• 제목/요약/키워드: Chronic renal failure

검색결과 315건 처리시간 0.034초

논문 검색을 통한 피부 부작용 사례 고찰 (A Review on Cases of Skin Adverse Reactions through the Search for Articles)

  • 조혜신;송아련;서형식
    • 한방안이비인후피부과학회지
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    • 제31권3호
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    • pp.50-59
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    • 2018
  • Objectives : The aim of this review is to investigate studies on skin adverse reactions and to demonstrate subjects related to the adverse effects in dermatology. Methods : Electric searches were performed with KISS(Korean studies Information Search System) and the key words were combination of 'skin' and 'adverse effect'. 87 literatures investigated in this review were issued from 1900 to 2016. Results : Among the 87 papers, dermatologic adverse reactions were reported in 83 papers in medicine, accounting for 95.4%. Of the adverse effects seen on the skin, 84 discoloration such as erythema, pigmentation and hemotelangiosis were the most common, accounting for 21%. Among the medical adverse reactions not seen on the skin, 21 infection were the most common, accounting for 25%. Among the subjective adverse reactions, of which 32 pruritus were the most common, accounting for 43%. Among the 87 papers, there were 3 cases with underlying diabetes and 3 cases with underlying hypertension, followed by 2 cases with chronic renal failure, HBV, atopic dermatitis and respectively 1 case with alcoholism, depression addiction, multiple myeloma, arthritis and psoriasis. The most frequent period until adverse reactions appeared was within 2 weeks, accounting for 13 papers. And 4 were the most frequent adverse reactions lasting less than 1 month, and 4 were more than 3 months and less than 6 months. There were 48 cases where adverse reactions were caused by nonmedical practioner's treatment. The adverse reactions by the pharmacist were the highest at 11 cases (23%). There were 17 cases of adverse reactions due to medical treatment, among which dermatologists and nondermatologists accounted for the majority of 5 cases, 29%. The most common cause of adverse reactions was the application of external medicine (41 cases), followed by 36 cases of foreign body implantation, eyebrow tattooing, ear piercing, etc. Conclusions : In this report, we demonstrated patterns of adverse reactions in the medical field of dermatology caused by non-medical personnel than medical personnel. We suggest that more effort should be followed by medical personnel to establish clear awareness of skin disease and by patients to be aware of the risks of the illegal medical treatment by non-medical personnel.

Laminotomy with Continuous Irrigation in Patients with Pyogenic Spondylitis in Thoracic and Lumbar Spine

  • Kim, Sung-Hyun;Lee, Jung-Kil;Jang, Jae-Won;Seo, Bo-Ra;Kim, Tae-Sun;Kim, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • 제50권4호
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    • pp.332-340
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    • 2011
  • Objective : Pyogenic spondylitis often results in acute neurological deterioration requiring adequate surgical intervention and appropriate antibiotic treatment. The purpose of this study was to conduct an analysis of the clinical effect of continuous irrigation via laminotomy in a series of patients with pyogenic spondylitis in thoracic and lumbar spine. Methods : The authors conducted a retrospective investigation of 31 consecutive patients with pyogenic thoracic and lumbar spondylitis who underwent continuous irrigation through laminotomy from 2004 to 2008. The study included 22 men and 9 women, ranging in age from 38 to 78 years (mean 58.1 years). The average follow-up duration was 13.4 months (range, 8-34 months). We performed debridement and abscess removal after simple laminotomy, and then washed out epidural and disc space using a continuous irrigation system. Broad spectrum antibiotics were administered empirically and changed according to the subsequent culture result. Clinical outcomes were based on the low back outcome scale (LBOS), visual analogue scale (VAS) score, and Frankel grade at the last follow-up. Radiological assessment involved plain radiographs, including functional views. Results : Common predisposing factors included local injection for pain therapy, diabetes mellitus, chronic renal failure, and liver cirrhosis. Causative microorganisms were identified in 22 cases (70.9%) : Staphylococcus aureus and Streptococcus spp. were the main organisms. After surgery, LBOS, VAS score, and Frankel grade showed significant improvement in most patients. Spinal stability was maintained during the follow-up period, making secondary reconstructive surgery unnecessary for all patients, except one. Conclusion : Simple laminotomy with continuous irrigation by insertion of a catheter into intervertebral disc space or epidural space was minimally invasive and effective in the treatment of pyogenic spondylitis. This procedure could be a beneficial treatment option in patients with thoracolumbar spondylitis combined with minimal or moderate destructive change of vertebrae.

