소아 청소년 천식 환자에서 폐기능 악화의 예측인자로서 경피적 산소 포화도 감시의 유용성

정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.1

천식 환아의 요중 leukotriene 배설에 미치는 theophylline의 영향

정혜리(Hai Lee Chung),이정진(Jung Jin Lee),김상경(Sang Gyung Kim) 대한천식알레르기학회 2000 천식 및 알레르기 Vol.20 No.5

N/A Background: Theophylline has been used in the treatment of asthma for decades as a bronchodilator, but recent studies suggested that it has anti-inflammatory and immunomodulatory properties. Objective : The aim of this study was to determine the effect of theophylline therapy on urinary excretion of leukotriene R4 (LTB4) and C4 (LTC4), which have been known to play a role in the airway inflammation in asthmatic patients. Methods : Fifty-one patients, aged 13 months to 6 years, who were hospitalized with asthma were randomized in to 3 groups according to treatment regimen. Twenty-one patients were administered theophylline with budesonide and salbutamol inhalation (Group 1). Fifteen patients were treated with budesonide and salbutamol inhalation (Group 2) and the other fifteen patients with salbutamol inhalation only (Group 3). Urine samples for the determination of LTB4 and LTC4 were collected on admission and on the fifth hospital day in each patient. The concentrations of urinary leukotrienes were measured by ELISA (Neogen, U.S.A.) and corrected by urinary creatinine levels. Ten controls were also studied. Results : The initial urinary LTC4 levels in asthmatic children were significantly higher than in controls. Urinary LTC4 was significantly decreased after treatment compared with the initial level in group 1 (p<0.05), but not in groups 2 and 3. Urinary LTB4 did not show significant difference between patients and controls on admission and showed no significant change after treatment compared with the initial levels in all three groups. Conclusion: These results suggest that the suppression of LTC4 synthesis is one of the anti-inflammatory mechanisms of theophylline and support the use of theophylline as a the rapeutic agent in asthmatic patients. (J Asthma Allergy Clin Immunol 20: 710-716, 2000)

소아 천식에서 측정 기기에 따른 호기 산화질소 농도의 비교

정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.1

Food Protein-Induced Enterocolitis Syndrome의 소장 점막에서 Transforming Growth Factor-β 수용체들의 표현에 대한 연구

정혜리 ( Hai Lee Chung ),정선미 ( Sun Mi Chung ),하경아 ( Gyung Ah Ha ),이정진 ( Jeong Jin Lee ),최은진 ( Eun Jin Choi ),김진경 ( Jin Gyung Kim ),김우택 ( Woo Taek Kim ),노은석 ( Un Seok Nho ),황진복 ( Jin Bok Hwang ),박정자 ( Jeo 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2002 소아알레르기 및 호흡기학회지 Vol.12 No.1

지속성 천식으로 치료 중인 10세 여아에서 발견된 식도이완불능증 1례

정해민 ( Hae Min Chung ),금경혜 ( Kyung Hye Keum ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),이경훈 ( Gyeong Hoon Lee ),최은진 ( Eun Jin Choi ),김진경 ( Jin Kyung Kim ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기 및 호흡기학회 2008 소아알레르기 및 호흡기학회지 Vol.18 No.1

마이코플라스마 폐렴에서 혈장 내 성장인자들의 상승

이현주 ( Hyun Ju Lee ),김지영 ( Ji Young Kim ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),최은진 ( Eun Jin Choi ),이경훈 ( Kyung Hoon Lee ),김진경 ( Jin Kyung Kim ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 소아알레르기 및 호흡기학회지 Vol.20 No.1

