3세 이하 소아에서 호흡기 바이러스와 아토피 소견이 바이러스성 천명의 재발에 미치는 영향
The Influence of Respiratory Virus and Atopy on Recurrence of Virus Induced Wheezing in Children
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목 적:3세 이하의 어린 소아에서 호흡기 바이러스와 관련한 천명의 경우 천명의 재발과 호흡기 바이러스 및 아토피 소견과의 관계는 분명치 않은 것으로 되어 있다. 따라서 저자들은 호흡기 바이러스와 관련한 천명을 가진 3세 이하의 소아에서 호흡기 바이러스 및 아토피 소견이 천명의 재발에 미치는 영향을 알고자 본 연구를 실시하였다. 방 법:2006년 3월에서 2009년 2월까지 3년간 대구파티마병원 소아청소년과에 상기도 감염 증상과 함께 갑작스런 호흡 곤란, 기침 및 호기성 천명과 함께 흉부방사선 소견이 정상 혹은 과팽창 등으로 입원한 3세 이하의 환아에서 비인두 흡인물을 채취, 다중 역전사 중합연쇄반응 검사를 이용하여 한 가지 이상의 호흡기 바이러스가 검출된 340명을 대상으로 대상 환아를 6개월 이하, 7-12개월, 13-24개월, 25-36개월의 네 가지 연령군으로 나누고 각 연령군을 첫 발병군과 2회 이상 천명이 있었던 재발군으로 구분하여 각 군에서 바이러스 종류 및 아토피 소견을 비교하였다. 결 과:호흡기 바이러스는 RSV, PIV, RV의 순으로 나타났고, RV와 PIV는 천명의 재발과 상당한 관련이 있는 것으로 나타났으나 RSV는 천명의 재발보다 첫발병과 좀더 관련이 있는 것으로 나타났다. 65 IU/mL 이상의 혈청 IgE의 증가와 함께 흡입항원 감작 및 음식항원 감작은 천명의 재발과 밀접한 관련이 있는 것으로 나타났으나, 4% 이상의 호산구의 증가는 천명의 재발과 관련이 적은 것으로 나타났다. 양친의 천식병력 및 아토피피부염의 과거력은 천명의 재발과 관련이 있는 것으로 나타났으나, 간접흡연은 천명의 재발과 관련이 적은 것으로 나타났다. 결 론:3세 이하의 어린 소아에서 호흡기 바이러스와 관련한 천명 환아에서 바이러스 종류는 천명의 재발에 다소 다르게 영향을 주며, 아토피 소견은 천명의 재발에 많은 영향을 미치는 것으로 나타났다. 그러나 본 연구는 입원 환자만을 대상으로 한 후향적 연구이므로 향후 이를 보완한 전향적 연구가 이루어져야 할 것으로 생각된다.
Abstract
Purpose:We studied to know the influence of respiratory virus and atopic characteristics on recurrence of virus-induced wheezing in children under 3 years of age. Methods:Between March 2006 and February 2009, 340 children who were hospitalized with symptoms of sudden onset of dyspnea, cough and wheezing after symptoms of acute upper respiratory tract infection and detected specific respiratory viruses by multiplex RT-PCR were enrolled. The data were analyzed according to age (≤6, 7-12, 13-24, and 25-36 months) as well as previous wheezing episodes (first or recurrent episode). Respiratory viruses and atopic characteristics were compared among individual groups. Results:The 3 commonly identified viruses were RSV (62.4%), PIV (15.6%) and RV (11.8%). PIV and RV were significantly associated with recurrence, but RSV was not significantly associated with recurrence. Food sensitization, aeroallergen sensitization, elevation of total IgE, history of atopic dermatitis and history of parent asthma were significantly associated with the recurrent episode, but serum eosinophil and passive smoking were not significantly associated with the recurrent episode. Conclusion:These findings show that specific respiratory viruses can have different influence on recurrence and that atopy may be a risk factor for recurrence of wheezing, in children under 3 years of age with virus-induced wheezing.
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