• 대한한방내과학회지
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• 제30권1호
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• pp.153-172
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• 2009

Background : The safety of Korean herbal Medicine (KHM: prescribed herbal medicine by doctors of traditional Korean medicine) is an important issue in Korea. Although both fields. western medicine and traditional Korean medicine. have been studied on the safety of herbs and KHM, their results were not concordance with each other. Objectives : This study aims to review the influence of KHM on liver function in Korean literature systematically. Additionally, we tried to estimate the change of data of liver function test (LFT) and the incidence of liver injury (LI) after the use of KHM. Methods : Systematic literature searches were performed on 4 major databases of Korea from their inception to May 2008. Screening and selection of the studies and the extraction of data were performed independently by two authors. There were no restrictions on the types of publication including grey literatures. Results : Forty studies were included. Only sixteen studies were performed prospectively and fifteen studies collected data from outpatients. Only 8 studies reported the occurrence of LI after the use of KHM. Nineteen cases of LI showed no or mild symptoms and the elevation of LFT was not high. All of LI patients used conventional western drug and KHM concomitantly. and causality of LI was not assessed properly. The incidence of LI related to the use of KHM was estimated as 0.59%-0.76% from all data of these studies. The conflicting results were shown on the change of alanine aminotransferase (ALT) and total bilirubin (TB) after the use of KHM. Conclusions : KHM might be a minor cause of LI in Korea. However the results are not strongly supported as enough to make the safety issue clear because of the limitations of original studies. More rigorous studies are required for answering the safety issue of KHM with the cooperative investigation of both fields of Korean traditional medicine and western medicine.

• Kidney Research and Clinical Practice
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• 제36권1호
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• pp.48-57
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• 2017

Background: Hepatic steatosis measured with controlled attenuation parameter (CAP) using transient elastography predicts metabolic syndrome in the general population. We investigated whether CAP predicted metabolic syndrome in chronic kidney disease patients. Methods: CAP was measured with transient elastography in 465 predialysis chronic kidney disease patients (mean age, 57.5 years). Results: The median CAP value was 239 (202-274) dB/m. In 195 (41.9%) patients with metabolic syndrome, diabetes mellitus was more prevalent (105 [53.8%] vs. 71 [26.3%], P < 0.001), with significantly increased urine albumin-to-creatinine ratio (184 [38-706] vs. 56 [16-408] mg/g Cr, P = 0.003), high sensitivity C-reactive protein levels (5.4 [1.4-28.2] vs. 1.7 [0.6-9.9] mg/L, P < 0.001), and CAP (248 [210-302] vs. 226 [196-259] dB/m, P < 0.001). In multiple linear regression analysis, CAP was independently related to body mass index (${\beta}=0.742$, P < 0.001), triglyceride levels (${\beta}=2.034$, P < 0.001), estimated glomerular filtration rate (${\beta}=0.316$, P = 0.001), serum albumin (${\beta}=1.386$, P < 0.001), alanine aminotransferase (${\beta}=0.064$, P = 0.029), and total bilirubin (${\beta}=-0.881$, P = 0.009). In multiple logistic regression analysis, increased CAP was independently associated with increased metabolic syndrome risk (per 10 dB/m increase; odds ratio, 1.093; 95% confidence interval, 1.009-1.183; P = 0.029) even after adjusting for multiple confounding factors. Conclusion: Increased CAP measured with transient elastography significantly correlated with and could predict increased metabolic syndrome risk in chronic kidney disease patients.

