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메타콜린과 운동 유발 기관지 수축반응의 상관관계에 대한 종단적 연구

A longitudinal study on the relationship between methacholine airway hyperresponsiveness and exercise-induced bronchoconstriction

최인선|김상훈|심현정|한의령|김창성|우학
대한내과학회 (The Korean Association Of Internal Medicine)|2009.10|대한내과학회지 (The Korean Journal of Medicine)|제77권 제4호|pp. 472-479

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참고문헌

키워드

천식; 운동; 메타콜린; 가변성Asthma; Exercise; Methacholine; Variable
주제분류내과학

초록

목적: 천식의 AHR에는 기도 염증과 관련된 가변성 AHR과 기도 재형성과 관련된 지속성 AHR이 있다. 가변성 AHR은 운동 등 간접 자극이 잘 반영하고, 지속성 AHR은 메타콜린 등 직접 자극이 반영한다고 알려졌으나 AHR 두 가지를 구별하여 추적검사한 논문은 없어서 이를 연구하였다. 방법: 2004년 12월~2008년 2월에 전남대학교병원에서 메타콜린 AHR 검사와 운동 유발시험을 함께 시행하고 나중에 반복 시행하였으며, 운동 유발성 천식이 1회 이상 증명된 젊은 남자환자 36명의 진료부 자료를 후향적으로 분석하였다. 각 자극에 대한 반응의 심한 정도를 0~ 3점으로 점수화하여 비교하였다. 결과: 처음과 추적검사 사이의 간격은 평균 9.8개월(5~58개월)이었다. 처음 검사에서는 차이가 없었으나 추적검사 때는 메타콜린 AHR 점수에 비해 운동 AHR 점수가 유의하게 낮았다(1.58±0.16 대 1.19±0.15, p<0.01). 처음 검사에 비해 추적 검사 때 메타콜린 AHR 점수는 유의한 차이가 없었으나 운동 AHR 점수는 유의하게 저하되었고(1.67±0.13 대 1.19± 0.15, p<0.01), 두 점수의 차이는 유의하게 상승하였다(0.03± 0.13 대 0.39 ± 0.13, p<0.05). 메타콜린 PC20은 운동 후 FEV1의 최대 저하치와 유의한 상관관계가 있었고(r=-0.571, p<0.001), 처음과 추적검사 사이의 메타콜린 PC20와 운동 후 FEV1의 최대 저하치 변화도 유의한 상관관계가 있었다(r=-0.467, p<0.01). 결론: 운동 유발성 기관지수축과 메타콜린 AHR은 서로 상관관계가 있으나 메타콜린 AHR 변화는 운동 유발반응의 변화보다 작았다. 이것은 메타콜린 AHR이 운동 유발반응과 관련된 가변성 AHR 뿐 아니라 시간 경과에 따라 점차 심해진 지속성 AHR을 함께 반영하기 때문일 것이다.

Abstract

Background/Aims: The airway hyperresponsiveness (AHR) in asthma has variable and persistent components that are related to airway inflammation and remodeling, respectively. This longitudinal study examined the relationship of airway responses between exercise (reflecting variable AHR) and methacholine (reflecting persistent AHR). Methods: The charts were reviewed of 36 young adult males who underwent both methacholine and exercise challenges at different times and were diagnosed with exercise-induced asthma. The severity of the response to each stimulus was scored (0~3). Results: The mean interval between the baseline and follow-up tests was 9.8 (5~58) months. The AHR score was significantly lower with the exercise challenge than with methacholine at follow-up (1.58±0.16 vs 1.19±0.15, p<0.01), but not at baseline. Compared to baseline, the AHR score was significantly lower with exercise (1.67±0.13 vs 1.19±0.15, p<0.01), but not with methacholine, and the difference in the AHR scores between exercise and methacholine increased significantly from baseline to follow-up (0.03±0.13 vs 0.39±0.13, p<0.05). The maximum fall in the forced expiratory volume in 1 s following exercise was significantly related to methacholine AHR (r=-0.571, p<0.001). Conclusions: Exercise-induced bronchoconstriction was significantly related to methacholine AHR. However, the change in methacholine AHR in a follow-up test was significantly lower than that in the exercise response, which might have resulted from persistent worsening of the AHR with time because methacholine AHR reflects both variable and persistent AHR.

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Airway Hyperresponsiveness to Hypertonic Saline as a Predictive Index of Exercise-Induced Bronchoconstriction고영일, 최인선, Jang Sik Moon, Myoung Ki Sim, Seo Na Hong, Se Woong Chung대한내과학회 · The Korean Journal of Internal Medicine2005 · 제20권 제4호천식경과 중 메타콜린 검사 음성화 전환 환자군의 임상적 특성박세미, 박중원, 이용원, 홍천수대한천식알레르기학회 · 천식 및 알레르기2008 · 제28권 제1호천식 환자에서 메타콜린 기도 과민성에 미치는 임상적 인자 평가김경묵, 김상헌, 김선신, 김유영, 김윤근, 김희규, 민경업, 박창한, 박흥우, 손성욱, 송우정, 이상민, 이현승, 장윤석, 조상헌대한천식알레르기학회 · 천식 및 알레르기2006 · 제26권 제1호메타콜린 기관지유발시험에 음성반응을 보인 천식 환자들의 임상적 특징남동호, 박해심, 박혜린, 반가영, 신유섭, 예영민, 황의경대한천식알레르기학회 · 천식 및 알레르기2012 · 제32권 제3호메타콜린 기관지유발검사의 임상적 고찰김소리대한 소아알레르기 호흡기학회 · Allergy Asthma & Respiratory Disease2024 · 제12권 제3호메타콜린기관지유발검사 민감도에 따른 천식의 임상적 양상 비교김미영, 남영희, 류효인, 박찬선, 방유미, 이승은, 이호영, 이홍열, 조은정, 최길순, 홍성민대한 소아알레르기 호흡기학회 · Allergy Asthma & Respiratory Disease2025 · 제13권 제2호

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