소아 기관지 천식 환자의 비염 발병 예측에서 호기산화질소의 역할
Role of Fractional Exhaled Nitric Oxide in Predicting Development of Allergic Rhinits in Children with Bronchial Asthma
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목 적:호기산화질소(exhaled nitric oxide, FeNO)의농도는 비침습적인 하기도 염증의 지표로 천식 환자에서 기관지 과민성과 관련이 있다고 알려져 있으며, 천식 없이 비염 등의 아토피 관련 질병이 있는 경우에도 증가한다. 기관지 과민성을 보이는 하기도 질환인 천식과 상기도 질환인비염은 알레르기 관련 염증 반응 및 그 밖의 여러 가지 요인으로 서로 관련이 있다고 생각된다. 이에 저자들은 소아 천식 환자의 비염 발병의 예측에서 호기산화질소 측정의 유용성을 알아보고자 본 연구를 시행하였다. 방 법: 2005년 4월부터 8월까지 경희대학교 의과대학소아청소년과학교실에서 천식으로 진단되어 호기산화질소의 농도, 총 호산구 수그리고혈청총 면역글로불린E를 측정했던 53명을 대상으로 하였다. 2011년 7월에 전화 설문조사 및 진료 기록을 통하여 비염 증상(맑은 콧물, 코막힘,코가려움증, 재채기)의 여부와 의사가 진단한 비염의 빈도를 조사하였다. 통계분석은 IBM SPSS ver 18.0을 이용하였다. 결 과:총 53명 중 36명의 환아(67.9%)에서 비염이 발병하였다. 호기산화질소의 평균 측정치는 연구군에서 29.4parts per billion (ppb)이었으며대조군에서는 13.6 ppb으로 통계적으로 유의한 차이를 보였다.(P =0.003, T-test)그 외 말초혈액 총호산구 수, 혈청 총 IgE, 아토피피부염의과거력, 아토피 관련 질환의 가족력은 연구군과 대조군에서유의한 차이가 없었다. 결 론 : 호기산화질소의 측정은 소아 천식 환자에서 향후비염 발병을 예측하는데 유용하게 사용될 수 있는 검사로생각한다.
Abstract
Purpose : Fractional exhaled nitric oxide (FeNO) has been widely reported as a marker for airway inflammationin, and FeNO have shown increased levels in the non-asthmatic patients with other atopy related diseases, such as rhinitis. Bronchial hyperresponsiveness is a characteristic feature of asthma, which is often associated with airway inflammationin allergic rhinitis. It has been suggested that asthma is associated with rhinitis, which is a link between the upper and the lower airways,beyond allergy associated inflammation in the respiratory tract. To evaluate the usefulness of FeNO measurement, as a risk factor of allergic and nonallergic rhinitis in children with asthma. Methods : Fifty-three children included in this study were diagnosed as asthma from April through August 2005 in the Department of Pediatrics, Kyung Hee University School of Medicine. They conducted FeNO monitoring, total eosinophil count and serum immunoglobulin E at that time. We put a question to the participants’ parents about the doctor diagnosed participants’ manifestations (sneezing, nasal congestion, nasal itching, rhinorrhea), via a telephone interview survey or at the outpatient department in July 2011. Statistical analyses were performed using IBM SPSS ver. 18.0. Results : The overall prevalence of rhinitis, among the 53 children, was 67.9%. The means of FeNO differed significantly between the two groups, being higher in children who have rhinitis symptoms and lower in asymptomatic children. (mean±SD, 29.4±24.6 to 13.6±11.8 parts per billion;P =0.003; T-test)Conclusion : To take the measurement of FeNO value in asthmatics may be a tool in the predictor of the causes of rhinitis.
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