• 대한한방내과학회지
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• 제44권3호
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• pp.402-417
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• 2023

Objective: Liver fibrosis is a highly conserved wound-healing response and the final common pathway of chronic inflammatory injury. This study aimed to evaluate the potential anti-fibrotic effect of the combination of Rhei Radix et Rhizoma water extract (RW) and silymarin in a thioacetamide (TAA)-induced liver fibrosis model. Methods: The liver fibrosis mouse model was established through the intraperitoneal injection of TAA (1 week 100 mg/kg, 2-3 weeks 200 mg/kg, 4-8 weeks 400 mg/kg) three times per week for eight weeks. Animal experiments were conducted in five groups; Normal, Control (TAA-induced liver fibrosis mice), Sily (silymarin 50 mg/kg), RSL (RW 50 mg/kg+silymarin 50 mg/kg), and RSH (RW 100 mg/kg+silymarin 50 mg/kg). Biochemical analyses were measured in serum, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), malondialdehyde (MDA), and ammonia levels. Liver inflammatory cytokines and fibrous biomarkers were measured by Western blot analysis, and liver histopathology was evaluated through tissue staining. Results: A significant decrease in the liver function markers AST and ALT and a reduction in ammonia and total bilirubin were observed in the group treated with RSL and RSH. Measurement of reactive oxygen species and MDA revealed a significant decrease in the RSL and RSH administration group compared to the TAA induction group. The expression of extracellular matrix-related proteins, such as transforming growth factor β1, α-smooth muscle actin, and collagen type I alpha 1, was likewise significantly decreased. All drug-administered groups had increased matrix metalloproteinase-9 but a decreasing tissue inhibitor of matrix metalloproteinase-1. RSL and RSH exerted a significant upregulation of NADPH oxidase 2, p22^phox, and p47^phox, which are oxidative stress-related factors. Furthermore, pro-inflammatory proteins such as cyclooxygenase 2 and interleukin-1β were markedly suppressed through the inhibition of nuclear factor kappa B activation. Conclusions: The administration of RW and silymarin suppressed the NADPH oxidase factor protein level and showed a tendency to reduce inflammation-related enzymes. These results suggest that the combined administration of RW and silymarin improves acute liver injury induced by TAA.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제27권3호
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• pp.158-167
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• 2024

Purpose: To evaluate the prevalence of vertebral fracture (VF) in children with chronic liver disease (CLD) with and without liver transplantation (LT) and to determine the associated factors. Methods: A cross-sectional study was conducted. Patients aged 3-21 years with CLD both before and after LT were enrolled in the study. Lateral thoracolumbar spine radiographs were obtained and assessed for VF using Mäkitie's method. Clinical and biochemical data were collected. Results: We enrolled 147 patients (80 females; median age 8.8 years [interquartile range 6.0-11.8]; 110 [74.8%] in the LT group and 37 [25.2%] in the non-LT group). VF was identified in 21 patients (14.3%): 17/110 (15.5%) in the LT group and 4/37 (10.8%) in the non-LT group (p=0.54). Back pain was noted in only three patients with VF. In the univariate analysis, a height z-score below -2.0 (p=0.010), pre-LT hepatopulmonary syndrome (p=0.014), elevated serum direct and total bilirubin levels (p=0.037 and p=0.049, respectively), and vitamin D deficiency at 1-year post-LT (p=0.048) were associated with VF in the LT group. In multivariate analysis, height z-score below -2.0 was the only significant associated factor (odds ratio, 5.94; 95% confidence interval, 1.49-23.76; p=0.012) for VF. All VFs in the non-LT group were reported in males. Conclusion: In children with CLD, VF is common before and after LT. Most patients with VF are asymptomatic. Screening for VF should be considered in patients with a height z-score below -2.0 after LT.

• 한국간담췌외과학회지
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• 제26권3호
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• pp.257-262
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• 2022

