• Tuberculosis and Respiratory Diseases
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• 제44권1호
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• pp.93-103
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• 1997

연구배경 : 만성 폐쇄성 폐질환 환자에서 영양결핍이 흔히 나타나며, 그 원인기전은 섭취의 부족보다는 호흡근의 열량요구량의 증가에 따른 과신진대사로 인하여 상대적인 결핍이 초래되기 때문으로 알려져 있다. 또한 만성 패쇄성 폐질환에서 영양결핍은 폐기능, 근력 및 운동수행능 등의 생리적 척도와도 유의한 상관관계를 보이며, 나아가서는 예후에도 영향을 미치는 독립적인 인자로 보고된 바 있다. 방법 : 만성 폐쇄성 폐질환 환자와 유사연령의 건강한 대조군에서 영양섭취량을 조사하였고, 신체계측과 혈액검사 등의 영양상태의 지표를 평가하였으며, 영양상태의 평가지표들과 만성 폐쇄성 폐질환의 중요한 폐기능지표인 1초간 노력성 호기량과의 상관성을 조사하였다. 결과 : 1) 대상 환자는 남자 25예였으며, 평균연령은 66.1세였고, 1초간 노력성 호기량의 예측치에 대한 비율은 $42{\pm}14%$였다. 대조군은 폐기능이 정상인 건강한 남자 26예였고, 평균연령은 65.0세였다. 2) 1일 열량섭취량/열량요구량 비율은 환자군에서 $107{\pm}28%$, 대조군에서 $94{\pm}14%$로 환자군에서 높은 경향을 보였다(p=0.06). 3) 환자군과 대조군의 비만도가 92.8% 및 101.6%로(p=0.024), 신체비만지수가 $20.0kg/m^2$ 및 $21.9kg/m^2$ 로(p=0.015), 악력이 29.0kg 및 34.3kg으로(p=0.003), 환자군에서 유의하게 낮았으나, 상완삼두근부위 피부두겹두께, 상완위 근육둘레, 알부민 및 총림프구수는 두 군간에 유의한 차이가 없었다. 환자군에서 저체중군의 비율은 40%(10/25)였고, 대조군에서는 15%(4/26)였다. 4) 비만도, 신체비만지수, 상완삼두근부위 피부두겹두께, 상완위 근육둘레 등은 1초간 노력성 호기량과 유의한 상관성이 있었다. 결론 : 이상의 결과에서 만성 패쇄성 폐질환 환자는 저체중과 말초근력의 저하 등 영양결핍의 소견을 보이나, 그 원인이 섭취량은 부족에 기인하지 않음을 알 수 있었으며, 영양상태 평가의 지표들이 1초간 노력성 호기량과 유의하게 상관됨을 알 수 있었다.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.15-26
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• 2019

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.

• Nutrition Research and Practice
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• 제16권5호
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• pp.604-615
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• 2022

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1-77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01-1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08-2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49-3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27-3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36-3.87), ICU admission (HR = 1.97; 95% CI, 1.17-3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59-19.43; stage III: HR = 16.20; 95% CI, 4.99-52.59) were significantly associated with CSS. CONCLUSIONS: Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Journal of Gastric Cancer
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• 제7권4호
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• pp.219-227
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• 2007

목적: 위전절제술 후 이용될 수 있는 재건 술식에 대해서는 많은 방법들이 보고되어 왔지만 지금까지도 이상적인 술식에 대해서는 논쟁의 여지가 있고 장기간에 걸친 비교 연구는 더욱이 부족한 실정이다. 이에 저자는 본원에서 실시한 4가지 술식들인 Roux-en-Y 술식(R-Y), 공장간치술(JI), 공장낭간치술(JPI), Double-tract 재건술(DT)간의 경과 관찰을 통해 보다 나은 재건 술식을 찾고자 하였다. 대상 및 방법: 본원에서 2000년 8월부터 2004년 1월까지 위암으로 근치적 위전절제수술을 받고 재발이 없고 추적이 가능한 환자 중 80세 이상과 병기 IV기를 제외하고 재건 술식에 따라 RY군(n=15), JI군(n=8), JPI군(n=8), DT군(n=10)으로 분류한 총 41명의 환자를 대상으로 수술 후 증상, 수술 후 1년, 3년째의 혈액 및 생화학적 검사의 변화, 체중 변화를 포함한 영양학적 변화 및 삶의 질을 평가하기위한 GSRS score를 분석하였다. 또한 내시경 소견을 통해 위식도 역류 여부를 확인하였다. 결과: 검사실소견은 3년째 총단백과 알부민에서 DT군이 유의하게 낮은 결과를 보였고(P=0.006, P=0.033), 체중감소는 JI군이 1년, 3년째에서 수술 전 체중의 84.50%, 86.50%로 가장 많았다(P=0.013, P=0.011). GSRS score에서 JPI군이 수술 후 1년, 3년 모두에서 유의하게 더 좋은 결과를 보였다. (P=0.028, P=0.003). 결론: 공장낭간치술은 위전절제술 후 환자의 삶의 질을 높일 수 있는 유용한 재건 방식으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.259-266
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• 2010

Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.