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EndoTODAY ³»½Ã°æ ±³½Ç


[°áÇÙ¼º À§ÀåÁúȯ. Gastrointestinal tuberculosis] - ðû

1. ½Äµµ °áÇÙ Esophageal tubuerculosis

2. À§ °áÇÙ Gastric tuberculosis

3. ½ÊÀÌÁöÀå °áÇÙ Duodenal tubercuosis

4. Àå °áÇÙ Intestinal tuberculosis

5. °áÇÙ¼º º¹¸·¿° Tuberculous peritonitis

6. º¹ºÎ °áÇÙ¼º ¸²ÇÁÀý¿° Abdominal tuberculous lymphadenitis

7. °áÇÙ¼º Èĵο° Tuberculous laryngitis

8. FAQ

9. References


1. ½Äµµ °áÇÙ

EndoTODAY ½Äµµ°áÇÙÀ» Âü°íÇϽñ⠹ٶø´Ï´Ù.


2. À§ °áÇÙ

À§Àå°ü °áÇÙÀº ȸ¸ÍºÎ¿¡ È£¹ßÇÕ´Ï´Ù. À§°áÇÙÀº ¸Å¿ì µå¹°°í ´ëºÎºÐ ÀÌÂ÷¼ºÀÔ´Ï´Ù. Ư¡ÀûÀÎ ³»½Ã°æ ¼Ò°ßÀº ¾øÀ¸¸ç Á¡¸·ÀÇ ºñÈijª ¹ßÀû, ºÒ±ÔÄ¢ÇÑ ¹Ì¶õÀ̳ª ±Ë¾çÀ» º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. ÀϹÝÀûÀÎ ±Ë¾çÄ¡·á·Î È£ÀüµÇÁö ¾Ê´Â °æ¿ì¿¡ ÀǽÉÇÒ ¼ö ÀÖ½À´Ï´Ù.

2018³â 12¿ù ¼ÒÈ­±âÇÐȸÁö¿¡ ÃâÇ÷·Î ³»¿øÇÑ À§ SMT ¾ç»óÀÇ °áÇÙ Áõ·Ê°¡ ÀÖ¾ú½À´Ï´Ù.

2021³â °Ç±¹´ë ³»½Ã°æ ÄûÁî¿¡ À§ °áÇÙ Áõ·Ê°¡ À־ ¾Æ·¡ ¿Å±é´Ï´Ù.


3. ½ÊÀÌÁöÀå °áÇÙ

½ÊÀÌÁöÀå Á¦3ºÎ ¸¸¼º ÇùÂøȯÀÚÀε¥ Á¶Á÷°Ë»ç¿¡¼­ non-caseating granuloma, MTB-PCA ¾ç¼ºÀ¸·Î ³ª¿Ô½À´Ï´Ù.


Áß¾Ó´ëÇб³ º´¿ø¿¡¼­ fellow °úÁ¤À» ¹â´Â Á¤ÁöÇý ¼±»ý´ÔÀÇ ¼Ò°³·Î ½ÊÀÌÁöÀå °áÇÙ Áõ·Ê(Clin Endosc 2014)¸¦ º¸¾Ò½À´Ï´Ù. Èæ»öº¯ÀÌ ÁÖ¼Ò¿´´ø 24¼¼ ³²ÀÚ¿´½À´Ï´Ù. ³»½Ã°æ Á¶Á÷°Ë»ç¿¡¼­´Â granulomatous inflammation°ú necrosis ¼Ò°ßÀ̾úÁö¸¸, QuantiFERON-TB GOLD (QFT-G; Cellestis Ltd., Carnegie, Australia) °Ë»ç°¡ ¾ç¼ºÀ̾ú´ø Á¡°ú °áÇÙ¾à Åõ¿© ÈÄ È£ÀüµÈ Á¡À¸·Î È®ÁøµÈ °æ¿ì¿´½À´Ï´Ù. °¡½¿ X-ray´Â Á¤»óÀ̾ú´Ù°í Çϳ׿ä.

An ulcerohypertrophic mass is noted at the duodenal second portion below the ampulla of Vater. (Clin Endosc 2014;47:346)

(A, B) The initial scan shows an ulcerohypertrophic lesion in the duodenal second to third portion (black arrow) and mass-like, multiple perilesional enlarged lymph nodes with some necrotic changes (white arrow). (C, D) After antituberculosis treatment for 6 months, the duodenal lesion (black arrow) and multiple lymph nodes (white arrow) were decreased. (Clin Endosc 2014;47:346)

Histopathological examination shows granulomatous inflammation with necrosis. (Clin Endosc 2014;47:346)

Transparent capped endoscopy shows a scared lesion with central depression and peripheral reepithelization at 1 month after treatment. (Clin Endosc 2014;47:346)


4. Àå°áÇÙ, °áÇÙ¼º Àå¿°

4-1. Àå°áÇÙÀÇ Áø´Ü

Àå°áÇÙÀÇ ÀüÇüÀûÀÎ ¼Ò°ßÀº dirty circular ulcerÀÔ´Ï´Ù.

¾Æ·¡ ÀοëÇÑ ¾Æ»êº´¿øÀÇ ¿¬±¸¿¡¼­µµ transverse ulcer°¡ Áß¿äÇÏ´Ù°í µÇ¾î ÀÖ½À´Ï´Ù. ±×·¯³ª Àú´Â µÎ Çü¿ë»ç Áß¿¡¼­ dirty°¡ circularº¸´Ù Áß¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ¹°·Ð dirty¶ó´Â °³³äÀ» ¿¬±¸¿¡ ³Ö±â´Â ¾î·Á¿ü°ÚÁö¸¸... ¿©ÇÏÆ° °áÇÙÀº µü º¸¸é ÁöÀúºÐÇÑ ´À³¦ÀÔ´Ï´Ù.

Lee YJ. Endoscopy 2006

Àå°áÇÙ°ú Å©·Ðº´À» ±¸ºÐÇϱâ À§ÇÑ ¸ÞŸºÐ¼®µµ ÀÖ¾ú½À´Ï´Ù (Limsrivilai J. Am J Gastroenterol 2017). ³»½Ã°æ ¼Ò°ß¿¡ ´ëÇÑ ºÎºÐÀº ´ÙÀ½°ú °°ÀÌ Á¤¸®µÇ¾ú½À´Ï´Ù.