Backgrounds/Aims: Middle hepatic vein (MHV) is usually preserved as a part of the right or left hepatectomy in order preserve the venous outflow of remnant liver. The aim of this study was to evaluate if resection of MHV could influence post-resection outcomes of standard right or left hepatectomy. Methods: Patients who underwent standard right or left hepatectomy between January 2015 and December 2019 were included. Anatomical remnant liver volumes were measured retrospectively using the Hermes workstation (Hermes Medical Solutions AB, Stockholm, Sweden). Uni- and multi-variate analyses were performed to assess the difference in outcomes of those with preservation of MHV and those without preservation. Results: A total of 144 patients were included. Right hepatectomy was performed for 114 (79.2%) and left hepatectomy was performed for 30 (20.8%) patients. MHV was resected for 13 (9.0%) in addition to the standard right or left hepatectomy. Median remnant liver volume was significantly higher in the MHV resected group (p < 0.01). There was no significant difference in serum level of bilirubin, international normalized ratio, alanine aminotransferase, creatinine on postoperative day 1, 3, 5, or 10, ≥ grade IIIa complications (p = 0.44), or 90-day mortality (p = 0.41). On multivariable analysis, resection of the MHV did not influence the incidence of post hepatectomy liver failure (p = 0.52). Conclusions: Resection of the MHV at standard right or left hepatectomy did not have a negative impact on postoperative outcomes of patients with adequate remnant liver volume.

• Clinical and Experimental Pediatrics
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• 제46권1호
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• pp.17-23
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• 2003

목 적 : 신생아 집중치료실 입원아는 오랫동안 전비경구 영양(total parenteral nutrition, TPN)을 필요로 하는 경우가 많다. 미숙아에게 있어 TPN을 오래 시행하는 경우 담즙 울체성 황달은 가장 중요한 합병증 가운데 하나이나 그 임상 양상에 대한 보고는 많지 않다. 이에 저자들은 신생아집중치료실 입원 미숙아 가운데 발생한 TPN 관련 담즙울체(TPN associated cholestasis, TPNAC) 환아를 대상으로 발생빈도, 임상 경과와 생화학적 지표의 변화 및 위험인자를 조사하였다. 방 법 : 2000년 6월부터 2002년 5월까지 2년 동안 경북대학교 병원 신생아 집중치료실에 입원하여 2주 이상 TPN을 시행 한 출생체중 2,000 gm 미만의 미숙아 66명 가운데 담즙 울체가 발생한 환아 21명을 대상으로 울체가 발생하지 않은 45명을 대조군으로 하였다. TPN 관련 담즙울체의 진단은 혈청 직접 빌리루빈이 2.0 mg/dL 이상이고 간염이나 담도 폐쇄 등의 다른 울체의 원인이 배제된 경우로 하였다. 담즙 울체의 발생시기, 빈도, 지속기간, 임상경과, 생화학적 지표의 변화 및 위험인자는 대상 환아의 의무기록지를 검토를 통해 후향적 조사를 시행하였다. 결 과 : TPNAC의 발생빈도는 31.8%였으며, 출생 체중이 적고 재태주령이 낮을수록, TPN 기간이 길수록 증가하였다. 발생시기는 TPN 시작 후 평균 41.7일${\pm}$17.4일이었으며 지속기간은 평균 $33.6{\pm}23.4$일이었다. TPNAC 환아는 대조군보다 생후 3주째의 경구 섭취량이 유의하게 적었으나 TPNAC 환아와 대조군 사이에 감염이나 가사의 빈도 차이는 없었다. TPNAC의 생화학적 지표로 사용되는 혈청 직접 빌리루빈은 4-6주에 증가하였으며 ALT(alanine aminotransferase, SGPT)는 생후 6-8주에 증가하였다. 결 론 : 본 조사에서 TPNAC는 출생체중이 적고 재태주령이 적은 미숙아에서 발생 빈도가 높고 TPN 기간이 길수록 호발하 였다. TPNAC 환아들은 TPN 시행 중 병행한 경구 수유량이 생후 3주째 대조군에 비해 적었다. 따라서 고위험 환아들은 TPN 영양 중에도 경구 영양을 적극적으로 시행하여 경구량을 증가시킴으로써 TPNAC 발생을 경감 시킬 수 있을 것으로 사료되나 이에 대한 추가적 연구가 계속되어야 할 것이다.

