학동기 및 청소년 천식 소아들의 임상 양상과 천명 시작 시기와의 관련성

장광천 ( Gwang Cheon Jang ),심정연 ( Jung Yeon Shim ),안영민 ( Young Min Ahn ),정진아 ( Jin A Jung ),김성원 ( Sung Won Kim ),정혜리 ( Hai Lee Chung ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.5

Purpose: We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma. Methods: Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age <3 years); group B, preschool onset (age 3-6 years); group C, late onset (age ≥6 years). Clinical characteristics including atopic sensitization, family history, combined allergic diseases, severity of asthma, and influence of asthma on daily life were examined. A history of hospitalization for early lower respiratory infection (LRI) and environmental tobacco smoking were studied and lung function tests were also performed. Results: There was no difference in demographics, prevalence of atopy, combined allergic diseases, and family history of allergy between 3 groups. A history of sever LRI in early life was more common in groups A and B compared with group C. Sensitization to Dermatophagoides pteronyssinus was more prevalent in groups A and B than in group C. Forced expiratory flow between 25% to 75% (FEF25%-75%) was lower in groups A and B than in group C, and methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) was lowest in group B. Significantly lower FEF25%-75% and methacholine PC20 were observed in the patients who had been hospitalized with LRI in early life. Conclusion: Our study shows significant difference in lung function and atopic sensitization in relation to the onset age of wheeze in school-age children and adolescents with asthma, and suggests that early LRI might contribute to the development of asthma in early life. (Allergy Asthma Respir Dis 2015;3:326-333)

Respiratory Syncytial Virus 재감염에 의한 기도과민성과 기도염증에 대한 Cytosine-phosphate-Guanine Oligodeoxynucleotides의 효과

장광천 ( Gwang Cheon Jang ),이용원 ( Yong Won Lee ),김규언 ( Kyu Earn Kim ),홍천수 ( Chein Soo Hong ),박중원 ( Jung Won Park ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.2

Background: Severe respiratory syncytial virus (RSV) infection in neonate has been reported as a risk factor for the development of allergic asthma or early transient wheezing. RSV can induce reinfection by the same strain. Reinfection after neonatal RSV infection can induce eosinophilic inflammation and aggravate airway hyperresponsiveness (AHR) in a BALB/C mouse model. Objective: We evaluated whether cytosine-phosphate- guanine oligodeoxynucleotides (CpG ODNs) administration at initial RSV infection could prevent the aggravation of AHR and eosinophilic inflammation with repeated RSV infection in a mouse model. Method: Mice were infected shortly after birth and were reinfected 5 weeks later by the intranasal administration of RSV (106 pfu) and followed by the assessment of airway function, airway inflammation, and lung histopathology. Phosphorothioate CpG (1,826s; 2 mcg/mouse) was also administered intranasally 2 days after initial RSV infection. Result: Repeated RSV infection induced methacholine (Mch) AHR, eosinophilic inflammation and goblet cell hyperplasia in the control ODN group. CpG ODN administration at initial RSV infection attenuated Mch AHR and eosinophilic inflammation, and decreased levels of IL-13 and IL-5, but increased IFN-γ in BAL fluid and RSV- IgG2a in sera. Conclusion: These findings suggest that CpG ODN can be used to prevent of airway allergic inflammation by RSV reinfection. (Korean J Asthma Allergy Clin Immunol 2010;30:123-130)

한국 아나필락시스의 진료

장광천 ( Gwang Cheon Jang ),장윤석 ( Yoon Seok Chang ),최선희 ( Sun Hee Choi ),송우정 ( Woo Jung Song ),이수영 ( Soo Young Lee ),박해심 ( Hae Sim Park ),강혜련 ( Hye Ryun Kang ),예영민 ( Yeong Min Ye ),진현정 ( Hyun Jung Jin ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Anaphylaxis is a medical emergency and all healthcare professionals need to be familiar with its diagnosis, acute management, long-term management including prevention of future episodes, and plan for patient education. Correct diagnosis and management for anaphylaxis is critical, but it is not easy in clinical setting. Up to the present, several practical guidelines for anaphylaxis are available for the practitioners. Among them, World Allergy Organization guideline for the assessment and management has recently been released and widely used. In this article, we reviewed and summarized the epidemiology, risk factors, diagnosis, management, prevention, and education based on case reports and studies of anaphylaxis in Korean and other countries. Although there are many controversies, this practical overview for anaphylaxis would provide a clinical guidance for Korean healthcare professionals. (Allergy Asthma Respir Dis 2013;1:181-196)