"The following endoscopic findings significantly favored CD: longitudinal ulcers, aphthous ulcers, cobblestone appearance, luminal stricture, mucosal bridge, and skip lesions. Transverse ulcers and a patulous ileocecal (IC) valve significantly favored ITB. All of them were selected to build the model. Pseudopolyps did not distinguish the two diseases. Mucosal nodularity was found more often in ITB, but this was not statistically significant. For the site of involvement, rectal and sigmoid colon involvement were significant predictors of CD, while involvement of the IC valve and cecum significantly favored ITB. Involvement of rectum, sigmoid colon, and cecum were selected to build the model. Involvement of IC valve may be correlated with patulous IC valve. To avoid the possibility of including potentially interdependent variables in the model, patulous IC valve that has been reported as a significant predictor in many studies was selected. Involvement of ileum, ascending colon, transverse colon, and descending colon was not significantly different between CD and ITB. "


4-2. Intestinal Tb °¡ ÀÇ½ÉµÉ °æ¿ì Á¶Á÷°Ë»ç ó¹æ

1) BL1A112A. colon »ý°Ë 1~3°³ → Æ÷¸£¸»¸° Åë
2) BL4112. AFB stain and culture ó¹æ (°Ëü others(specify)) → saline Åë
3) BG510101. Mycobacterium tuverculosis,nested PCR (°Ëü P17 colon) → »ý°ËÁ¶Á÷¸¸
Á¶Á÷°Ë»çÇϱâ Àü ¹Ì¸® °£È£»ç¿¡°Ô Á¤º¸¸¦ ÁÖ¾î¾ß Æ÷¸£¸»¸°Åë¿¡ °Ëü°¡ ¸ðµÎ ´ã±â´Â °ÍÀ» ¸·À» ¼ö ÀÖ½À´Ï´Ù. ²À ¹Ì¸® ¼ÒÅëÇϼ¼¿ä.


4-3. Àå°áÇ٠ȯÀÚÀÇ ¹ß¿­

20´ë ¿©¼ºÀÌ ¿øÀÎ ¹Ì»óÀÇ ¹ß¿­·Î ³»¿øÇÏ¿´½À´Ï´Ù. Àå°áÇÙÀ¸·Î Áø´ÜÇÏ°í Ç×°áÇÙÁ¦¸¦ Åõ¿© ÈÄ ±Þ¼ÓÈ÷ ¿­ÀÌ ¾ø¾îÁ³½À´Ï´Ù. Åë»ó 2-3ÀÏ ³»·Î ÇöÀúÈ÷ ü¿ÂÀÌ ¶³¾îÁý´Ï´Ù.


4. More cases of TB colitis

¿ìÃø conjunctivaÀÇ melanoma·Î ¼ö¼ú, ¹æ»ç¼± Ä¡·á, Ç×¾ÏÄ¡·á ÈÄ interferon Ä¡·á¸¦ ¹Þ°í °è½Å ºÐÀÔ´Ï´Ù. PET¿¡¼­ »óÇà°áÀåÀÇ º´¼Ò°¡ ÀǽɵǾú½À´Ï´Ù (Èò È­»ìÇ¥). Cecum¿¡´Â °áÇÙ¼º Àå¿°ÀÇ scar°¡ ´Ù¼ö °üÂûµÇ¾úÀ¸³ª À̺¸´Ù ¾à°£ ¿øÀ§ºÎÀÎ A colon¿¡¼­ circumferential ¹æÇâÀÇ ¾è°í ÁöÀúºÐÇغ¸ÀÌ´Â ±Ë¾çÀÌ °üÂûµÇ¾ú½À´Ï´Ù. AFB smear¿Í nested PCRÀº À½¼ºÀ̾úÀ¸³ª tissue culture¿¡¼­ °áÇÙ±ÕÀÌ ¹è¾çµÇ¾ú½À´Ï´Ù. Ç×°áÇÙÄ¡·á ÈÄ È£ÀüµÇ¾ú½À´Ï´Ù. (EndoTODAY ¸ñ¿ä³»½Ã°æÁý´ãȸ 20170223)

´ëÀå¾Ï ¼ö¼ú ÈÄ ÃßÀû ³»½Ã°æ ÀÔ´Ï´Ù. Ascending colon¿¡¼­ ¿ì¿¬È÷ °áÇÙ¼º ´ëÀå¿°ÀÌ ¹ß°ßµÇ¾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­´Â focal active colitis with focal crypt abscess Á¤µµÀÇ ¼Ò°ßÀ̾úÁö¸¸ tissus nested PCR ¿¡¼­´Â M. tuberculosis°¡ ³ª¿Ô½À´Ï´Ù. ¹«Áõ»ó °áÇÙ¼º ´ëÀå¿°µµ ¹Ýµå½Ã Ä¡·áÇØ¾ß Çϴ°¡ ³í¶õÀÌ °¡´ÉÇÏÁö¸¸, ÀÌ·± °æ¿ì Àú´Â º¸Åë Ä¡·á¸¦ ±ÇÇÏ°í ÀÖ½À´Ï´Ù.

left: terminal ileum, right: ascending colon (EndoTODAY ¸ñ¿ä³»½Ã°æÁý´ãȸ 20170413)

50´ë ¿©¼º. A colon biopsy: Focal active inflammation with a non-caseating granuloma and lymphoid aggregates, Culture: Mycobacterium tuberculosis complex isolated

°áÇÙ¼º Àå¿°ÀÇ ´Ù¾çÇÑ ¸ð½À - ÀϺ»¼ÒÈ­±â³»½Ã°æÇÐȸ (2017)

°áÇÙ¼º Àå¿°ÀÇ ´Ù¾çÇÑ ¸ð½À - ÀϺ»¼ÒÈ­±â³»½Ã°æÇÐȸ (2017)


5. °áÇÙ¼º º¹¸·¿°

°áÇÙ¼º º¹¸·¿° ȯÀÚÀÇ serum CA-125´Â »ó´çÈ÷ ³ôÀ» ¼ö ÀÖ½À´Ï´Ù. ÀúÈñ º´¿ø¿¡¼­ °áÇÙ¼º º¹¸·¿° ȯÀÚ 48¸íÀÇ serum CA-125¸¦ Á¶»çÇØ º» ¹Ù 4¸í¿¡¼­ 1,000 ÀÌ»óÀ̾ú½À´Ï´Ù. ±× Áß¿¡¼­ °¡Àå ³ô¾Ò´ø °æ¿ì´Â CA-125°¡ 2,702ÀÎ ¿©¼ºÀ̾ú½À´Ï´Ù.

°áÇÙ¼º º¹¸·¿° ȯÀÚ¸¦ Áø·áÇÒ ¶§¿¡´Â Á¶±Ý ÀÌ»óÇÑ ±âºÐÀÌ µì´Ï´Ù. ÀÀ±Þ½ÇÀ» ÅëÇÏ¿© ÀÔ¿øÇÑ È¯ÀÚÀÇ º´½Ç¿¡ µé¾î°¡¸é °ÅÀÇ È¸ÁøÀÌ µÇÁö ¾Ê½À´Ï´Ù. ȯÀÚ¿Í °¡Á· ¸ðµÎ°¡ ½ÉÇÏ°Ô ¿ï°í Àֱ⠶§¹®ÀÔ´Ï´Ù. ÃÊ»óÁý ºÐÀ§±âÀÌÁö¿ä. ³­¼Ò¾ÏÀε¥ ³Ê¹« ¹øÁ®¼­ °ÅÀÇ ¼Õ¾²±â ¾î·Æ´Ù°í µé°í ¿ï°í ÀÖ´Â »óȲÀÔ´Ï´Ù. °áÇÙÀε¥ ¾ÏÀ¸·Î ¿ÀÁøÇÑ °ÍÀÎÁöµµ ¸ð¸£°í....

