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소아 결핵 감염 진단에 있어서 결핵 특이항원 자극 Interferon-${\gamma}$ 분비능 측정의 진단적 유용성
순유진,임백근,김황민,남궁미경,차병호,어영,전진경,Soon, Eu-Gene,Lim, Baek-Keun,Kim, Hwang-Min,NamGoong, Mee-Kyung,Cha, Byung-Ho,Uh, Young,Chun, Jin-Kyong 대한결핵및호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.5
Background: $QuantiFERON^{(R)}$-TB Gold In Tube (QFT-G IT) has been used for diagnosing latent tuberculosis infection and active tuberculosis (TB) since 2007. However, there has not been enough data on QFT-G IT for universal use in children. In this study, we evaluated the clinical usefulness of the QFT-G IT in pediatric practice. Methods: We retrospectively reviewed the clinical records of 70 patients younger than 18 years of age who had taken QFT-G IT and had a tuberculin skin test (TST) between July 2007 and July 2009 at Wonju Christian Hospital. The subjects were divided into two groups, asymptomatic TB exposure group and disease group. Four patients who were taking immunosuppressants during the study period were excluded. Results: A total of 66 immunocompetent children were included in this study. Among 27 asymptomatic children who had contact histories of TB, 6 (22.2%) were found to be positive by QFT-G IT. Eleven (40.7%) and 5 (18.5%) children were found to be positive by TST with cutoff values of ${\geq}5mm$ and ${\geq}10mm$, respectively. Agreement was fair to good between QFT-G IT and TST (${\kappa}=0.59$: cutoff value ${\geq}5mm$, ${\kappa}=0.7$: cutoff value ${\geq}10mm$). In disease group, 14 patients (35.9%) were diagnosed with active tuberculosis, 8/14 (57.1%) were positive on TST and 9/14 (64.3%) on QFT-G IT. The positive rate of acid-fast bacilli smear, TB-polymerase chain reaction, and culture for tuberculosis was 11% (1/9), 27.3% (3/11) and 33.3% (3/9), respectively. Conclusion: Our data support that the QFT-G IT can be used as an additional diagnostic tool for latent and active tuberculosis infection in children.
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소아 결핵 감염 진단에 있어서 결핵 특이항원 자극 Interferon-γ 분비능 측정의 진단적 유용성
순유진 ( Eu Gene Soon ),임백근 ( Baek Keun Lim ),김황민 ( Hwang Min Kim ),남궁미경 ( Mee Kyung Namgoong ),차병호 ( Byung Ho Cha ),어영 ( Young Uh ),전진경 ( Jin Kyong Chun ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.5
Background: QuantiFERON(R)-TB Gold In Tube (QFT-G IT) has been used for diagnosing Latent tuberculosis infection and active tuberculosis (TB) since 2007. However, there has not been enough data on QFT-G IT for universal use in children. In this study, we evaluated the clinical usefulness of the QFT-G IT in pediatric practice. Methods: We retrospectively reviewed the clinical records of 70 patients younger than 18 years of age who had taken QFT-G IT and had a tuberculin skin test (TST) between July 2007 and July 2009 at Wonju Christian Hospital. The subjects were divided into two groups, asymptomatic TB exposure group and disease group. Four patients who were taking immunosuppressants during the study period were excluded. Results: A total of 66 immunocompetent children were included in this study. Among 27 asymptomatic children who had contact histories of TB, 6 (22.2%) were found to be positive by QFT-G IT. Eleven (40.7%) and 5 (18.5%) children were found to be positive by TST with cutoff values of ≥5 mm and ≥10 mm, respectively. Agreement was fair to good between QFT-G IT and TST (κ=0.59: cutoff value ≥5 mm, κ=0.7: cutoff value ≥10 mm). In disease group, 14 patients (35.9%) were diagnosed with active tuberculosis, 8/14 (57.1%) were positive on TST and 9/14 (64.3%) on QFT-G IT. The positive rate of acid-fast bacilli smear, TB-polymerase chain reaction, and culture for tuberculosis was 11% (1/9), 27.3% (3/11) and 33.3% (3/9), respectively. Conclusion: Our data support that the QFT-G IT can be used as an additional diagnostic tool for Latent and active tuberculosis infection in children.
