마크로라이드 내성 마이코플라스마 폐렴이 우리에게 안긴 숙제는?

유진호 ( Jinho Yu ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.1

6-8세 천식 환아에서 △FVC(메타콜린 PC₂₀에서의 강제폐활량의 감소율)와 혈청 호산구 양이온 단백의 관계

서동인,유진호,유영,김도균,강희,고영률,Suh, Dong In,Yu, Jinho,Yoo Young,Kim, Do Kyun,Kang, Hee,Koh, Young Yull 대한소아청소년과학회 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.10

목 적 : 기관지 과반응성은 천식의 주된 특징이다. 또한 천식 환자에서 혈청 호산구 양이온 단백의 농도가 증가되어 있음이 잘 알려져 있다. 혈청 호산구 양이온 단백의 농도와, 기관지 과반응성의 대표적 지표인 메타콜린 $PC_{20}$과의 관계에 대해서 결과가 다소 상반되는 여러 보고가 있어왔다. 본 연구의 목적은 혈청 호산구 양이온 단백의 농도와 기관지 과반응성의 또다른 지표로서 최대 기도 반응을 반영하는 ${\Delta}FVC$와의 상관관계를 살펴보는 것이다. 방 법 : 6-8세 천식 환아 109명을 대상으로 폐기능 검사 및 메타콜린 기관지 흡입 유발 시험을 시행하였다. 개개의 환자로부터 메타콜린 용량 반응 곡선에서 ${\Delta}FVC$ 및 $PC_{20}$을 계산하였다. 이들의 혈액 내 총 호산구 수 및 혈청 ECP 농도를 측정하여 ${\Delta}FVC$ 및 $PC_{20}$과 상관관계를 분석하였다. 결 과 : 혈청 ECP는 ${\Delta}FVC$(r=0.217, P=0.023) 및 $PC_{20}$(r=-0.208, P=0.030)과 상관관계를 나타내었다. 반면 혈액 내 총 호산구 수는 ${\Delta}FVC$(r=0.085, P=0.378) 및 $PC_{20}$(r=-0.148, P=0.125)과 상관관계를 보이지 않았다. ${\Delta}FVC$는 $PC_{20}$과도 상관관계를 보이지 않았다(r=-0.079, P=0.417). 결 론 : 6-8세 천식 환아에서 기관지 과반응성이, 민감성 증가뿐만 아니라 최대반응의 증가라는 측면에서도 호산구성 염증의 활성화와 관련이 있다. Purpose : Bronchial hyperresponsiveness(BHR) is considered a hallmark of asthma. Increased levels of eosinophil cationic protein(ECP) have been identified in serum of asthma patients. Several studies have examined the relationship between serum ECP and bronchial responsiveness, expressed as methacholine $PC_{20}$ in asthmatic patients, with conflicting results. The aims of this study were to examine the relationship between serum ECP and ${\Delta}FVC$, another index of bronchial responsiveness, which reflects increased maximal airway response. Methods : Six to 8-year-old children with asthma(n=109) underwent methacholine bronchoprovocation testing. The $PC_{20}$ dose of methacholine and ${\Delta}FVC$ were calculated for each individual from the methacholine dose response curves. Serum ECP levels and blood total eosinophil counts were also measured. Results : Serum ECP correlated with ${\Delta}FVC$(r=0.217, P=0.023), as well as $PC_{20}$(r=-0.208, P=0.030). However, blood eosinophil counts failed to show any correlations with ${\Delta}FVC$(r=0.085, P=0.378) or $PC_{20}$(r=-0.148, P=0.125). ${\Delta}FVC$ did not correlate with $PC_{20}$(r=-0.079, P=0.417). Conclusion : Blood eosinophil activation is associated with both components of BHR including increased sensitivity and increased maximal response in 6-8 year old children with asthma.