Á¦°¡ ȯÀÚ¿¡°Ô ¸î °¡Áö¸¦ ¹°¾îº¸°í (±âħÇÑ ÀûÀº ¾ø´ÂÁö, ¹ß¿­Àº ¾ø¾ú´ÂÁö µîµî) ¾ÏÀÌ ¾Æ´Ò ¼öµµ ÀÖ´Ù°í Çϸé ȯÀÚ, º¸È£ÀÚ ¸ðµÎ ±ô¦ ³î¶õ Ç¥Á¤À» Áþ½À´Ï´Ù. »ç±â²Û º¸´Â °Í°ú °°Àº ´«Ãʸ®·Î °·¡º¸´Â ºÐµµ °è¼Ì½À´Ï´Ù. ¹Ý´ë·Î ¹«½¼ ±¸¼¼ÁÖ¸¦ ¸¸³­ °Í °°Àº ±âºÐÀ̾ú´Ù°í ¸»ÇÑ È¯ÀÚµµ ÀÖ¾ú½À´Ï´Ù. ¿©ÇÏÆ° Á×À» »· ÇÏ´Ù°¡ »ì¾Æ³­ °æ¿ìÀÔ´Ï´Ù.

CA-125°¡ ³ô´Ù°í ¸ðµÎ ¾ÏÀº ¾Æ´Õ´Ï´Ù.


Áö±Ý±îÁö »ï¼º¼­¿ïº´¿ø¿¡¼­ °æÇèÇÏ¿´´ø °áÇÙ¼º º¹¸·¿° 48¿¹¸¦ ºÐ¼®ÇÏ¿© ªÀº ±Û·Î ¸¸µé¾î Yonsei Medical Journal¿¡ Clinical Significance of Serum CA-125 in Korean Females with Ascites¶ó´Â Á¦¸ñÀ¸·Î ±â°íÇÏ¿´½À´Ï´Ù.

Purpose: Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area.
Materials and Methods: The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed.
Results: Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p¡Â0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%).
Conclusion: Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.

Ç÷û CA-125ÀÇ ºÐÆ÷ÀÔ´Ï´Ù. °áÇÙ¼º º¹¸·¿°¿¡¼­´Â ¾îÁ¦ÀÇ Áõ·Ê°¡ °¡Àå ³ô¾Æ 2,702¿´½À´Ï´Ù. ±×·¯³ª 1,000 ÀÌ»óÀÌ¸é ´ëºÎºÐ ³­¼Ò¾ÏÀ̾ú½À´Ï´Ù. ³­¼Ò¾Ï¿¡¼­ Æò±Õ CA-125Ä¡´Â 1,002¿´°í °áÇÙ¼º º¹¸·¿°¿¡¼­´Â 418À̾ú½À´Ï´Ù.

CA-125 ¿µ¿ªº° °áÇÙ¼º º¹¸·¿°ÀÇ ºÐÆ÷ÀÔ´Ï´Ù. ¿¹¸¦ µé¾î¼­ 500 Á¤µµ¸é ¾à 25%´Â °áÇÙ¼º º¹¸·¿°À̾ú½À´Ï´Ù.

Á¶Á÷À¸·Î È®ÀÎµÈ ÀüÇüÀûÀÎ °áÇÙ¼º º¹¸·¿°ÀÇ Áõ·ÊÀÔ´Ï´Ù. Fig. 5. A case of tuberculous peritonitis. (A) A 68-year old woman came to the hospital with abdominal distention which developed 2 months prior. CT scan was taken and the first impression was peritoneal carcinomatosis. (B) Laparoscopy was done and the histology showed chronic granulomatous inflammation with multinucleated giant cells. (C) No ascites were seen at the follow-up CT scan, 4 months after taking anti-Mycobacterium medication.

°áÇÙ¼º º¹¸·¿°°ú ³­¼Ò¾ÏÀÇ ºñ±³ÀÔ´Ï´Ù.


6. º¹ºÎ °áÇÙ¼º ¸²ÇÁÀý¿°

2°³¿ù Á¤µµÀÇ ºñƯÀÌÀû »óºÎÀ§Àå°ü ºÒÆí°¨ÀÌ ÀÖ´ø 40´ë ¿©¼ºÀÔ´Ï´Ù. ³»½Ã°æ °Ë»ç¿¡¼­ ½ÊÀÌÁöÀå ±¸ºÎÀÇ µÕ±Ù À¶±âºÎ°¡ ÀÖ°í ±× Áß¾ÓÀÇ ±Ë¾çÀÌ ¹ß°ßµÇ¾ú°í °°Àº ³¯ ½ÃÇàÇÑ º¹ºÎ ÃÊÀ½ÆÄ¿¡¼­ ÃéÀå ÁÖº¯ÀÇ mass°¡ ÀǽɵǾî ÀǷڵǾú½À´Ï´Ù. CT, PET, EUS-guided FNA µîÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. CT¿¡¼­´Â multiple lymph adenopathy°¡ ÀÖ°í ½ÊÀÌÁöÀå ±¸ºÎ¿¡ ÀÎÁ¢ÇÑ ¸²ÇÁÀý ³»ºÎ¿¡ air°¡ º¸¿´½À´Ï´Ù.

Abdominal TB lymphadenitis with fistula into the duodenal bulb·Î Ç×°áÇÙÁ¦¸¦ Åõ¿©ÇÏ¿´½À´Ï´Ù. PPI°¡ ÇÊ¿äÇÑÁö ¸íÈ®ÇÏÁö ¾Ê¾Ò½À´Ï´Ù. °¨¿°³»°ú¿¡¼­ PPI¸¦ ¹Þ¾Æ µå½Ã°í °è¼Ì´Âµ¥ Áß´ÜÀ» ±ÇÇÏÁö´Â ¾Ê¾Ò½À´Ï´Ù.


7. °áÇÙ¼º Èĵο°. TB laryngitis with lymphadenitis

40´ë ³²¼ºÀÔ´Ï´Ù. ¸ñÀÌ ºÒÆíÇÏ°í, µ¢¾î¸®Áö°í Å« °ÍÀ» ¸ÔÀ» ¶§ ¾ÆÇÁ´Ù´Â Áõ»óÀ¸·Î À̺ñÀÎÈÄ°ú fellow ¼±»ý´Ô ¿Ü·¡¸¦ ¹æ¹® ÈÄ Á¶Á÷°Ë»ç°¡ ½ÃÇàµÇ¾ú°í ´ÙÀ½ÀÇ ¼Ò°ßÀ̾ú½À´Ï´Ù. "Pyriform sinus, left, punch biopsy: Chronic inflammation and inflamed granulation tissue."

À̺ñÀÎÈÄ°ú¿¡¼­ ½ÃÇàÇÑ CT¿¡¼­´Â ´ÙÀ½°ú °°ÀÌ Æǵ¶µÇ¾ú½À´Ï´Ù.