• Journal of Chest Surgery
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• 제37권9호
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• pp.742-748
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• 2004

On-X 판막은 비교적 최근 소개된 이엽성 기계판막으로 국립의료원에서 시행한 28명의 환자의 단기 임상성적을 통하여 판막의 안정성과 유용성을 보고하고자 한다. 대상 및 방법: 1999년 5월부터 2003년 5월까지 On-X 판막을 이용하여 32예의 판막치환술을 받은 28명의 연속적인 환자를 대상으로 하였으며 승모판막 치환 12예, 대동맥 판막치환 10예 그리고 승모판막 및 대동맥판막치환 6예이었다. 수술 후 발생한 합병증 및 사망률에 대한 정의 및 분류는 심장 판막수술에 대한 AATS/STS 지침에 근거하여 분석하였다. 전체 추적기간은 64환자-년이었고 평균 27개월이었다 결과: 수술 후 30일 이내의 조기 사망률은 7.14% (2/28)이었으며 만기사망은 없었다. 2년 생존율은 전체적으로 92.86$\pm$4.87% 이며 대동맥판막치환술이 90$\pm$9.49%, 이중판막치환술이 83.3$\pm$1.52%, 승모판막치환술이 100%로 나타났다. 혈전 색전증이 가장 많은 합병증으로 2예가 있었으며 모두 승모판막치환 증례에서 발생되어 Linearized Ratio는 총 3.17%/환자-년이었으며 승모판막만을 보면 6.5%/환자-년이었고 항응고제와 관련 된 출혈, 판막폐쇄증, 판막주위누출, 심내막염 등의 합병증의 모든 예에서 발생되지 않아 판막관련 합병증이 없는 2년간의 빈도는 84.85 $\pm$ 10.75% (freedom from valve related complication)이었다. 수술전 NYHA Class III 이상인 증례가 24예(85.71%)이었으나 수술 후에는 NYHA Class I 또는 II에 속하는 증례가 25예로 89.29%를 보였다. 용혈척도로서 혈색소 수치, 혈장 LDH, 망상적혈구수치, 간접 빌리루빈치는 수술 3개월 후 검사에서 모두 정상수치를 보였다. 수술 후 3개월 추적관찰 시 시행한 심초음파상 승모판막의 최대 압력차는 6.1 $\pm$ 1.8 mmHg, 평균 압력차는 3.0$\pm$0.6 mmHg이었고 유효 개구 면적은 판막 직경 27 mm, 29 mm, 31 mm, 33 mm 각각 2.54$\pm$0.56 $m^2$, 2.39 $\pm$0.73 $m^2$, 2.34 $\pm$0.55 $m^2$, 2.40$\pm$0.63 $m^2$이었다. 대동맥판막의 최대 압력차는 21.1$\pm$14.12 mmHg,평균 압력차는 12.3$\pm$6.52 mmHg. 결론： On-X 판막수술 후 사망률, 판막관련합병증, 도플러 심초음파상 다른 판막들과 큰 차이를 보이지 않은 점과 NYHA Class의 호전과 정상수치를 유지하는 용혈지표를 고려한다면 비교적 좋은 결과를 보였으며 증례의 축적과 장기간의 임상분석이 이루어지면 안전하고 유용한 판막으로 입증될 것이라고 생각한다.

• Neonatal Medicine
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• 제17권2호
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• pp.239-244
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• 2010

