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대한내과학회> Korean Journal of Medicine(구 대한내과학회지)> 취약계층 결핵 환자의 치료 성공 관련 요인

KCI후보

취약계층 결핵 환자의 치료 성공 관련 요인

Factors Related to Successful Tuberculosis Treatment in Vulnerable Groups

김영현 ( Younghyun Kim ) , 이지연 ( Ji Yeon Lee ) , 정인아 ( Ina Jeong ) , 김정현 ( Junghyun Kim ) , 김주혜 ( Joohae Kim ) , 한지연 ( Jiyeon Han ) , 정은진 ( Eunjin Jeong ) , 한아연 ( Ah Yeon Han ) , 조준성 ( Joon-sung Joh ) , 박정덕 ( Jung-duck Park )
  • : 대한내과학회
  • : Korean Journal of Medicine(구 대한내과학회지) 97권1호
  • : 연속간행물
  • : 2022년 02월
  • : 50-59(10pages)
Korean Journal of Medicine(구 대한내과학회지)

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목적: 우리나라 결핵의 발생률과 사망률은 감소하고 있는 추세이나 취약계층 결핵 환자 치료비 지원자 수는 2017년에 비해 2019년에 3.8배 증가하였다(결핵안심벨트 지원사업, 2019). 이 연구의 목적은 취약계층 결핵 환자의 치료 성공 여부에 영향을 미치는 요인을 규명해 보는 것이다.
방법: 취약계층 결핵 환자 지원사업인 결핵안심벨트 사업에서 치료비 지원을 받은 환자의 2014-2018년 자료를 분석하였다. 연구 분석 대상자는 137명이고 독립변수는 환자의 개인요인(연령, 성별, 국적, 결핵 종류, 내성결핵 여부, 동반 질환 수, 주거 형태)과 치료 형태요인(외래, 입원)이며 종속변수는 치료 성공 여부이다.
결과: 동반 질환 수는 없음보다 동반 질환 1개(OR 0.202), 2개(OR 0.147), 3개 이상(OR 0.070)일 때 모두 치료 성공 가능성이 낮아지고 통계적으로 유의한 것으로 나타났으며, 주거 형태는 동거(시설, 일터, 지인 집)를 기준으로 독거(OR 0.097)와 노숙(OR 0.053)이 치료 성공 가능성이 낮아지고 통계적으로 유의하게 나타났다. 국적은 외국인에 비해 내국인(OR 8.512)이 치료 성공 가능성이 높아지고 통계적으로 유의하게 나타났다.
결론: 동반 질환이 있는 취약계층 결핵 환자의 관리가 강조되어야 할 것으로 판단되고, 주거 형태가 불안정한 독거생활을 하는 결핵 환자나 노숙인 결핵 환자의 경우 결핵 환자시설로의 입소를 지원하기 위한 지역사회기반의 마련 및 외국인 거주자에 대한 대처방안이 취약계층 결핵 환자의 효율적인 관리를 위해 필요하다고 판단된다.
Background/Aims: Although the incidence and mortality of tuberculosis are decreasing in South Korea, the number of applications for financial assistance with the cost of tuberculosis treatment made by individuals from vulnerable groups was 3.8 times higher in 2019 compared to 2017 (Tuberculosis Relief Belt Project, 2019).
Methods: We analyzed the data of patients who received financial aid for tuberculosis treatment (in the period 2014-2018) from the Tuberculosis Relief Belt Project, which was designed to assist vulnerable groups. This study analyzed 137 subjects, and the independent variables included patient factors (age, gender, nationality, tuberculosis type, number of comorbidities, and place of residence) and treatment type (outpatient or inpatient). The dependent variable was the treatment outcome.
Results: The likelihood of treatment success was significantly lower for patients with one (odds ratio [OR] 0.202), two (OR 0.147), or three or more (OR 0.070) comorbidities compared to those with no comorbidities. This was also the case for patients living alone (OR 0.097), and for those classified as homeless (OR 0.053). Korean patients (OR 8.512) had a significantly higher probability of a successful treatment outcome than foreigners.
Conclusions: Appropriate community-based management of individuals with tuberculosis from vulnerable groups, including foreigners, people with comorbidities, people living alone, and people with an unstable residential situation or homeless status, is important. (Korean J Med 2022;97:50-59)

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  • : 의약학분야  > 내과학
  • : KCI후보
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  • : 격월
  • : 1738-9364
  • : 2289-0769
  • : 학술지
  • : 연속간행물
  • : 1949-2022
  • : 12170


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97권3호(2022년 06월) 수록논문
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KCI후보

