• 핵의학기술
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• 제18권1호
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• pp.153-157
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• 2014

Anti double-stranded DNA (Anti-ds DNA)항체의 검출은 SLE의 진단에 중요하며 American College of Rheumatologists의 SLE 진단기준에 포함되어 있다. 또한 SLE 질병의 활성도와 Anti-ds DNA 항체 수준의 상관성이 보고되어 있으며 Anti-ds DNA 항체 정량검사는 SLE의 치료 전, 후 추적에 매우 유용하다. Anti-ds DNA 항체의 검출을 위한 검사 방법으로 방사면역측정법(radioimmunoassay, RIA)을 이용한 Farr assay, Crithidia luciliae를 이용한 면역형광 측정법(immunofluorescence Test, CLIFT), 효소면역측정법(enzyme-linked immunosorbent assay, ELISA), 화학발광면역 측정법(chemiluminescence immunoassay, CLIA)이 있다. 본원에서 방사면역측정법(radioimmunoassay, RIA)으로 Anti-ds DNA 항체 검사 과정에서 lipemic한 검체의 경우 침전물의 형성이 원활하지 않거나 침전물도 같이 흡입되는 상황이 발생 하였고, 이러한 문제점을 해결하기 위해 lipemic 검체가 분석 결과에 미치는 영향 정도를 평가하였다. 2012년 9월부터 2013년 2월까지 Anti-ds DNA 항체 검사가 의뢰된 검체 중 lipemic한 검체(n=81)를 선택하여 마이크로 원심분리기로 전처리(고속 원심분리: 14,000 rpm 5 mins)한 후 동시에 Anti-ds DNA 항체 검사(Anti-ds DNA kit, Trinity Biotech, Ireland)를 시행하였다. 실험군 1 (lipemic 검체의 Anti-ds DNA 항체 농도 ${\leq}7IU/mL$)에서 y=0.3636x+4.7322, $R^2=0.0238$, Pearson 상관계수는 0.154, paired t-test (P=0.003), Difference (%) mean 65.7의 결과를 얻었으며 통계적으로 유의한 차이를 보였다. 그러나 실험군 2 (lipemic 검체의 Anti-ds DNA 항체 농도 ${\geq}8IU/mL$)에서 y=0.9837x+0.2982, $R^2=0.994$, Pearson 상관계수는 0.997, paired t-test (P=0.181), Difference (%) mean -5.53을 보였고 통계적으로 유의한 차이가 없음을 확인할 수 있었다. 임상에서 SLE (systemic lupus erythematosus)의 진단에 중요한 역할을 하는 Anti-ds DNA 항체 검사는 lipemic 검체의 영향을 배제하기 위해서 반드시 전처리(고속 원심분리: 14,000 rpm 5 mins) 과정을 통해 혈청 내 지질 성분을 제거한 후 검사를 시행하여야 한다.

• Journal of Oral Medicine and Pain
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• 제32권4호
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• pp.397-402
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• 2007