스테로이드 저항성 신증후군 환아에서의 Methylprednisolone 충격 요법의 치료 효과 (The Effect of Methylprednisolone Pulse Therapy against Steroid Resistant Nephrotic Syndrome in Children)

  • 이창연;하일수;정해일;최용
    • Childhood Kidney Diseases
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    • 제1권2호
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    • pp.123-129
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    • 1997
  • 목적 : 소아의 스테로이드 저항성 신증후군은 예후가 불량함에도 불구하고 지금까지 효과적인 치료방법이 없는 병이었으나 1990년 Mendoza등이 Methylprednisolone 충격 요법이 스테로이드 저항성 신증후군에서 효과적이라는 것을 보고하였다. 하지만 2년 뒤 Waldo 등은 Methylprednisolone 충격 요법이 Mendoza 등의 보고와는 다르게 스테로이드 저항성 신증후군에 효과가 적었다고 보고하여 이에 저자는 한국 소아에서 스테로이드 저항성 신증후군이 발생한 경우 Methylprednisolone 충격 요법의 효과를 알아보고 위의 보고의 서로 다른 결과를 확인하고자 본 연구를 시행하였다. 방법 : 1990년부터 1995년까지 만 5년간 서울대병원 소아과에 스테로이드 저항성 신증후군으로 입원한 소아를 대상으로 Methylprednisolone 충격 요법을 시행하여 $30{\pm}11$개월동안 추적 관찰하였다. 결과 : 1) Methylprednisolone 충격 요법 치료로 신증후군이 완해가 유도된 환아는 20명중 9명으로 45%이었다. 2) Methylprednisolone 충격 요법 치료후 신증후군의 완해가 유지된 환아는 20명중 9명으로 45%이었다. 3) Methylprednisolone 충격 요법에 반응이 없었던 환아중 만성 신부전으로 이행된 경우는 5례로서 25%이었다. 결론 : Methylprednisolone 충격 요법은 스테로이드 저항성 신증후군 소아의 45%에서 신증후군의 완해를 유도하고 유지시키는 효과적인 치료 방법이었다.

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정상 성인의 정중지단신경에 대한 전기생리학적 연구 (An Electrophysiologic Study on the Median Digital Nerves in Healthy Adults)

  • 김종순;이현옥;안소윤;구봉오;남건우;류재관;류재문
    • The Journal of Korean Physical Therapy
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    • 제17권3호
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    • pp.329-338
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    • 2005
  • The determination of peripheral nerve conduction velocity is an important part to electrodiagnosis. Its value as neurophysiologic investigative procedure has been known for many years but normal value of digital nerve was not reported in Korea. To evaluate of digital nerve conduction velocity of median nerve for obtain clinically useful reference value and compare difference in each fingers. 71 normal volunteers(age, 19-65 years; 142 hands) examined who has no history of peripheral neuropathy, diabetic mellitus, chronic renal failure, endocrine disorders, anti-cancer medicine, anti-tubercle medicine, alcoholism, trauma, radiculopathy. Nicolet Viking II was use for detected conduction velocity and amplitude of digital nerves in median nerve. Data analysis was performed using SPSS. Descriptive analysis was used for obtain mean and standard deviation, ANOVA was used to compare each fingers and independent t-test was used to compare between Rt and Lt side also compare between different in genders. Conduction velocity of the right thumb was 49.77m/sec, index finger was 56.80m/sec, middle finger was 56.15m/sec and ring finger was 53.38m/sec. The left thumb was 50.48m/sec, index finger was 56.76m/sec, middle finger was 55.99m/sec and ring finger was 53.23m/sec. Amplitude of the right thumb was $64.30{\mu}V$, index finger was $73.95{\mu}V$, middle finger was $77.97{\mu}V$ and ring finger was $43.92{\mu}V$. The left thumb was $74.21{\mu}V$, index finger was $85.72{\mu}V$, middle finger was $88.06{\mu}V$ and ring finger was $47.28{\mu}V$. There were significantly difference between thumb, index, middle and ring fingers(p<.01) but there were no statistically difference between conduction velocity and amplitude of index and middle fingers(p>.01). The conduction velocity of index finger are faster than other fingers and amplitude of middle finger are greater than other fingers. The present results revealed that electodiagnosis can easily perform in index and middle finger for digital nerve of median nerve study.

