마이코플라스마 폐렴에서 혈청 항체가와 임상 양상과의 관련성
Serum Antibody Responses Associated with Clinical Features of Mycoplasma pneumoniae Pneumonia
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목 적 : 본 연구에서 저자들은 마이코플라스마에 의한 급성 폐렴으로 입원하였던 소아들을 대상으로 혈청 IgM 항체 반응의 정도 및 입원 당시의 호흡기 증상의 심한 정도가 마이코플라스마 재감염 여부, 천식의 동반 여부, 입원 당시의 임상 양상과 어떠한 관련성을 보이는지 조사해 보고자 하였다. 방 법 : 2007년 5 월부터 2008년 5월까지 폐렴으로 입원한 환아에서 마이코플라스마 특이 IgM과 IgG를 측정하였으며 특이 IgM 양성인 85명의 환아를 대상으로 하였다. 재감염은 병력상 입원 최소 12개월 이전에 마이코플라스마 폐렴을 앓은 적이 있고 특이 IgG가 양성인 경우로 정의하였으며, 초감염은 이전에 폐렴을 앓은 적이 없으면서 IgG가 음성인 경우로 정의하였다. 입원 당시의 IgM 항체가 및 임상 증상의 심한 정도가 초감염군과 재감염군 간에 차이를 보이는지, 환자들의 천식 동반 여부 및 입원 기간 중 천명유무 등과 관련성이 있는지를 조사하였다. 결 과 : 재감염군에서 의미있게 높은 특이 IgM 항체가가 관찰되었다.(P<0.01) 천식군에서 비천식군에 비하여 IgM 항체가가 높았으나, 통계학적으로 유의하지는 않았다.(P=0.08) 천식군과(P< 0.05) 천명군에서(P<0.01) 호흡기 증상이 의미있게 오래 지속되는 것을 관찰하였다. 천식 환아가 마이코플라스마 폐렴에 재감염된 경우에서 높은 IgM 항체가가 관찰되었다. 결 론 : 본 연구의 결과로 재발성 마이코플라스마 폐렴이 소아에서 흔하게 발생한다는 것을 알 수 있었고 초감염에 비해 의미 있게 높은 IgM 항체 반응을 관찰할 수 있었으며 이는 특히 천식을 가진 소아들에서 더 뚜렷하였다. 반복적인 마이코플라스마 감염과 관련된 이러한 항체 면역 반응의 증가가 실제로 어떤 임상적 의미를 가지는지에 대해서는 앞으로 더 연구해야 할 과제로 생각된다.
Abstract
Purpose : Serum specific IgM and IgG responses have been used to diagnose Mycoplasma pneumoniae (M. pneumoniae) infection. The aim of this study was to investigate the relationship between antibody responses and the clinical features of M. pneumoniae pneumonia. Methods : Eighty-five children admitted due to M. pneumoniae pneumonia were enrolled. Serum specific IgM and IgG were measured semiquantatively by ELISA, and acute infection was determined by IgM concentration above the specified cutoff value. Recurrent M. pneumoniae pneumonia was defined as a history of proven M. pneumoniae pneumonia before at least 12 months with positive IgG, while the first pneumonia was defined as no past history of pneumonia with negative IgG. Both IgM titer and symptom duration were evaluated whether the patients had recurrent or the first M. pneumoniae pneumonia, they had current asthma or not and they presented wheeze during admission. Results : Significantly higher specific IgM titers were observed in patients with recurrent pneumonia than those without.(P＜0.01) The IgM titer was higher in patients with asthma than those without which was not statistically significant.(P=0.08) Significantly prolonged symptoms were observed in patients with asthma (P<0.05) and those with wheezing during admission. (P<0.01) The highest IgM titer was observed in asthmatic children with recurrent M. pneumoniae pneumonia. Conclusion : Our study shows that significantly higher specific IgM titer in the children with recurrent M. pneumoniae pneumonia comparing with their counterparts, which was more prominent in asthmatic patients. Further studies are needed to evaluate the clinical significance of an increased serum antibody level in recurrent M. pneumoniae pneumonia.
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