1노인장기요양제도와 의료서비스: 의료계 역할을 중심으로

저자 : 장현재 ( Hyun Jae Jang )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 147-149 (3 pages)

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노인장기요양보험 제도는 2005년부터 3년 동안 시범사업을 거쳐, 지난 2008년 7월부터 본격적으로 시행되었다. 이 제도의 목적은 증가되는 노인 인구에 있어, 노인의 삶의 질 개선과 가족의 돌봄 부담 경감이다. 2021년, 노인장기요양보험 수급자는 86만 명, 급여비는 9조 8,248억 원으로 도입된 이후 그 규모가 2-4배로 증가하였다. 이러한 증가에 맞추어 효율적으로 제도가 안착되고, 수급자의 의료적 요구를 바로 연계할 수 있는 제도의 보완이 필요하다. 이를 통하여 급증하는 노인 진료비의 지출의 감소, 즉 사회적 비용의 감소의 효과도 볼 수 있다. 결론적으로, 노인 돌봄은 의료·보건·복지가 각 영역 내 혹은 영역 간에 유기적으로 연계할 수 있도록 제대로 체계를 마련되고 시행되어야 하겠다.


The long-term care insurance for the elderly system was officially implemented in July 2008, following a 3-year pilot program starting in 2005. The purpose of this system was to improve the quality of life of seniors and reduce the burden of care among family members, given the growing elderly population. By 2021, the scale of the system had increased by two to four times, with 860,000 beneficiaries and 9,824,800,000,000 KRW worth of insurance benefits. In line with this increase, it is necessary to efficiently establish and improve the system so that it can directly meet the medical needs of the beneficiaries. This may serve to reduce the rapidly increasing expenditure related to the elderly medical expenses, which in turn leads to a decrease in societal costs. In conclusion, senior care needs to be properly established and implemented in order to create organic intra- and inter-field connections between medicine, healthcare, and welfare. (Korean J Med 2022;97:147-149)

KCI후보

2수술 및 시술 시 항혈전제 사용에 대한 전문가 합의문: 1부. 종설편

저자 : 박용휘 ( Yongwhi Park ) , 허애영 ( Ae-young Her ) , 김현국 ( Hyun Kuk Kim ) , 문재연 ( Jae Youn Moon ) , 박재형 ( Jae Hyoung Park ) , 박근호 ( Keun-ho Park ) , 이경훈 ( Kyung Hoon Lee ) , 주형준 ( Hyung Joon Joo ) , 원호연 ( Ho Yeon Won ) , 안성균 ( Sung Gyun Ahn ) , 박홍준 ( Hong Jun Par

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 150-168 (19 pages)

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The prevalence of ischemic heart disease is steadily growing as populations age. Antithrombotic treatment is a key therapeutic modality for the prevention of secondary cerebro-cardiovascular disease. Patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention must be treated with dual antiplatelet therapy for a mandatory period. The optimal perioperative antithrombotic regimen remains debatable; antithrombotics can cause bleeding. Inadequate antithrombotic regimens are associated with perioperative ischemic events, but continuation of therapy may increase the risks of perioperative hemorrhagic complications (including mortality). Many guidelines on the perioperative management of antithrombotic agents have been established by academic societies. However, the existing guidelines do not cover all specialties, nor do they describe the thrombotic and hemorrhagic risks associated with various surgical interventions. Moreover, few practical recommendations on the modification of antithrombotic regimens in patients who require non-deferrable interventions/surgeries or procedures associated with a high risk of hemorrhage have appeared. Therefore, cardiologists, specialists performing invasive procedures, surgeons, dentists, and anesthesiologists have not come to a consensus on optimal perioperative antithrombotic regimens. The Korean Platelet-Thrombosis Research Group presented a positioning paper on perioperative antithrombotic management. We here discuss commonly encountered clinical scenarios and engage in evidence-based discussion to assist individualized, perioperative antithrombotic management in clinical practice. (Korean J Med 2022;97:150-163)

KCI후보

3진행성 악성 간문부 담관 폐쇄의 고식적 치료를 위한 담관내 고주파 소작술

저자 : 강화평 ( Huapyong Kang ) , 김의주 ( Eui Joo Kim ) , 김연석 ( Yeon Suk Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 164-170 (7 pages)

