소아 신증후군에서 Cyclosporine A에 의한 만성 조직학적 신독성의 발현빈도에 대한 연구 (Incidence of Chronic Pathologic Nephrotoxicity of Cyclosporine A in Pediatric Nephrotic Syndrome)
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- Childhood Kidney Diseases
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- 제3권2호
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- pp.130-144
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- 1999
목적 : Cyclosporine A(CsA)의 장기적인 치료에서 CsA의 신독성에 의하여 나타나게 되는 만성적인 신조직의 변화는 구심성 소동맥의 수축으로 인한 신혈류의 감소에서 시작되어, 신세뇨관의 위축과 간질조직의 섬유화를 포함하는 비특이적인 간질성 신염과 비교적 특징적이라 할 수 있는 사구체 주위 소동맥의 변화로 나타나게 된다. 본 연구에서는 원발성 및 이차성 신증후군의 CsA치료에서 치료기간 및 원발성 질환에 따른 조직학적인 신독성의 빈도 및 임상적인 신독성과의 관계를 알아보고 최적의 치료기간을 결정하고자 하였다. 방법 : 1986년부터 1997년까지 본원 소아과에서 신장조직검사로 확진된 신증후군 환아 중 스테로이드 저항성, 빈발 재발형 혹은 스테로이드 의존성으로 인하여 CsA로 치료받았던 102례(미세변화신증후군 58례, 국소성분절성 사구체신염 10례, 막성사구체신염 10례, 자반성신염 15례, IgA신병증 9례)를 대상으로 하였다. CsA를 미세변화신 증후군은 1년간 24례, 1.5년간 12례 2년간 22례에서 투여하였고, 국소성 분절성 사구체 경화증은 1년간 2례, 1.5년간 2례, 2년간 6례에서, 막성사구체신염은 1년간 8례, 2년간 2례에서 투여하였다. 자반성신염 과 IgA신병증은 모든 례에서 1년간 사용하였다. 전체 대상 환아에서 치료전과 치료 종료후 1개월 째 신장조직검사를 시행하여 신독성 여부를 조사하였다. 결과 : 전체대상 환아에서 신증후군의 완전관해율은 86%였다(미세변화증후군 96%, 막성사구체신염 90%, 국소성분절성사구체경화증 60%, 자반성신염 80%, IgA 신병증 55%). 스테로이드 반응성의 미세변화신증후군 및 국소성분절성사구체경화증 환아에서 CsA치료후 6개월간의 재발의 빈도는 각각
The intention of this study is to apprehend the con. tents and methods of herb remedies that are commonly conducted when there are health-problem cases of ENT, eyes, teeth and skin. Methods of this study are divided into two stages : 1) For a period of six months from December 1994 to June 1995, some 40 persons who are believed to be well versed with herb remedies have been randomly chosen, and we made a survey on herb remedies by symptoms: and 2) we have endeavored to make their grounds evident through the studies on literatures with the focus on the basic data collected. Their results are as follows: 1) When one feels a pain in ears, such herb remedies are employed as pouring the vapor into ears, which is made by steaming Alaska pollack, or as applying or wiping with the juices of radish or the ginkgo, or' alum. Applying the radish juice is effective for sterilization and fever removal: and applying the ginkgo juice is effective for cleanliness. But, plastering alum, sesame oil or castor oil, or pouring the vapor of Alaska pollack into ears are perhaps effective but do not have any pharmacologic grounds. 2) When one bleeds at the nose, such kinds of herb remedies are applied as stimulating nose or head with cold water, pressing nose or ridge of nose, or filling up nares with mashed mugworts. In addition, they have utilized garlic or leeks. Such methods as stimulating with cold water or just pressing nose and ridge of nose is based on reasonable grounds, i.e. vasoconstriction and vascular compression ; and applying mashed garlic on the sole of foot is good for the circulation of Qui ; and the use of mugworts and leeks is based upon the pharmacological function of hemostasis. 3) When one feels a sore throat such kinds of herb remedies are employed as gargling or rinsing throat with brine, drinking hot gruel or water, or drinking the juice of mugwort, radish, ginger or Chinese quince. Gargling with brine or drinking the juice of mugwort, radish or ginger is based upon the pharmacological function of pain alleviation, fever removal, and detoxication. 4) When a boil is formed in mouth, such herb remedies are applied as spreading honey, brine or alum water, and taking gall nut, Chinese matrimony vine, lotus root, etc, for drugs. Spreading honey, brine or water that is made by infusing gallnut, Chinese matrimony vine, lotus root is based upon such functions as hematosis, astriction, antibacterial, and antiphlogistic, Alum, eggplant and licorice are said to be effective, but their pharmacological effects have no grounds. 5) When one has conjunctivitis such herb remedies are commonly applied as irrigation with brine and dropping breast milk in eyes. Moreover, such other drugs are used as plantain. shepherd's purse, and purslane, etc. The use of brine, breast milk, plantain, shepherd's purse and purslane is based upon such functions as sterilization, antiphlogistic, disinfection and pain relieving. Eriocaulon sieboldianum, bean stem, bean pod and narcissus leaves are said to be effective, but their pharmacological action have no basis. When one has a stye, such herb remedies are applied as extracting eyelashes, stimulating by a massage of middle finger, third finger or big toe, as well as sear ing with a heated bamboo comb that is fine-toothed. Other than these, plantain and nightshade's nuts are used as drugs for it. Extracting eyelashes corresponds with exclusing suppurative node and draining the stye of pus ; and the use of plantain is based upon disinfection: and nightshade's nuts are said to be effective, however, their pharmacological action has no grounds. 