기관지 과민성을 가진 장기간 천식 관해 상태의 청소년에서 혈액 내 호산구와 혈청 호산구 양이온 단백에 대한 연구

강희,유영,유진호,박양,고영률,Kang, Hee,Yoo, Young,Yu, Jinho,Park, Yang,Koh, Young Yull 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.10

목 적 : 천식 환자에서 특징적으로 존재하는 BHR의 기전으로 호산구성 기도 염증 반응이 중요시 생각되고 있다. 그러나 장기간 천식 관해 상태인 청소년에서 BHR이 지속되는 기전에 대해서는 아직 명확하지 않은 실정이다. 본 연구는 장기간 천식 관해 된 청소년에서의 BHR이 호산구성 기도 혈액내 총 호산구 증가와 혈청 ECP 농도의 증가와 연관되어 있는지 알아보고자 시행하였다. 방 법 : 서울대학교 어린이병원 소아과 외래에서 아토피성 천식으로 진단되었던 청소년 중 임상적으로 장기간 관해(최근 2년간 천식 증상이 없고 치료가 필요 없었던 경우)되었으나 BHR이 잔존하는 35명과 이들과 서로 대응하는 BHR을 갖고 있으면서 현증을 보이는 아토피 천식 청소년 35명을 대상으로 하였다. 이 두 군간의 총 호산구 수와 혈청 ECP 농도를 비교하고 각 군에서 총 호산구 수 및 혈청 ECP 농도와 $PC_{20}$ 사이에 상관 관계가 있는 지 분석하였다. 결 과 : 장기간 관해 된 군의 혈액 내 호산구 수와 혈청 ECP 농도의 평균값이 현증을 보이는 군보다 통계적으로 유의하게 낮았다($273{\pm}108$ vs. $365{\pm}178/{\mu}L$; $16.3{\pm}9.4$ vs. $26.5{\pm}15.1{\mu}g/L$, both, P<0.05). 현증을 보이는 군에서는 메타콜린 $PC_{20}$에 따라 혈액 내 호산구 수 및 혈청 ECP 농도가 각각 통계적으로 유의한 음의 상관관계를 보였으나(r=-0.385, P=0.022; r=-0.439, P=0.008) 장기간 관해 된 군에서는 유의한 상관관계를 보이지 않았다(r=-0.292, P=0.089; r=-0.243, P=0.159). 결 론 : 이와 같은 소견은 장기간 관해시의 BHR은 호산구성 염증과 연관성이 없으며 현증 천식에서의 BHR과는 다른 기전으로 설명될 수 있을 것으로 추정된다. 장기간 천식 관해 된 청소년에서 BHR이 잔존하는 기전에 대하여 정확히 밝히기 위해서 향후 BAL, 조직 검사, 유도 객담 등을 이용한 연구를 시행할 필요가 있다. Purpose : Bronchial hyperresponsiveness(BHR) in asthma is thought to be a consequence of underlying airway inflammation. But the mechanism responsible for persistent BHR in adolescents with long-term asthma remission is poorly understood. The aim of this study was to examine whether BHR in adolescents with asthma remission is associated with peripheral blood eosinophilia and/or increased serum levels of eosinophil cationic protein(ECP). Methods : We studied 35 adolescents with long-term asthma remission(neither symptoms nor medication during the previous two years) who have persistent BHR(remission group) and 35 adolescents with symptomatic asthma(symptomatic group) who were matched for methacholine provocative concentration producing a 20% fall in $FEV_1(PC_{20})$ with subjects in the remission group. The peripheral blood eosinophil counts and serum ECP concentrations were compared between these two groups. Correlations between $PC_{20}$ and peripheral blood eosinophil counts or serum ECP concentrations were assessed in these two groups. Results : Peripheral blood eosinophil counts and serum ECP concentrations were significantly lower in the remission group than in the symptomatic group($273{\pm}108$ vs. $365{\pm}178/{\mu}L$; $16.3{\pm}9.4$ vs. $26.5{\pm}15.1{\mu}g/L$, both, P<0.05). $PC_{20}$ was correlated with peripheral blood eosinophil counts and serum ECP concentrations in the symptomatic group(r=-0.385, P=0.022; r=-0.439, P=0.008), but not in the remission group(r=-0.292, P=0.089; r=-0.243, P=0.159). Conclusion : BHR in adolescents with long-term asthma remission is not associated with peripheral blood eosinophilia or an increase in serum ECP concentration, which suggests that BHR in this clinical setting may not be attributed to airway eosinophilic inflammation. Further studies including direct assessment of airway inflammation are needed to confirm this conclusion.

군용 하이브리드 추진시스템 회생제동장치 연비개선 평가

최현석(Hyunseok Choi),한규홍(Kyuhong Han),유진호(Jinho Yu),장교근(Kyogun Chang),이윤복(Yoonbok Lee) 한국자동차공학회 2012 한국자동차공학회 부문종합 학술대회 Vol.2012 No.5

Regenerative brake system in currently developing lightweight tactical HEV can"t absorb maximum regenerative power because of braking feeling. In this study, we didn"t activate frictional brake until regenerative brake absorbs maximum torque by making additional devices and setting them to the vehicle. And we performed the fuel economy test on the vehicle 4X4 TM dynamometer. The result shows that 53% energy absorption increase in brake-stop test, 8.7% fuel economy increase in FTP-72 mode and 10.8% increase in South Korean forward area driving mode.