목적: 본 연구에서 저자들은 마이코플라스마에 의한 급성 폐렴으로 입원하였던 소아들을 대상으로 기도의 섬유화 현상과 개형에 관여하는 것으로 알려진 TGF-β1 및 PDGF-BB와 같은 성장인자들이 증가되어 있는지와 이들이 임상 양상에 따라 어떤 차이를 보이는지 알아보고자 하였다. 방법: 2006년 8월부터 2008년 2월까지 마이코플라스마 폐렴으로 입원한 환아 52명을 대상으로 잦은 천명 증상을 보인 천명군과 이전에 천명의 병력이 없었던 비천명군으로 분류하였다. 천명군은 입원 이전에 3번 이상의 반복적인 천명의 병력이 있었던 환아들로 정의하였다. 경미한 수술을 위해 입원한 15명의 환아를 대조군으로 선정하여 함께 조사하였다. ELISA로 TGF-β1 및 PDGF-BB를 측정하였고 이들이 마이코플라스마 감염동안에 증가하는지, 환아들의 임상 양상에 따라 어떤 차이를 보이는지를 조사하였다. 결과: TGF-β1 및 PDGF-BB는 대조군에 비하여 마이코플라스마 폐렴 환아에서 의미있게 증가되어 있었으며, 천명군에서 비천명군에 비해 증가되어 있었으나, 통계학적 유의성은 없었다. 천명군 내에서 TGF-β1은 아토피 환자에서 비아토피군에 비해 의미있게 증가되어 있었다. 결론: 본 연구에서는 마이코플라스마 폐렴으로 입원한 어린 소아들에서 TGF-β1 및 PDGF-BB 등의 성장 인자들이 의미있게 증가된다는 것을 보여 주며, 이들이 마이코플라스마에 의한 하부기도 감염의 병태생리학적 기전에서 중요한 역할을 한다는 것을 시사하는 것으로 생각되었다. Purpose: Mycoplasma pneumoniae is a common causative agent of community acquired pneumonia in children and is well known to cause various respiratory and extrapulmonary diseases. We determined whether growth factors, including transforming growth factor (TGF)-β1 and platelet-derived growth factor (PDGF-BB) that regulate airway fibrosis and remodeling, are increased in young children with M. pneumoniae pneumonia and also investigated if there was any difference in relation to the clinical status of the patients. Methods: Fifty-two patients (3 to 6 years of age) who were admitted with M. pneumoniae pneumonia were enrolled and divided into 2 groups: the patients with frequent wheezing episodes (group A, n=28) and the patients with no previous history of wheeze (group B, n=24). The former group included the patients who had recurrent wheeze more than 3 times before admission. Fifteen children admitted with minor surgical problems were also studied as controls. TGF-β1 and PDGF-BB were measured in the plasma samples collected on admission using ELISA in both patient groups and controls. Results: Plasma TGF-β1 and PDGF-BB levels were increased significantly in the patients with M. pneumoniae pneumonia as compared to the controls (P<0.01, respectively). TGF-β1 and PDGF-BB were higher in group A than in group B, but the difference was not statistically significant (P=0.08 vs. P=0.05). In group A, TGF-β1 was significantly higher in atopic patients than in non-atopic patients (P<0.05). Conclusion: Our study showed significantly increased TGF- β1 and PDGF-BB in patients with M. pneumoniae pneumonia. It is suggested that these growth factors may play an important role in the pathogenesis of lower airway infection by M. pneumoniae. [Pediatr Allergy Respir Dis (Korea) 2010;20:41-47]

한국 소아 호흡기질환의 연구 현황과 과제

한만용 ( Man Yong Han ),정혜리 ( Hai Lee Chung ),안영민 ( Young Min Ahn ),심정연 ( Jung Yeon Shim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.S