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Malignant hilar biliary obstruction (MHBO) frequently accompanies cholestasis and cholangitis, and requires biliary stent placement. To prevent stent occlusion and prolong survival, local ablation therapy can be considered adjunctive to stent placement. Intraductal radiofrequency ablation (ID-RFA) is a recently developed local therapy for malignant biliary obstruction that can be easily performed employing endoscopic retrograde cholangiography. The use of ID-RFA to treat MHBO (as distinct from distal biliary obstruction) was suggested to be associated with severe adverse events. However, recent comparative studies have shown that ID-RFA is feasible and safe, and acceptably efficacious, in patients with advanced MHBO; newer temperature-controlled ID-RFA devices may enhance safety further. Regularly repeated ID-RFA with stent exchange affords better survival than stenting alone. However, the optimal ID-RFA strategy for MHBO remains inconclusive given the lack of data. Further large-scale clinical trials are needed. (Korean J Med 2022;97:164-170)

KCI후보

4이차고혈압의 진단과 치료

저자 : 송수현 ( Su Hyun Song ) , 최홍상 ( Hong Sang Choi ) , 배은희 ( Eun Hui Bae )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 171-178 (8 pages)

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Secondary hypertension, which refers to arterial hypertension caused by an identifiable medical condition, accounts for 5-10% of all hypertensive diagnoses; however, this is thought to be an underestimate. If diagnosed promptly, secondary hypertension can be treated, and proper blood pressure restored. This review focuses on the screening, diagnosis, and management of the most common forms of secondary hypertension, including primary aldosteronism, renovascular hypertension, pheochromocytoma, Cushing's syndrome, and renal parenchymal disease. (Korean J Med 2022;97:171-178)

KCI후보

5호기산화질소 검사의 시행과 해석

저자 : 권재우 ( Jae-woo Kwon )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 179-185 (7 pages)

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Nitric oxide is produced by the human lungs and increases in response to type 2 inflammation. The level of fractional exhaled nitric oxide (FeNO) may reflect type 2 inflammation in the airways, which is related to eosinophilic inflammation and treatment responsiveness to corticosteroids. The FeNO test is a non-invasive, simple, and safe point-of-care test to evaluate airway inflammation. It has been standardized for clinical use and has been widely utilized in daily medical practice. However, various intrinsic and extrinsic factors can affect FeNO levels, and understanding and controlling such factors will improve the utility of this measure. The FeNO test can be used to confirm an asthma diagnosis, predict treatment responses to corticosteroids, and guide inhaled corticosteroid therapy for asthma treatment. (Korean J Med 2022;97:179-185)

KCI후보

6육아종성 세관사이질신염으로 확인된 크론병

저자 : 한정석 ( Jung Suk Han ) , 최범순 ( Bum Soon Choi ) , 박철휘 ( Cheol Whee Park ) , 최영진 ( Yeong Jin Choi ) , 양철우 ( Chul Woo Yang ) , 이한희 ( Han Hee Lee ) , 반태현 ( Tae Hyun Ban )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 186-190 (5 pages)

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크론병의 장관 외 발현 중 육아종성 세관사이질신염은 매우 드문 사례이다. 아직 정립된 치료는 없으나, 크론병 환자에서 신기능의 악화를 보인다면 크론병에 의한 세관사이질신염을 의심하여야 하며, 빠른 진단과 치료를 하여 환자의 신기능의 악화를 억제하여야 한다.


Crohn's disease is usually diagnosed according to intestinal symptoms, but extra-intestinal manifestations are important in approximately one-third of cases. Although several extra-intestinal symptoms associated with various organs have been reported, renal involvement is uncommon in patients with Crohn's disease. Tubulointerstitial nephritis in a patient with Crohn's disease is usually caused by infection, sarcoidosis, or medications. However, primary tubulointerstitial nephritis caused by Crohn's disease alone is extremely rare. A 19-year-old male patient was referred to our hospital because of an increase in serum creatinine level. He underwent a kidney biopsy with renal insufficiency. Renal histological findings revealed granulomatous tubulointerstitial nephritis. Thereafter, a colonoscopy was performed with suspicion of Crohn's disease. Ultimately, he was diagnosed with granulomatous tubulointerstitial nephritis based on Crohn's disease. The patient had improved gastrointestinal symptoms after the last treatment. This case report presents a rare case of primary tubulointerstitial nephritis caused by Crohn's disease. (Korean J Med 2022;97:186-190)

KCI후보

7소장 폐색이 합병된 말기 암환자에서 고식적 내시경 초음파하 소장 연결술

저자 : 오지홍 ( Ji Hong Oh ) , 홍승권 ( Seung Goun Hong )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 3호 발행 연도 : 2022 페이지 : pp. 191-197 (7 pages)

