학동전기 천식환자에서 혈청 총 IgE와 항원감작 및 기관지과민성과의 관계
Relationship between Total Serum IgE Level and Allergic Sensitization/Bronchial Hyperresponsiveness in Preschool Children with Asthma
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서 론 : 천식환자에서 IgE의 증가는 폐기능 및 기관지과민성과 관련이 있고 특히 항원 감작정도가 IgE의 증가에 상당한 영향을 미친다. 따라서 저자들은 학동전기 소아 천식환자에서 혈청 IgE의 증가와 항원감작 및 기관지과민성과의 관계를 알고자 본 연구를 실시하였다. 대 상 : 최근 3년간 대구파티마병원 소아청소년과 외래를 방문한 4-6세 사이의 천식 환자 중 알레르기 검사와 함께 메타콜린 흡입 후 흉부청진 즉, Provocative concentration at wheezing (PCw) 및 산소포화도 측정 Provocative concentration at 5% fall of oxygen saturation (PCsat)을 이용한 기관지과민성 검사가 가능했던 환아 109명을 혈청 IgE가 120 IU/mL 미만인 IgE 비증가군 (38명), 120-1,000 IU/mL인 중등도증가군과(45명), 1,000 IU/mL 이상의 고증가군 (26명)으로 분류하여 IgE와 천식병력, 항원 감작, 천식의 중증도 및 기관지과민성과의 관계를 비교하였다. 결 과 : 가족의 천식병력, 영아기의 모유수유, 집안의 애완동물, 간접흡연이 IgE의 증가와 관련이 없었으나(P>0.050, P=0.631, P=0.066, P=0.056), 아토피피부염의 동반과 함께 혈중 호산구 및 ECP의 증가는 IgE의 증가와 관련이 있었다.(P=0.003, P=0.000, P=0.011) 천식의 중증도와 함께 기관지과민성의 증가는 IgE의 증가와 관련이 없었으나, 음식항원, 흡입항원, 음식 및 흡입항원 동시 감작의 빈도는 IgE 증가시 감작 빈도가 유의하게 높았다.(P=0.000, P=0.000, P=0.000) IgE 고증가군의 위험요인으로 450/mm3 이상의 혈중 호산구, 아토피피부염의 동반, 음식항원 감작, 흡입항원 감작의 Odds ratio (95% Confidence interval)가 각각 3.2 (1.2-9.2), 4.4 (1.7-11.2), 4.8 (1.7-13.2), 5.5 (1.2-24.9)로 의미 있게 나타났다. 결 론 : 학동전기 소아천식환자에서 IgE의 중등도 증가는 항원감작과 및 기관지과민성과 상당한 관련이 있으나, 고증가군은 항원감작과 함께 다른 요인이 관여할 것으로 생각되며 향후 좀 더 많은 연구가 필요할 것으로 생각된다.
Abstract
Purpose : This study aimed to evaluate the relationship between the serum IgE level and allergic sensitization/bronchial hyperresponsiveness (BHR) in preschool children with asthma. Methods : One hundred nine asthmatic children age 4-6 years were enrolled. Total serum IgE levels, and specific IgE level to food and inhalant allergens were tested using Pharmacia Auto CAP system RAST®FEIA, methacholine bronchial challenge test (PCw=Provocative concentration at wheezing. PCsat=Provocative concentration at 5% fall of oxygen saturation) were performed in all subjects. They were divided into 3 groups according to the serum IgE level : less than 120 IU/mL (group A, n=38), 120 to 1,000 IU/mL (group B, n=45), and greater than 1,000 IU/mL (group C, n=26). The relationships with allergic sensitization and BHR were evaluatied among the 3 groups. Results : Sensitization to foods and inhalant allergens were related to a higher total serum IgE levels. However, BHR and severity of asthma were not related to higher total serum IgE levels, except in group B. Presence of atopic dermatitis, high serum eosinophil (＞450/mm3), allergic sensitization to foods and inhalants were related to high serum IgE greater than 1,000 IU/mL. (odds ratio ; 95% confidence interval=4.4;1.7-11.2, 3.2;1.2-9.2, 4.8;1.7-13.2, 5.5;1.2-24.9) Conclusion : Moderately elevated total serum IgE was related to allergic sensitization, severity of asthma and BHR. However highly elevated total serum IgE was related to only allergic sensitization. This may be attributed to other factors in preschool children with asthma.
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