소아 천식의 진단에서 호기산화질소와 메타콜린 및 adenosine-5`-monophosphate 기관지유발시험의 비교

윤지선 ( Jisun Yoon ),박준성 ( Jun Sung Park ),조현주 ( Hyun Ju Cho ),이은 ( Eun Lee ),양송이 ( Song I Yang ),홍수종 ( Soo Jong Hong ),유진호 ( Jinho Yu ) 대한천식알레르기학회 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2

Purpose: Asthma is a chronic airway inflammatory disease characterized by bronchial hyperresponsiveness and reversible airway obstruction. Bronchial challenge with methacholine or adenosine-5`-monophosphate (AMP) has been used to diagnose asthma. Recently, measurement of exhaled nitric oxide (eNO) can also be used for the diagnosis of asthma. The aim of this study was to compare the diagnostic value for asthma between challenge with methacholine or AMP and eNO in children with chronic nonspecific respiratory symptoms. Methods: One hundred thirty-three children who have chronic nonspecific respiratory symptoms were enrolled. Bronchial challenge with methacholin and AMP were performed, and eNO was measured in all subjects. Subjects were defined as asthma based on the clinical symptoms and bronchodilator response during follow-up of at least 3 months after test. Results: Thirty-three subjects (34%) were finally diagnosed as asthma among 97 patients after 3-month follow-up. The area under the receiver operating characteristic curves for the diagnosis of asthma were 0.903 (95% confidence interval [CI], 0.838-0.969; P<0.001) for methacholline challenge, 0.867 (95% CI, 0.783-0.950; P<0.001) for AMP challenge, and 0.588 (95% CI, 0.467-0.709, P=0.156) for eNO measurement. The cutoff values of these tests were methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) 12.0 mg/mL (sensitivity, 87.9%; specificity, 82.8%), AMP PC20 566.2 mg/mL (sensitivity, 84.8%; specificity, 85.9%), and eNO 18.5 ppb (sensitivity, 45.5%; specificity, 71.9%). Conclusion: Measurement of eNO may be inferior to challenge with methacholine and AMP for the diagnosis of asthma in children. (Allergy Asthma Respir Dis 2016;4:100-106)

알레르기비염 동반 여부에 따른 소아 아토피 천식 환자의 호기산화질소 농도와 기관지 과민성

박준성 ( Junsung Park ),이은 ( Eun Lee ),양송이 ( Song I Yang ),윤지선 ( Jisun Yoon ),조현주 ( Hyun Ju Cho ),홍수종 ( Soo Jong Hong ),유진호 ( Jinho Yu ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Purpose: Children with asthma frequently have allergic rhinitis (AR) as a comorbidity. Asthmatic children with AR have a higher exhaled nitric oxide (eNO) level and bronchial hyperresponsiveness (BHR) than those without. The purpose of this study is to investigate the difference in lung function, eNO, and BHR between atopic asthma with and without AR, and the association of eNO and BHR with atopic intensity in total asthmatics. Methods: We recruited 69 atopic asthmatic children with AR, 19 atopic asthmatic children without AR, 38 children with AR, and 43 nonatopic controls. We measured forced expiratory volume in one second (FEV1) and forced expiratory flow at 25% to 75% of forced vital capacity (FEF25%-75%), dose response slope (DRS) of bronchial challenge with methacholine and adenosine 5’-monophosphate (AMP), the levels of eNO, and the ratio of sum of allergen wheal diameter to histamine using skin prick tests. Results: Atopic asthmatic children with AR had a higher eNO level compared to those without AR (P<0.05). However, there was no difference in FEV1 %predicted, FEF25%-75% %predicted, methacholine DRS, and AMP DRS between asthmatic children with and without AR. In total asthmatics, methacholine DRS and AMP DRS significantly correlated with eNO levels (r=0.338, P<0.001; r=0.365, P<0.001), but not with total IgE levels. However, eNO significantly correlated with total IgE levels (r=0.479, P<0.001). Conclusion: These results suggest that AR may enhance airway inflammation but may not lead to enhanced BHR in children with asthma. (Allergy Asthma Respir Dis 2015;3:425-431)