한국 아나필락시스의 진료

장광천 ( Gwang Cheon Jang ),장윤석 ( Yoon Seok Chang ),최선희 ( Sun Hee Choi ),송우정 ( Woo Jung Song ),이수영 ( Soo Young Lee ),박해심 ( Hae Sim Park ),강혜련 ( Hye Ryun Kang ),예영민 ( Yeong Min Ye ),진현정 ( Hyun Jung Jin ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3

Anaphylaxis is a medical emergency and all healthcare professionals need to be familiar with its diagnosis, acute management, longterm management including prevention of future episodes, and plan for patient education. Correct diagnosis and management for anaphylaxis is critical, but it is not easy in clinical setting. Up to the present, several practical guidelines for anaphylaxis are available for the practitioners. Among them, World Allergy Organization guideline for the assessment and management has recently been released and widely used. In this article, we reviewed and summarized the epidemiology, risk factors, diagnosis, management, prevention, and education based on case reports and studies of anaphylaxis in Korean and other countries. Although there are many controversies, this practical overview for anaphylaxis would provide a clinical guidance for Korean healthcare professionals. (Allergy Asthma Respir Dis 2013;1:181-196)

폐구균의 질병양상 및 항균제 내성률의 변화

장광천,신경미,용동은,이경원,김동수,Jang, Gwang-Cheon,Shin, Kyoung Mi,Yong, Dong-Eun,Lee, Kyung-Won,Kim, Dong-Soo 대한소아감염학회 2003 Pediatric Infection and Vaccine Vol.10 No.1

목 적 : 폐구균은 중이염, 폐렴등의 흔한 원인이며 패혈증 및 뇌수막염 등 중증감염을 일으킬 수 있다. 최근 폐구균의 항균제 내성률이 증가하는 추세를 보이며, 예방접종이 개발되어 우리나라에서도 곧 시행될 전망이다. 이에 본 연구에서는 폐구균에 의한 질병분포 및 내성률에 대한 변화 등을 알아보고자 하였다. 방 법 : 1991년 1월부터 2000년 12월까지 연세대학교 신촌세브란스병원 소아과에서 시행한 배양검사상 폐구균이 확인된 환아 306명을 대상으로 임상양상과 진단명을 의무기록을 통해 후향적으로 조사하였고, 선천성 심질환이나 혈액종양질환을 앓고 있는 환아는 조사대상에서 제외하였다. 월별 빈도와 연도별 내성률의 변화 및 연령에 따른 중증감염의 정도를 비교하였다. 결 과 : 1) 검사 당시 연령은 2개월부터 15세까지의 분포를 보이며 평균연령은 7.9세이었고, 연령별로는 6세 미만이 77%로 대부분을 차지하고 2세 미만이 42%이었다. 남녀 비는 1.6 : 1이었다. 2) 월별 분포는 봄에 해당하는 3월과 4월이 42%로 높았고 여름에 해당하는 8월과 9월이 6%로 낮았다. 3) 질병별로는 폐렴 29.2%, 중이염 19.3%, 패혈증 17.6%, 뇌막염 9.5%순이었고, 연령별 차이는 없었다. 4) 페니실린에 대한 내성률은 1991년 65%에서 2000년에 84%로 점차 증가하는 추세였다. 다제내성의 경우도 1991년 10%에서 2000년 78.3%로 점차 증가하는 추세를 보였다. 결 론 : 6세 미만의 어린 소아에서 중증감염을 일으키는 원인의 하나인 폐구균은 점차 내성률 및 다제내성 빈도가 증가하는 추세로 전국적 조사가 필요하며, 이의 예방을 위해 폐구균의 예방접종에 대한 검토가 필요하다. Purpose : Streptococcus pneumoniae remains a leading cause of meningitis, sepsis, pneumonia, and otitis media in children worldwide. Emergence of drug-resistant organism has substantially complicated the therapy of these infections. This study was conducted to determine the clinical features and changing patterns of antibiotic-resistant rates of Streptococcus pneumoniae. Methods : We have retrospectively examined 306 cases of culture proven patients who were admitted to the Department of Pediatrics, Severance hospital, from the year 1991 to year 2000. The type of culture specimen used, presence of penicillin resistance, characteristics according to various presenting diseases and their prevailing year were also examined. Results : The mean age of cases was 7.9 year and the ratio of male to female was 1.6 : 1. The main age group of pneumococcal infection was under 2 years(42%). Systemic infections associated with pneumococci were sepsis(19.3%) and meningitis(9.5%), while local infections presented as pneumonia(29.2%), otitis media(19.3%), exudative tonsillitis(13.3%), and sinusitis(9.2%) in the order of frequency. Seasonal variation was seen in the incidence of pneumococcal infection: high incidence of infection was seen in Spring(Mar.~Apr; 32%), while the incidence was low during summer(Aug.~Sep.; 6%). Penicillin-resistant rate of pneumococci was steadily on the increase since the year 1991(65%) to year 2000(84%). Conclusion : Antibiotic-resistant pneumococci increased during the past decade. For effective prevention of pneumococcal infections, national survey of pneumococcal infections and expanded use of pneumococcal vaccination would be needed.