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경추 경막외강 확인법의 비교 연구 (Comparison of Methods to Confirm the Cervical Epidural Space)

  • 옥시영;전혜림;백영희;김상호;김순임;김선종;박욱;송단
    • The Korean Journal of Pain
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    • 제22권2호
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    • pp.158-162
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    • 2009
  • Background: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. Methods: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. Results: Using the drip infusion method, we identify the epidural space in all the patients as +/++ grade. The catheter insertion method was also successful in identifying those epidural spaces over a ${\pm}$ grade. The pseudo LOR was over ${\pm}$ grade in 47 patients. Conclusions: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.

정중운동신경과 척골운동신경의 전기생리학적 연구 (An Electrophysiologic Study on the Median Motor Nerve and Ulnar Motor Nerve)

  • 김종순;이현옥;안소윤;구봉오;남건우;김영직;김호봉;류재관;류재문
    • 대한정형도수물리치료학회지
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    • 제11권2호
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    • pp.62-70
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    • 2005
  • The determination of peripheral nerve conduction velocity is an important part to electrodiagnosis. Its value as neurophysiologic investigative procedure has been known for many years but normal value of median and ulnar motor nerve was poorly reported in Korea. To evaluate of median and ulnar motor nerve terminal latency, amplitude of CMAP(compound muscle action potential), conduction velocity and F-wave latency for obtain clinically useful reference value. 71 normal volunteers(age, 19-65 years; 142 hands) examined who has no history of peripheral neuropathy, diabetic mellitus, chronic renal failure, endocrine disorders, anti-cancer medicine, anti-tubercle medicine, alcoholism, trauma, radiculopathy. Nicolet Viking II was use for detected terminal latency, amplitude of CMAP, conduction velocity and F-wave latency of median and ulnar motor nerve. Data analysis was performed using SPSS. Descriptive analysis was used for obtain mean and standard deviation, independent t-test was used to compare between Rt and Lt side also compare between different in genders. The results are summarized as follows: 1. Median motor nerve terminal latency was right 3.00ms, left 2.99ms and there was no significantly differences between right and left side and genders. 2. Median motor nerve amplitude of CMAP was right 17.26mV, left 1750mV and there was no significantly differences between right and left side and genders. 3. Median motor nerve conduction velocity was right 57.89m/sec, left 58.03m/sec and there was no significantly differences between right and left side and genders. 4. Median motor nerve F-wave latency was right 25.74ms, left 25.59ms and there was significantly differences between genders. 5. Ulnar motor nerve terminal latency was right 2.38ms, left 2.45ms and there was significantly differences between right and left side. 6. Ulnar motor nerve amplitude of CMAP was right 15.99mV, left 16.02mV and there was no significantly differences between right and left side and genders. 7. Ulnar motor nerve conduction velocity was right 60.35m/sec, left 59.73m/sec and there was no significantly differences between right and left side and genders. 8. Ulnar motor nerve F-wave latency was right 25.53ms, left 25.57ms and there was significantly differences between genders.

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척골 지단 신경의 전기생리학적 연구 (An Electrophysiologic Study on the Ulnar Digital Nerves)

