가와사끼병에서 감마글로불린 치료 용량(1g/kg 단일요법과 2g/kg 단일요법)의 비교

인수미,안인철,길홍량,정용현 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.7

목 적 : 가와사끼병에서 아스피린과 IVGG 병용투여가 가장 효과적인 방법으로 알려져 있으나 IVGG의 적절한 용량 및 용법 등이 여전히 논란의 여지가 많다. 이에 저자들은 기존의 IVGG 2g/kg 단일요법과 비교하여 IVGG 1g/kg 단일요법의 임상적 적용과 치료효과에 대하여 알아보고자 하였다.방 법 : 1996년 2월부터 1999년 1월까지 충남대학교병원 소아과에 입원한 가와사끼병 환아중 고위험군(Harada 점수 4점 이상)을 대상(63명)으로 IVGG 1g/ kg 1회 A군(32명), 2g/kg 1회 B군(31명)으로 나누어 IVGG 치료 전, 후의 임상경과, 검사 소견 및 심혈관 합병증을 비교 분석하였다. Purpose : Treatment of Kawasaki disease with intravenous gamma globulin(IVGG), together with aspirin, has been demonstrated to be safe and effective in preventing coronary artery lesion and systemic inflammation, but optimal IVGG dosage and administration method are still controversial. We compared the therapeutic efficacy and clinical response of single IVGG 1g/kg to that of IVGG 2g/kg for comparable risk group of Kawasaki disease. Methods : We conducted a prospective study involving 63 children with Kawasaki disease requiring IVGG treatment(Harada score■4) at Chungnam National University Hospital from February 1996 to January 1999. The children were assigned to receive IVGG either as a single infusion of 1g/kg(A group, 32 person) or 2g/kg(B group, 31 person) and aspirn(100mg/kg/day through acute phase, then 3 to 5mg/kg/day for 8 weeks of duration). Results : There were no significant difference between the two groups according to clinical and laboratry data, including coronary artery lesions(group A, 31.3% and group B, 29.0%) before treatment. After IVGG treatment ratio of complication with coronary artery lesion(group A 1/32=3.1% and group B, 2/31=6.5%) and that of retreatment(group A, 4/32=12.5%, group B, 2/31=6.5%), duration of fever(group A, 1.3■1.6 days and group B, 0.7■1.4 days), hospital stay(group A, 7.0■1.4 days and group B, 6.5■2.0 days), laboratory finding and side effects of IVGG were not significantly different(P>0.05). The total dosage of IVGG was significantly lower in group A than group B(group A, 1.16■0.37g/kg, 375,421■207,351 ￦ and group B, 2.10■0.40g/kg, 641,498■274,750 ￦(P<0.05). Conclusion : The therapeutic efficacy and clinical response of single 1g/kg therapy are comparable to that of single 2g/kg therapy.

영·유아에서 Polaroid Photoscreening을 이용한 약시검증의 유용성 평가

인수미,변상현,조항진,민병무 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.10

Purpose : Amblyopia is the commonest cause of defective vision in childhood. It develops during the sensitive period of visual maturation which continues until about 7-8 years of age. The authors investigated the effect of a polaroid photoscreening camera designed to detect amblyogenic factors, including asymmetric and abnormal refractive errors, strabismus, ptosis and media opacities. Methods : Fifty-four children aged 3-24 months were evaluated for amblyogenic factors using the polaroid photoscreening camera from March 1998 to March 1999 in Chungnam National University Children's Hospital. Then each child underwent medical examination by an ophthamologist. Results : The mean age was 9.0■4.5 months. The results of photoscreening were normal findings of 74.1%, abnormal findings of 25.9%, and slight eccentric fixation in 18 cases, normal findings in 9 cases, peripheral crescents in 13 cases, strabismus in 4 cases, myopia in 5 cases, hyperopia in 2 cases, anisometropia in 2 cases, ptosis in 1 case and reexam in 14 cases. The photoscreener had a sensitivity rate of 81.8%, a specificity rate of 88.4%, a positive predictive value of 64.3% and a negative predictive value of 95.0%. Conclusion : Polaroid photoscreening method is an easy, noninvasive and reliable mass screening method of detecting amblyogenic factors in undilated children. 목 적 : 소아에서 약시는 시력감퇴의 주요요인으로, 약시의 발견 시기는 그 치료와 예후에 큰 영향을 준다. 이는 1-3세 경 잠복기에 조기진단을 하여 발생률을 감소시킬 수 있으나, 현재 시력선발검사가 대개 7-8세에 이루어지므로 조기치료의 시기를 놓치는 경우가 많다. 이에 저자들은 영, 유아에서 주변조명을 이용한 Polaroid photoscreening을 이용하여 굴절 이상, 양안부동시, 사시, 안검하수, 매체혼탁 등의 약시 유발인자의 발견에 대한 유용성 여부를 조사하였다.방 법 : 1998년 3월부터 1999년 3월까지 충남대학교 소아과에 입원하였던 환아(총 54명)를 대상으로, 출생 3-24개월에 photoscreening과 임상검사를 실시하여 이를 비교하였다.

