첫 번째 respiratory syncytial virus 세기관지염 시기와 추후 천명 및 천식 발생 사이의 연관성
The Relationship between the Time of First Respiratory Syncytial Virus Bronchiolitis and Later Wheezing and Asthma Development
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목 적:Respiratory syncytial virus (RSV) 세기관지염은 영아기 천명의 가장 흔한 원인으로, 이후의 재발성 천명 및 천식과 관련이 있다는 연구 결과가 많다. 본 연구는 첫 번째 RSV 세기관지염 발생 시기와 이후 2년 동안의 천명 발생 및 천식 진단 사이에 연관성이 있는지 알아보고자 하였으며, 그 외 천명 및 천식과 관련 있는 다른 인자들도 알아보았다. 방 법:2005년부터 2007년까지 순천향대학교 부천병원 소아과에 RSV 세기관지염으로 입원한 24개월 이하 영아 255명을 대상으로 하였다. 의무기록을 후향적으로 분석하였으며, RSV 세기관지염 후 2년 동안의 천명 발생과 천식 진단 여부는 전화 설문을 통해 조사하였다. 대상 환아를 3개월 이하와 4-12개월, 13-24개월로 나누어 비교하였다. 결 과:3개월 이하가 81명, 4-12개월은 115명, 13-24개월은 59명이었다. 남녀 비는 각각 1:1, 1.6:1, 3.2:1로 연령이 높을수록 남아의 비율이 높았다. 연령에 따라 알레르기 질환의 병력과 가족력은 차이가 없었으며, 중증도도 차이를 보이지 않았다. 천명 발생은 아토피피부염과 식품 알레르기 병력 및 알레르기 질환의 가족력과 유의한 연관이 있었으나 성별, 세기관지염의 중증도와는 연관성이 없었다. 나이가 많은 연령군에서 2년 동안의 천식 진단율이 높았으며, 연령군으로 나누지 않았을 때도 첫 번째 RSV 세기관지염의 발생 나이가 많을수록 천식 진단을 받을 가능성이 높게 나타났다. 아토피피부염과 식품 알레르기의 병력이 있는 경우에 천식 진단을 받을 위험성이 증가하였다.(adjusted odds ratio, 3.34; 95% confidence interval, 1.38-8.07)결 론:첫 번째 RSV 세기관지염의 발생 나이가 많을수록 천식 진단율이 높게 나타났으며, 알레르기 질환의 병력 및 가족력이 반복성 천명 혹은 천식 진단의 주 위험인자였다. 따라서 RSV 세기관지염 자체가 반복성 천명이나 천식의 위험인자나 원인이라기보다는 유전적 소인이 있는 환아에서 RSV 감염 시 천명이 발생하였을 가능성이 높다고 생각된다.
Abstract
Purpose:Respiratory syncytial virus(RSV) bronchiolitis is believed to be associated with later development of asthma and wheezing. This study was conducted to determine the relationship between the age of the first RSV bronchiolitis episode, the development of later wheezing and asthma, and the related other factors. Methods:We studied 255 infants admitted with their first episode of RSV bronchiolitis. Epidemiological and clinical data were collected retrospectively from medical records and through telephone interviews. The patients were divided into ≤3 months, 4 to 12 months, and 13 to 24 months. Results:Eighty-one infants were ≤3 months, 115 were 4 to 12 months, and 59 were 13 to 24 months old. The gender ratios (Male:Female) were 1:1, 1.6:1, and 3.2:1. Familial and personal history of allergic diseases and disease severity did not significantly differ according to the age of the first RSV bronchiolitis episode. The occurrence of wheezing was associated with the presence of a familial and personal history of allergic diseases, but not with gender (male) or disease severity. The risk for asthma increased when the infants had their first RSV bronchiolitis episode at an older age. A personal history of allergic diseases was associated with an increased risk for asthma. Conclusion:Asthma was more frequently diagnosed in older infants. The most important risk factors for recurrent wheezing and asthma were a familial and personal history of allergic diseases. Therefore, it was thought that RSV bronchiolitis is not the cause of recurrent wheezing and asthma, but that infants with a genetic predisposition to asthma have an increased risk for RSV bronchiolitis.
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