¼Ò°ß: Left pyriform sinus¿¡ 2.7 cm °¡·®ÀÇ heterogeneously enhancing soft-tissue mass°¡ °üÂûµÇ¸ç ÀÌ mass´Â pyriform sinusÀÇ apex±îÁö extension µÇ¾î ÀÖÀ½. Left neckÀÇ IIa¿Í ¾çÃø¿¡ supraclavicular fossa¿¡ multiple variable sized heterogeneously enhancing lymphadenopathy°¡ °üÂûµÊ.
Impression: Left pyriform sinus cancer with bilateral multiple lymph node metastases (T2 N2c)

½Äµµ Áúȯ À¯¹«¸¦ È®ÀÎÇϱâ À§ÇÏ¿© ³»½Ã°æ °Ë»ç°¡ ÀǷڵǾú½À´Ï´Ù. ½Äµµ´Â Á¤»óÀ̾ú°í post-cricoid areaºÎÅÍ left pyriform sinus media wall¿¡ °ÉÃÄ white plaque¸¦ º¸ÀÌ´Â ÇÏÀεΠÁ¡¸· ¿°Áõ ¼Ò°ßÀÌ °üÂûµÇ¾ú½À´Ï´Ù.

"Left pyriform sinus¿¡ buling ¹× whitish patch lesion ÀÖ¾î fiberoptic guided biopsy ÇÏ¿´½À´Ï´Ù. biopsy »ó¿¡¼­´Â Chronic inflammation ¼Ò°ß pending EBV ¼Ò°ßÀ̳ª ROF CT »ó Left pyriform sinus cancer with bilateral multiple lymph node metastases (T2N2c)" ¼Ò°ßÀ¸·Î Á¾¾ç Àü¹® À̺ñÀÎÈÄ°ú ±³¼ö´Ô²² ÀÇ·ÚµÈ ÈÄ ¼ö¼ú(diagnostic laryngomicroscopic surgery with biopsy + excisional biopsy of cervical lymph node)ÀÌ ½ÃÇàµÇ¾ú½À´Ï´Ù.

ÃÖÁ¾ º´¸®°á°ú´Â "(1) Left pyriform sinus: Chronic inflammation, Multiple granulomas and multiple granulomatous vasculitis, (2) Lymph nodes, level III: Two reactive lymph nodes"·Î ³ª¿Ô´Âµ¥ ÇÔ²² ÀÇ·ÚµÈ Tuberculosis PCR °Ë»ç¿¡¼­ ¾ç¼ºÀ¸·Î ³ª¿Í Tb laryngitis with lymphadenitis·Î Áø´ÜÇÒ ¼ö ÀÖ¾ú½À´Ï´Ù. Ç×°áÇÙÄ¡·á ÈÄ È£ÀüµÇ¾ú½À´Ï´Ù.


[FAQ]

[2015-12-30. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô, ¾È³çÇϽʴϱî? Ç×»ó ÁÁÀº Á¤º¸, ÀÚ·á¿Í ¿­Á¤¿¡ °¨»çµå¸³´Ï´Ù. »õÇØ¿¡µµ °Ç½ÂÇÏ½Ã°í ¼Ò¿ø ¼ºÃëÇϽñ⸦ ¹Ù¶ø´Ï´Ù. ¸çÄ¥ Àü ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 15ÀÇ ´ëÀå °áÇÙÀ» º¸°í ¹®µæ Áú¹®µå¸³´Ï´Ù.

°áÇÙÀÌ ÀÇ½ÉµÉ ¶§ Á¶Á÷°Ë»çµµ ÇÏ°í Tb PCR µµ º¸³»°ï ÇÕ´Ï´Ù¸¸, PCR °á°ú°¡ ¾ç¼ºÀ¸·Î ³ª¿À´Â °æ¿ì¸¦ º°·Î ¸ø º» °Í °°½À´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ °áÇÙÀÌ ¾Ö¸Å¸ðÈ£ÇÒ ¶§ PCR °á°ú¿¡¼­ ´Ü¼­¸¦ ¾ò°Å³ª Áø´Ü¿¡ µµ¿òµÇ±â¸¦ ±â´ëÇÏÁö¸¸ ±×·± °æ¿ì°¡ ¾ø¾î¼­ ¾î°¾ß ÁÁÀ»Áö Àǹ®½º·´½À´Ï´Ù. °áÇÙ Áø´Ü¿¡¼­ PCR Àº ¾î¶² Áø´ÜÀû Àǹ̰¡ ÀÖ´Â °ÍÀÎÁö¿ä? PCR ¿¡¼­ µµ¿òÀ» ¾òÀ¸·Á¸é Á¶Á÷À» ¾òÀ» ¶§ ƯÈ÷ ÁÖÀÇÇØ¾ß ÇÒ Á¡ÀÌ ÀÖ´ÂÁöµµ ±Ã±ÝÇÕ´Ï´Ù.

[2015-12-30. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. Àú´Â Àå°áÇ٠ȯÀÚ¸¦ ¸¹ÀÌ º¸Áö ¾Ê½À´Ï´Ù¸¸, ÀÏ´Ü 2009³â À忬±¸ÇÐȸ¿¡¼­ ³ª¿Â Àå°áÇÙ Áø´Ü °¡À̵å¶óÀÎÀÇ ÀϺθ¦ ¿Å±é´Ï´Ù.