신생아에서의 Nitroblue Tetrazolium 검사에 대한 연구

박성근,인수미,장미영,변상현 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Purpose : Nitroblue Tetrazolium(NBT) reduction test is ingested by a normal phagocytic neutrophil. It's use on the observation that neutrophil reduction of NBT to an intracellular formazan precipitate by superoxide. Author designed this study to identify the effectiveness of NBT test for prediction of neonatal infection. Methods : In this study, 49 cases of non-infected neonates(Group A, 26cases) and infected cases(Group B, 23cases) who had been admitted at the NICU of Chungnam National University Hospital from June to September, 1998, were included. Author performed NBT tests of two samples on admission(NBT1) and on the 7th day of hospitalization(NBT2) in each group. Results 1) Mean age at NBT1 was 4.00±2.69 days in group A, 3.37±2.87 days in group B, at NBT2 was 11.07±2.70 days in group A, 10.37±2.87 days in group B. 2) NBT1 value was 58.75±28.50% in group A and 55.00±28.23% in group B. NBT2 value was 33.42±19.58% in group A and 40.76±29.32% in group B. There was no significant difference of NBT1 and NBT2 between group A and B. Normal infants, NBT value had higher positive value than other reference values. When infants were infected & normal infants had increased NBT value. 3) In group B, apparent symptoms did not give any influences to the value of NBT1 and NBT 2 significantly. There was no significant difference on NBT test results according to the isolation of pathogen. Conclusion : During neonatal period, there would be false positive & false negative value of NBT test. So, to define infection of neonate, We should consider clinical manifestations & other laboratory findings.

고위험군 가와사끼병에서 스테로이드 추가 요법의 효과

강선미,문은경,인수미,길홍량,Kang, Seon-Mi,Moon, Eun-Kyung,In, Su-Mi,Kil, Hong-Ryang 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.12

Purpose : Recently, clinical trials of steroid add-on therapy were reported with variable results in Kawasaki disease. We analyzed the clinical outcomes of patients at high risk of with Kawasaki disease(${\geq}4$ points of Harada score) treated by three commonly used different treatment regimens, with or without corticosteroids. Methods : Medical records of 96 children with Kawasaki disease treated with one of the threee regimens were reviewed retrospectively. Regimen 1 was aspirin(100 mg/kg/day) plus intravenous gamma globulin 2 g/kg single dose; regimen 2, aspirin(100 mg/kg/day) plus intravenous gamma globulin 1 g/kg single dose; regimen 3, regimen 2 plus prednisolone(2 mg/kg/day), followed by tapering two weeks and pulse therapy of methyl prednisolone performed in cases of retreatment. Also low dose aspirin was given in all three regimens for eight weeks after the acute phase. The cardiovascular and laboratory evaluations were performed on acute phase, immediate after acute phase, and subacute phase, eight weeks after treatment. Results : The frequency of coronary artery lesions and laboratory findings in the three different regimens were similar. The more rapid control of fever after treatment was noted in regimen 3. Furthermore the frequency of retreatment was decreased in regimen 3 compared to the other two regimens. Conclusion : Steroid add-on therapy showed some beneficial outcome compared to conventional treatment regimens. The role of steroid in the treatment of Kawasaki disease should be reassessed in systemic manner. 목 적: 최근 들어 가와사끼병 치료에서 고전적인 치료(정맥 내 감마 글로불린+아스피린) 이외에 과거에 금기시 되었던 스테로이드 병용 요법의 다양한 임상적 결과가 보고되고 있어 가와사끼병 고위험군(Harada score 4점 이상)에서 스테로이드 추가 요법의 임상적 효과를 평가 하고자 하였다. 방 법: 1996년부터 2001년까지 충남대학교병원에서 가와사끼병으로 진단된 96명을 대상으로 급성기의 치료 방법에 따라 3군으로 나누어 비교하였다. 가와사끼병 급성기에 A군은 아스피린(100 mg/kg/day)과 정맥내 감마 글로불린 2 g/kg 1회; B군은 아스피린(100 mg/kg/day)과 정맥내 감마 글로불린 1 g/kg 1회; C군은 B군에 prednisolone(2 mg/kg/day)을 추가 하였고 2주간에 걸쳐 점차 용량을 감소하여 중단하였으며, 재치료시에는 methyl-prednisolone 대용량 요법을 사용하였다. 모든 군에서 급성기 이후 8주간 저용량 아스피린을 사용하였다. 임상적, 심혈관계, 및 혈액학적 평가는 급성기, 급성기 직후, 및 아급성기인 치료 8주 후 시행하였다. 결 과 : 관상 동맥 이상 빈도와 혈액학적 이상 정도는 세 치료군에 유의한 차이는 없었으나 치료 후 해열까지의 기간 및 재치료율에 있어서는 스테로이드 추가 요법 군에서 유의한 감소를 보였다. 결 론 : 스테로이드 추가 요법은 IVGG 단일요법과 비교해 볼 때 관상동맥 질환의 발생, 입원기간 등에서 동등한 치료 효과를 보이며, 해열기간, 재치료율 등에 유의한 감소를 보여 가와사끼병 고위험군에 대한 일차적인 치료법으로 고려될 수 있다.