Thirty years have passed since the Korean Association of Pediatric Allergy and Respiratory Disease was founded. There have been great changes in the pattern of respiratory diseases in Korean children during the last 30 years with economic development in the country. Pneumonia remains the leading cause of childhood morbidity, despite advances in the prevention and management. The incidence and mortality of pneumonia caused by typical bacterial pathogens have been reduced. However, the predominance of Mycoplasma pneumoniae or virus-associated diseases is emerging, which suggests that novel diagnostic and therapeutic strategies are needed. Viral bronchiolitis is one of the most substantial health burdens for infants and young children worldwide. Although respiratory syncytial virus is the most common pathogen, molecular diagnostic techniques have identified many other viruses including human rhinovirus causing bronchiolitis. Bronchiectasis is a chronic respiratory condition characterized by chronic infection, airway inflammation, and progressive lung function decline. Research into the interactions between early life respiratory infections and development of bronchiectasis is imperative to halt the disease in its origin and improve adult outcomes. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening lung disease with diffuse inflammatory lung injury leading to pulmonary edema and hypoxia. Although many modalities to treat ARDS have been studied, supportive therapies and lung protective ventilator support remains the mainstay. This review focuses on the current trends in research on these childhood respiratory diseases through literature review and aims to investigate the impact of Korean study results in this field. (Allergy Asthma Respir Dis 2018;6 Suppl 1:S66-76)

우유 과민성 장병증(cow's milk-sensitive enteropathy)의 장기 추적관찰

송애령,최은진,한창호,정혜리,권영대,황진복,Song, Ae-Ryong,Choi, Eun-Jin,Han, Chang-Ho,Chung, Hai-Lee,Kwon, Young-Dae,Hwang, Jin-Bok 대한소아소화기영양학회 2001 Pediatric gastroenterology, hepatology & nutrition Vol.4 No.1

목 적: 우유 과민성 장병증(cow's milk-sensitive enteropathy, CMSE)은 글루텐 과민성 장병증과는 달리 일시적인 질환으로 알려져 있다. CMSE의 장기 추적관찰을 통하여 우유 및 타 음식에 대한 내성 시기, 발현 증상, 알레르기 질환 동반 유무, 가족력 등을 파악하여 환자에 대한 예후설명, 수유방법의 변화시기와 이유식의 이용 등 향후 식이 조절에 대한 지침을 마련하고자 본 연구를 시행하였다. 대상 및 방법: 1992년 3월부터 1997년 3월까지 대구가톨릭대학병원 소아과에서 성장장애와 설사를 주소로 내원하여, 우유 유발 및 제거시험, 소장 생검조직의 형태학적 계측을 통하여 CMSE로 진단받은 후 추적 관찰과 전화 설문이 가능하였던 21명을 대상으로 하였다. 입원당시 연령은 $30.7{\pm}8.8$ (18~47)일, 설문당시는 $43.4{\pm}23.7$ (16~84)개월이였다. 생후 6개월까지는 절대적으로 단백가수 분해물을 수유하게 하였으며, 추후 2개월 간격으로 유발시험을 시행하는 치료 계획서를 작성 이용하였다. 결 과: 1) 우유를 먹여도 내성을 보였던 최종 연령은 $12.6{\pm}3.7$ (6~24)개월이었다. 2) 나이에 적합한 식이 가능한 모든 식품에 내성을 보였던 연령은 $15.5{\pm}3.7$ (10~24)개월이었다. 3) 우유 유발시험에 따라 관찰된 유해반응 19회 중 구토(31%), 설사(31%), 보챔 혹은 기면(21%), 발진(10%), 복부팽만(5%)의 증세를 보였다. 4) 입원당시 혈중 IgE와 우유 RAST에 양성을 보인 5명과 음성을 보였던 16명을 비교하여 우유 및 타 식품에 대한 내성 시기(p>0.05), 타 알레르기 질환의 발현 유무, 알레르기 가족력에서 의미 있는 차이가 관찰되지 않았다. 결 론: CMSE는 2세 이내에 임상적으로 완전한 회복을 보인다. 우유에 대하여 61%에서 1세까지, 전례에서 2세 전까지 내성을 보여 영유아기의 일시적 질환으로 판단된다. 타 식품에 대한 알레르기 발현은 특정 음식보다는 개인에 따른 다양한 음식물에서 발생하며, 전례에서 2세까지 내성을 보인다. 진단 당시 우유 RAST, 혈중 IgE의 상승과 우유 및 타 식품에 대한 내성의 발현 시기와는 무관하다. Purpose: Following up the cases of cow's milk-sensitive enteropathy (CMSE), We observed the development of clinical tolerance with cow's milk and other foods. We investigated the clinical outcome of CMSE. Methods: We reviewed the clinical records of patients who had been admitted and diagnosed as CMSE by responses to cow's milk challenge and elimination test and the findings of small intestinal biopsy at Department of Pediatrics, Taegu Catholic University Hospital from March 1992 to March 1997. All of them were being fed with protein hydrolysate before 6 months old, and tried cow's milk and other foods challenge test at following each two month. Twenty-one cases of them returned to be followed. The age at admission was $30.7{\pm}8.8$ (18~47) days old and at survey was $43.4{\pm}23.7$ (16~84) months old. Results: 1) Although the body weight at birth of the patients was 25~75 percentile, all on admission was below 3 percentile. The body weight on interview was 25~75 percentile. 2) The development of clinical tolerance in cow's milk was observed at 16~24 months of age and the tolerance rate was 61% at 12 months of age, 90% at 16 months of age. The development of clinical tolerance in other foods was observed at 10~24 months of age and the tolerance rate was 33% at 12 months of age, 80% at 18 months of age. 3) Adverse reactions after challenge test with cow's milk were observed at 19 cases, manifestated as vomiting (31%), diarrhea (31%), irritability or lethargy (21%), skin rash (10%), and abdominal distention (5%). 4) Comparing serum IgE and milk RAST positive group on admission (5 cases) and negative group on admission (16 cases), there was no significant difference at the age of tolerance in cow's milk (p>0.05), the age of tolerance in other foods (p>0.05), allergy history in family, and the incidence of other allergic diseases. 5) The history of family allergy was observed in 3 cases (14%) in 21 patients and 3 cases (14%) showed rhinitis, urticaria or asthma through a follow-up interview. Conclusion: The development of clinical tolerance in cow's and other foods was sharply increased at 12 months of age and most of all tolerated within 24 months of age. CMSE is a temporary disorder of infancy.

