학동기 소아에서 impulse oscillometry system로 측정한 폐기능 정상치

위영선,김형윤,정다운,박혜원,신윤호,한만용 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.9

목 적 : IOS는 호흡 노력을 요하지 않으며 호흡기 저항을 측정하는 비침습적인 방법이다. IOS를 이용하여 국내 학동기 소아에서의 표준치를 알아보고자 하였다. 방 법 : 7-12세의 건강한 소아 92명을 대상으로 IOS를 시행하였다. IOS 결과 값과 키, 몸무게, 체표 면적, 신체 질량 지수 및 나이 등의 연관성에 대하여 선형 회귀 분석을 시행하였다 결 과 : IOS 성공률은 92.4%였다. 키, 몸무게, 체표 면적, 신체 질량 지수, 나이 등 5가지 변수값과 Rrs 및 Xrs를 분석한 결과, 키가 의미 있는 예측 인자였으며, 5가지 변수 모두 적용한 경우 가장 설명력이 높았다. 각각의 주파수에 따라 회귀 곡선 공식을 구하였으며, 이는 이전 연구들의 표준 공식과 비슷하였다. 결 론 : IOS의 표준치를 구하였으며 이를 활용하여 다양한 호흡기 질환의 진단에 활용될 수 있을 것이라 여겨진다. Purpose : The impulse oscillometry (IOS) is applicable to young children because it requires minimal cooperation and a non-invasive method to measure the mechanics of respiratory system. This study aimed to develop the reference values in school-aged children in Korea, using IOS which is a modification of forced oscillation technique (FOT). Methods : Measurements were performed in 92 previously untrained healthy children, aged 7 to 12 years old, using IOS. We analyzed the relationships between the data about their age, height, weight, body surface area (BSA), body mass index (BMI) and the result of IOS using the linear regression test. Results : The success rate of IOS was 92.4%. Stepwise multiple regression of resistance of respiratory system (Rrs) and reactance of respiratory system (Xrs) in natural form for age, height, weight, BSA, BMI showed that height was the most significant predictor and altogether of 5 variables explained the Rrs and Xrs most. Our regression equations at multiple frequencys were comparable to published reference values, especially about the Rrs obtained at 5 Hz. Conclusion : IOS is a feasible method to measure the respiratory resistance in untrained children. We got the reference values using IOS and it seems to be useful to diagnose a variety of respiratory diseases.

미숙아에서 초기 스트레스성 고혈당과 예후 사이의 연관성

위영선,안계현,유은경,임인숙,이규형 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.5

Purpose:Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods:In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results:There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion:Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants. (Korean J Pediatr 2007;51:474-480) Purpose:Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods:In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results:There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion:Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants. (Korean J Pediatr 2007;51:474-480)

방광 요관 역류를 동반한 Goldenhar 증후군 1례

안계현 ( Gae Hyun Ahn ),위영선 ( Young Sun Wee ),이규형 ( Kyu Hyung Lee ) 대한주산의학회 2007 Perinatology Vol.18 No.3

Goldenhar`s syndrome is a kind of congenital anomaly with epibulbar dermoid, preauricular skin tag, blind-ended fistula and vertebral anomaly. The primary cause is unknown but thought to be a structural developmental abnormalities of the 1st, and 2nd branchial arch. In this syndrome, we can observe characteristic anomalies of the face, ear, vertebrae, heart, and the nervous system. Treatment is surgical correction, removal of epibulbar dermoid, prevention of hearing loss through early hearing test. The consultations of ophthalmologist, otorhinolaryngologist, orthopedist and dentist are necessary for this syndrome. We report a case of Goldenhar`s syndrome with hemifacial hypoplasia, preauricular skin tags, blind-ended fistulas, hemivertebrae and vesicoureteral reflux.

