Relationship between serum 25-hydroxyvitamin D and interleukin-31 levels, and the severity of atopic dermatitis in children

천보람,신정은,김윤지,심재원,김덕수,정혜림,박문수,심정연 대한소아청소년과학회 2015 Clinical and Experimental Pediatrics (CEP) Vol.58 No.3

Purpose: Atopic dermatitis (AD) is a chronic inflammatory relapsing skin disorder. Vitamin D plays apivotal role in the development of AD, and interleukin (IL) 31 is known to be related to pruritus in AD. The aim of our study was to determine whether 25-hydroxyvitamin D (25(OH)D) levels are related to IL-31 levels or to the severity of AD. Methods: We enrolled 91 children with AD and 32 control subjects without history or symptomsof allergic diseases. Blood was drawn to evaluate complete blood cell count, total eosinophil count(TEC), and total IgE, specific IgE to common allergens, 25(OH)D, and IL-31 levels. Serum 25(OH)Dand IL-31 levels were measured using high-performance liquid chromatography and enzyme-linkedimmunosorbent assay, respectively. The scoring atopic dermatitis (SCORAD) index was used toevaluate the severity of AD. Results: The mean 25(OH)D level was significantly lower in the AD group than in the control group;25(OH)D decreased greatly in the moderate and severe AD groups compared with the mild AD group. Children with atopic sensitization showed significantly lower 25(OH)D levels than nonatopic children. However, serum IL-31 levels were not related to AD group, SCORAD index, or 25(OH)D levels. TheSCORAD index was inversely correlated with serum 25(OH)D level and positively correlated with TECsand total IgE levels. Children with moderate and severe AD had significantly higher TECs than childrenwith mild AD. Conclusion: Vitamin D is related to the severity of AD independently of IL-31.

Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma

신정은,천보람,심재원,김덕수,정혜림,박문수,심정연 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.6

Purpose: A nationwide outbreak of Mycoplasma pneumoniae pneumonia (MP) refractory to macrolideantibiotics occurred in Korea during 2011. Steroid therapy has been reported to be both efficacious andwell tolerated in pediatric patients with refractory MP. We compared clinical features and laboratorycharacteristics between children with refractory MP requiring steroid treatment and those withmacrolide-responsive MP and evaluated the risk factors associated with refractory MP. Methods: We investigated 203 children who were admitted to our institution with MP from June toNovember 2011. Refractory MP was defined by persistent fever over 38.3℃ with progressive pulmonaryconsolidation or pleural effusion despite administration of appropriate macrolide antibiotics for 5 daysor longer after admission. Steroid therapy was initiated on the fifth day after admission for refractorycases. Results: There were 26 patients with refractory MP requiring steroid therapy. The mean duration ofsteroid therapy was 5.4 days and most of the patients were afebrile within 24 hours after initiation ofsteroid therapy. The prevalence of refractory MP was higher in patients with pleural effusion, lobarpneumonia affecting more than 2 lobes, higher levels of serum lactate dehydrogenase, increasedoxygen requirements, and longer duration of hospitalization. Atopic sensitization and history of asthmawere also associated with refractory MP after adjusting for age and gender. Conclusion: Children with refractory MP had more severe pneumonia. Atopic sensitization and historyof asthma may be risk factors for refractory MP requiring steroid therapy in Korean children.

