인플루엔자 B 바이러스와 연관된 근염의 임상적 고찰
Clinical Study of Influenza B-Associated Myositis
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목적:인플루엔자 B 바이러스에 기인한 근염은 소아에서 나타나는 인플루엔자 감염의 합병증 중 드문 것으로 현재까지 알려진 바가 매우 적었던 질환이다. 본 연구는 한국 소아에서 나타난 인플루엔자 B 바이러스 연관 근염의 임상 양상, 검사 소견, 진단 및 치료 성과에 대하여 분석하고자 하였다. 방 법:2010년 4월에서 5월까지 가톨릭대학교 의과대학 부천성모병원에서 인플루엔자 B 바이러스 연관 근염으로 진단되었던 16세 이하 환자들에 대해 후향적으로 의무 기록을 분석하였다. 결 과:16 명의 환아들이 분석되었고, 인플루엔자 B 바이러스 연관 근염은 전형적으로 학령 전기 소아들에서 발생하였으며, 남녀 비는 3:1이었다. 평균 연령은 4.6세이며 (3-7세). 인플루엔자 감염 이후 근염 발현까지 기간의 중앙값은 3일(1–7일)이었다. 모든 환자들이 종아리 근육에서만 근염 증상을 보였으며, 혈청 CPK 농도는 매우 상승된 소견을 보였다. 임상 증상 회복 기간의 중앙값은 3일(1–4일)이었다. 횡문근융해증, 신부전 등의 합병증 및 후유증은 나타나지 않았다. 항바이러스 제제는 투여하지 않았으며, 모든 환자들에서 양호한 치료 결과가 확인되었다. 결 론:인플루엔자 B 바이러스 연관 근염의 임상 양상과 검사 소견은 매우 특징적이어서 인플루엔자 유행 기간 동안 조기 진단이 가능하다. 그리고, 적절한 대증 요법 만으로도 그 치료 성과는 매우 양호한 것으로 확인되었다.
Abstract
Purpose:Influenza B-associated myositis is an infrequent and poorly known complication of influenza B virus infection in children. The aim of this study was to describe the clinical and laboratory manifestations, diagnosis, and outcomes of influenza B-associated myositis in Korean children. Methods:A retrospective analysis was conducted in patients aged <16 years who had been diagnosed with influenza B-associated myositis at the Catholic University Bucheon Saint Mary’s Hospital between April 2010 and May 2010. Results:Overall, 16 cases were analyzed. Influenza B-associated myositis typically occurred in preschool-aged children with a 3:1 male predominance. The mean age was 4.6 years (range, 3 to 7 years). The median interval between onset of influenza infection and onset of influenza B-associated myositis was 3 days (range, 1 to 7 days). Only the calf muscles were involved in all patients. Blood creatine phosphokinase concentration was elevated in most patients. Median duration to clinical recovery was 3 days (range, 1 to 4 days). No patient had rhabdomyolysis, renal failure, or related sequelae. All patients had a favorable outcome without administration of antiviral drugs. Conclusion:Clinical and laboratory findings of influenza B-associated myositis are very characteristic and allow a rapid diagnosis during the influenza season. Outcomes of influenza B-associated myositis are good with only proper supportive treatment.
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