소아에서 발병한 human metapneumovirus와 respiratory syncytial virus에 의한 호흡기 감염의 임상 양상

김유경,유은경,김진우,위영선,한만용 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.1

Purpose : To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. Methods : The participants of our study were 1,104 children who were admitted to Bungdang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. Results : The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age ≥2 years, while in the RSV group, 19% were age ≥2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. Conclusion : hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children. 목 적 : 국내에서 호발하는 hMPV와 RSV감염의 임상 양상의 차이가 아직 명확하지 않아 이를 확인하고자 한다. 방 법 : 2006년 8월부터 2007년 7월까지 분당 차병원에 하부 호흡기 감염으로 입원한 환아 1,104명을 대상으로 비인강 흡입법과 RT-PCR을 이용하여 바이러스를 검출하였다. 이중 hMPV와 RSV 감염 양성인 환자 각각 51명과 138명을 대상으로 후향적인 의무기록분석을 통해 검출 시기, 연령, 성별, 임상 진단명, 임상 양상 및 검사 소견을 비교 분석하였다. 결 과 : hMPV감염은 4월에, RSV감염은 11월에 가장 많이 발생하였다. 두 군 모두 1세 미만의 영아가 가장 많았으나 6개월 이하의 군에서 hMPV는 25% RSV는 40%를 차지하였다. 2세 이상의 군에서는 hMPV가 33.4%, RSV는 19%였다. 진단명은 두 군 모두 폐렴, 급성 세기관지염, 급성 기관지염 순으로 차이를 보이지 않았다. 말초 혈액 백혈구수는 RSV 감염시 더 높았고, 입원 당시 열이 있는 환아의 비율은 hMPV군에서 더 높았다. 결 론 : 본 연구에서 hMPV는 영유아에서 바이러스성 하부 호흡기 감염의 네 번째로 흔한 원인으로, hMPV 감염의 임상양상은 RSV 감염과 유사하였다. 향후 이러한 연구가 호흡기 바이러스 감염의 효율적인 관리에 도움이 될 것이라 여겨진다.

학동 전기 소아에서 폐활량 측정의 질관리와 성공률

서현경,장선정,정다운,위영선,지혜미,서지영,한만용 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.11

Purpose:We examined the ability of preschool aged children to meet the American Thoracic Society (ATS) and European Resiratory Society (ERS) goals for spirometry quality and tried to find out the major factor for improving the rate of success of spiromety test in this age group. Methods:Spirometry was performed in 2-6 aged 155 children with chronic cough or suspicious asthma with the recording of maneuver quality measures of forced expiratory time, end-of-test volume, back-extrapolated volume (Vbe), and forced vital capacity (FVC), as well as flow-volume curve. The subjects were tested several times and the two best results in each subject were selected. All criteria for quality control were suggested by ATS/ERS guidelines. The criteria for starting of the test was Vbe <80 mL and Vbe/FVC <12.5%. The criteria for repeatability of the test was that second highest FVC and FEV1 are within 100 ml or 10% of the highest value, whichever is greater. For the criteria for termination of the test for preschool aged children, we evaluated the flow-volume curve Results:As getting older, the success rate of spirometry increased and rapidly increased after 3 years old. Total success rate of the test was 59.4% (2 years old - 14.3%, 3 years old - 53.7%, 4 years old - 65.1%, 5 years old - 69.7%, 6 years old- 70.8%). The percentage of failure to meet the criteria for starting the test was 6.5%, repeatability of the test was 12.3% and end of the test was 31%. There was a significant difference only in age between success group and failure group. Evaluating the quality control criteria of previous studies, the success rate increased with age. Conclusion:About 60% of preschool aged children met ATS/ERS goals for spirometry test performance and the success rate was highly correlated with age. It is clearly needed that developing more feasible and suitable criteria for quality control of spirometry test in preschool aged children. 목 적:국내 학동 전기 소아를 대상으로 폐활량 측정법을 시행하여 기존에 제시된 여러 지표를 기준으로 검사 결과의 적정성을 평가함으로써 이 연령대에서의 폐기능 검사의 성공률을 알아보고자 하였다. 방 법:만성 기침이나 천식이 의심되어 내원한 2세 이상 6세 이하의 176명을 대상으로 폐활량 측정법을 시도하여 총 155 명에서 측정 결과를 얻을 수 있었다. ATS/ERS 에서 제시한 기준에 따라 후외삽용적(Vbe)이 80 mL 미만이고 FVC의 12.5% 미만일 때를 시작 기준에 적합하다고 정의하였다. 검사의 반복성을 확인하기 위해 선별한 두개의 유량-용적 곡선에서 FVC, FEV1 의 차이를 구하여 FVC와 FEV1의 절대적 차이값이 100 mL 또는 10% 미만인 경우를 적합하다고 정하였다. 검사의 종료에 대한 기준은 학동 전기 연령에서 수치적으로 정의되어 있지 않지만 유량-용적 곡선이 초기에 급격하게 증가해서 후기에 완만하게 감소하는 것을 합당하다고 보았다. 또한 유량-용적 곡선이 적절하게 나온 대상자(107명)를 선별하여 다른 문헌에 발표된 여러 정도 관리 기준에 맞추어 각 항목별로 성공률을 비교하였다 결 과:전체 폐기능 검사의 성공률은 59% 이었고 연령이 증가할수록 폐활량 측정법의 성공률이 증가하였으며, 특히 3세부터 급격하게 성공률이 증가하였다(2세 14.3%, 3세 53.7%, 4세 65.1%, 5세 69.7%, 6세 70.8%). 폐활량 측정법의 실패 원인으로는 시작 기준에 맞지 않는 경우가 전체의 6.5%, 반복성 기준에 맞지 않는 경우가 12.3% 또 최대 호기량의 부족, 조기 종료 등으로 인해 검사 종료 기준에 맞지 않는 경우가 전체의 31% 로 가장 높았다. 폐활량 측정법 성공군와 실패군을 비교하였을 때 나이에서만 유의한 차이가 있었다(P<0.01). 정도 관리에 대한 몇몇 연구결과에 따라 각 항목별로 성공률을 보았을 때 연령이 증가할수록 성공률도 증가하였다. 결 론:학동 전기 소아에서도 약 60% 정도 폐활량 측정법을 성공적으로 수행하였다. 성공률은 연령에 따라 급격히 변화하므로 각 연령에 적합한 정도 관리 기준을 개발하여 이용한다면 검사의 성공률을 높일 수 있을 것으로 사료된다.