목적: 효과적인 미숙아에서의 채혈방법을 모색하기 위해 미숙아에서 발뒤꿈치 천자시 새로운 자동화 천자기구(automatic lancet device)와 기존에 사용되던 고식적 수동식 천자침(conventional manual lancet device) 의 효과를 비교하여 임상에서의 유용성을 알아보고자 한다 방법: 재태 연령 37주 미만의 미숙아 총 100명을 대상으로 하였다. 연구 대상아들은 발뒤꿈치 천자시 무작위로 각 50명씩 고식적 수동식 천자 기구를 사용한 군(50명)과 자동화 천자 기구를 사용한 군(50명)으로 나누었으며, 발뒤꿈치 천자시 통증의 정도 및 천자 횟수, 검사 시간, 출혈의 여부 등을 평가하였다. 통증의 평가는 Premature Infant Pain Profile (PIPP) 점수와 최고 심장 박동수를 측정하였고, 검사시간은 발뒤꿈치 천자 시작으로부터 1개의 microtube에 채혈을 완료하는 시간까지를 측정하여 비교하였다. 천자횟수는 1개의 microtube를 혈액으로 채우기 위해 발뒤꿈치를 천자한 횟수를 측정하였다. 그리고 검사 12시간 이내에 발뒤꿈치 및 발목 주위에 출혈이나 멍 등을 관찰하였다. 결과: 통증을 나타내는 PIPP 점수의 평균은 자동화 천자기구군에서 4.91로 고식적 천자기구 군 5.84에 비해 유의하게 낮게 측정되었다(P=0.0255). 검사에 소요되는 시간은 고식적 천자군에서 평균 48.92초, 자동화 천자군에서 평균 30.69초로 자동화천자기구를 사용한 군에서 통계적으로 유의하게 짧았다(P<0.0001). 천자 횟수의 평균값은, 자동화 천자군에서 1.02로, 고식적 천자군 1.35에 비해 통계적으로 의미 있게 낮았다(P=0.0001). 검사후 출혈반점이나 멍 등은 고식적 천자기구 군에서 15례(30%), 자동화 천자기구 군에서 3례(6%)로 자동화 천자기구 사용 군에서 의미 있게 적게 나타남을 관찰할 수 있었다(P=0.0024). 결론: 자동화 절개형 천자기구(BD QuickHeel)는 검사 실패율이 낮으며, 짧은 시간에 채혈이 가능하고, 멍이나 출혈 같은 부작용이 적어 신생아, 특히 최근 생존율이 향상되어 증가되고 있는 미숙아에서 발뒤꿈치 천자에 의한 채혈에 유용한 도구가 될 수 있겠다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7825-7829
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• 2015

Background: Egypt has the highest prevalence of HCV infection in the world (~14.7%). Around 10-15% of HCV-infected persons will advance to cirrhosis within the first 20 years. The incidence of HCC is expected to grow in the next two decades, largely due to HCV related cirrhosis, and detection of HCC at an early stage is critical for a favorable clinical outcome. No simple reliable non-invasive marker has been available till now. B2M, a non-glycosylated polypeptide composed of 99 amino acids, is one of the components of HLA class I molecules on the surfaces of all nucleated cells. It has been reported that the level of serum B2M is elevated in patients with chronic hepatitis C and HCV-related HCC when compared to HCV-negative patients or healthy donors. Determining the clinical utility of serum B2M as a marker for disease progression in Egyptian patients with HCV related chronic hepatitis, cirrhosis and hepatocellular carcinoma was the aim of the present study. Materials and Methods: In this analytical cross sectional study 92 participants were included in 4 equal groups: Group (1) non cirrhotic chronic HCV; Group (2) HCV related liver cirrhosis; Group (3) HCC on top of HCV,; and Group (4) healthy controls. History taking, clinical examination, routine labs and abdominal ultrasound were conducted for all patients, PCR and Metavir scores for group (1) patients, and triphasic CT abdomen and AFP for Group (3) patients. B2M levels were measured in serum with a fully-automated IMX system. Results: The mean serum B2M level of Group (1) was $4.25{\pm}1.48{\mu}g/ml$., Group (2) was $7.48{\pm}3.04$, Group (3) was $6.62{\pm}2.49$ and Group (4) was $1.62{\pm}0.63$. Serum B2M levels were significantly higher in diseased than control group (p<0.01) being significantly higher in cirrhosis ($7.48{\pm}3.04$) and HCC groups ($6.62{\pm}2.49$) than the HCV group ($4.25{\pm}1.48$) (p<0.01). There was a significant correlation between B2M Level and ALK, total and direct bilirubin and INR (p<0.05), and a significant inverse correlation between B2M level and albumin, total proteins, HB andWBCS values (p<0.05). There was no significant correlation between B2M level and viral load or Metavir score, largest tumour size or AFP (p>0.05). The best B2M cut-off for HCV diagnosis was 2.6 with a sensitivity of 100%, a specificity of 92%, a positive predictive value (PPV) of 97% and a negative predictive value (NPV) of 100%. The best B2M cut-off for HCC diagnosis was 4.55 which yielded sensitivity, specificity, positive predictive value, negative predictive values of 74%, 62%, 39.5, 87.8% respectively (p-value <0.01) while best cut-off for cirrhosis was 4.9, with sensitivity 74 % and specificity 74%.The sensitivity for HCC diagnosis increased upon B2M and AFP combined estimation to 91%, specificity to 79%, NPV to 95% and accuracy to 83%. Conclusions: Serum B2M level is elevated in HCV related chronic liver diseases and may be used as a marker for HCV disease progression towards cirrhosis and carcinoma.