영아기 가와사끼병의 임상 양상

최윤근,홍정민,인수미,임혜경,길홍량 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.1

목 적 : 영아 가와사끼병 환자에서 관상동맥 병변의 빈도, 관상동맥 병변 발생의 위험인자, 면역 글로블린 정주와 아스피린 요법의 치료 효과 및 임상 양상의 특징을 알아보고자 본 연구를 시행하였다. 방 법 : 1994년부터 1998년까지 충남대학교병원 소아과에서 진단받은 1세미만의 영아 가와사끼병 환자 32명의 의무 기록을 후향적으로 조사하였고, 임상적 특성, 검사 소견, 심초음파검사 소견, 추적관찰 소견 등을 참고로 하였다.결 과 : 1세 미만 영아 가와사끼병 환자는 전체 가와사끼병 환자 중 16%(32/202)를 차지하였고 남녀 비는 2.5 : 1이었으며, 이중 6개월 이하는 22%, 6-12개월 사이는 78%였다. 급성기의 백혈구, 혈소판, C-양성 단백질, 헤마토크릿, 알부민 수치는 관상동맥 병변의 발생 유무와 관계가 없었으나, Harada score는 관상동맥 병변의 유무과 유의한 상관관계가 있었다. 급성기에 관상동맥 병변의 발생은 6개월 미만에서 71 %, 6-12개월에서는 40%로 1세 이후보다 높았고, 특히 6개월 미만에서 높았다. 치료 1년 후에도 17%에서는 관상동맥 병변이 남아 있었다. 발열기간과 치료 후 해열까지의 기간은 관상동맥 병변의 유무와 관계가 없었다. 전형적인 가와사끼병은 75%, 비전형적인 가와사끼병은 25%이었으며, 이 중 50%에서 관상동맥 병변을 보였다. Purpose : To assess the incidence of coronary artery lesion(CAL) and the efficacy of intravenously administered immune globulin(IVGG) and aspirin therapy, identify risk factors for CAL, and analyze clinical characteristics in infants less than 12 months of age with Kawasaki disease. Methods : Retrospective chart review of children less than 12 months of age with Kawasaki disease between 1994 and 1998, diagnosed at Chungnam National University Hospital. Results : Of 202 patients with Kawasaki disease, 32(16 percent) were less than 1 year of age, including 7(3 percent) less than 6 months. Sex ratio of male to female was 2.5 : 1. Age at onset and Harada score were a predictor of the development of CAL : 5(71 percent) of 7 children less than 6 months and 10(40 percent) of 25 children between 6 to 12 months of age acquired CAL (P<0.05), and 1(14 percent) of 7 children less than 6 months of age acquired giant CAL. No specific clinical or laboratory features predicted the development of CAL. Persistent(greater than 1 year) CAL were present in 2(7 percent) of 29 IVGG-treated children. The typical clinical features of Kawasaki disease was noted 24(75 percent) of 32 and the atypical one, 8(25 percent) of 32 children less than 12 months of age. Conclusion : Patients with Kawasaki disease of less than 12 months of age are at particularly increased risk of having CAL and difficulty in diagnosis due to atypical clinical features. So, it is suggested to intervene in the diagnostic criteria or risk factors for CAL, especially for patients with infant Kawasaki disease of less than 6 months of age.

고위험군 가와사끼병에서 스테로이드 추가 요법의 효과

강선미,문은경,인수미,길홍량 대한소아과학회 2002 小兒科 Vol.45 No.12