¨ç ´ëÀå Á¡¸· Á¶Á÷ PCR¹ýÀ» ÀÌ¿ëÇÑ °áÇÙ±ÕÀÇ Áõ¸íÀº °Ë»çÀÇ Æ¯À̵µ°¡ ³ôÀº ¹Ý¸é ¹Î°¨µµ°¡ ³·¾Æ Àå°áÇÙÀ» Å©·Ðº´°ú °¨º°ÇÏ´Â µ¥ °áÁ¤ÀûÀÎ ¼ö´ÜÀÌ µÇÁö ¸øÇϳª, ÀÓ»óÀûÀ¸·Î °áÇÙÀÌ ÀǽɵǴ °æ¿ì º¸Á¶ Áø´Ü ¹æ¹ýÀ¸·Î È°¿ë °¡´É¼ºÀº ÀÖ´Ù. ÀϹÝÀûÀ¸·Î insertion element IS6110À» ÀÌ¿ëÇÏ¿© PCRÀ» ½ÃÇàÇÑ´Ù. ÃÖÃÊ·Î Àå°áÇÙ Áø´Ü¿¡ ´ëÀå Á¡¸· Á¶Á÷ °áÇÙ±Õ PCRÀÇ À¯¿ë¼ºÀ» ¾Ë¾Æº» ¿¬±¸¿¡¼­´Â °áÇÙ±Õ µµ¸»°Ë»ç¿¡¼­ ¾ç¼ºÀÎ °æ¿ì 93.8%, À½¼ºÀÎ °æ¿ì 60.0%¿¡¼­ PCR ¾ç¼ºÀ̶ó°í º¸°íÇÏ¿´´Ù. ±¹³» ¿¬±¸´Â Àå°áÇ٠ȯÀÚ Áß PCR ¾ç¼ºÀÌ 9.8%, Å©·Ðº´À̳ª º£Ã¼Æ®º´ ȯÀÚ´Â PCR ¾ç¼ºÀÌ 0%·Î ºñ±³Àû ³·Àº ¾ç¼º·üÀ» º¸¿´À¸¸ç À§À½¼ºÀÇ °¡´ÉÇÑ ¿øÀÎÀ¸·Î ¹ÝÀÀ ÀúÇØÁ¦ °¡´É¼º, °áÇÙ±ÕÀÇ ¼ö°¡ Àû°Å³ª ±ÕµîÇÏ°Ô ºÐÆ÷µÇÁö ¾Ê¾Æ »ý°Ë °Ëü ³»¿¡ Æ÷ÇÔµÇÁö ¾Ê¾ÒÀ» °¡´É¼º, ±×¸®°í ÆĶóÇÉ Æ÷¸Å Á¶Á÷À̹ǷΠ°áÇÙ±Õ DNA°¡ º¯¼ºµÇ°Å³ª Æı«µÇ¾úÀ» °¡´É¼ºÀ» Á¦½ÃÇÏ¿´´Ù. ´Ù¸¥ ±¹³» ¿¬±¸¿¡¼­´Â ÆĶóÇÉ Æ÷¸ÅÁ¶Á÷ÀÇ PCR ¾ç¼º·ü 45%, ½Å¼±ÇÑ Á¶Á÷ÀÇ PCR ¾ç¼º·ü 30%·Î °ÅÀÇ Â÷ÀÌ°¡ ¾øÀ¸¸ç ÃæºÐÇÑ ¾çÀÇ ¿©·¯ °³ÀÇ Á¶Á÷À¸·Î PCRÀ» ½ÃÇàÇÒ °æ¿ì ¾ç¼º·üÀ» ³ôÀ̸ç, À°¾ÆÁ¾ÀÌ °üÂûµÇÁö ¾Ê´Â °æ¿ì¿¡ ƯÈ÷ PCRÀÌ Áø´Ü ±â¹ýÀ¸·Î Àǹ̰¡ ÀÖ´Ù°í ÇÏ¿´´Ù. ÆĶóÇÉ Æ÷¸Å Á¶Á÷À» Åë»óÀÇ PCR ¹æ¹ýÀ¸·Î ÇÒ °æ¿ì 33.3%ÀÇ ¾ç¼º·üÀ» º¸ÀÎ ¹Ý¸é real-time PCR ¹æ¹ýÀ» »ç¿ëÇÒ °æ¿ì 66.7%ÀÇ º¸´Ù ³ôÀº ¾ç¼º·üÀ» º¸°íÇÑ ¿¬±¸µµ ÀÖ´Ù.

¨è Àå°áÇÙ¿¡¼­ ´ëÀå Á¡¸· Á¶Á÷ PCRÀÌ À§¾ç¼ºÀ¸·Î ³ª¿À´Â °æ¿ì´Â PCR »ê¹°ÀÇ ¿À¿° ¹× °áÇÙ±Õ DNAÀÇ ¿À¿°À¸·Î ÀÎÇÑ °ÍÀÌ ´ëºÎºÐÀÌ°í PCRÀÌ À§À½¼ºÀÎ °æ¿ì´Â °¡°Ë¹°¿¡ Á¸ÀçÇÏ´Â ÁßÇÕÈ¿¼Ò¾ïÁ¦ÀÎÀÚ ¶§¹®ÀÌ´Ù. µû¶ó¼­ À§¾ç¼º ¹× À§À½¼ºÀ» ³·Ãß±â À§Çؼ­´Â °¡°Ë¹°À» 1% NaOH·Î 100µµ¿¡¼­ 2-5ºÐ°£ ó¸®ÇÏ¸é ¿À¿° ¹× ¾ïÁ¦ÀÎÀÚ¸¦ È¿°úÀûÀ¸·Î Á¦°ÅÇÒ ¼ö ÀÖ´Ù.

ÀÌ ºÐ¾ß Àü¹®°¡ ¸î ºÐ¿¡°Ô ÀÚ¹®ÇÑ ÈÄ ´Ù½Ã ´äº¯µå¸®°Ú½À´Ï´Ù.


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Àå°áÇÙÀÇ Áõ»óÀº ºñƯÀÌÀûÀÎ °æ¿ì°¡ ¸¹°í ½ÉÁö¾î ¾Æ¹« Áõ»óÀÌ ¾øÀÌ °ËÁø ´ëÀå³»½Ã°æ¿¡¼­ ¹ß°ßµÇ±âµµ ÇÕ´Ï´Ù. ºñ±³Àû ÈçÇÑ Áõ»óÀº Á¡Â÷ ÁøÇàÇÏ´Â ¼³»ç, º¹Åë, üÁß°¨¼Ò µîÀ̸ç, ±¸¿ª°¨, Ç÷º¯, ¹ß¿­ µîÀ» µ¿¹ÝÇϱ⵵ ÇÕ´Ï´Ù.

Àå°áÇÙÀÇ Áø´Ü¿¡ °¡Àå Áß½ÉÀûÀÎ °ÍÀº ´ëÀå³»½Ã°æÀ¸·Î, transverse directionÀÇ ±Ë¾ç, ±Ë¾çÀÇ marginÀÌ ´Ù¼Ò nodular ÇÏ°í dirtyÇÑ ¼Ò°ßÀ» º¸ÀÏ ¶§ ÀǽÉÇÒ ¼ö ÀÖ½À´Ï´Ù. È®ÁøÀº Á¶Á÷¿¡¼­ caseating granuloma°¡ °üÂûµÇ°Å³ª, AFB ¾ç¼º ¼Ò°ß ¶Ç´Â Á¶Á÷¹è¾ç¿¡¼­ M. tuberculosis°¡ ÀÚ¶ö °æ¿ì ³»¸± ¼ö ÀÖÀ¸³ª, ¾Æ½±°Ôµµ 30% ³»¿ÜÀÔ´Ï´Ù. µû¶ó¼­ Áõ»ó°ú ´ëÀå³»½Ã°æ ¼Ò°ß¿¡¼­ Àå°áÇÙÀÌ °­·ÂÈ÷ ÀÇ½ÉµÉ °æ¿ì, °æÇèÀû Ç×°áÇÙÁ¦ Ä¡·á¸¦ ÅëÇØ Áø´Ü³»¸®´Â °æ¿ì°¡ ¹Ý¼ö ÀÌ»óÀÔ´Ï´Ù.

°áÇÙ±Õ PCR °Ë»ç´Â °áÇÙ±Õ¿¡¸¸ ƯÀÌÇÏ°Ô Á¸ÀçÇÏ´Â ÇÙ»ê(DNA)À» ÁßÇÕÈ¿¼Ò¿¬¼â¹ÝÀÀ°Ë»ç·Î ÁõÆøÇÏ¿© È®ÀÎÇÏ´Â ºÐÀÚ»ý¹°ÇÐÀû °Ë»ç·Î ºñ±³Àû ƯÀ̵µ°¡ ³ô°í °á°ú¸¦ ´Ü½Ã°£³» ¾òÀ» ¼ö ÀÖ´Ù´Â ÀåÁ¡ÀÌ ÀÖÀ¸³ª °íºñ¿ëÀÎ Á¡, Á¦Ç°¸¶´Ù ¹Î°¨µµ¿Í ƯÀ̵µ°¡ ´Ù¾çÇÏ´Ù´Â ´ÜÁ¡ÀÌ ÀÖ¾î, ±âÁ¸ÀÇ Áø´Ü °Ë»ç¸¦ ´ëÄ¡ÇÒ ¼ö ¾ø°í º¸Á¶Àû Áø´Ü ¼ö´ÜÀ¸·Î ÀÌ¿ëµÇ¾î¾ß ÇÕ´Ï´Ù.

