Respiratory Syncytial Virus에 의한 급성 세기관지염에서 비분비물 내 Interleukin-33 측정치의 증가
Increased Nasal Interleukin-33 in the Infants with Acute Respiratory Syncytial Virus Bronchiolitis
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목 적:Interleukin (IL)-33은 IL-1 계열에 속하는 사이토카인으로 호흡기 점막의 선천 면역에 기여하며 Th2 면역 반응을 유도하는 것으로 알려져 있다. 본 연구에서는 RSV 감염에 의한 급성 세기관지염으로 입원하였던 소아들에서 IL-33이 기도 염증 반응의 기전에 관여하는지 알아보고자 하였다. 방 법:출생 이후 처음으로 respiratory syncytial virus (RSV) 감염에 의한 급성 세기관지염으로 입원 치료하였던 38명의 24개월 미만 연령의 소아들을 대상으로 하였다. 아토피는 최소한 1개 이상의 혈청 내 알레르겐 특이 immunoglobulin E 항체를 가지고 있거나 알레르겐에 대한 피부 반응 검사에서 1 개 이상의 양성 반응을 보였던 경우로 정의하였고 입원 중 산소 포화도가 92% 이하인 상태가 있었거나, 빈호흡이 있었거나, 천명의 지속 기간이 1주일 이상이었던 경우들 중 2가지 이상의 소견을 나타내었던 경우를 심한 호흡기 증상을 나타내었던 경우로 정의하였다. IL-33과 IL-33 수용체(sST2)는 입원 당시 채취한 비분비물에서 enzyme-linked immunosorbent assay 방법으로 측정하여 대조군과 비교하였으며 또한 소아들의 아토피 상태 및 증상의 심한 정도에 따른 차이가 있는지 조사하였다. 결 과:비분비물의 IL-33 측정치는 RSV 세기관지염 환자군에서 대조군에 비해 유의하게 증가되어 있었으나(P˂0.05), IL-33 수용체는 두 군간에 차이를 보이지 않았다. IL-33과 IL-33 수용체는 모두 소아들의 아토피나 증상의 심한 정도와는 관련성을 보이지 않았다. 결 론:본 연구의 결과는 RSV 감염에 의한 호흡기 염증 반응의 기전에 IL-33이 중요하게 관여할 가능성을 시사하는 것으로 생각된다.
Abstract
Purpose:Interleukin (IL)-33, a member of the IL-1 cytokine family, is considered to be important for innate-type mucosal immunity of the lung and also has been suggested to induce Th2-type immune responses. We aimed to investigate if IL-33 is involved in airway inflammation due to respiratory syncytial virus (RSV) infection in young children. Methods:Thirty-eight infants (≤24 months of age) admitted with their first episode of RSV bronchiolitis were enrolled in the study. Atopy was defined by having at least 1 allergen-specific immunoglobulin E (IgE), positive result to skin prick test, or high serum IgE levels. The patients were assessed to have severe symptoms when they had ≥2 of the following clinical findings: hypoxemia (˂92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and ˃7 days of hospital stay. The levels of IL-33 and the IL-33 receptor (sST2) were measured using enzyme-linked immunosorbent assay in nasal secretion samples collected from the patients on admission and compared with 20 age-matched controls. We also investigated the levels of IL-33 and sST2 in relation to the atopic status and symptom severity of the patients. Results:Nasal IL-33 levels in the patients with acute RSV bronchiolitis were significantly increased (P˂0.05), but sST2 showed no difference compared to the controls. Neither IL-33 nor sST2 showed significant difference in relation to the atopic status or severity of symptoms. Conclusion:Our study showed significantly increased IL-33 in the nasal secretions of the young infants admitted with acute RSV bronchiolitis and suggests that IL-33 is involved in the pathogenesis of RSV-induced airway inflammation.
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