  • 김종순;이현옥;안소윤;구봉오;남건우;김호봉;류재관;류재문
    • 대한정형도수물리치료학회지
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    • 제11권2호
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    • pp.13-18
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    • 2005
  • The ulnar nerve extends down the arm, across the elbow, and into the hand. It provides sensation to the little and ring fingers and activates many of the small muscles in the hand. The determination of peripheral nerve conduction velocity is an important part of ulnar nerve evaluation. The electrodiagnostic value as neurophysiologic investigative procedure has been known for many years but normal value of digital nerve was not reported in Korea. The purpose of this investigation was to measure the digital nerve conduction velocity of ulnar nerve for obtain clinically useful reference value and compare difference in each fingers and then compare with the other countries. 71 normal Korean volunteers (age, 19-65 years; 142 hands) examined who has no history of peripheral neuropathy, diabetic mellitus, chronic renal failure, endocrine disorders, anti-cancer medicine, anti-tubercle medicine, alcoholism, trauma, radiculopathy. Nicolet Viking II (EMG machine) was use for detected conduction velocity and amplitude of digital nerves in ulnar nerve. Data analysis was performed using SPSS. Descriptive analysis was used for obtain mean and standard deviation and independent t-test was used to compare with ring and little finger. Conduction velocity of the right ring finger was 57.44m/sec and little finger was 55.32msec. The left ring finger was 55.55msec and little finger was 54.11msec. Amplitude of the right ring finger was $30.28{\mu}V$ and little finger was $48.36{\mu}V$. The left ring finger was $30.67{\mu}V$ and little finger was $52.76{\mu}V$. There were significantly difference between ring and little in amplitude (p<.05) but there were no statistically difference between conduction velocity of ring and little finger (p>.05). The amplitude of little finger are greater than ring finger. The present results revealed that electodiagnosis can easily perform in little finger for digital nerve of ulnar nerve study.

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An Assessment of the Usefulness of Time of Flight in Magnetic Resonance Angiography Covering the Aortic Arch

  • Yoo, Yeong-Jun;Choi, Sung-Hyun;Dong, Kyung-Rae;Ji, Yun-Sang;Choi, Ji-Won;Ryu, Jae-Kwang
    • 방사선산업학회지
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    • 제12권4호
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    • pp.325-332
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    • 2018
  • Carotid angiography covering the aortic arch includes contrast-enhanced magnetic resonance angiography (CEA), which is applied to a large region and usually employs contrast media. However, the use of contrast media can be dangerous in infants, pregnant women, and patients with chronic renal failure (CRF). Follow-up patients informed of a lesion may also want to avoid constant exposure to contrast media. We aimed to apply time-of-flight (TOF) angiography to a large region and compare its usefulness with that of CEA. Ten patients (mean age, 58 years; range, 45~75 years) who visited our hospital for magnetic resonance angiography (MRA) participated in this study. A 3.0 Tesla Achieva magnetic resonance imaging (MRI) system (Philips, Netherland) and the SENSE NeuroVascular 16-channel coil were employed for both methods. Both methods were applied simultaneously to the same patient. Three TOF stacks were connected to cover the aortic arch through the circle of Willis, and CEA was applied in the same manner. For the quantitative assessment, the acquired images were used to set the regions of interest (ROIs) in the common carotid artery (CCA) bifurcation, internal carotid artery, external carotid artery, middle cerebral artery, and vertebral artery, and to obtain the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) for the soft tissues. Three radiologists and one radiological resident performed the qualitative assessment on a 5-point scale - 1 point, "very bad"; 2 points, "bad"; 3 points, "average"; 4 points, "good"; and 5 points, "very good" - with regard to 4 items: (1) sharpness, (2) distortion, (3) vein contamination, and (4) expression of peripheral vessels. For the quantitative assessment, we estimated the mean SNR and CNR in each of the 5 ROIs. In general, the mean SNR was higher in TOF angiography (166.1, 205.2, 154.39, 172.23, and 161.95) than in CEA(92.05, 95.43, 84.76, 73.69, and 88.3). Both methods had a similar mean CNR: 67.62, 106.71, 55.9, 73.74, and 63.46 for TOF angiography, and 67.82, 71.19, 60.52, 49.45, and 64.07 for CEA. In all ROIs, the mean SNR was statistically significant (p<0.05), whereas the mean CNR was insignificant (p>0.05). The mean values of TOF angiography and CEA for each item in the qualitative assessment were 4.2 and 4.28, respectively for item 1; 2.93 and 4.55, respectively, for item 2; 4.6 and 3.13, respectively, for item 3; and 2.88 and 4.65, respectively, for item 4. Therefore, TOF angiography had a higher mean for item 3, and CEA had a higher mean for items 2 and 4; there was no significant difference between the two methods for item 1. The results for item 1 were statistically insignificant (p>0.05), whereas the results for items 2~4 were statistically significant (p<0.05). Both methods have advantages and disadvantages and they complement each other. However, CEA is usually applied to a large region covering the aortic arch. Time-of-flight angiography may be useful for people such as infants, pregnant women, CRF patients, and followup patients for whom the use of contrast media can be dangerous or unnecessary, depending on the circumstance.