Àå°áÇÙ¿¡¼­ Áø´ÜÀ» À§ÇÑ °áÇÙ±Õ PCR °Ë»ç´Â ¾ÆÁ÷ µ¥ÀÌÅÍ°¡ ÃæºÐÇÏÁö ¾ÊÀº »óȲÀ¸·Î ƯÈ÷ Àå°áÇÙ¿¡¼­´Â °áÇÙ±ÕÀÇ ¾çÀÌ »ó´ëÀûÀ¸·Î À۱⠶§¹®¿¡ ¹Î°¨µµ°¡ ³·Àº ´ÜÁ¡ÀÌ ÀÖ½À´Ï´Ù. ¶ÇÇÑ À§¾ç¼ºÀ» ¹æÁöÇϱâ À§ÇØ ¿À¿° °¡´É¼ºÀ» ³·Ãß¾î¾ß ÇÕ´Ï´Ù. °áÇÙ±Õ PCR °Ë»ç´Â °Ë»ç Å°Æ® Á¦Á¶ÀÚ¿¡ µû¶ó ³ª´­ ¼ö Àִµ¥, °¢ °Ë»ç½Ç¿¡¼­ Á÷Á¢ °Ë»ç¸¦ À§ÇØ Á¦Á¶ÇÑ Å°Æ®´Â Ç¥ÁØÈ­°¡ µÇÁö ¾Ê¾Æ Áø´Ü¿¡ »ç¿ëÇϱ⿡´Â ¸¹Àº ¹«¸®°¡ ÀÖ½À´Ï´Ù.

»çÁøÀÇ Áõ·Ê´Â Àå°áÇÙÀÇ ºñ±³Àû ÀüÇüÀûÀÎ ´ëÀå³»½Ã°æ ¼Ò°ßÀ¸·Î, Á¶Á÷°Ë»ç¿¡¼­ È®ÁøµÇÁö ¾Ê´õ¶óµµ °æÇèÀû Ç×°áÇÙÁ¦ Ä¡·á¸¦ ½ÃÀÛÇØ¾ß ÇÕ´Ï´Ù. °áÇÙ±Õ PCR °Ë»ç¿Í ´õºÒ¾î º¸Á¶Àû Áø´Ü ±â¹ýÀ¸·Î »ç¿ëÇÒ ¼ö ÀÖ´Â °ÍÀº IGRA (interferon gamma release assay) testÀε¥, ¿ì¸®³ª¶óÀÇ °æ¿ì, Àå°áÇ٠ȯÀÚÀÇ ¾à 70%¿¡¼­ ¾ç¼º ¼Ò°ßÀ» º¸ÀÔ´Ï´Ù. ÇÏÁö¸¸ IGRA test ¾ç¼ºÀÌ È°µ¿¼º °áÇÙÀ» ÀǹÌÇÏ´Â ¹Ù´Â ¾Æ´Õ´Ï´Ù.


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Àå °áÇÙÀº Á¶Á÷¼Ò°ß/PCR/¹è¾ç°Ë»ç¿¡¼­ Áø´ÜÀÌ ¾ÈµÇ´Â °æ¿ì°¡ ¸¹¾Æ¼­, ÀÏ´Ü ÀÓ»ó Áõ»óÀÌ ¾ø°Å³ª ¹Ì¹ÌÇÏ°í ³»½Ã°æ À°¾È ¼Ò°ßÀÌ Àå °áÇÙ¿¡ ºÎÇյǸé, À°¾È ¼Ò°ß¿¡ ÀÇÁ¸Çؼ­ Áø´ÜÇÏ°í 2-4°³¿ù °æÇèÀû Ä¡·á ÈÄ È£Àü ¿©ºÎ¿¡ µû¶ó Ä¡·á Áö¼Ó ¿©ºÎ¸¦ °áÁ¤ÇÏ°í ÀÖ½À´Ï´Ù.

Àå°áÇ٠ȯÀÚ¿¡¼­ PCR ¾ç¼º·üÀ» ³ôÀÌ´Â °Í¿¡ ´ëÇÑ Á¦ ÀÇ°ßÀ» µå¸®ÀÚ¸é, °áÇÙ±ÕÀº ´ëÇ¥ÀûÀΠȣ±â¼º ¼¼±ÕÀε¥ »ê¼ÒºÐ¾ÐÀÌ ³·°í Çø±â¼º ¼¼±ÕÀÌ µæ¼¼ÇÏ°í ÀÖ´Â ¸»´ÜºÎȸÀå/´ëÀåÀº °áÇÙ±ÕÀÌ »ì±â¿¡ ÀûÇÕÇÏÁö ¾ÊÀº ȯ°æÀÎ ¹Ù, ¹è¾ç°Ë»ç ¹× PCR ¾ç¼º·üÀÌ ³·Àº °ÍÀº ¾îÂ¸é ´ç¿¬ÇÏ´Ù°í ÇÏ°Ú½À´Ï´Ù.

°³ÀÎÀûÀÎ °æÇè¿¡¼­ »ý°Ë¿¡¼­ À°¾ÆÁ¾ÀÌ Áø´ÜµÇ´Â °æ¿ìµµ 50%¸¦ ¹Øµµ´Â Á¤µµ¿´´Âµ¥, ÀÌ ¶ÇÇÑ ±Ë¾çÀÇ Å©±â°¡ ÀÛÀº Ãʱ⠺´º¯¿¡¼­ ¾ç¼º·üÀÌ ³ô¾Ò´ø µíÇÕ´Ï´Ù. »ê¼ÒºÐ¾ÐÀÌ ³·Àº Ȥµ¶ÇÑ È¯°æ¿¡ ´ú ³ëÃâµÈ ½Å¼±ÇÑ(?) º´º¯¿¡¼­ Áø´ÜÀ²ÀÌ ³ô¾Ò´ø ¹Ù, PCR ¾ç¼ºÀ²À» ³ôÀ̱â À§Çؼ­µµ Ãʱ⠺´º¯¿¡¼­ ÁýÁßÀûÀ¸·Î »ý°ËÀ» Çϸé ÁÁ°Ú´Ù´Â »ý°¢ÀÔ´Ï´Ù.


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1) °áÇÙ Áø´Ü¿¡¼­ PCR Àº ¾î¶² Áø´ÜÀû Àǹ̰¡ ÀÖ´Â °ÍÀÎÁö¿ä?