복수를 동반한 Epstein-Barr바이러스 연관성 혈구탐식증후군 1례

최예나,장광천,김동수,박영년,Choi, Ye-Na,Jang, Gwang-Cheon,Kim, Dong-Soo,Park, Young-Nyun 대한소아감염학회 2002 Pediatric Infection and Vaccine Vol.9 No.1

저자들은 내원 1개월 전부터의 고열 복통을 주소로 전원되어 복수를 동반한 EBV 연관성 VAHS로 진단된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hemophagocytic syndrome(HPS) has four subgroup, sporadic disorder, associated with acute infection, familial form seen in children, and associated with malignant disorders, immunodeficiencies, defective leukocyte function. Histologically, Hemopoietic cells are actively ingested by moncytes/macrophages in various organs, including lymph nodes, bone marrow, liver, and spleen. Epstein-Barr virus(EBV) is now thought to be one of the major causes for the virus-associated hemophagocytic syndrome(VAHS). Epstein-Barr(EB) virus infection is common, with up to 90% of individuals demonstrating positive titiers by age 20. Although elevated liver function tests commonly occur, severe hepatitis is rare. Only seven cases of ascites complicating Epstein-Barr infection are reported, but none clearly demonstrate the abscence of other causes of hepatic dysfunction. We are reporting a case of Epstein-Barr Virus-associated hemophagocytic syndrome with ascites.

혈중 Vitamin D 저하를 보인 광범위한 포진상 습진 2예 -병인 및 Intravenous Immunoglobulin 치료에 대한 고찰

김수민 ( Soo Min Kim ),장광천 ( Gwang Cheon Jang ),김의정 ( Yee Jeong Kim ),조남준 ( Nam Joon Cho ) 대한피부과학회 2013 대한피부과학회지 Vol.51 No.11

Eczema herpeticum is a disseminated herpes simplex virus infection mainly in atopic individuals. Low expression of cathelicidin in atopic dermatitis contributes to the lack of defense capability against viral infection. Serum vitamin D level, which is essential for cathelicidin induction, is reported to be low in patients with severe atopic dermatitis. However, serum vitamin D level has not been studied in patients with eczema herpeticum. The mainstay of treatment of eczema herpeticum is systemic antiviral therapy. In atopic individuals with eczema herpeticum, intravenous immunoglobulin is less likely to enhance cutaneous viral susceptibility than other immunomodulators. Herein, we report two pediatric cases of widespread eczema herpeticum, both accompanied by high fever and low serum vitamin D levels. The patients were successfully treated with intravenous acyclovir and intravenous immunoglobulin. Serum 25-hydroxyvitamin D3 level was even less than 4.0 ng/ml in one patient, and no more repeated episodes of eczema herpeticum occurred, after supplementation of vitamin D. (Korean J Dermatol 2013;51(11):893∼897)

Renal Manifestations and Imaging Studies of Kawasaki Disease

오지영,박세진,김선정,장광천,김유리아,신재일,김기혁,Oh, Ji Young,Park, Se Jin,Kim, Sun Jung,Jang, Gwang-Cheon,Kim, Uria,Shin, Jae Il,Kim, Kee Hyuck Korean Society of Pediatric Nephrology 2013 Childhood kidney diseases Vol.17 No.2