소아 급속 진행성 사구체신염의 임상적 고찰 (Analysis of Childhood Rapidly Progressive Glomerulonephritis)

  • 엄지현;김미진;이영목;김지홍;이재승;김병길;홍순원;정현주
    • Childhood Kidney Diseases
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    • 제5권2호
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    • pp.78-86
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    • 2001
  • 목 적 : 급속 진행성 사구체신염(Rapidly Progressive Glomerulonephritis)은 초기에는 급성 사구체신염이나 신증의 소견을 나타내다가 수주 내지 수개월 내에 급성 신부전에 빠지게 되는 임상 양상을 보이며, 조직학적으로 반월상, 즉 모세혈관외 증식과 분절성 사구체 괴사가 특징적이어서 반월상 사구체신염으로 불리기도 한다. 이 질환의 병인이나 임상양상, 치료 및 예후에 대한 보고는 아직 많지 않은 상태이며, 특히 소아와 관련된 국내 연구는 미미한 상태이다. 이에 저자들은 급속 진행성 사구체신염으로 진단받은 환아들을 대상으로 원인질환과 임상양상의 특징을 분석하였다. 대상 및 방법 : 1990년 5월부터 2000년 5월까지 소아과에 내원하여 임상 양상과 신생검 소견을 종합하여 급속 진행성 사구체신염으로 진단받고 계속적인 추적 관찰이 가능하였던 10명을 대상으로 치료반응 및 임상경과에 대하여 후향적으로 조사하였다. 급속 진행성 사구체신염의 진단 기준으로는 임상적으로 신기능의 급속한 감소(3개월 이내에 사구체 여과율이 $50\%$이상 감소) 소견이 있으면서, 신조직검사상 $50\%$ 이상의 사구체가 반월상을 형성하고 있는 경우로 정의하였다. 결 과 : 발병당시의 평균 연령은 $10.9{\pm}3.8세$였고, 7세 이상의 학동기 환아가 9명으로 대부분이었고 남녀비는 1.5:1이었다. 신조직검사상 원인질환으로는 Henoch-$Sch{\ddot{o}}nlein$ 자반증이 3례($30\%$), 특발성 급속 진행성 사구체신염과 루푸스 신염이 각각 2례 ($20\%$)씩 있었으며, 용혈성 요독 증후군, 막성 사구체신염, 현미경적 다발성 동맥염이 각각 1례($10\%$)씩 있었다. 내원 당시의 주증상으로는 핍뇨와 육안적 혈뇨가 가장 많았고, 발병당시의 임상양상으로는 핍뇨, 현미경적 혈뇨, 육안적 혈뇨, 단백뇨, 부종, 고혈압, 오심, 구토, 관절의 통증 등이 있었다. 혈중 요소 질소치는 평균 $74.2{\pm}39.1\;mg/dL$, 크레아티닌은 평균 $3.2{\pm}1.8\;mg/dL$, 크레아티닌 제거율은 평균 $26.5{\pm}13.2\;mL/min/1.73m^2$로 신기능이 많이 감소되어 있었다. 항호중구 세포질 항체(antineutrophil cytoplasmic antibody)가 양성으로 나온 경우는 현미경적 다발성 동맥염 1례($10\%$)이었고, 항핵 항체 및 항DNA 항체는 루푸스 신염 환아 2례($20\%$)에서 양성 소견을 보였고, 혈중 보체가는 4례($40\%$)에서 감소 소견을 보였다. 용혈성 요독 증후군을 제외한 모든 환아에서 스테로이드 충걱요법 및 면역억제제 병합요법을 시행하였으며, 응급 복막투석은 3례($30\%$), 혈장교환술은 2례($20\%$)에서 시행하였다. 이후 정상적인 신기능으로 회복된 경우는 6례($60\%$) 있었고. 만성 신부전으로 진행된 경우가 4례($40\%$) 있었는데, 2례($20\%$)에서 지속적인 복막투석을 시행하였으며, 이중 1례는 심부전으로 사망하였다. 결 론 : 아직까지 국내에서의 급속 진행형 사구체신염에 대한 연구보고는 미미한 상태로 질환의 정확한 이해를 통한 조기진단이 필요하며, 적극적인 치료와 더불어 장기예후에 대한 지속적인 조사와 연구가 필요할 것으로 사료된다.