대기 미세먼지가 천식 발생과 조절에 미치는 영향

김상헌 ( Sang Heon Kim ),양현종 ( Hyeon Jong Yang ),장안수 ( An Soo Jang ),김상훈 ( Sang Hoon Kim ),송우정 ( Woo Jung Song ),김태범 ( Tae Bum Kim ),예영민 ( Young Min Ye ),유영 ( Young Yoo ),유진호 ( Jinho Yu ),윤종서 ( Jong Seo 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.5

There has been growing concern regarding the effects of ambient air pollution on asthma. Particulate matter (PM) is one of the major air pollutants affecting both general population and the patients with asthma. This paper reviews the recent evidence of the adverse effects of PM on the inception and morbidity of asthma. Epidemiological studies confirmed that short-term exposure to PM aggravated respiratory symptoms and lung function in asthma patients. Furthermore, PM induces acute exacerbations of asthma with increased risk of hospitalization and death. Long-term exposure to PM is responsible for new onset of asthma and lung function decline in both children and adults. Various mechanisms are involved in the effects of PM on airway including oxidative stress, augmentation of inflammation, promotion of allergen sensitization, induction of airway hyperresponsiveness, aggravation of rhinitis and DNA methylation. Special attention and care is needed for the patients with asthma to prevent the detrimental effects of PM. (Allergy Asthma Respir Dis 2015;3:313-319)

단일기관에서 전산을 통해 수집된 자발적 소아 약물유해반응 보고사례의 분석

박근미 ( Geun-mi Park ),박주현 ( Joo Hyun Park ),정주원 ( Joo Won Jung ),한혜원 ( Hye Won Han ),김재연 ( Jae Youn Kim ),이은 ( Eun Lee ),조현주 ( Hyun-ju Cho ),김영호 ( Yeongho Kim ),윤지선 ( Jisun Yoon ),유진호 ( Jinho Yu ),김태범 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.5

Purpose: The incidence of adverse drug reactions (ADRs) is increasing. However, studies on the prevalence of ADRs in children are rare. The aim of this study was to investigate the causative drugs and clinical features of ADRs for children in a tertiary university hospital of Korea. Methods: We retrospectively collected ADRs by a computerized self-reporting system in Asan Medical Center. ADRs of children under the age 18 were collected from January 2005 to August 2015, and we analyzed only ADRs containing current symptoms among total ADR data. Results: A total of 1,408 ADR cases were reported, There were 764 male (54.3%) and 644 female patients (45.7%), and the mean age was 11.5±5.8 years (range, 0.18 years). Antibiotics (n=479, 34.0%) were the most common causative drugs, followed by tramadol (n=173, 12.3%), nonsteroidal anti-inflammatory agents (NSAIDs) and acetylsalicylic acid (n=103, 7.3%), narcotics (n=91, 6.5%), antineoplastics (n=87, 6.2%), and sedatives (n=82, 5.8%). The most common clinical features were skin manifestations (n=500, 34.4%). Gastrointestinal symptoms (n=435, 29.9%) were the second most common clinical features, followed by neuropsychiatric symptoms (n=155, 10.7%) and respiratory symptoms (n=123, 8.5%). Among antibiotics, glycopeptides (n=110, 23.0%), third-generation cephalosporins (n=83, 17.3%), and penicillin/ß-lactamase inhibitors (n=60, 12.7%) were the most frequently reported causative drugs. Conclusion: Antibiotics were the most reported common causative drugs of ADRs in children, followed by tramadol, NSAID, and narcortics. Compared with adults, the prevalence of contrast medium-induced ADR was lower in children with a higher prevalence of sedative-associated ADR. Greater attention to possible ADRs in children is needed among medical personnel. (Allergy Asthma Respir Dis 2016:4:354-359)

아토피 소아와 아토피 부모에서 피부 단자 시험 결과의 일치도

강희,유진호,유영,고영률 대한알레르기학회 2004 천식 및 알레르기 Vol.24 No.2

학령 전기 아동의 천식 진단에서 흉부 청진과 산소 포화도를 이용한 기관지 과민성 측정의 진단적 의의

서동인,유영,김도균,유진호,강희,고영률 대한 소아알레르기 및 호흡기학회 2004 소아알레르기 및 호흡기학회지 Vol.14 No.2