6) For a treatment of toothache, such herb remedies are commonly employed as rinsing mouth with brine and holding cold water or gasoline in the mouth ; and as the drugs that are believed to be effective have been Welsh onion, ginger and castor-oil, plant, etc. The use of Welsh onion is based upon pain killing, antiinflammatory actions, and the use of ginger is based upon detoxication and disinfection ; and seeds of castor-oil plants are said to be effective, but they have no pharmacological basis. 7) When one has hives, such herb remedies are commonly applied as rubbing burned straw in affected parts, exposing to its smoke, rubbing with salt, sweeping down with a broom, and spreading and drinking boiled water of trifoliate orange. The use of cassia tora seeds, walnut, aloe and radish is said to be effective. The use of cassia tor a seeds has the functions of intestinal order, anti-paralysis, etc. The use of walnut has resulted in an increase of blood by invigorating spirits ; and the use of aloe is based upon disinfection, antibiotic, anti-salt, antihistamine and detoxication action. But, the effects of radish juice and straw's smoke have no pharmacological grounds. 8) When one gets a boil, such herb remedies are commonly used as applying a plaster, paste of flour mixed with yolk, soy sauce or honey, as well as spreading pounded elm tree. Other remedies that have been said to be effective are ; heating with mugwort, brine, wild rocambole, aloe, onion, squid's bone, etc. The use of mugwort is based upon pain killing, astringent antiinflammatory and tranquility. Wild rocambole is based upon the generation and maintenance functions of cell-joining textures ; elm tree upon antiphlogistic ; aloe upon fever removal and antiphlogistic ; onion on pain killing, fever removal, antiphlogistic and tranquility ; squid's bone on astriction: and brine or vinegar on sterilization. Pine resin and gardenia seed are said to be effective, but they have no pharmacological basis. 9) When one cuts his skin, such herb remedies are commonly employed as spreading mugwort's juice or squid's bone powder, or pressing the wounds. In addition, kalopanax, onion and fine soil are employed. The use of mugwort, kalopanax and squid's bone is based upon such functions as hemostasis, sedation, pain killing, antibacterial ; and fine soil is said to be effective, but it has no pharmacological basis. 10) When one suffers from whitlow, such herb remedies are commonly utilized as heating with boiled soy sauce, spreading soybean paste, or dipping into eggs, etc. Other drugs that have been employed are onion root, brine, eggplant, potato, loach, etc. The use of onion is based upon pain killing and antiphlogistic functions ; and that of brine upon antiphlogistic function. The use of soy sauce or soybean paste, fomentation, eggplant, potato and loach is said to be effective, but it has no pharmacblogic ground. 11) For the treatment of frostbite, such herb remedies are commonly used as dipping the affected part into frozen soybean sack, using boiled water of eggplant stem, garlic caulis, onion, hot pepper, caulis. Onion is based upon antiphlogistic and tranquility actions garlic upon disintection, metabolic exacerbation, tonic and aphrodisiac actions and the use of eggplant and hot pepper is based upon help blood circulation, dissolution and excretion of waste matters in vein. 12) For the treatment of burn, such herb remedies or drugs are commonly used as cleansing with Korean gin, spreading eggs, cleansing with cold water and soap water ; and as brine, cactus, moss, soybean paste, oil, etc. The cleansing with Korean gin, cold water, soap water, brine, vinegar is based upon cleaning and sterilizing functions ; and the use of cucumber is based upon nu. trition provision, and strengthening of resisting power by adjustment of metabolism. The use of potato, cactus, moss, oil and eggs is said to be effective, but their phamacological functions are not clarified. In view of the above results, we can realize that the drugs that have been employed in herb remedies are quite diverse. However, in regard to majority of herb remedies that have been employed by symptoms, the pharmacological functions of their drugs have not been clarified, and they are merely known as effective. Furthermore, they have not been recorded in the literature as yet ; and we confirm that there have been many herb remedies that were executed without the proper knowlege of their effects. It is now our view that the results of this survey may be utilized for consulting data in regard to the use of herb remedies.