학동전기 소아 천식의 천명 유형에 따른 아토피 및 폐기능 특성
Characteristics of Atopy and Pulmonary Functions According to the Wheezing Phenotype in Preschool Children
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목 적 : 학동전기 아이들에서 보이는 천명은 다양한 형태를 보이며 모두 천식으로 진행하지 않는다. 그러나, 우리나라에서는 재발성 천명을 보이는 이들을 대상으로 천명의 표현형과 천식과의 관련성에 관한 연구가 많지 않다. 방 법 : 1998년 1월부터 2007년 8월까지 서울아산병원 소아 천식아토피센터를 재발성 천명으로 방문한 3-6세 소아 272명을 대상으로 전향적 추적조사 하였다(Asan Asthma Allergy Cohort). 이들을 세 군으로 분류하여 조기 발현 지속성 천명에서 천식진행군(조기천명 천식군), 조기 발현 지속성 천명에서 천식으로 진행하지 않은 군(조기천명 완해군), 후기 발현 천명에서 천식진행군(후기천명 천식군)으로 나누어 7세때 폐기능 검사, 메타콜린 유발검사 그리고 알레르기 관련 혈액검사를 시행하였다. 결 과 : 조기천명 천식군에서 노력성 호기 중간 유량(FEF25-75%)이 후기천명 천식군에 비해 현저하게 감소되어 있었으나 조기천명 완해군에 비해서는 낮은 경향만 보였다. 기도과민성은 조기천명 천식군과 후기천명 천식군 모두 조기천명 완해군과 비교하여 의미있게 증가되었다. 혈청 내 D.p와 D.f-특이 IgE 농도와 항원특이 IgE 항체 농도합은 후기천명 천식군이 조기천명 천식군과 조기천명 완해군에 비해 의미있게 높았다. 결 론 : 영유아 천식 중 조기천명 천식군과 후기천명 천식군은 아토피, 기도과민성과 유의한 상관관계를 보이는 것이 공통된 특징이지만 후기천명 천식군이 보다 더 아토피와 연관성이 높다. 또한 조기천명 천식군은 후기천명 천식군에 비해 유의한 폐기능의 감소를 보였다. 이는 우리나라 학동전기 아이들에서의 천식으로의 진행은 아토피와 관련되고 그 중 조기천명 천식군에서는 7세 이전에 이미 기도개형이 시작됨을 시사한다.
Abstract
Purpose : The wheezing phenotype in early childhood is heterogeneous and does not always develop asthma. However, the severity of the disease associated with these phenotypes has not been extensively studied in Korean children. Methods : Two hundred seventy-two children with recurrent wheezing aged 3-6 yrears who visited the Childhood Asthma and Atopy Center in Asan Medical Center from January 1998 to August 2007 were enrolled and followed up prospectively. The patients were divided into 3 groups: early-onset persistent wheezers (E/P) with asthma, E/P wheezers without asthma and late-onset wheezers with asthma. We investigated asthma-related biomarkers, pulmonary function and methacholine challenge at the age of 7. Results : FEF25-75% in the E/P wheezers with asthma was significantly lower than that in the late-onset wheezers with asthma. However, there was no significant difference in FEF25- 75% between the E/P wheezers with asthna and those without. The E/P wheezers with asthma and the late-onset wheezers with asthma demonstrated enhanced Bronchial Hyperrsponsiveness (BHR) compared with E/P wheezers without asthma. Dermatophagoides farinae (D.f) or Dermatophagoides pteronyssinus (D.p)-specific IgE and sum of specific IgE in the late-onset wheezers with asthma were significantly higher than in the E/P wheezers with or without asthma. Conclusion : The E/P wheezers with asthma and late-onset wheezers with asthma were associated with high levels of atopy and BHR, even though the late-onset wheezers with asthma were more related to atopy. The E/P wheezers with asthma showed decreased pulmonary function. These findings suggest that the development of asthma in Korean preschool children may be strongly associated with atopy and that E/P wheezers with asthma may show airway remodeling even before the age of 7.
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