천식 소아에서 혈청 vascular endothelial growth factor, transforming growth factor-beta1과 YKL-40 증가의 임상적 의의

장윤영 ( Yoon Young Jang ),이현석 ( Hyun Seok Lee ),정지은 ( Ji Eun Jeong ),이은주 ( Eun Joo Lee ),홍석진 ( Suk Jin Hong ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Wootaek Kim ),정혜리 ( Hai Lee Chung ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Purpose: Vascular endothelial growth factor (VEGF), transforming growth factor beta1 (TGF-β1), and platelet derived growth factor (PDGF) are known to be involved in the pathogenesis of inflammation and remodeling in asthmatic airways. YKL-40, a chitinase-like protein, and clusterin have been reported to be biomarkers for severe asthma. We examined the serum levels of growth factors, YKL-40, and clusterin in children with acute asthma or stable asthma, and investigated their correlation with clinical findings and lung function parameters. Methods: Forty-one children (≥6 years of age) with asthma were enrolled, and 2 groups were defined: 23 patients admitted with acute asthma (acute asthma group) and 18 patients with stable asthma (stable asthma group). The serum levels of VEGF, TGF-β1, PDGF-BB, YKL-40, and clusterin were measured using enzyme-linked immunosorbent assay and assessed in relation to clinical manifestations and spirometric parameters. Fifteen age-matched controls were also studied. Results: The serum levels of VEGF, TGF-β1, and YKL-40 were significantly elevated in children with acute asthma compared to controls. The serum levels of VEGF and YKL-40 were higher in the stable asthma group than in controls. The serum levels of VEGF, TGF-β1, and YKL-40 were not different between the acute asthma and stable asthma groups. The serum VEGF levels in the acute asthma group correlated significantly with asthma severity. The serum TGF-β1 levels in stable asthma group showed a significant inverse correlation with (FEV1) forced expiratory volume in one second and FEF25% 75% (forced expiratory flow between 25 and 75 percent of expired vital capacity). Serum YKL-40 had no significant relationship with clinical manifestations and spirometric parameters. Conclusion: Our study suggests that increased serum levels of VEGF and YKL-40 might affect asthmatic airways not only during acute exacerbation but also in stable state and that serum TGF-β1 might be a biomarker for airway obstruction in children with asthma. (Allergy Asthma Respir Dis 2015;3:417-424)