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비결핵항산균증 전국 실태조사 (National Survey of Mycobacterial Diseases Other Than Tuberculosis in Korea)

  • 대한결핵 및 호흡기학회 학술위원회
    • Tuberculosis and Respiratory Diseases
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    • 제42권3호
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    • pp.277-294
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    • 1995
  • 연구 배경: 우리나라에서 과거 30년 동안 결핵 유병률은 현저히 감소되어 왔으나 비결핵항산균에 의한 질병의 발생빈도는 아직 정확하게 알려져 있지 않다. 대한결핵 및 호흡기학회는 전국 실태조사를 통하여 현재까지 확인된 전국의 비결핵항산균증 발생 현황을 파악하고 이를 분석하여 외국의 보고와 비교함으로써 일반 개업의 및 내과 전문의의 진료 활동에 도움이 되도록 하고자 본 사업을 시행하였다. 방법: 조사와 분석은 1981년 1월부터 1994년 10월까지 대한결핵협회 결핵연구원에 의뢰된 검체중 비결핵항산균의 종(species)이 확인된 158예를 대상으로 검사를 의뢰한 병원의 진료의에게 증례 기록지를 보내어 정확한 임상 및 검사 정보를 기록하여 회신 하도록하는 후향적 조사 방법으로 그 결과를 수집 분석하였다. 결과: 1) 연도별로 보면 1981년에 1예, 1982년 2예 등으로 1990년 이전에는 매년 10예 미만 이던 것이 1991년에 14예, 1992년 10예, 1993년 4예, 1994년에는 96예로 1990년 이후가 전체의 84.2%를 차지하였다. 2) 연령은 10대 1예, 20대 6예, 30대 15예, 40대 19예, 50대 27예, 60대 51예, 70세 이상 39예로 60세 이상이 전체의 57%를 차지하였다 성별 분포는 남자 114예(72.1%), 여자 44예(27.9%) 이었다. 3) 병원별 분포는 복십자의원 61예(38.6%), 보건소 42예(26.6%), 3차기관 21예(13.3%), 2차기관 15예(9.5%), 1차기관 10예(6.3%) 이었으며, 지역별 분포는 서울 98예(62%), 경상북도 17예(10.8%), 경기도 12예(7.6%), 충청남도 8예(5.1%), 경상남도와 충청북도 각각 5예(3.2%), 기타 지역이 6예(3.8%) 이었다. 4) 선행 폐 질환은 폐결핵 113예(71.5%), 기관지확장증 6예(3.8%), 만성 기관지염 10예(6.3%), 폐섬유증 6예(3.8%) 등이었다. 폐결핵의 발병 시기는 1년 이내가 7예(6.2%), 2~5년전 32 예(28.3%), 6~10년전 29예(25.7% ) 등으로 2~10년전이 전체의 54%를 차지하였다. 폐결핵의 치료 기간은 3개월 이내가 6예로 5.3%이었으며, 4~6개월이 17예(15%), 7~9개월 16예(14.2%), 10~12 개월 11예(9.7%), 1~2년 21예(18.6%), 2년 이상 8예로 7.1% 이었다. 폐결핵의 치료 결과는 완치가 44예(38.9%), 치료 설패가 25예(22.1%) 이었다. 5) 동반된 폐외질환은 만성 간질환과 만성 산부전이 함께 있었던 경우 각각 1예를 포함하여 당뇨병이 9예(5.7%)에서 있었으며, 심혈관계질환 2예(1.3%), 장기간 스테로이드를 투여 받은 경우 2예(1.3%) 그리고 만성 간질환, 만성 신부전, 대장염 및 진폐증이 각 1예(0.6%)씩 있었다. 6) 비결핵항산균증이 발현한 임상상은 만성 폐 감염증 86예(54.4%), 경부 및 기타 임파선염 1예(0.6%), 기관지 결핵 3예(1.9%), 장결핵 1예(0.6%) 이었다. 7) 임상 소견은 기침 62%, 객담 61.4%, 호흡곤란 30.4%, 객혈 및 혈담 20.9%, 체중 감소 l3.3%, 발열 6.3%, 기타 4.4% 등 이었다. 8) 흉부 X-선 소견은 정상 7예(4.4%), 경증 20예(12.7%), 중등증 67예(42.4%), 중증 47예(29.8%)이었으며, 공동은 43예(27.2%)에서 동반되었고, 흉막염은 18예(11.4%)에서 동반되었다. 