쉐그렌 증후군은 만성 자가 면역 질환으로 특히 눈물샘과 침샘에 영향을 주어 구강건조증, 건성각결막염, 이하선 확대 등을 나타낸다. 일반적으로, 특발성으로 발생하여 쉐그렌 증후군이 단독으로 나타나는 원발성 쉐그렌 증후군과 류마티스 관절염, 전신성 홍반성 낭창 등과 같은 다른 자가 면역 질환과 함께 나타나는 이차성 쉐그렌 증후군으로 분류할 수 있다. 쉐그렌 증후군의 경우, 구강 건조감으로 인한 불편감을 호소하는 대신, 불쾌한 맛, 이하선 부위의 붓는 느낌 등 구강건조증 이외의 증상을 호소하기도 한다. 따라서 구강건조증을 호소하는 환자에 있어서만 쉐그렌 증후군을 감별진단에서 고려할 것이 아니라, 쉐그렌 증후군의 관련 소견 중 구강건조증 이외의 증상이나 징후에 대해서도 충분히 주목하여, 관련 증상이나 징후를 보이는 경우 쉐그렌 증후군 관련 검사를 고려하고 시행하는 것이 필요하며, 2002년 수정된 쉐그렌 증후군 진단 기준에 부합되는 검사들을 통해 조기에 진단을 하는 것이 필수적일 것으로 사료된다. Manthorpe등은 처음 쉐그렌 증상이 발생한 때로부터 진단이 될 때까지 평균 10년이라는 긴 시간이 소요된다고 보고였는데, 이는 쉐그렌 증후군 진단이 조기에 잘 이루어지지 않는다는 것을 반영하는 것임을 알 수 있다. Kassan등에 의하면, 쉐그렌 증후군의 여러 전신적 증상 중 림프종의 발생 정도는 건강한 사람들에 비해 쉐그렌 증후군을 갖고 있는 환자의 경우 44배정도 높은 것으로 보고되고 있다. 따라서 쉐그렌 증후군 환자의 정확하고 신속한 진단은 쉐그렌 증후군과 관련하여 발생될 수 있는 합병증등을 예방, 관리하는데 있어서 중요한 의미를 지닌다고 할 수 있다.

• Annals of Clinical Neurophysiology
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• 제9권1호
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• pp.11-15
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• 2007

Background: The term "overlap syndromes" designates a group of diseases in which polymyositis (PM) or dermatomyositis (DM) is associated with some other disorders of connective tissues. The aim of this study was to delineate the clinical features, laboratory findings, and outcome of treatment of "overlap syndromes" Methods: We analyzed the medical records of 16 patients (PM in 10, DM in 6) with well documented "overlap syndromes" between 1997 and 2004. The diagnosis was made when the criteria for two different disorders were fulfilled. Results: All patients were female. Age of onset ranged from 14 to 52 years (mean 29.8 years) with peak incidence in the third and fourth decades. Systemic lupus erythematosus (SLE) was associated in 10, systemic sclerosis in 7, and rheumatoid arthritis in 3 patients. Four of the patients had two different connective tissue diseases simultaneously. The characteristic clinical features were muscle weakness, arthralgia, Raynaud's phenomenon, and myalgia. In laboratory tests, creatine kinase (CK), lactic dehydrogenase (LDH), and transaminases were usually abnormal. Positive antinuclear antibody (ANA), rheumatoid factor (RF), and cryoglobulin were found in 100%, 69%, and 67% of the patients, respectively. Needle electromyography (EMG) showed abnormal findings compatible with myopathy in 15 patients. The pathology of muscle biopsy from 14 patients revealed findings compatible with inflammatory myopathy. Glucocorticoids were administered to 15 patients. The muscle strength improved in all the treated patients, which was well correlated with repeat CK level and EMG findings. Conclusions: The presence of autoantibodies such as ANA, RF, and cryoglobulin in patients with PM or DM highly suggests the possibility of an overlap syndromes. These syndromes reveal a strong female predominance. The myositis associated with them usually shows a good response to glucocorticoids treatment.

• Tuberculosis and Respiratory Diseases
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• 제38권1호
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• pp.1-7
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• 1991

To study the frequency of the underlying disease of the diffuse pulmonary infiltrates in korea, we ansalyzed retrospectively 982 patients who were seen at nine university hospitals and one general hospital in Seoul area. The results are folloing: 1) Among the total 982 patients, 490 patients were male and 492 patients were female. The mean age was 44.3 years. 2) The most common etiology was milliary tuberculosis (38%), which was followed by, idopathic pulmonary fibrosis (27%), pulmonary fibrosis associated with collagen-vascular disease (15%), and diffuse pulmonary infiltrates by malignancy (10%). 3) Amon the connective tissue disease which was accompanied by the interstitial lung disease, rheumatoid arthritis was the most common disease (43%), systemic lupus erythematosus was the 2nd (28%), and progressive systemic sclerosis was the 3re (16%). 4) Among 101 cases of malignant disease, lung was the most frequent primary site (31%), which was followed by stomach (28%), thyroid (16%), and breast (6%). 5) For the diagnosis of the underlying disease of pulmonary infiltrates, the transbronchial lung biopsy was performed in 21% of the patients and open lung biopsy was done in 7%.