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일측성 편마비를 동반한 A군 ${\beta}$-용혈성 사슬알균 수막뇌염 1례
김기원,순유진,차병호,이해용,어영,김선주,전진경,Kim, Ki-Won,Soon, Eu-Gene,Cha, Byung Ho,Lee, Hae Yong,Uh, Young,Kim, Sunjoo,Chun, Jin-Kyong 대한소아감염학회 2009 Pediatric Infection and Vaccine Vol.16 No.2
저자들은 건강하던 8세 남아에서 A군 $\beta$-용혈성 사슬알균(Group A $\beta$-hemolytic streptococci, GABHS) 감염 후 발생한 일련의 면역반응으로 인한 응고장애와 좌측 편마비 및 경련이 발생한 수막뇌염을 경험하여 문헌고찰과 함께 보고하는 바이다. Group A streptococcus (GAS) rarely causes meningoencephalitis in children without risk factors. A previously healthy 8 year-old child presented with lethargy, high fever, and vomiting. The clinical course was unusual including intractable seizures, disseminated intravascular coagulation (DIC), and left hemiparesis in spite of the appropriate and timely administration of antibiotics and corticosteroids. The microbiologic studies revealed that the pathogen was susceptible to penicillin and GAS M18 strains. This case showed the importance of the GAS vaccine in addition to appropriate antibiotics.
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Effects of Ketotifen on an Experimental Model of IgA Nephropathy
도영선,순유진,남궁미경,Do, Young-Sun,Soon, Eu-Jene,NamGoong, Mee-Kyung Korean Society of Pediatric Nephrology 2009 Childhood kidney diseases Vol.13 No.2
목적 : 장점막 손상은 IgA 신증의 병리기전중의 하나로 알려져 있다. 구강항원은 보통 Th2 세포와 비반세포를 활성화 시킨다. 이러한 세포들은 IL-4, IL-5 TGF-${\beta}$와 같은 싸이토카인들을 분비하여 IgA 생성을 증가시킨다. 케토티펜(benzpxycloheptathiophene)은 H1항체이자 비반세포의 막안정제로 IL-4, IL-5, PGE2, LTB4 등의 생산을 억제하고, 질산화산소합성제의 활성화를 감소시켜 위장관막을 보호한다. 저자들은 구강항원으로 인한 IgA 신증의 발병을 케토티펜이 예방할 수 있는지 관찰하였다. 방법 : ICR 생쥐를 이용하여 구강 폴리오백신(백신군)을 투여하면서, 다른 군에서는 케토티펜(케토티펜군)을 백신과 동시에 투여하였다. 결과 : 메산지움의 IgA 침착은 백신군에서 18마리중 11마리에서 발생하였으나, 케토티펜군에서는 9마리 중 3마리에서 볼 수 있었다. 메산지움의 조직 변화는 백신군에서 18마리 중 16마리, 케토티펜 군에서는 9마리 중 5마리에서 볼 수 있었다. 혈청 IL-4, IL-5치는 케토티펜 군에서 백신군과 비교해 다소 낮기는 하지만 의미있는 감소는 하지 않았다. 결론 : 케토티펜은 IgA 신증의 사구체 변화를 감소시키는데 유효한 것으로 사료된다. Purpose : The intestinal mucosal defect has been known as one of the pathogenicmechanisms of IgA nephropathy. Oral antigens usually induce the activation of Th2 cells and mast cells. These cells secrete cytokines IL-4, IL-5 and TGF-$\beta$, which increase IgA production. Although ketotifen (benzocycloheptathiophene) is an H1 antagonist and a mast cell membrane stabilizer, it could protect the gastrointestinal membrane through inhibiting the production of IL-4, IL-5, PGE2, and LTB4, and decreasing the activity of nitric oxide synthease. Therefore, we have investigated if ketotifen may protect the development of IgA nephropathy with an oral antigen. Methods : ICR mice were used as an animal model orally with Poliovax only [ketotifen (-)], the other group was given oral ketotifen [ketotifen (+)] in addition to Poliovax. Results : Mesangial IgA deposition developed in 11 out of the 18 mice in the ketotifen (-) group, while in three out of the nine mice in ketotifen (+) group. The mesangial change developed in 16 out of the 18 mice in the ketotifen (-) group, while in five out of the nine mice in the ketotifen (+) group. Serum IL-4 and IL-5 levels were not significantly lower in the latter group than in the former. Conclusion : According to the statistical results from the above, ketotifen therapy would be beneficial to reducing mesangial changes in IgA nephropathy.
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