소아에서 발병한 human metapneumovirus와 respiratory syncytial virus에 의한 호흡기 감염의 임상 양상

김유경 ( Yu Kyung Kim ),김진우 ( Jin Woo Kim ),위영선 ( Young Sun Wee ),유은경 ( Eun Gyong Yoo ),한만용 ( Man Yong Han ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.1

목적: 국내에서 호발하는 hMPV와 RSV 감염의 임상 양상의 차이가 아직 명확하지 않아 이를 확인하고자 한다. 방법: 2006년 8월부터 2007년 7월까지 분당차병원에 하부 호흡기 감염으로 입원한 환아 1,104명을 대상으로 비인강 흡입법과 RT-PCR을 이용하여 바이러스를 검출하였다. 이중 hMPV와 RSV 감염 양성인 환자 각각 51명과 138명을 대상으로 후향적인 의무기록분석을 통해 검출 시기, 연령, 성별, 임상 진단명, 임상 양상 및 검사 소견을 비교 분석하였다. 결과: hMPV감염은 4월에, RSV감염은 11월에 가장 많이 발생하였다. 두 군 모두 1세 미만의 영아가 가장 많았으나 6개월 이하의 군에서 hMPV는 25% RSV는 40%를 차지하였다. 2세 이상의 군에서는 hMPV가 33.4%, RSV는 19%였다. 진단명은 두 군 모두 폐렴, 급성 세기관지염, 급성 기관지염 순으로 차이를 보이지 않았다. 말초 혈액 백혈구수는 RSV 감염시 더 높았고, 입원 당시 열이 있는 환아의 비율은 hMPV군에서 더 높았다. 결론: 본 연구에서 hMPV는 영유아에서 바이러스성 하부 호흡기 감염의 네 번째로 흔한 원인으로, hMPV 감염의 임상양상은 RSV 감염과 유사하였다. 향후 이러한 연구가 호흡기 바이러스 감염의 효율적인 관리에 도움이 될 것이라 여겨진다. Purpose: To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. Methods: The participants of our study were 1,104 children who were admitted to Bung-dang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. Results: The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age ≥2 years, while in the RSV group, 19% were age ≥2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. Conclusion: hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children. [Pediatr Allergy Respir Dis(Korea) 2009;19:12-19]