생후 6개월 이하의 중등증 및 중증아토피피부염 환자에서 위험요인 분석
Risk Factors of Moderate to Severe Atopic Drmatitis in the First 6
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목 적 : 생후 6개월 이하의 아토피피부염 환자들에서 중증도에 따른 위험요인을 비교 분석하고자 하였다.방 법 : 생후 6개월 이하의 아토피피부염 환자 134명을 대상으로 Six Area, Six Sign in Atopic Dermatitis(SASSAD) score를 기록하여 14점 이하 90명을 경증, 15점 이상 44명을 중등증 및 중증으로 분류하였다. 이들은 모유나 분유 수유를 하면서 쌀미음과 야채 외의 이유식은 진행하지 않은 상태였다. 환자들의 성별, 수유형태, 가족력, 형제 수, 총 IgE 값, 호산구수, 난백, 우유, 콩, 밀에 대한 CAP assay(Pharmacia, Uppsala, Sweden) 결과 등을 분석하였다. 호산구수는 중등증 및 중증 아토피피부염 환자는 1,863±2,032/ L, 경증 아토피피부염 환자는 686±539/ L이었다.(P=0.0006) 결 과 : 총 IgE 값은 중등증 및 중증 아토피피부염 환자는 180.6±44.7 U/mL, 경증 아토피피부염 환자는 32.2±6.1 U/mL이었다.(P=0.002) 난백, 콩, 밀에 대한 특이 IgE 값(중등증 및 중증에서 각각 19.03±4.48 U/mL, 7.07±0.40 U/ mL, 4.68±1.89 U/mL; 경증에서 각각 1.78±0.43 U/mL, 0.09±0.03 U/mL, 0.15±0.11 U/ mL; P<0.05)은 중증도와 유의하게 관련되나, 우유에 대한 특이 IgE 값(중등증 및 중증 4.34±2.50 U/mL, 경증 0.80±0.44 U/mL)은 중증도와 무관하였다. 중등증 및 중증과 경증 아토피피부염 환자간에 성별, 수유형태, 가족력, 형제 수에는 통계적으로 유의한 차이가 없었다. 총 IgE 값은 나이에 의한 영향을 보정하였을 때 모유 수유기간이 길수록 증가하는 양의 상관관계가 있으며(b=24.3, P<0.05) 난백에 대한 특이 IgE 값도 모유 수유기간이 길수록 증가하는 양의 상관관계가 있었다.(b=2.28, P<0.05) 또한 일반조제유 수유기간과 난백 특이 IgE 값은 역비례하는 상관관계가 있었다.(b=-2.36, P<0.05) 그러나 우유, 콩, 밀에 대한 특이 IgE는 이러한 상관관계가 없었다.결 론:이유식을 진행하지 않은 생후 6개월 이하의 어린 영아라도 중등증 이상의 아토피피부염의 경우에는 식품 알레르겐에 대한 감작과 연관이 있고, 모유를 통해 식품알레르겐에 감작되어 있을 가능성이 있으므로 이를 확인해야 한다.
Abstract
Purpose : The aim of this study was to analyze the risk factors of moderate to severe atopic dermatitis(AD) in the first 6 months of life. Methods : Children aged less than 6 months with AD were divided into two groups according to Six Area, Six Sign Atopic Dermatitis(SASSAD) Score. Children with scores of less than 14 were classified as Mild AD(n=90) and above 15 as Moderate to Severe (Mod-severe) AD(n=44). These patients were fed with breast milk or cow's milk formula, and no allergenic food was given except rice and some vegetables. We analyzed the gender, feeding patterns, family history of allergy, number of siblings, total IgE and specific IgE to common food allergens(egg white, cow's milk, soy, wheat) by CAP assay(Pharmacia, Uppsala, Sweden). Results : Total IgE was 180.6±44.7 U/mL in mod-severe AD and 32.2±6.1 U/mL in mild AD(P=0.002). Specific IgE to egg white, soy and wheat(19.03±4.48 U/mL; 7.07±0.40 U/mL, 4.68±1.89 U/mL in mod-severe AD; 1.78±0.43 U/mL, 0.09±0.03 U/mL, 0.15±0.11 U/mL in mild AD; P<0.05) were associated with mod-severe AD, but cow's milk(4.34±2.50 U/mL in mod-severe AD; 0.80±0.44 U/mL in mild AD) showed no statistical difference. Gender, feeding patterns, family history and number of siblings were not significantly associated with mod-severe AD. The total IgE level and egg white specific IgE level significantly increased as the duration of breast feeding increased(P<0.05). Conclusion : Mod-severe atopic dermatitis in the first 6 months of life is associated with sensitization to food allergens, which might be transferred via breast milk.
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