ÀÌÁØÇà ±³¼ö´Ô²²¼­ °¡À̵å¶óÀÎÀ» ÀοëÇÏ¿© ¸»¾¸ÇϽŠ°Íó·³ Àå°áÇÙÀ» Áø´ÜÇϴµ¥ °­·ÂÇÑ º¸Á¶ÀûÀÎ ¼ö´ÜÀÔ´Ï´Ù (°Ëü contaminationÀÌ ¾ø´Ù¸é¿ä... ) . ÇÏÁö¸¸, AFB culture +³ª AFB stain + ÀÎ °æ¿ìó·³ definite diagnosis·Î º¼ ¼ö ¾ø±â¿¡ empirical TB treatment 2°³¿ù Á¤µµ ÈÄ¿¡ ´Ù½Ã ³»½Ã°æÀ» ÃßÀû °Ë»çÇÏ¿© anti-tb ¾àÁ¦ÀÇ response¸¦ È®ÀÎÇÔÀÌ ÇÊ¿äÇÕ´Ï´Ù.

2) PCR ¿¡¼­ µµ¿òÀ» ¾òÀ¸·Á¸é Á¶Á÷À» ¾òÀ» ¶§ ƯÈ÷ ÁÖÀÇÇØ¾ß ÇÒ Á¡ÀÌ ÀÖ´ÂÁöµµ ±Ã±ÝÇÕ´Ï´Ù.

Á¶Á÷°Ë»ç´Â ±Ë¾ç margin°ú base¿¡¼­ ¿©·¯ Á¶Á÷À» ¾ò´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Á¡¸·¿¡´Â °áÇÙ±ÕÀÌ ¸¹Áö ¾Ê°í À°¾ÆÁ¾ Çü¼ºµµ ¶Ñ·ÇÇÏÁö ¾Ê±â ¶§¹®¿¡ ´ëºÎºÐÀÇ Á¶Á÷°Ë»ç¿¡¼­ pathognomonic findingÀ» ÁÖÁö ¸øÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·¡¼­ ±Ë¾çÀÇ base¿¡¼­ ÃæºÐÇÑ ±íÀÌÀÇ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ Áø´ÜÀ²À» ³ôÀÌ´Â °¡Àå ÁÁÀº ¹æ¹ýÀÔ´Ï´Ù¡¦ ÇÏÁö¸¸, mucus°¡ µÎÅÓ°Ô ºÙ¾î ÀÖ°í biopsy forcepÀÌ Àß ¹Ì²ø¾îÁö±â¿¡ ½±Áö¸¸Àº ¾ÊÁö¿ä¡¦ µû¶ó¼­, »ó´ëÀûÀ¸·Î Á¶Á÷°Ë»ç°¡ ¼ö¿ùÇÑ margin¿¡¼­µµ ÃæºÐÇÑ ±íÀÌÀÇ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.

°áÇÙ°ú Å©·Ðº´ÀÇ °¨º°Àº ÀϺΠÀü¹®°¡´Â ¾î·ÆÁö ¾Ê´Ù°í ÇÏÁö¸¸, ½±Áö ¾ÊÀº °æ¿ì°¡ Á¾Á¾ ÀÖ½À´Ï´Ù. Å©·Ðº´À» Àå°áÇÙÀ¸·Î »ý°¢Çؼ­ Ä¡·á°¡ delayed µÇ°í ȯÀÚ compliance°¡ ¶³¾îÁö±âµµ ÇÏ°í (ÀϺδ °áÇÙ¾à ºÎÀÛ¿ë¿¡ °íÅë¹Þ±âµµ ÇÏ°í¡¦), Àå°áÇÙÀ» Å©·Ðº´À¸·Î »ý°¢ÇØ ¼º±ÞÇÏ°Ô »ó¿ëÇÑ ¸é¿ª¾ïÁ¦Á¦·Î °áÇÙÀÇ ¾ÇÈ­°¡ °ÆÁ¤µÇ±âµµ Çؼ­ ÀÓ»ó¿¡¼­´Â °í¹ÎµÇ´Â °æ¿ì°¡ Á¾Á¾ ÀÖ´Â °Í °°½À´Ï´Ù. Á¦°æ¿ì¿¡´Â¡¦ Á¶Á÷À» ÀÌ¿ëÇÑ AFB smear, PCR, culture ¸ðµÎ Áø´ÜÀûÀÌÁö ¸øÇÑ °æ¿ì¿¡´Â ³»½Ã°æ ¼Ò°ß, chest X ray, ÀÓ»ó ¼Ò°ßÀ» ÀÌ¿ëÇÏ¿© ÀáÁ¤ Áø´ÜÀ» ³»·Á¾ß ÇÏ°ÚÁö¸¸, ÀÌ·Ã °æ¿ì IGRA (º¸ÇèÀº ¾ÈµË´Ï´Ù¸¸)³ª small bowel imaging (small bowel series, CT enterography µî)°¡ µµ¿òÀ» ÁÖ´Â °æ¿ì°¡ Àֱ⿡ Àú´Â °Ë»ç¸¦ ÇÏ°í ÀÖ½À´Ï´Ù. ¶ÇÇÑ, Á¤¸» ÆÇ´ÜÀÌ ¾î·Á¿î °æ¿ì ȯÀÚ°¡ Áõ»óÀÌ ¾ø°Å³ª °æ¹ÌÇÑ °æ¿ì¿¡´Â ÀüÅëÀûÀÎ Á¢±ÙÀ¸·Î °áÇÙ¾àÀ» ÀÌ¿ëÇÑ therapeutic trialÀ» ¼±È£ÇÕ´Ï´Ù.


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Àå°áÇÙ¿¡ ´ëÇÑ ¾Öµ¶ÀÚ ÀÇ°ß°ú Àü¹®°¡ ´äº¯ Áß "°áÇÙ±ÕÀº ´ëÇ¥ÀûÀΠȣ±â¼º ¼¼±ÕÀε¥ »ê¼ÒºÐ¾ÐÀÌ ³·°í Çø±â¼º ¼¼±ÕÀÌ µæ¼¼ÇÏ°í ÀÖ´Â ¸»´ÜºÎȸÀå/´ëÀåÀº °áÇÙ±ÕÀÌ »ì±â¿¡ ÀûÇÕÇÏÁö ¾ÊÀº ȯ°æÀÎ ¹Ù" ºÎºÐÀº ¸»´ÜºÎȸÀå ÁÖº¯ÀÌ IC valve ¿¡ ÀÇÇØ ´ëº¯ÀÌ ¸Ó¹°¸é¼­ °¡Àå °áÇÙ±Õ¿¡ ¿À·¡ ³ëÃâµÇ°í µû¶ó¼­ °¡Àå Àå°áÇÙ º´º¯ÀÌ ºó¹ßÇÏ´Â ºÎºÐÀε¥ ÀÚÄ© ÇØ´ç ºÎÀ§¿¡ Àå°áÇÙÀÌ µå¹°´Ù´Â ¶æÀ¸·Î ¿ÀÇØÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. Áö³­ ¾Öµ¶ÀÚ Áú¹® Áß¿¡ Àå°áÇÙÀÌ ¿Ö ¸»´ÜȸÀå ÁÖº¯¿¡ È£¹ßÇϳĴ Áú¹®µµ ÀÖ¾ú±â¿¡ ÇÑ ¹ø ¤¾îÁÖ½Ã¸é ´õ ÁÁÀ» °Í °°½À´Ï´Ù.


