Respiratory syncytial virus에 의한 세기관지염에서 연령에 따른 면역 반응의 변화
Developmental Changes in Immune Responses During Respiratory Syncytial Virus Bronchiolitis
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목 적 : RSV 감염에 의한 급성 세기관지염의 증상은 흔히 6개월 이하의 영아에서 더 심한 양상으로 관찰된다. 선천성 및 획득성 면역 반응은 출생 후 첫 1-2년 동안 성장하면서 변화를 보이는 것으로 알려져 있다. 저자들은 급성 RSV 세기관지염에 이환된 어린 소아에서 연령과 관련된 면역반응의 차이가 있는지를 알아보고자 본 연구를 시행하였다. 방 법 : 급성 세기관지염으로 입원한 소아들 중 RSV에 의한 감염이 증명되었던 45명을 대상으로 하였으며 이들을 다시 6개월 미만인 군(환자군 1)과 12-24개월 사이 군(환자군 2)으로 나누었다. 동시에 각각의 환자군과 동일한 연령대의 두 대조군(대조군1, 2)을 선정하였다. 환자의 혈액에서 ELISA 방법을 이용하여 sCD14, IFN- γ, IL-13, 그리고 IL-4를 측정하였다. 각각의 환자군과 대조군, 두 대조군 간에 각 지표들의 차이가 있는지를 조사하였다. 결 과 : 두 대조군을 비교하면 혈청 sCD14 농도는 생후 2년 동안 의미 있게 증가하였으며, IFN-γ와 IL-13 농도는 감소하였다. 혈청 내 sCD14 농도는 두 환자군 모두에서 각각의 대조군에 비해 의미 있게 증가하였으며 높은 연령에서 더욱 뚜렷하였다. IFN-γ는 환자군 2에서 대조군 2에 비해 의미 있게 증가하였으나, 환자군 1에서는 대조군 1에 비해 낮은 경향을 보였다. IL-13 농도는 환자군 2에서 대조군 2에 비해 의미 있게 높게 관찰되었으나 환자군 1과 대조군 1 간에는 의미 있는 차이를 보이지 않았다. 결 론 : 본 연구의 결과는 CD14를 통한 선천성 면역 반응이 생후 첫 2년 동안의 RSV 세기관지염의 병태생리학적인 기전에서 중요한 역할을 한다는 것과 RSV 감염에 대한 사이토카인 반응이 연령에 따라 다르게 나타나는 양상을 보여주고 있으며 이는 RSV 세기관지염의 치료에 있어 고려되어야 할 부분으로 생각된다.
Abstract
Purpose : This study was performed to examine the developmental changes in the innate or adaptive immune responses in serum during naturally occurring acute respiratory syncytial virus (RSV) bronchiolitis. Methods : Forty-five children who were admitted with acute RSV bronchiolitis were enrolled. Two patient groups were defined: Group 1: young infants under 6 months of age; and Group 2: young children of less than 2 years of age. Immune responses in serum were determined in these two patient groups and compared with two age-matched control groups (Control 1 and 2), respectively. Serum samples were obtained on admission and analyzed for sCD14, a receptor for innate immune response, and the cytokines, IFN-γ and IL-13 using ELISA. Results : Serum sCD14 levels were significantly higher but IFN-γ and IL-13 levels were lower in control 2 compared with control 1. During RSV bronchiolitis, serum sCD14 increased significantly in both patient groups comparing each age-matched control group, which was even greater in group 2. IFN-γ significantly increased in group 2, but showed a trend to decrease in group 1. IL-13 levels were significantly higher in group 2, but showed no significant difference in group 1 compared with age-matched controls. Conclusion : Our study showed that innate immunity plays an important role in the pathophysiology of acute RSV bronchiolitis during early life and suggests that developmental changes in the innate and adaptive immunity may be considered in treatment of the disease.
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