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Recurrent or refractory small bowel obstruction in postsurgical patients with advanced malignancies poses therapeutic dilemmas. Although some promising results have been achieved as small bowel endoscopic techniques advanced, palliative stent placement is both challenging and complex. Endoscopic ultrasound (EUS)-guided anastomosis using a lumen-apposing metal stent has been recently used during gastroenterostomy to treat benign or malignant gastric outlet obstruction. Data on the outcomes of EUS-guided enterostomy in patients with recurrent small bowel obstruction are lacking, although the technique is applicable throughout the entire gastrointestinal tract. We recently encountered recurrent or refractory small bowel obstruction in two poor surgical candidates. For the first case, we performed EUS-guided enterostomy to treat a recurrent obstruction after conventional stent insertion. The second case underwent EUS-guided transenteric stent placement to treat refractory small bowel obstruction associated with diffuse peritoneal carcinomatosis after failure of a conventional “push” endoscopic procedure. (Korean J Med 2022;97:191-197)

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1임의비급여진료는 요양급여대상진료이다

저자 : 임철희 ( Chulhui Lim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 1-4 (4 pages)

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KCI후보

22021 대한부정맥학회 심방세동 전극도자 및 수술적 절제술 지침

저자 : 임우현 ( Woo-hyun Lim ) , 심재민 ( Jaemin Shim ) , 이지현 ( Ji-hyun Lee ) , 정보영 ( Boyoung Joung )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 5-22 (18 pages)

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Rhythm control therapy is used in atrial fibrillation (AF) management to improve AF-related symptoms along with rate control. AF catheter ablation is effective in maintaining sinus rhythm and has an acceptable complication rate. Compared with antiarrhythmic drugs, AF catheter ablation is superior with respect to arrhythmia-free survival and improvement in the quality of life. Therefore, AF ablation is recommended for rhythm control after the failure of antiarrhythmic drugs and is sometimes considered a first-line therapy for AF patients. Radiofrequency and cryoballoon ablation show similar efficacy, with slightly different complication profiles. Surgery for AF is also an effective rhythm control therapy and should be considered in patients undergoing cardiac surgery or in those with failed catheter ablation. For patients undergoing AF catheter ablation, performing ablation under uninterrupted warfarin or non-vitamin K oral anticoagulant treatment is recommended for periprocedural stroke risk management. Here, we review existing data and discuss the general principles of AF catheter and surgical ablation in patients with AF. (Korean J Med 2022;97:5-22)

KCI후보

3COVID-19와 장기 후유증

저자 : 김윤정 ( Youn Jeong Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 23-27 (5 pages)

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After acute corona virus disease 2019 (COVID-19), there have been increasing reports of persistent and long-term symptoms similar to the post- viral syndromes described in survivors of severe acute respiratory syndrome (SARS) or middle east respiratory syndrome (MERS). Here, we provide a comprehensive review of the current literature on long-term COVID-19 focusing on organ- specific sequelae. Many of the recovered COVID-19 patients may be affected by long-term health. The future for COVID-19 survivors remains uncertain, and well conducted long term research will be needed. (Korean J Med 2022;97:23-27)

KCI후보

4현대의료에서의 입원의학의 가치

저자 : 신동호 ( Dong-ho Shin )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 28-32 (5 pages)

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In healthcare, value is defined as the measured improvement in a person's health outcomes for the cost of achieving that improvement. In the era of value in healthcare, hospital medicine successfully embraced strategies to improve hospital safety and to reduce medical error, length of stay and medical cost. As a specialist in general care and hospital system, hospitalists should learn topics of hospital medicine including safety, quality improvement, co-management, professionalism and leadership. (Korean J Med 2022;97:28-32)

KCI후보

5자가면역간염의 진단적 접근

저자 : 임기영 ( Kiyoung Lim ) , 박정길 ( Jung Gil Park )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 33-41 (9 pages)

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Autoimmune hepatitis (AIH) is a chronic liver disease caused by unknown etiology, characterized by elevated liver enzyme, hypergammaglobulinemia, circulating autoantibodies, and histological interface hepatitis. As untreated AIH often leads to decompensated cirrhosis and even death, prompt and timely diagnosis is essential. However, about 1/3 of patients with AIH have cirrhosis at diagnosis. On the other hand, new onset acute or acute exacerbation of previous undiagnosed AIH can be presented as acute hepatitis. Thus, any patients with acute or chronic liver disease with hypergammagloblinemia without other cause should be considered to evaluate circulating non-organ specific autoantibodies for diagnosis of AIH. In case of suspected AIH, liver biopsy should be considered to evaluate its histological characteristics including interface hepatitis, plasma cell infiltration, emperipolesis, and rosettes. When the diagnosis is made, prompt treatment with prednisolone followed by combined azathioprine should be considered to improve its prognosis. (Korean J Med 2022;97:33-41)