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º¸³»ÁֽŠ³»¿ë(Àå°áÇÙ¿¡ ´ëÇÑ ¾Öµ¶ÀÚ ÀÇ°ß°ú Àü¹®°¡ ´äº¯)À» Àаí Á¦ °æ¿ì¿¡ ÀÇ¿Ü·Î tuberculin test°¡ Å« µµ¿òÀÌ µÇ¾ú±â¿¡ ¸»¾¸µå¸³´Ï´Ù. ¾î·ÈÀ» ¶§ °áÇÙ¿¹¹æÁֻ縦 ¸Â¾Ò´Ù°í ÇÏ´õ¶óµµ, ´ëºÎºÐÀÇ ¼ºÀÎÀº tuberculin test °Ë»ç½Ã °­ÇÑ ¾ç¼º ¹ÝÀÀÀ» º¸ÀÌÁö ¾Ê´Â´Ù´Â »ç½ÇÀ» Áö³­ 10³â°£ÀÇ °æÇèÀ» ÅëÇØ Å͵æÇ߱⿡ ¸»¾¸µå¸³´Ï´Ù.

Àú´Â ´ëÀå³»½Ã°æ ¼Ò°ß°ú Á¶Á÷°Ë»ç °á°ú°¡ ÀÇ½ÉµÉ °æ¿ì, ¿Ü·¡¿¡¼­ tuberculin test¸¦ ½ÃÇàÇؼ­ °­ÇÑ ¾ç¼ºÀ» º¸À̸é HREZ regimenÀ» ½ÃÀÛÇÕ´Ï´Ù. ¹Ý´ë·Î tuberculin test°¡ À½¼ºÀ̸é mesalazine 1g tid po¸¸ ó¹æÇÕ´Ï´Ù. Á¦°¡ ¿îÀÌ ÁÁÀº °ÇÁö ¸ô¶óµµ Áö±Ý±îÁö À§ ¹æ¹ýÀ¸·Î ¾à¹°Åõ¿©¸¦ Çϸç ÃßÀû´ëÀå³»½Ã°æ °Ë»ç¸¦ ÇÑ °á°ú, tuberculin test ÈÄ¿¡ ³»¸° Áø´Ü¸íÀº ¸ðµÎ ÀûÁßÇÏ¿´½À´Ï´Ù. ±×·¡¼­ Á¦ ¿Ü·¡¿¡´Â ¿ÏÄ¡µÈ Tbc colitis ȯÀÚµé°ú Àå±â°£ ÃßÀû ÁßÀÎ Crohn's disease ȯÀÚµé ¼ö°¡ ¸Å³â ´©ÀûµÇ°í ÀÖ½À´Ï´Ù. À§ ¿Ü°ú ±³¼ö´Ô²²µµ tuberculin test¸¦ Àû±Ø È°¿ëÇÏ½Ç °ÍÀ» ÃßõÇص帮°í ½Í½À´Ï´Ù.


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Tuberculin test´Â ÁÁÀº ¾ÆÀ̵ð¾îÀÔ´Ï´Ù. ÀÌ À̽´¿¡ ´ëÇÑ ÁÁÀº ±¹³»ÀڷḦ º¸Áö ¸øÇÑ °Í °°°í 2009³â °¡À̵å¶óÀο¡´Â ¾ÆÁ÷ ¾Æ·¡¿Í °°ÀÌ ¾ð±ÞµÇ°í ÀÖÀ» »ÓÀÌÁö¸¸, ¿¬±¸ÇØ º¼ °¡Ä¡°¡ ÀÖ´Â ÁÁÀº À̽´¶ó°í »ý°¢ÇÕ´Ï´Ù. Àå°áÇÙ°ú ´Ù¸¥ ¿°Áõ¼º ÀåÁúȯÀ» °¨º°Áø´ÜÇÏ´Â µ¥ ÀÖ¾î TSTÀÇ À¯¿ë¼º¿¡ ´ëÇÑ ÁÁÀº ¿¬±¸ °á°ú´Â ÇöÀç ¾ø´Â ½ÇÁ¤ÀÌ´Ù. ƯÈ÷ °áÇÙ °¨¿°·üÀÌ ³ôÀº Áö¿ª¿¡¼­´Â BCG¿ÍÀÇ ±³Â÷ ¹ÝÀÀ°ú °áÇÙ±ÕÀÇ Àẹ °¨¿°À¸·Î TST°¡ ¾ç¼ºÀ¸·Î ³ª¿Ã °¡´É¼ºÀÌ ÀÖ¾î TST ¾ç¼º °á°ú¸¦ Æǵ¶ÇÏ´Â µ¥ ¾î·Á¿òÀÌ ÀÖ´Ù


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º´¿ø ½Ä´ç¿¡ ¿µ»óÀÇÇаúÁ¦ÄûÁî¸ôÀÌ ÀÖ½À´Ï´Ù. »ó´çÈ÷ ¾î·Á¿î ¹®Á¦°¡ ¸¹Àºµ¥¿ä... À̹ø ¹®Á¦´Â ƯÈ÷ ¾î·Á¿ü´ø ¸ð¾çÀÔ´Ï´Ù. Adrenal tuberculosis.


[References]

1) Àå°áÇÙ Áø´Ü °¡À̵å¶óÀÎ ´ëÇѼÒÈ­±âÇÐȸÁö 2009. PDF 0.7M

2) Differentiation of tuberculous peritonitis from peritonitis carcinomatosa without surgical intervention - Turkey ÀÇ»çµéÀÌ Saudi ArabiaÀÇ Àú³Î¿¡ ½ÇÀº ³»¿ëÀε¥ ¸Å¿ì clearÇÑ °á·ÐÀÔ´Ï´Ù. ÃÊ·Ï ÀϺθ¦ ¿Å±é´Ï´Ù.

In univariate analysis; fever, night sweats, and abdominal pain were significantly more frequent in the TBP group compared to those in the Ov Ca group (P < 0.001, P < 0.001, and P = 0.035, respectively) and the Ga Ca group (P < 0.001, P < 0.001, and P = 0.015, respectively). Serum CA 19-9 and carcino embryonic antigen (CEA) levels were significantly lower in the TBP and Ov Ca group compared to the Ga Ca group (P < 0.001 and P < 0.001, respectively). Elevated serum CA 125 level was found in all patients with TBP and Ov Ca and in 86.6% of patients with Ga Ca. In the multivariate analysis, presence of fever (P < 0.001), night sweats (P < 0.001), age under 40 years (P = 0.008), and normal serum CA 19-9 level (P = 0.044) were independent predictor of diagnosis of tuberculous peritonitis.

5) Etiologic and laboratory analyses of ascites in patients who underwent diagnostic paracentesis

6) Clinical significance of serum CA 125 in patients with chronic liver diseases

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.