),박상면(Sang Myun Park),조재연(Jae Yeon Jho),심재정(Jae Jeong Shim),강경호(Kyung Ho Kang),심완주(Wan Joo Shim),유세화(Se Hwa Yoo) 대한내과학회 1995 대한내과학회지 Vol.49 No.4

Objectives: The presence of pulmonary hypertension in patients with hypoxic lung disease is associated with poor prognosis. Right heart catheterization is the reference method for the diagnosis of pulmonary arterial hypertension but this invasive technique is not always well tolerated in all patients with hypoxic lung disease. There is a need for noninvasive method to allow the accurate estimation of pulmonary arterial pressure in these patients. To find reliable noninvasive methods of measuring pulmonary artery pressure, we evaluated the reliability of continuous wave Doppler echocardiography and gated cardiac blood pool scintigraphy in patents with hypoxic lung disease. Methods: Noninvasive measurements of systolic pulmonary artery pressure by continuous wave Doppler echocardiography and right ventricular ejection fraction by gated cardiac blood pool scintigraphy were compared with systolic pulmonary atery pressure measured by cardiac catheterization in 12 patients with hypoxic lung disease. Results: 1) The systolic pulmonary artery pressures estimated by continuous wave Doppler echocardiography correlated closely with those measured by cardiac catheterization (r=0.88, p<0.01) 2) The right ventricular ejection fraction estimated by gated cardiac blood pool scintigraphy was also correlated well with the systolic pulmonary artery pressure measured by cardiac catheterization (r=0.85, p<0.01). Conclusion: Continuous wave Doppler echocar-diographic estimation of systolic pulmonary artery pressure and gated car diac blood pool scintigraphic estimation of right ventricular ejection pressure are reliable and feasible noninvasive assessment of pulmonary hypertension in patients with hypoxic lung disease.

Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations

Elaheh Malakan Rad,Reza Elhamian,Keyhan Sayadpour Zanjani,Reza Shabanian,Ehsan Aghaei Moghadam,Mohamad Taghi Majnoon,Aliakbar Zeinaloo 한국심초음파학회 2024 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.32 No.-

Background Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD). Methods A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland–Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH. Results The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures. Conclusions The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.

Risk Factor and Mortality in Patients with Pulmonary Embolism Combined with Infectious Disease

( Gi Dong Lee ),( Sunmi Ju ),( Ju-young Kim ),( Tae Hoon Kim ),( Jung-wan Yoo ),( Seung Jun Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Kyung Nyeo Jeon ),( Jong Deog Lee ),( Ho Cheol Kim ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.2

Background: Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study was to evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonary embolism (PE). Methods: Patients with PE diagnosed based on spiral computed tomography findings of the chest were retrospectively analyzed. They were classified into two groups: patients who developed PE in the setting of infectious disease or those with PE without infection based on review of their medical charts. Results: Of 258 patients with PE, 67 (25.9%) were considered as having PE combined with infectious disease. The sites of infections were the respiratory tract in 52 patients (77.6%), genitourinary tract in three patients (4.5%), and hepatobiliary tract in three patients (4.5%). Underlying lung disease (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.926-7.081; p<0.001), bed-ridden state (OR, 2.84; 95% CI, 1.390-5.811; p=0.004), and malignant disease (OR, 1.867; 95% CI, 1.017-3.425; p=0.044) were associated with combined infectious disease in patients with PE. In-hospital mortality was higher in patients with PE combined with infectious disease than in those with PE without infection (24.6% vs. 11.0%, p=0.006). In the multivariate analysis, combined infectious disease (OR, 4.189; 95% CI, 1.692-10.372; p=0.002) were associated with non-survivors in patients with PE. Conclusion: A substantial portion of patients with PE has concomitant infectious disease and it may contribute a mortality in patients with PE.

호흡기내과 의사를 위한 폐혈관 질환 리뷰

임성용 ( Seong Yong Lim ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.4

Pulmonary vascular disease is a category of disorders, including pulmonary hypertension, pulmonary embolism or chronic thromboembolic pulmonary hypertension, pulmonary vasculitis, pulmonary vascular disease secondary to chronic respiratory disease, and pulmonary vascular tumor and malformations. This article reviews the recent advances in this wide spectrum of pulmonary vascular diseases.

A Study on Risk Factors of Chronic Lung Disease That Threatens National Happiness

Jeong-Il Kang(강정일),Dae-Keun Jeong(정대근) 한국엔터테인먼트산업학회 2015 한국엔터테인먼트산업학회논문지 Vol.9 No.3

This study aims to compare the change patterns vs. risk factors of osteoporosis depending on the classification of the severity of pulmonary function in patients with chronic pulmonary disease, identify the highly relevant factors and points of time among the patients period-specific factors, and provide basic analytical data of osteoporosis in patients with chronic pulmonary disease. This study targeted 48 outpatients who were receiving outpatient treatment after being diagnosed with chronic obstructive pulmonary disease at H hospital located at South Jeolla Province. All of them were classified into four groups depending on the classification of the severity of GOLD, and bone density was measured from each group in order to measure and compare the related risk factors. As a result, there was a significant difference in body weight, BMI, FEV1 in FEV1/FVC (p<0.001); there was also a significant difference in changes of T-score between experimental groups (p<0.01); and there was a significant difference in red blood cell count, white blood cell count, and C-protein and erythrocyte sedimertation rate (p<0.01)(p<0.01). It was found that patients with chronic obstructive pulmonary disease were exposed to diseases and simultaneously to the risk of osteoporosis. Physically, inflammation reactions got worse largely in serious cases. Smoking and steroid use were also risk factors. Thus, it is considered that the risk factors should be recognized simultaneously according to the classification of severity as well as pulmonary function in treatment manuals for the patients with chronic obstructive pulmonary disease.

Prevalence and impact of airway diseases on clinical outcomes in idiopathic pulmonary fibrosis

( Heemoon Park ),( Jaeyoung Cho ),( Jinwoo Lee ),( Young Sik Park ),( Chang-hoon Lee ),( Sang-min Lee ),( Chul-gyu Yoo ),( Young Whan Kim ),( Sung Koo Han ),( Sun Mi Choi ) 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.2

Background/Aims: The prevalence and effects of airway diseases, including asthma, eosinophilic bronchitis (EB), chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) have not been thoroughly studied in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to evaluate the prevalence of airway diseases in patients with IPF and to identify the differences in symptoms based on the presence of airway diseases. Methods: This single-institution prospective cohort study was conducted from June 2017 to September 2018, at the Seoul National University Hospital. Spirometry with bronchodilator, methacholine bronchial provocation test, induced sputum with eosinophil stain, and exhaled nitric oxide were performed to confirm the presence of airway disease. The modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), St. George’s Respiratory Questionnaire (SGRQ), EuroQol-5 dimension (EQ-5D) index, and cough-specific quality of life questionnaire (CQLQ) data were collected to assess symptom severity. Results: Total 147 patients with IPF were screened, and 70 patients were analyzed. The prevalence of airway diseases in the participants was as follows: 5.0% had COPD, 1.7% had asthma, 3.3% had ACO, and 1.7% had EB. The mMRC, CAT, SGRQ, EQ-5D, and CQLQ scores did not differ regardless of combined airway disease. After 3 months, the SGRQ (p = 0.028) and CQLQ (p = 0.030) scores were significantly higher in patients with airway disease than in those without. Conclusions: The prevalence of airway diseases in patients with IPF is low, but when airway diseases are accompanied by IPF, symptom severity and quality of life may worsen rapidly.