간담도계질환시 혈청 및 담즙내의 면역글로부린에 대한 연구

Abstract

[한글]

면역현상은 전신면역과 국소면역기전으로 대별되며 근래 국소면역기전에 대한 여러가지 시도라 관심이 증가되고 있다(Tomasi등 1980, Gilliland 1982). 국소면역기전에는 여러가지 인체분비액내의 면역글로부린과 보체가 관계되며 분비액의 종류에 따라 면역글로부

린들의 농도도 다르다(Delacroix와 Vaerman 1983). 본 연구에서 조기위암 및 대장암 환자를 대조군으로 하고 담낭염군, 폐쇄성황달 환자중 담도염 동반군과 비동반군을 실험군으로 하여, 개복수술시 혈청, 담낭액, 담도액과 폐쇄성 황달환자에서, 혈청과 동시에 T-tub

e를 통하여 담도액을 수술후 3일, 6일에 채취하고 immunodiffusion plate를 이용하여 IgG, IgA, IgM, C^^3 c, C^^4 를 측정한 후, 통계적으로 분석하여 이들을 상호비교하고 문헌고찰하였다.

담낭액은 검사치가 각 군간에서 통계학적 의미가 없었으며, 혈청과 담도액은 통계학적으로 의미있는 차이가 있었다. 면역글로부린중 IgA와 보체중 C^^3 c의 농도차이가 통계학적 의의가 있었다. 폐쇄성황달과 염증정도에 따라 혈청내 IgA, IgG, IgM은 증가되고 담즙

내에서는 감소되는경향을 보였고, 보체의 변화는 뚜렷하지 않았다. 황달과 염증이 수술후 완화됨에 따라서 혈청내에서 IgA는 의의있게 감소하고 담도액내에서는 증가함을 보였으며, 이는 황달과 염증완화와 직접관계가 있는 것으로 생각된다. C^^3 c, C^^4 는 혈청내에서 의의있게 증가되고 특히 C^^3 c는 담도액에서도 의의있계 증가되었다. 본 연구에서는 수술후 정상회복된 환자에서의 결과이고 사망에 까지 이른 환자는 아니었으므로, 추후 이런 환자에서도 측정하여 상호 비교 관찰한다면, 임상적으로 더욱 가치있는 연구가 될 것이며, 폐쇄성화농성 담낭염의 예후를 안정하는데 좋은 검사방법이 될 수 있을 것으로 생각된다.

A Study on the Immunoglobulin in Serum and Bile in Cases of Biliary System Diseases

Eui Suk Koh

Department of Medical Science The Graduate School, Yonsei University

(Directed by Prof. Choon Kyu Kim, M.D.)

It is well known facts that systemic and local immune reatcions take place in

case of infection. (Tomasi et at, 1987; Gilliland, 1982). There are several

immunoglobulin and comptement secretions with varying degree of its concentrations

according to pathologic conditions (Delacroix and Vaerman, 1983). Immune reactions

are multiple.

This experiment was undertaken to determine immunoglobulin and complement

concentration in various biliary disease conditions.

Materials and methods ;

As a relative control early stages of cancer(stomach 5 cases and colon 2 cases)

were chosen. Experimental groups are divided into group Ⅰ, Ⅱ, and Ⅲ. Group Ⅰ

was made up only gall-bladder disease (13 cases) and group Ⅱ had obstructive

jaundice with cholangitis (17 cases) and group Ⅲ had obstructive jaundice without

cholangitis(16 cases). Sample collections were made from blood, gall-bladder and

common bile duct at the time of exploration. In group Ⅱ and Ⅲ, T-tube was placed

in the common bile duct and T-tube bile was collected at postoperative 3rd and 6th

day along with blood sample. Immunoglobulin G, A and M, complement C^^3 c and C^^4

amounts were measured by immunodiffusion method and ccmpared between three groups.

Result:

1. IgA and C^^3 c concentration difference had statistical significance between

groups.

IgA concetration was increased in serum, but decreased in bile in cases of

biliary disease Complement activation seems to be more active in the alternative

pathway rather than classical pathway.

2. The determination of immunoglobulin and complement concentration in bile and

serum had significance to measure humoral defense ability for an icteric patient

with inflammation.

3. It was noted that there was reciprocal trend in the quantitative change

between serum and bile IgA in the recovery phase of jaundiced patient with

inflammation that was to say. IgA concentration was decreased in serum and

increased in the bile with statistical significance.

4. C^^3 c and C^^4 concentration increased significantly in serum, particularly

C^^3 c concentration was increased in biliary tract bile in recovery phase.

5. It can be concluded that the changes of immunoglobulin and complement

concentration measurement in serum and bile might be a good prognostic indicatior

in cases of obstructive jaundice with inflammation.

[영문]

It is well known facts that systemic and local immune reatcions take place in case of infection. (Tomasi et at, 1987; Gilliland, 1982). There are several immunoglobulin and comptement secretions with varying degree of its concentrations according to pathologic conditions (Delacroix and Vaerman, 1983). Immune reactions are multiple.

This experiment was undertaken to determine immunoglobulin and complement concentration in various biliary disease conditions.

Materials and methods ;

As a relative control early stages of cancer(stomach 5 cases and colon 2 cases) were chosen. Experimental groups are divided into group Ⅰ, Ⅱ, and Ⅲ. Group Ⅰ was made up only gall-bladder disease (13 cases) and group Ⅱ had obstructive jaundice with cholangitis (17 cases) and group Ⅲ had obstructive jaundice without cholangitis(16 cases). Sample collections were made from blood, gall-bladder and common bile duct at the time of exploration. In group Ⅱ and Ⅲ, T-tube was placed in the common bile duct and T-tube bile was collected at postoperative 3rd and 6th day along with blood sample. Immunoglobulin G, A and M, complement C^^3 c and C^^4 amounts were measured by immunodiffusion method and ccmpared between three groups.

Result:

1. IgA and C^^3 c concentration difference had statistical significance between groups.

IgA concetration was increased in serum, but decreased in bile in cases of biliary disease Complement activation seems to be more active in the alternative pathway rather than classical pathway.

2. The determination of immunoglobulin and complement concentration in bile and serum had significance to measure humoral defense ability for an icteric patient with inflammation.

3. It was noted that there was reciprocal trend in the quantitative change between serum and bile IgA in the recovery phase of jaundiced patient with inflammation that was to say. IgA concentration was decreased in serum and increased in the bile with statistical significance.

4. C^^3 c and C^^4 concentration increased significantly in serum, particularly C^^3 c concentration was increased in biliary tract bile in recovery phase.

5. It can be concluded that the changes of immunoglobulin and complement concentration measurement in serum and bile might be a good prognostic indicatior in cases of obstructive jaundice with inflammation.