목적: 본 연구는 가와사키 질환의 신장 침범에 대하여 비교적 덜 침습적이며, 특이도와 민감도가 높은 검사인 Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT)을 통하여 밝혀보고자 한다. 방법: 2011년 3월부터 10월까지 국민건강보험 일산병원에서 가와사키로 진단된 15명의 환아들을 대상으로 진행하였다. 15명의 환아 모두 가와사키의 급성기에 DMSA renal SPECT를 시행하였다. 또한 신장 세뇨관 손상 지표인 요중 ${\beta}2$-microglobulin (${\beta}2$-MG)을 측정하여 이를 통한 가와사키 환아에서 신장 손상의 조기 진단 가능 여부를 연구해보았다. 결과: 환아 15명 모두의 신기능 검사는 정상이었다. 소변 검사상 현미경적 혈뇨와 농뇨가 각각 13%, 33%에서 관찰되었다. 요중 ${\beta}2$-MG는 46%에서 증가된 소견을 보였다. 또한 환아들을 요중 ${\beta}2$MG를 기준으로 증가되어 있는 군과 증가되지 않은 군으로 나누어 비교, 분석해 보았으며, 두군간에 임상 증상, 임상 검사, 초음파 검사 및 심초음파 검사에서 유의한 차이를 보이지 않았다. 모든 환아에서 DMSA renal SPECT는 정상 소견을 보였다. 결론: 본 연구에서 가와사키 질환의 신장 침범은 경한 소변 검사 이상 및 일부 환아에서의 요중 ${\beta}2$-MG의 상승 소견을 보였으며, DMSA renal SPECT에서 관찰될 정도의 신장 침범은 보이지 않았다. Purpose: The aim of this study was to verify renal inflammation following Kawasaki disease (KD) using single photon emission computed tomography along with Technetium-99m dimercaptosuccinic acid scintigraphy (DMSA renal SPECT). Methods: From March 2011 to October 2011, 15 patients diagnosed with KD at the National Health Insurance System Ilsan Hospital were enrolled in the study. All patients underwent DMSA renal SPECT to evaluate renal involvement during the acute phase of KD. Urine ${\beta}2$-microglobulin (${\beta}2$-MG), a marker of renal proximal tubular dysfunction, was also measured to assess renal damage. Results: All 15 patients had normal renal function test results. However, microscopic hematuria and pyuria were observed in 13% and 33% of the patients, respectively. Moreover, urine ${\beta}2$-MG was elevated in 46% of the patients. In addition, patients were divided into two groups based on ${\beta}2$-MG level: those with an increased ${\beta}2$-MG level, and those with a normal ${\beta}2$-MG level. No significant differences were found between these two groups in clinical characteristics, laboratory, sonography, and echocardiography findings. All patients' DMSA renal SPECT scans were normal. Conclusion: Our study showed that mild abnormalities in the urinalysis and elevated urine ${\beta}2$-MG were the only findings of renal involvement in KD. However, no aggressive renal manifestations were detected on DMSA renal SPECT.

만성 두드러기의 진단과 치료: 전문가 의견서

예영민 ( Young Min Ye ),장광천 ( Gwang Cheon Jang ),최선희 ( Sun Hee Choi ),이정민 ( Jeong Min Lee ),유혜수 ( Hye Soo Yoo ),박경희 ( Kyung Hee Park ),신미용 ( Mee Yong Shin ),김지현 ( Ji Hyun Kim ),이서영 ( Suh Young Lee ),최정희 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Chronic urticaria (CU) is defined by the presence of urticaria that has been continuously or intermittently for a period of 6 weeks or longer. The prevalence of CU in the general population has been estimated to range from 0.5% to 5%. Correct diagnosis and proper management for CU is essential to improve the quality of care. To date, several practical guidelines have been available for practitioners. In this article, we reviewed and summarized the epidemiology, pathogenesis, diagnosis, and management based on case reports and studies of CU from Korea and the other part of world, and recently published guidelines. Although there are many controversies, this report for CU would provide a clinical guidance for healthcare professionals in Korea.

부비동염이후 발생한 경막하 농양 1례

변정희,황인경,박은경,강주완,김동수,장광천,Byun, Jung Hee,Hwang, In Kyung,Park, Eun Kyung,Kang, Ju Wan,Kim, Dong Soo,Jang, Gwang Cheon 대한소아감염학회 2014 Pediatric Infection and Vaccine Vol.21 No.1

부비동염은 흔하고 일반적으로 소아에서는 양성질환인 경우가 많다. 경험적으로 사용하고 있는 항생제로 인해 소아의 부비동염의 두 개강 내 합병증은 드물지만, 발생할 경우 생명에 위협적일 수 있다. 두 개강 내 합병증은 정맥동 혈전, 안와 합병증, 뇌수막염, 뇌수막하 농양 등이 있다. 이러한 합병증은 소아에서 심각한 예후를 보일 수 있다. 따라서 뇌수막하 농양을 초기에 정확하게 진단하여 치료를 시작하는 것이 중요하다. 저자들은, 급성 부비동염 치료 중이던 15세 남아가 3일간의 발열, 두통을 동반한 편마비 증상으로 내원하여 뇌 전산화 단층촬영에서 뇌수막하 농양으로 진단되어 항생제 투여 및 신경학적 수술로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.