소아 기관지 천식과 부비동염에서 면역 반응의 비교
Comparison of Immune Response between Pediatric Bronchial Asthma and Sinusitis
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목 적:천식과 부비동염은 염증성 반응이라는 동일한 병리학적 현상이 호흡기계 내의 서로 다른 표적기관에서 나타나는 것일 뿐 근본적으로 하나의 연계된 기도질환이라고 알려져 있다. 본 연구에서는 부비동염과 천식 사이의 혈청학적 검사를 통해 주된 면역반응의 차이점과 임상 양상을 비교해 보고자 하였다. 방 법:2005년 3월부터 2008년 2월까지 동아대학교 의료원 소아청소년과와 부산의료원 소아청소년과 알레르기센터를 방문한 118명의 학동기 환자들을 대상으로 말초 혈액 호산구수, 총 IgE, 7종 흡입항원(유럽 집먼지진드기, 아메리카 집먼지진드기, Alternaria, 바퀴벌레, 고양이, 개, 화분)에 대한 특이 IgE와 IL-4, IFN-γ를 측정하였다. 이들은 부비동염으로 진단된 환자 31명(A군), 천식으로 진단된 환자 36명(B군), 천식과 부비동염이 병발된 환자 51명(C군)으로 나누어 결과들을 비교하였다. 결 과:말초 혈액 호산구수와 총 IgE는 A군에서 현저하게 낮았다. 흡입항원에 대한 피부 단자 시험의 경우, 유럽 집먼지진드기와 아메리카 집먼지진드기에 대한 양성률은 B군과 C군이 비슷하였으나, Alternaria와 개에 대한 양성률은 C군에서, 고양이와 화분에 대한 양성률은 B군에서 높게 나왔다. C군에서 임상증상은 골고루 나타나면서 알레르기비염의 동반률은 B군과 비슷하였으며, 기관지 유발 검사 민감도는 높게 나왔다. 혈청 IL-4는 B군와 C군이 A군보다 의미있게 높게 나왔으며,(P<0.001) IFN-γ의 경우 A군이 C군보다 의미있게 높게 나왔다.(P<0.027)결 론:기관지 천식에서는 Th2 면역반응이, 부비동염에서는 Th1 면역반응이 주된 역할을 하지만, 두 질환의 동반 유무에 따라 면역반응이 다양하게 관찰되어진다.
Abstract
Purpose:Bronchial asthma and sinusitis have been grouped together and classified as one airway‐related disease, with the same underlying inflammatory etiology. Through serological examination, we ascertained a difference in the immune response between bronchial asthma and sinusitis. Methods:We measured the peripheral blood eosinophil count, total IgE and specific IgE to 7 aeroallergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Alternaria, cockroach, cat, dog and pollen), and interleukin (IL)-4 and interferon (IFN)-γ of 118 school‐aged patients who visited Dong‐A University Medical Center and Busan Medical Center from March 2005 to February 2008. We divided these patients into 31 diagnosed with sinusitis (Group A), 36 diagnosed with bronchial asthma (Group B), and 51 diagnosed with both sinusitis and asthma (Group C). Results:The peripheral blood eosinophil count and total IgE were markedly lower in group A. Dermatophagoides pteryonyssinus and Dermatophagoides farinae had higher sensitization rates than other aeroallergens in groups B and C. The sensitization rates to Alternaria and dog were higher in group C than in group B, and the sensitization rates to cat and pollen were higher in group B than in group C. In group C, clinical symptoms occurred evenly and allergic rhinitis was concurrent, similar to group B; however, the sensitivity of the bronchial provocation test was higher than in group B. Serum IL‐4 in group B and C were significantly higher than in group A (P<0.001), and serum IFN‐γ was significantly higher in group A than in group C (P<0.027). Conclusion:Bronchial asthma was primarily related to IL-4 and Th2 cytokines, while sinusitis was primarily related to IFN‐γ and Th1 cytokines. According to the degree of association between the 2 diseases, various immune responses were observed.
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