급성 Respiratory syncytial virus 세기관지염 환아의 비인두흡인액에서 혈관내피세포 성장인자의 증가
Increased Vascular Endothelial Growth Factors in Nasopharyngeal Aspirates from Children with Acute RSV Bronchiolitis
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목 적:급성 respiratory syncytial virus (RSV) 세기관지염으로 입원한 2세 이하 환아에서 천명의 지속 기간과 혈청 또는 비인두흡인액 VEGF 농도와의 관계를 알아보고자 하였다. 방 법:2008년 11월부터 2009년 4월까지 고려대학교 안암병원 소아청소년과에 급성 바이러스성 세기관지염으로 입원한 2세 이하 환아 94명을 대상으로 혈액의 알레르기 염증 지표를 검사하고 의무기록지를 토대로 발열, 천명, 입원 기간 등의 임상 소견을 분석하고, 비인두흡인액과 혈청 VEGF 농도를 측정하였다. 결 과:대상 환아 94명 중 비인두흡인액 바이러스 배양에서 RSV가 검출된 RSV 양성군 51명과 RSV 음성군 43명에서 입원 기간은 각각 6.9±2.1일과 5.5±1.8일로 차이가 없었으나, 천명의 지속기간은 RSV 양성군이 3.8±2.7일로 RSV 음성군의 2.4±1.8일에 비해 유의하게 길었다. 혈청 VEGF 농도의 평균값은 RSV 양성군이 240.3±113.2 pg/mL로 RSV 음성군의 194.4±119.3 pg/mL 보다 약간 높았으나 통계적인 유의성은 없었고 (P=0.134), 비인두흡인액 VEGF 농도는 RSV 양성군이 331.8±197.8 pg/mL로 RSV 음성군의 204.5±97.0 pg/mL 보다 유의하게 높았다(P=0.002). 결 론:RSV 양성 세기관지염 환아군에서 RSV 음성 환아군에 비해 비인두흡인액 VEGF 농도가 높았고, 천명의 지속 기간도 길게 나타났다. 이는 RSV 세기관지염에서 증가된 VEGF가 기관지벽의 투과도 증가와 부종을 유발하고 기류제한을 초래하여 천명이 오래 지속되는 것에 일부 관계 있을 것으로 생각해 볼 수 있다.
Abstract
Purpose:Viral infection is known as one of the dominant risk factors for wheezing in children hospitalized before 2 years of age. Although the major viral pathogen associated with wheezing is respiratory syncytial virus (RSV), the mechanisms of wheezing remain unclear. Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis and vascular permeability. The aim of this study was to evaluate the relationship between VEGF concentration and wheezing in children with acute RSV bronchiolitis. Methods:Ninety-four children with acute bronchiolitis who were admitted to Korea University Anam Hospital were enrolled in this study. Based on the proven viral agents, children with bronchiolitis were divided into 2 groups: those who were infected with RSV (RSV (+) group, n=51) and those who were not (RSV (–) group, n=43). A complete history taking, physical examination and routine laboratory tests were performed on all children. VEGF levels in serum and nasopharyngeal aspirates (NPA) were determined by ELISA. Results:NPA VEGF levels were significantly higher in the RSV (+) group than in the RSV (-) group (331.8±197.8 vs. 204.5±97.0 pg/mL, P=0.002). The duration of wheezing is significantly longer in the RSV (+) group than in the RSV (-) group (3.8±2.7 days vs. 2.4±1.8 days, P=0.037). Conclusion:The results of this study suggest that children with RSV bronchiolitis may have significantly higher NPA VEGF levels than those without, which may be associated with a longer duration of wheezing in those with RSV bronchiolitis.
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