소아 아토피피부염에서 중증도 및 흡입 항원 감작과 요중 leukotriene E4농도의 연관성
Association of SCORAD Index and Aeroallergen Sensitization on Urinary Leukotriene E4 in Children with Atopic Dermatitis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목 적:아토피피부염은 질병 자체의 다양성(heterogeneity)이 존재하므로 질병 상태를 잘 반영하는 객관적인 실험실 지표가 유용할 수 있다. 아토피피부염 소아에서 요중 leukotriene E4 (LTE4)를 측정하고 증상 점수 혹은 흡입 항원 감작 정도와의 관련성을 분석하여 요중 LTE4가 아토피피부염에서 임상 지표와 상관관계가 좋은 생물학적 표지로서의 가능성이 있는지 알아보고자 하였다. 방 법:아토피피부염을 진단받은 5–12세 소아 46명을 대상으로 International Study of Asthma and Allergies in Childhood (ISAAC) 설문지를 이용하여 알레르기 질환의 병력을 조사하였고 증상 정도를 scoring atopic dermatitis (SCORAD) index로 평가하였다. 요중 LTE4의 분석은 ACE enzyme immunoassay kit를 사용하였다. 대상군에 대해 혈청 총 IgE와 UniCAP을 이용하여 흡입 알레르겐에 대한 특이 IgE 항체 검사를 시행하였고 피부 단자 검사를 흡입 및 식품 알레르겐 28종에 대해 시행하였다. 대상군에서 요중 LTE4농도와 천식 등 다른 동반 알레르기 질환의 병력의 상관관계를 분석하였고 요중 LTE4와 SCORAD를 이용한 증상 점수, 혈액 내 호산구 수, 혈청 총 IgE와 흡입 항원에 대한 특이 IgE 항체 감작 정도와의 상관관계를 분석하였다. 결 과:대상군의 전반적 SCORAD (total SCORAD, tSCORAD) 점수와 요중 LTE4 농도는 유의한 양의 상관관계를 보였다.(γ=0.340, P=0.021) 특히 SCORAD 항목 중 objective SCORAD (oSCORAD) 역시 유의한 양의 상관관계를 보였다.(γ=0.342, P=0.020) 대상군의 혈액 내 총 호산구 수 및 혈청 총 Ig와 요중 LTE4 농도는 유의한 양의 상관 관계를 보였다.(γ=0.347, P=0.018; γ=0.390, P=0.007) 그리고 대상군에서 감작된 흡입 알레르겐의 수와 요중 LTE4 농도는 강한 양의 상관 관계를 보였다.(γ=0.414, P=0.004)결 론:요중 LTE4의 측정이 아토피피부염에서 비침습적 방법이라는 장점이 있으며 알레르기 염증의 정도를 평가할 수 있는 생물학적 표지로서의 가능성이 있다. 단면적으로는 요중 LTE4 농도가 아토피피부염의 일부 증상과 연관성이 있었지만 SCORAD 점수의 변화와의 상관관계를 입증하기 위해서는 보다 많은 대상군에서 후속 연구가 필요하다.
Abstract
Purpose:Atopic dermatitis (AD) is a genetically determined, chronic relapsing skin disease. The pathogenesis of AD is complex and the course is unpredictable. Atopy is an important risk factor for the development of AD. Cysteinyl leukotrienes (Cys-LTs) were implicated in the pathophysiology of allergic diseases, and are being targeted for their diagnosis and treatments. Early detection of tissue inflammation of target organ is important to enable early prevention and management of allergic diseases. The aim of our study is to evaluate the differences in urinary leukotrienes E4 (LTE4) levels, according to AD symptom score and aeroallergen sensitization in children with AD by using noninvasive techniques. Methods:We recruited 46 children with AD, using predetermined criteria. Clinical features of AD were evaluated by a physician, using scoring atopic dermatitis (SCORAD) index. Aeroallergen sensitization was measured by using a skin prick test and UniCap. Urine samples were also collected on day of the 1st and 2nd visits, and were analyzed for LTE4 with an enzyme-linked immunoassay kit. Results:SCORAD indeces of children with AD were correlated with urinary LTE4 levels. Total immunoglobulin E (IgE) and eosinophil counts also had significant correlation with urinary LTE4 levels. Especially, aeroallergen sensitization of atopic AD significantly correlated with urinary LTE4 of these patients. Conclusion:Urinary LTE4 levels significantly correlated with serum total IgE and number of sensitized aeroallergen in children with AD. Clinical features of AD evaluated with SCORAD index related with urinary LTE4 level. Urinary LTE4 might be a valuable, noninvasive marker for different pathogenesis of AD.