• 대한약리학회지
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• 제17권1호
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• pp.17-25
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• 1981

No evidence has accumulated that lead compound is an essential component for biological function in animals. Lead is absorbed primarily through the epithelial mucosal cells in duodenum and the absorption can be enhanced by the substances which bind lead and increase its solubility. Iron, zinc and calcium ions, however, decrease the absorption of lead without affecting its solubility, probably by competing for shared absorptive receptors in the intestinal mucosa. Therefore, the absorption of lead is increased in iron deficient animals. Lead shows a strong affinity for ligands such as phosphate, cysteinyl and histidyl side chains of proteins, pterins and porphyrins. Hence lead can act on various active sites of enzymes, inhibiting the enzymes which has functional sulfhydryl groups. lead inhibits the activity of ${\delta}$-aminolevulinic acid dehydratase for the biosynthesis of hemoproteins and cytochrome, which catalyzed the synthesis of monopyrrole prophobilinogen from ${\delta}$-aminolevulinic acid. Accordingly lead decrease hepatic cytochrome p-450 content, resulting an inhibition of the activity of demethylase and hydroxylase in liver. Little informations are available on the effect of lead on digestive system although the catastrophic effects of lead intoxication are well documented. The present study was, therefore, attempted to investigate the effect of lead on pancreaticobiliary secretion in rats. Albino rats of both sexes weighing $170{\sim}230g$ were used for this study. The animals were divided into one control and three treated groups, i.e., control (physiologic saline 1.5ml/kg i.p.), lead acetate $(l0{\mu}mole/kg/day\;i.p.)$, $Pb(Ac)_2$ and EDTA$(each\;10{\mu}mole/kg/day\;i.p.)$, $Pb(Ac)_2$ and $FeSO_4(each\;l0{\mu}mole/kg/day\;hp)$. The pancreatico-biliary juice was collected under urethane anesthesia, and activities of amylase and lipase were determined by employing Sumner's and Cherry and Crandall's methods. The summarized results are follows. 1) In the experiment for acute toxicity of lead acetate, 20% of mortality was observed in rat treated with lead acetate as well as inhibition of the activity of amylase in the juice at the 3 rd day of the treatment. 2) No increases in body weight were observed in rats treated with lead acetate, while in control group the significant increases were observed. However, the body weights of animals were increased in the group lead acetate plus EDTA or $FeSO_4$. 3) Lead acetate decreased significantly the volume of pancreatico-biliary juice whereas additional treatment of EDTA and $FeSO_4$ prevented it. 4) Total activity of amylase was markedly reduced due to lead acetate treatment, but no change was showed following additional treatment with EDTA and $FeSO_4$. 5) No changes in the cholate and lipase output were observed in rats treated with lead acetate as compared with that of control rats. 6) Increase in bilirubin output in rats treated with lead acetate was shown on the 2nd and 3rd weeks treatment. 7) In the case of in vitro experiment, lead acetate also markedly inhibited release of amylase from pancreatic fragment. 8) Histologic finding indicated that acini vacuolation was induced in the pancreatic tissue of rat treated with lead acete. From the above results, it might be concluded that lead acetate decreases the volume of pancreatico-biliary secretion and inhibits the amylase activity, by acting directly on pancreatic cells.