운동유발 기도과민성과 호기산화질소와의 상관성
Nitric Oxide Correlates with Exercise-Induced Bronchoconstriction in Asthmatic Children
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목적:운동유발 기도과민성은 운동에 의해 유발된 기관지수축으로 학교일상생활을 제한받게 됨으로써 신체 발달과 사회성의 발달에 지장을 주고 있다. 호기산화질소(exhaled NO, eNO)는 천식 환자에서 기관지 염증을 평가하기 위한 비침습적인 생물학적 지표로 사용되고 있다. 본 연구는 소아에서 운동유발 기도과민성과 eNO의 관계를 밝혀냄으로써 운동유발 기도과민성을 예측하고 진단하는데 있어 eNO의 임상적 유용성을 밝히고자 한다. 방 법:대상자는 6-18세 소아 총 101명이었고 운동유발 기도과민성을 동반한 천식 환아(n=31), 운동유발 기도과민성을 동반하지 않은 천식 환아(n=28), 건강한 대조군(n=42)으로 각각 분류하였다. 혈액에서 혈청 총 IgE와 알레르겐 특이 IgE치, 말초혈액 호산구 수와 혈청 호산구 음이온단백을 각각 측정하였고 eNO를 측정하였다. 모든 환자에서 메타콜린 흡입과 자유 운동에 의한 기관지유발시험을 각각 시행하였다. 결 과:천식군의 eNO 측정값은 정상 대조군에 비해 유의하게 높았으며(P<0.001)운동유발 기도과민성을 동반한 천식군에서 운동유발 기도과민성을 동반하지 않은 천식군보다 유의하게 높았다(P=0.033). eNO값은 PC_(20)과 유의한 상관관계를 보이지 않았고 운동 후 FEV_1 감소와는 유의한 상관관계를 보였다(r=0.637, P<0.001; r, partial correlation coefficient adjusted for age and height). eNO 측정값에 대해 운동유발 기도과민성에 대한 receiver operating characteristic (ROC) 곡선 분석 결과 eNO 측정값이 20 ppb 보다 높을 때, 특이도 80.0%, 민감도 61.3%, 양성예측치(positive predictive value) 57.6%, 음성예측치(negative predictive value) 82.4%로 eNO 측정치는 운동유발 기도과민성 예측에 도움이 될 수 있는 것으로 관찰 되었다(ROC 곡선 하 면적=0.767, P<0.0001). 결 론:본 연구에서 eNO는 운동유발 기도과민성과 좋은 상관관계를 보이므로 운동유발 기도과민성의 예측지표로서 그 유용성이 있을 것으로 생각한다.
Abstract
Purpose:Exercise-induced bronchoconstriction (EIB) affects daily activities as well as school performance in children. Exhaled nitric oxide (eNO) is a noninvasive test that measures airway inflammation in asthmatics. The aim of this study was to address the relationship between eNO and childhood EIB. Methods:Our study consisted of 101 children aged 6 to 18 years belonging to one of three groups, asthmatic children with EIB (n=31), asthmatic children without EIB (n=28), or healthy controls (n=42). After children were taken off drugs that treated their asthma, baseline (pre- exercise) eNO and biomarkers of inflammation were measured. All subjects underwent spirometry and the bronchial challenge by methacholine inhalation and outdoor free running. Results:eNO levels in asthmatic children with EIB were significantly greater than those in both asthmatic children without EIB (P=0.012) and controls (P<0.001). The median eNO (interquartile range) levels were 26.0 (15.0 to 46.0) parts per billion (ppb) in asthmatic children with EIB, 16.0 (12.5 to 28.0) ppb in asthmatic children without EIB, and 12.0 (10.0 to 15.3) ppb in controls. Post- exercise decrease of forced expiratory volume in 1 second correlated positively with eNO (r=0.637, P<0.001; r, partial correlation coefficient adjusted for age and height). The cutoff value for prediction of significant EIB was 20 ppb, and the overall sensitivity, specificity, positive predictive value, and negative predictive values were 61.3%, 80.0%, 57.6%, and 82.4%, respectively. The area under the receiver operating characteristic curve was 0.767 (95% confidence interval, 0.661 to 0.874). Conclusion:Baseline eNO levels correlate with the post-exercise decrease of forced expiratory volume in 1 second, suggesting that eNO may be a tool in the prediction of EIB.
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