우리나라 대도시와 중소도시에 거주하는 산모의 출생아에 비교연구

신정은,천보람,심재원 대한신생아학회 2012 Neonatal medicine Vol.19 No.3

Purpose: Premature and low birth weighted (LBW) infants as well as small for gestational age (SGA) infants have a high death rate and increasing the prevalence rate. We compared the proportion of these high-risk neonates and the relevant factor between the four regional settings. Methods: We reviewed the data from 2005 to 2010, from the Korea National Statistics Office and compared the proportions of premature infants, LBW infants and SGA babies and the relevant factors between Seoul, metropolitan cities and small-to-mediumsized ones. Results: Premature birth rate is as follows in each area: 4.00% in Seoul, 4.21% in metropolitan areas, 4.11% in small and medium size cities, and 4.27% in small towns. SGA birth rate is slightly lower in the medium-sized cities and higher in small towns. The birth rate of low birth weight infants is higher only in small towns (3.58%). It appears that low maternal age and low maternal education levels increase these high-risk newborns. Once calibrated variables, the result showed that the risk of premature infants is higher in the metropolitan areas (OR, 1.05), and the risk of SGA (OR, 1.06) and low birth weight (1.03) is higher in a small town. Conclusion: There were significant differences in the premature infants, low birth weight infants and SGA babies between the four different regional settings. Following the adjustment of the relevant variables, the proportion premature infant was higher in metropolitan cities and SGA babies and LBW infants were higher in small ones. 목적: 미숙아, 저출생체중아와 부당경량아는 신생아 시기의 사망률을 높일 뿐 아니라 이후의 유병률에도 많은 영향을 준다. 이에 수도 서울, 대도시와 중소도시에서의 지역간 이들 질환의 발병 빈도와영향을 주는 인자를 분석하고자 하였다. 방법: 우리나라 통계청 인구동태 자료 중 2005년에서 2010년까지6년간의 출생기록의 원시자료에서 단태아 자료를 추출하였고, 서울지역, 광역시, 중소도시, 소도시에서의 미숙아, 부당경량아, 저출생체중아의 발병빈도와 이에 영향을 주는 인자를 비교하였다. 결과: 지역에 따른 미숙아 출생률은 서울시 광역시, 중소도시와소도시에서 각각 4.00%, 4.21%, 4.11%, 4.27%로 나타났으며, 부당경량아 출생률은 중소도시(9.25%)에서 약간 낮고, 소도시(9.88%)에서 높았으며, 저출생체중아의 출생률은 소도시(3.58%)에서만 높았다. 인구학적으로 저연령의 산모와 낮은 산모의 교육수준이 이들 고위험신생아의 출생률을 높이는 것으로 나타났으며, 산모의 나이, 교 육 정도, 결혼력, 첫째 아이 여부와 출생아의 성별 등의 인자로 교정하여 분석하면, 광역시에서 거주하는 경우 미숙아의 위험도(OR,1.05, 95% CI 1.03-1.06)가 높게 유지되었으며, 소도시에 거주하는경우 부당경량아(OR 1.06, 95% CI 1.05-1.08)와 저출생체중아(1.03,95% CI 1.01-1.06) 출생의 위험도가 높았다. 결론: 미숙아와 저출생체중아 그리고 부당경량아에 출생률에는서울시, 광역시, 중소도시 그리고 소도시에 차이가 있었으며, 20세이하의 저연령산모, 산모의 낮은 교육 정도가 영향을 주는 인자로나타났다. 고위험 신생아의 출생과 연관된 인자를 교정하면 미숙아의 출생은 광역시에서, 부당경량아와 저출생체중아는 소도시에서많았다.

폐출혈을 초기 증상으로 보인 전신홍반루푸스 여아

양윤석 ( Yun Seok Yang ),천보람 ( Bo Ram Cheon ),심재원 ( Jae Won Shim ),김덕수 ( Deok Soo Kim ),정혜림 ( Hye Lim Jung ),박문수 ( Moon Soo Park ),심정연 ( Jung Yeon Shim ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.5

Pulmonary hemorrhage as the initial manifestation of systemic lupus erythematosus (SLE) has been rarely reported in children. We present the case of a 10-year-old girl who was admitted to Kangbuk Samsung Hospital with hemoptysis. She had a 5-day history of cough with dyspnea. On physical exam, breath sound was significantly decreased combined with rales on both lung fields. Blood tests revealed pancytopenia, decreased complement levels (C3, 21.28 mg/dL; C4, 3.10 mg/dL), positive antinuclear antibody (>1:640) and anti-double-stranded DNA antibody (262.5 IU/mL). Chest computed tomography revealed patchy ground glass opacity on both lung fields. She had proteinuria and diffuse lupus nephritis (International Society of Nephrology/Renal Pathology Society class IV-G(A)) confirmed by renal biopsy. High-dose methylprednisolone pulse therapy (30 mg/kg/day) was given for 3 days and then switched to a maintenance dose (1 mg/kg/day). Initially hemoptysis resolved after administration of methylprednisolone, but recurred on the 14th day of treatment. She was then treated with cyclophosphamide pulse therapy and hemoptysis subsided without recurrence. She was discharged on the 31st day of admission. She continued to receive monthly cyclophosphamide pulse therapy until the occurrence of leukopenia and then her regimen was switched to mycophenolate and hydroxychloroquine. SLE continues to be well controlled after 18 months of treatment. Recognition of pulmonary hemorrhage as a possible initial manifestation of SLE is crucial for early diagnosis. SLE was successfully treated with good outcome. (Allergy Asthma Respir Dis 2015;3:370-374)