경증 천식 환아의 기관지과민성 유발 관여 요소
Crucial Factors for Bronchial Hyperresponsiveness inChildren with Mild Asthma
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목 적 : 천식에서 기관지과민성은 주요 특징 중 하나로서 경증 천식 환자라 하더라도 중증도의 기관지과민성을 보이는 경우가 있으며 기관지과민성을 좌우하는 여러 가지 인자들이 천식의 임상 경과에 영향을 끼치는 것으로 알려져 있다. 또한 기관지과민성이 알레르기 염증과 기도개형 및 감소된 기도내경과 연관성이 있는 것으로 보인다. 이에 저자들은 경증 천식 환아에서 기관지과민성과 연관된 여러 인자들과의 상관관계를 통해 기관지과민성을 좌우하는 결정적 인자들을 규명해 보고자 하였다.방 법 : 경증 천식으로 진단된(소아천식 진료 가이드라인 2003) 소아 62명(남자 49명, 여자 13명)을 대상으로 메타콜린 기도유발시험을 시행하여 두 군으로 나누어 단순 폐기능 검사, 메타콜린 기도유발시험, 알레르겐 피부단자시험 및 혈청 특이 IgE 항체들의 결과를 후향적으로 비교하였다. 메타콜린 기도유발시험은 PC20가 8 mg/mL 미만인 경우를 양성으로 판정하였고, 자료 분석은 통계프로그램 STATISTICA 6.0을 이용하였다. 결 과: 1)대상 환아 중 메타콜린 기도유발시험 양성은 33명(53.2%)이었고, 음성은 29명(46.8%)이었으며, 두 군간에 성별과 연령의 차이는 없었다. 혈액내 호산구 수는 메타콜린 기도유발시험 양성군이 음성군에서보다 의미 있게 높게 측정되었으나,(P=0.034) 혈청 총 IgE치는 차이가 없었다.(P>0.05) 2)혈청 특이 IgE 항체 측정 및 알레르겐 피부단자시험에서 메타콜린 기도유발시험 양성군이 음성군에 비해 집먼지진드기(Dp, Df)에 대한 높은 양성 빈도를 보였다. 3)단순 폐기능 검사 결과 양성군과 음성군간에 %FEV1은 차이가 없었으나 %FEF50, %FEF75, %MMEF 등이 양성 군에서 유의하게 더 낮은 경향을 보였다. 결 론:메타콜린 기도유발시험 양성군에서 집먼지진드기(Dp, Df) 등 주요 흡입항원에 대한 감작이 증가되어 있고, 말초 기도의 유량, 특히 %MMEF가 감소되어 있었다. 이러한 주요 흡입항원에 대한 감작의 증가 및 말초기도 유량의 감소 등이 경증 천식 환자에 있어 기관지과민성을 결정짓는 중요한 인자로 생각되며 이의 조절을 통한 적절한 천식 관리가 가능할 것으로 사료된다.
Abstract
Purpose : Bronchial hyperresponsiveness(BHR) is one of the key components of childhood asthma phenotype. Patients with mild asthma may have coexisting severe BHR, although the reasons for this are uncertain. The factors of any relationship between BHR has been identified as a central issue in our understanding of asthma. Methods : To investigate the factors that determine the presence of BHR in mild childhood asthmatics, 62 children(49 boys and 13 girls) with mild asthma were studied. Patients were characterized by skin prick tests, spirometry and bronchial challenge with methacholine. BHR to methacholine was expressed as the provocative methacholine concentration causing a 20 percent fall in FEV1(PC20), PC20 value of 8 mg/mL was used as a cut-off for defining a BHR to methacholine. Results : This cohort of 62 children with mild asthma was classified into two groups according to the results of methacholine challenge test(MCT). A positive MCT group was obtained for 33 subjects(53.2 percent). The proportion of children sensitized to house-dust mites(HDM) was significantly higher in the MCT-positive group than the negative one. Results showed a, a positive rate of skin prick test : 47% vs. 23%(P<0.05) and HDM-specific IgE : 68% vs. 43%(P<0.05). Conclusion : Asthmatics with positive MCT were clearly accompanied by increased sensitization to house-dust mites and reduced small airway calibers. Therefore, sensitization to common aeroallergens and changed small airway calibers might be crucial factors in the successful management of asthma.
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