참고문헌 (32)
- Leung DY, "Atopic dermatitis", Lancet, 361, pp.151~160 (2003)
- Pelclova D, "Increased oxidative", nitrosative stress markers measured non- invasively in patients with high 2,3,7,8-tetrachloro-dibenzo-p-dioxin plasma level, 2011, pp.32(Suppl 1), 71~76
- Taylor DR, "Biomarkers in the assessment and management of airways diseases", Postgrad Med J, 84, pp.628~634 (2008)
- Charman C, "Outcome measures of disease severity in atopic eczema", Arch Dermatol, 136, pp.763~769 (2000)
- "Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis", Dermatology, 186, pp.23~31 (1993)
- Hon KL, "Urinary leukotriene E4 correlates with severity of atopic dermatitis in children", Clin Exp Dermatol, 29, pp.277~281 (2004)
- Adamek-Guzik T, "Urinary leukotriene levels are increased during exacerbation of atopic eczema", dermatitis syndrome. Relation to clinical status, 2002, pp.57, 732~736
- Oymar K, "Increased levels of urinary leukotriene E4 in children with severe atopic eczema", dermatitis syndrome, 2005, pp.60, 86~89
- Leung TF, "Serum concentration of macrophage-derived chemokine may be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young children", Pediatr Allergy Immunol, 14, pp.296~301 (2003)
- Austen KF, "The leukotriene E4 puzzle: finding the missing pieces and revealing the pathobiologic implications", J Allergy Clin Immunol, 124, pp.406~414 (2009)
- 권수정, "천명이 있는 영유아에서 뇨중 Leukotriene E4와 비인두액 Eosinophil Cationic Protein에 관한 연구", Allergy Asthma & Respiratory Diseases, 14(1), pp.46~52 (2004), 대한 소아알레르기 호흡기학회
- Hanifin JM, "Diagnostic features of atopic dermatitis", Acta Derm Venereol (Stockh), 59(Suppl 92), pp.44~47 (1979)
- Kumlin M, "Validation and application of a new simple strategy for measurements of urinary leukotriene E4 in humans", Clin Exp Allergy, 25, pp.467~479 (1995)
- Sansom JE, "Urinary leukotriene E4 levels in patients with atopic dermatitis", Br J Dermatol, 136, pp.790~791 (1997)
- Hishinuma T, "Increased urinary leukotriene E4 excretion in patients with atopic dermatitis", Br J Dermatol, 144, pp.19~23 (2001)
- 조중범, "아토피피부염의 중증도 변화에 따른 삶의 질 변화", Allergy Asthma & Respiratory Diseases, 22(1), pp.86~99 (2012), 대한 소아알레르기 호흡기학회[DOI]
- Kunz B, "Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis", Dermatology, 195, pp.10~19 (1997)
- Koro O, "Chemical mediators in atopic dermatitis: involvement of leukotriene B4 released by a type I allergic reaction in the pathogenesis of atopic dermatitis", J Allergy Clin Immunol, 103, pp.663~670 (1999)
- Maekawa A, "Functional recognition of a distinct receptor preferential for leukotriene E4 in mice lacking the cysteinyl leukotriene 1 and 2 receptors", Proc Natl Acad Sci U S A, 105, pp.16695~16700 (2008)
- Soter NA, "Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4, and LTB4) in human skin", J Invest Dermatol, 80, pp.115~119 (1983)
- Hua Z, "Evaluation and interference of serum and skin lesion levels of leukotrienes in patients with eczema", Prostaglandins Leukot Essent Fatty Acids, 75, pp.51~55 (2006)
- Oyoshi MK, "Eosinophil-derived leukotriene C4 signals via type 2 cysteinyl leukotriene receptor to promote skin fibrosis in a mouse model of atopic dermatitis", Proc Natl Acad Sci U S A, 109, pp.4992~4997 (2012)
- Kagi MK, "Leukotriene receptor antagonists: a novel therapeutic approach in atopic dermatitis?", Dermatology, 203, pp.280~283 (2001)
- Nettis E, "Efficacy and tolerability of montelukast as a therapeutic agent for severe atopic dermatitis in adults", Acta Derm Venereol, 82, pp.297~298 (2002)
- Yanase DJ, "The leukotriene antagonist montelukast as a therapeutic agent for atopic dermatitis", J Am Acad Dermatol, 44, pp.89~93 (2001)
- Carucci JA, "The leukotriene antagonist zafirlukast as a therapeutic agent for atopic dermatitis", Arch Dermatol, 134, pp.785~786 (1998)
- Ehlayel MS, "Montelukast treatment in children with moderately severe atopic dermatitis", Eur Ann Allergy Clin Immunol, 39, pp.232~236 (2007)
- Broshtilova V, "Therapeutic hotline: cysteinyl leukotriene receptor antagonist montelukast in the treatment of atopic dermatitis", Dermatol Ther, 23, pp.90~93 (2010)
- Veien NK, "Montelukast treatment of moderate to severe atopic dermatitis in adults: a randomized, double-blind, placebo-controlled trial", J Am Acad Dermatol, 53, pp.147~149 (2005)
- Friedmann PS, "A double-blind, placebo-controlled trial of montelukast in adult atopic eczema", Clin Exp Allergy, 37, pp.1536~1540 (2007)
- Fujisawa T, "Presence of high contents of thymus and activation-regulated chemokine in platelets and elevated plasma levels of thymus and activation-regulated chemokine and macrophage-derived chemokine in patients with atopic dermatitis", J Allergy Clin Immunol, 110, pp.139~146 (2002)
- Gutgesell C, "Comparison of different activity parameters in atopic dermatitis: correlation with clinical scores", Br J Dermatol, 147, pp.914~919 (2002)