• IMMUNE NETWORK
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• 제14권1호
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• pp.21-29
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• 2014

Follicular helper T ($T_{FH}$) cells are recently highlighted as their crucial role for humoral immunity to infection as well as their abnormal control to induce autoimmune disease. During an infection, na$\ddot{i}$ve T cells are differentiating into $T_{FH}$ cells which mediate memory B cells and long-lived plasma cells in germinal center (GC). $T_{FH}$ cells are characterized by their expression of master regulator, Bcl-6, and chemokine receptor, CXCR5, which are essential for the migration of T cells into the B cell follicle. Within the follicle, crosstalk occurs between B cells and $T_{FH}$ cells, leading to class switch recombination and affinity maturation. Various signaling molecules, including cytokines, surface molecules, and transcription factors are involved in $T_{FH}$ cell differentiation. IL-6 and IL-21 cytokine-mediated STAT signaling pathways, including STAT1 and STAT3, are crucial for inducing Bcl-6 expression and $T_{FH}$ cell differentiation. $T_{FH}$ cells express important surface molecules such as ICOS, PD-1, IL-21, BTLA, SAP and CD40L for mediating the interaction between T and B cells. Recently, two types of microRNA (miRNA) were found to be involved in the regulation of $T_{FH}$ cells. The miR-17-92 cluster induces Bcl-6 and $T_{FH}$ cell differentiation, whereas miR-10a negatively regulates Bcl-6 expression in T cells. In addition, follicular regulatory T ($T_{FR}$) cells are studied as thymus-derived $CXCR5^+PD-1^+Foxp3^+\;T_{reg}$ cells that play a significant role in limiting the GC response. Regulation of $T_{FH}$ cell differentiation and the GC reaction via miRNA and $T_{FR}$ cells could be important regulatory mechanisms for maintaining immune tolerance and preventing autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Here, we review recent studies on the various factors that affect $T_{FH}$ cell differentiation, and the role of $T_{FH}$ cells in autoimmune diseases.

• Tuberculosis and Respiratory Diseases
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• 제43권4호
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• pp.630-636
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• 1996

환자는 20 여년전에 류마티스 관절염으로 진단받고 93년 6월부터 본원 외래를 통해 치료 받아오던 중 기침을 호소하고 방사선 검사상 이상소견이 발견되어 입원하였다. 광범위 항생제 투여를 시작하였으나 호전을 보이지 않았고 오히려 중증의 호흡곤란이 동반되었으며 객담 및 혈액배양 검사상 배양된 균주는 없었다. 이에 간질성 폐질환 등을 의심하여 기관지 내시경하 조직검사를 시행하였고, 곧바로 스테로이드 치료를 시작하였다. 조직검사 결과 폐쇄성 세기관지염 간질성 폐염으로 진단되었고, 환자는 현저한 임상상의 호전을 보여 퇴원하였으며 현재 재발 없이 외래 통해 추적 관찰 중이다. 저자 등은 20여년전 류마티스 관절염으로 진단받고 치유 받아오던 중 급성의 호흡곤란이 발생한 환자에서 기환지 내시경을 통한 조직 검사를 시행하여 폐쇄성 세기관지염 간질정 폐염으로 확진한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제67권1호
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• pp.32-36
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• 2009

본 증례는 AIDS가 아닌 면역저하 환자에서 M. intracellulare에 의하여 관절염 및 흉수가 발생한 파종성 질환의 예로 국내에서 두 번째로 보고되는 바이다.