9) 비결핵항산균이 확언된 검사물은 객담 143예(90.5%), 객담 및 기관지세척액 4예(2.5%), 기관지세척액 1예(0.6%) 이었다. 동정된 비결핵항산균의 종류는 M. avium-intracellulare가 104예로 전체의 65.2%를 차지하였고 M. fortuitum 20예(12.7%), M. chelonae 15예(9.5%), M. gordonae 7예(4.4%), M. terrae 5예(3.2%), M. scrofulaceum 3예(1.9%), M. kansasii와 M. szulgai가 각각 2예(1.3%), 그리고 M. avium-intracellulare와 M. terrae가 동시에 확인된 경우가 1예(0.6%) 이었다. 10) 도말 및 배양 검사 결과는 4번의 검사 중 도말 음성, 배양 양성인 경우는 첫번째 검사상 59예로 37.3%이었고, 두번째 검사에서는 22.8%, 세번째 검사에서는 15.2%, 네번째 검사에서는 14.6% 이었으며, 도말 양성, 배양 양성인 경우는 첫번째 검사상 48예로 30.4% 이었고, 두번째와 세번째 검사에서는 각각 34예(21.5%), 네번째 검사에서는 22예(13.9%)이었다. 이상의 배양 검사 결과를 종합하면 4번 검사한 것 중에서 4회 모두 배양 양성으로 확인된 경우가 21예(13.3%)이었고 3회 배양 양성은 37예(23.4%), 2회 배양 양성은 38예(24.1%)로 2번 이상 배양 양성으로 확인된 경우는 총 96예(60.8%) 이었다. 11) 모든 비결핵항산균에 대한 약제 내성률은 INH 62%, EMB 55.7%, RMP 52.5%, PZA 34.8%, OFX 29.1%, SM 36.7%, KM 27.2%, TUM 24.1%, CS 23.4%, TH 34.2%, PAS 44.9% 이었다. M. avium intracellulare에 대한 내성률은 INH 62.5%, EMB 59.6%, RMP 51.9%, PZA 29.8%, OFX 33.7%, SM 30.8%, KM 20.2%, TUM 17.3%, CS 14.4%, TH 31.7%, PAS 38.5%이었다. M. chelonae에 대한 내성률은 INH 66.7%, EMB 66.7%, RMP 66.7%, PZA 40%, OFX 26.7%, SM 66.7%, KM 53.3%, TUM 53.3%, CS 60%, TH 53.3%, PAS 66.7% 이었다. M. fortuitum 에 대한 내성률은 INH 65%, EMB 55%, RMP 65%, PZA 50%, OFX 25%, SM 55%, KM 45%, TUM 55%, CS 65%, TH 45%, PAS 60% 이었다. 12) 비결핵항산균증의 치료는 129예(81.7%)에서 시행하였으며, 1차 치료 처방 중 INH와 RMP을 포함하는 복합 처방은 86예(66.7%) 이었고, INH 혹은 RMP 중 한가지만을 포함하는 처방은 30예(23.3%), INH와 RMP이 포함되지 않은 처방은 9예(7%)에서 있었다. 2차 치료를 시행한 65예의 처방은 2제 이하 2예(3.1%), 3제 15예(23.1%), 4제 20예(30.8%), 5제 9예(13.8%), 6제이상 19예(29.2%) 이었다. 치료 후 경과는 36예(27.9%)에서 호전, 65예(50.4%)에서 변화 없었으며, 4예(3.1%)에서 악화 4예(3.1%)에서 사망하였다. 호전된 경우 34예(94.4%)에서 균 음전이 확인되었으며, 균 음전 시기는 1개월 이내 2예(5.9%), 3개월 이내 11예(32.4%), 6개월 이내 14예(41.2%), 1년 이내 2예(5.9%), 1년 이상 1예(2.9%) 등 이었다. 결론: 비결핵항산균증 전국실태조사 결과 아직 우리나라에서 확인된 비결핵항산균 감염 예가 많지 않으나 1990년 이후 비결핵항산균증이 현저히 증가하는 경향이었으므로 앞으로 이에 대한 임상의들의 관심이 더욱 필요하리라 생각된다.

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