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6저선량 흉부 단층촬영을 이용한 폐암검진

저자 : 김연욱 ( Yeon Wook Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 42-49 (8 pages)

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Early detection and treatment is important to reduce mortality from lung cancer. Based on the positive results of lung cancer-related mortality reduction from large randomized trials of low-dose chest computed tomography (LDCT)-based screening in high-risk populations, LDCT-based screening programs have been implemented in several countries including Republic of Korea. This review focus on the current evidence and state of the art of LDCT-based lung cancer screening, and further discuss the ongoing efforts to develop more efficient screening programs worldwide. This article includes recent updates on the identification of high-risk population eligible for screening and management for screen-detected nodules. Additionally, aspects on future research direction would be addressed. (Korean J Med 2022;97:42-49)

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7취약계층 결핵 환자의 치료 성공 관련 요인

저자 : 김영현 ( Younghyun Kim ) , 이지연 ( Ji Yeon Lee ) , 정인아 ( Ina Jeong ) , 김정현 ( Junghyun Kim ) , 김주혜 ( Joohae Kim ) , 한지연 ( Jiyeon Han ) , 정은진 ( Eunjin Jeong ) , 한아연 ( Ah Yeon Han ) , 조준성 ( Joon-sung Joh ) , 박정덕 ( Jung-duck Park )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 50-59 (10 pages)

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목적: 우리나라 결핵의 발생률과 사망률은 감소하고 있는 추세이나 취약계층 결핵 환자 치료비 지원자 수는 2017년에 비해 2019년에 3.8배 증가하였다(결핵안심벨트 지원사업, 2019). 이 연구의 목적은 취약계층 결핵 환자의 치료 성공 여부에 영향을 미치는 요인을 규명해 보는 것이다.
방법: 취약계층 결핵 환자 지원사업인 결핵안심벨트 사업에서 치료비 지원을 받은 환자의 2014-2018년 자료를 분석하였다. 연구 분석 대상자는 137명이고 독립변수는 환자의 개인요인(연령, 성별, 국적, 결핵 종류, 내성결핵 여부, 동반 질환 수, 주거 형태)과 치료 형태요인(외래, 입원)이며 종속변수는 치료 성공 여부이다.
결과: 동반 질환 수는 없음보다 동반 질환 1개(OR 0.202), 2개(OR 0.147), 3개 이상(OR 0.070)일 때 모두 치료 성공 가능성이 낮아지고 통계적으로 유의한 것으로 나타났으며, 주거 형태는 동거(시설, 일터, 지인 집)를 기준으로 독거(OR 0.097)와 노숙(OR 0.053)이 치료 성공 가능성이 낮아지고 통계적으로 유의하게 나타났다. 국적은 외국인에 비해 내국인(OR 8.512)이 치료 성공 가능성이 높아지고 통계적으로 유의하게 나타났다.
결론: 동반 질환이 있는 취약계층 결핵 환자의 관리가 강조되어야 할 것으로 판단되고, 주거 형태가 불안정한 독거생활을 하는 결핵 환자나 노숙인 결핵 환자의 경우 결핵 환자시설로의 입소를 지원하기 위한 지역사회기반의 마련 및 외국인 거주자에 대한 대처방안이 취약계층 결핵 환자의 효율적인 관리를 위해 필요하다고 판단된다.

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8CD19 양성 혼합표현형급성백혈병의 블리나투모맙 치료 1예

저자 : 박영훈 ( Young Hoon Park ) , 박동진 ( Dong Jin Park )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 97권 1호 발행 연도 : 2022 페이지 : pp. 60-63 (4 pages)

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Mixed phenotype acute leukemia (MPAL) encompasses a rare group of acute leukemia with blasts expressing markers specific to several lineages, which accounts for 2-5% of all newly diagnosed cases of acute leukemia. At present, patients with MPAL are treated with acute lymphoblastic leukemia (ALL)-directed chemotherapy. However, the prognosis of MPAL, especially in cases of relapsed/refractory (R/R) disease, remains poor. Blinatumomab, a bispecific T cell-engaging antibody, has shown encouraging outcomes in R/R B cell ALL positive for CD19. Here, we report a patient with CD19+ MPAL who achieved complete remission after treatment with blinatumomab, which may be a therapeutic option for patients with relapsed CD19+ MPAL. To our knowledge, this is the first case report of MPAL treated with blinatumomab in Korea. (Korean J Med 2022;97:60-63)

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