• Asian-Australasian Journal of Animal Sciences
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• 제31권1호
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• pp.138-148
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• 2018

Objective: Fusarium mycotoxins deoxynivalenol (DON) and zearalenone (ZEN), common contaminants in the feed of farm animals, cause immune function impairment and organ inflammation. Consequently, the main objective of this study was to elucidate DON and ZEN effects on the mRNA expression of pro-inflammatory cytokines and other immune related genes in the kidneys of piglets. Methods: Fifteen 6-week-old piglets were randomly assigned to three dietary treatments for 4 weeks: control diet, and diets contaminated with either 8 mg DON/kg feed or 0.8 mg ZEN/kg feed. Kidney samples were collected after treatment, and RNA-seq was used to investigate the effects on immune-related genes and gene networks. Results: A total of 186 differentially expressed genes (DEGs) were screened (120 upregulated and 66 downregulated). Gene ontology analysis revealed that the immune response, and cellular and metabolic processes were significantly controlled by these DEGs. The inflammatory stimulation might be an effect of the following enriched Kyoto encyclopedia of genes and genomes pathway analysis found related to immune and disease responses: cytokine-cytokine receptor interaction, chemokine signaling pathway, toll-like receptor signaling pathway, systemic lupus erythematosus (SLE), tuberculosis, Epstein-Barr virus infection, and chemical carcinogenesis. The effects of DON and ZEN on genome-wide expression were assessed, and it was found that the DEGs associated with inflammatory cytokines (interleukin 10 receptor, beta, chemokine [C-X-C motif] ligand 9, CXCL10, chemokine [C-C motif] ligand 4), proliferation (insulin like growth factor binding protein 4, IgG heavy chain, receptor-type tyrosine-protein phosphatase C, cytochrome P450 1A1, ATP-binding cassette sub-family 8), and other immune response networks (lysozyme, complement component 4 binding protein alpha, oligoadenylate synthetase 2, signaling lymphocytic activation molecule-9, ${\alpha}$-aminoadipic semialdehyde dehydrogenase, Ig lambda chain c region, pyruvate dehydrogenase kinase, isozyme 4, carboxylesterase 1), were suppressed by DON and ZEN. Conclusion: In summary, our results indicate that high concentrations of DON and ZEN suppress the inflammatory response in kidneys, leading to potential effects on immune homeostasis.

• Pediatric Infection and Vaccine
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• 제11권1호
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• pp.126-130
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• 2004

본 저자들은 A군 연쇄구균 감염 후 급성 사구체신염과 동반된 수막구균감염증(수막구균 뇌수막염, 수막구균혈증)에 걸린 7세 남아를 경험하였는데 A군 연쇄구균 감염 후 급성 사구체 신염으로 인해서 C3가 감소하여 수막구균감염증에 감염이 되었는지, 역으로 가능성은 떨어지지만 수막구균감염증의 결과로 C3가 감소하였고 사구체신염이 생긴 것인지 전후 관계가 확실하지 않은 증례를 문헌고찰과 함께 보고하는 바이다.

• 대한임상검사과학회지
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• 제38권3호
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• pp.208-211
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• 2006

Microalbuminuria is most frequently caused by kidney damage from diabetes. Moreover, many other conditions can lead to kidney damage, such as high blood pressure, heart failure, cirrhosis, or systemic lupus erythematosus (SLE). The measurement of the microalbumin in urine may be useful for the early diagnosis or as a predictor of nephropathy in diabetes. The most common method for getting a quantitative measurement of urinary protein relies on a 24-hour urine collection. The result of this method is accurate. But 24hr urine collection is difficult to obtain and variations in volume are frequent. Also the patients complain about urine collection. We tried to measure reference values for microalbumin using fasting urine and compare them with the albumin/creatinine ratio using 24hr urine. The concentrations of microalbumin in fasting urine and 24hr urine were $7.1{\pm}3.8mg/L$, $5.7{\pm}2.9mg/L$ (r=0.61, p=0.27), respectively. The albumin/creatinine ratios using fasting urine and 24hr urine were $8.7{\pm}4.2{\mu}g/mg$, $8.7{\pm}4.0{\mu}g/mg$ (r=0.76, p=0.88), respectively. This study indicated that the measurement of microalbumin in fasting urine was an easy and simple method for early diagnosis or to predict nephropathy in diabetes. Thus, setting up the reference value using fasting urine may be useful in the screening test for the diabetic nephropathy patients instead of using the 24hr albumin excretion rate (AER).