천식 환아에서 호기산화질소(exhaled nitric oxide)와 폐기능 및 기도과민성의 연관성
Relationship between Exhaled Nitric Oxide Concentration and Pulmonary Function/Airway Hyperresponsiveness in Asthmatic Children
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목 적 : 호기산화질소는 하기도 염증의 지표로 천식의 진단, 중증도 평가, 및 추적관찰의 도구로써 의미가 있다고 보고되고 있으나 아직 논란이 있다. 폐기능 검사는 천식의 진단 및 치료, 관리에 많이 이용되고 있으며, 기도과민성은 천식의 중요한 특징으로 메타콜린 유발검사나 기관지 확장제 투여 후 폐기능 검사 등으로 평가한다. 본 연구에서는 천식 환아에서 호기산화질소가 반영하는 기도 염증과 폐기능 및 기도과민성의 연관성에 대해 알아보고자 하였다. 방 법 : 2007년 6월부터 2008년 10월까지 세브란스 어린이병원으로 내원하여 천식으로 진단받은 환아 121명과 대조군 81명을 대상으로 하였다. 4주 이내에 스테로이드 등의 조절제를 사용하였거나 급성 호흡기 감염이 있었던 경우는 제외하였다. 전체군을 대상으로 호기산화질소농도, 폐기능 검사, 기관지 확장제 투여 후 폐기능 검사, 메타콜린 유발검사, impulse oscillometry (IOS)검사를 시행하였다. 호기산화질소와 다른 검사 결과값들과의 연관성에 대해 분석하였으며 각 군 간의 호기산화질소를 비교 분석하였다. 결 과 : 호기산화질소는 천식군[28.3(15-55.75) ppb]에서 대조군[20(12.35-39.7) ppb]보다 높은 결과를 보였다.(P=0.015) 호기산화질소는 폐기능 검사와는 FEF25-75 (%pred)에 대해서만 약한 연관성을 보였다.(r=-0.169, P=0.022) 기도가역성을 나타내는 dFEV1 (r=0.23, P=0.001), dR5 (r=-0.148, P=0.044)에서 호기산화질소와 유의한 연관성을 보였다. 메타콜린 유발검사상 PC20값과 호기산화질소는 음의 상관관계를 보였다.(r=-0.318, P< 0.001) 결 론 : 호기산화질소는 기도염증 및 기도과민성을 반영하는 보조적인 표지자로서 천식 진단 및 추적 관찰 도구로써 유용할 것으로 생각되나, 폐기능을 직접적으로 반영하지는 않는 것으로 생각된다.
Abstract
Purpose : Exhaled nitric oxide (eNO) has been proposed as a non-invasive marker for airway inflammation in asthma. Pulmonary function tests have been widely used in the diagnosis and management of asthma. Airway hyperresponsiveness (AHR) is one of the major features in asthma and usually assessed by the methacholine challenge test. The purpose of the present study was to assess the possible relationship between eNO and pulmonary function/AHR in asthmatic children. Methods : There were 121 asthmatic children and 81 controls in the study. The eNO level was measured, the methacholline challenge test, spirometry, impulse oscillometry (IOS) and assessment of their bronchodilator responses were performed on all subjects. Results : The asthma group had a higher eNO value than the control group [28.3 (15-55.75) vs. 20 (12.35-39.7) ppb, P=0.015]. The eNO level correlated positively with dFEV1 (r=0.230, P= 0.001). It correlate inversely with dR5 (r=-0.149, P=0.036), eNO with PC20 (r=-0.318, P<0.001) and with FEF25-75 (r=-0.17, P=0.015), but not with FEV1. Conclusion : This study suggests that eNO values may reflect AHR, as well as airway inflammation, but not pulmonary function.
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