마이코플라스마 폐렴에서 혈청 항체가와 임상 양상과의 관련성

김지영 ( Ji Young Kim ),이현주 ( Hyun Ju Lee ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.3

목적: 본 연구에서 저자들은 마이코플라스마에 의한 급성 폐렴으로 입원하였던 소아들을 대상으로 혈청 IgM 항체 반응의 정도 및 입원 당시의 호흡기 증상의 심한 정도가 마이코플라스마 재감염 여부, 천식의 동반 여부, 입원 당시의 임상 양상과 어떠한 관련성을 보이는지 조사해 보고자 하였다. 방법: 2007년 5월부터 2008년 5월까지 폐렴으로 입원한 환아에서 마이코플라스마 특이 IgM과 IgG를 측정하였으며 특이 IgM 양성인 85명의 환아를 대상으로 하였다. 재감염은 병력상 입원 최소 12개월 이전에 마이코플라스마 폐렴을 앓은 적이 있고 특이 IgG가 양성인 경우로 정의하였으며, 초감염은 이전에 폐렴을 앓은 적이 없으면서 IgG가 음성인 경우로 정의하였다. 입원 당시의 IgM 항체가 및 임상 증상의 심한 정도가 초감염군과 재감염군 간에 차이를 보이는지, 환자들의 천식 동반 여부 및 입원 기간 중 천명유무 등과 관련성이 있는지를 조사하였다. 결과: 재감염군에서 의미있게 높은 특이 IgM 항체가가 관찰되었다.(P<0.01) 천식군에서 비천식군에 비하여 IgM 항체가가 높았으나, 통계학적으로 유의하지는 않았다.(P=0.08) 천식군과(P<0.05) 천명군에서(P<0.01) 호흡기 증상이 의미있게 오래 지속되는 것을 관찰하였다. 천식 환아가 마이코플라스마 폐렴에 재감염된 경우에서 높은 IgM 항체가가 관찰되었다. 결론: 본 연구의 결과로 재발성 마이코플라스마 폐렴이 소아에서 흔하게 발생한다는 것을 알 수 있었고 초감염에 비해 의미 있게 높은 IgM 항체반응을 관찰할 수 있었으며 이는 특히 천식을 가진 소아들에서 더 뚜렷하였다. 반복적인 마이코플라스마 감염과 관련된 이러한 항체 면역 반응의 증가가 실제로 어떤 임상적 의미를 가지는지에 대해서는 앞으로 더 연구해야 할 과제로 생각된다. Purpose: Serum specific IgM and IgG responses have been used to diagnose Mycoplasma pneumoniae (M. pneumoniae) infection. The aim of this study was to investigate the relationship between antibody responses and the clinical features of M. pneumoniae pneumonia. Methods: Eighty-five children admitted due to M. pneumoniae pneumonia were enrolled. Serum specific IgM and IgG were measured semiquantatively by ELISA, and acute infection was determined by IgM concentration above the specified cutoff value. Recurrent M. pneumoniae pneumonia was defined as a history of proven M. pneumoniae pneumonia before at least 12 months with positive IgG, while the first pneumonia was defined as no past history of pneumonia with negative IgG. Both IgM titer and symptom duration were evaluated whether the patients had recurrent or the first M. pneumoniae pneumonia, they had current asthma or not and they presented wheeze during admission. Results: Significantly higher specific IgM titers were observed in patients with recurrent pneumonia than those without.(P<0.01) The IgM titer was higher in patients with asthma than those without which was not statistically significant.(P=0.08) Significantly prolonged symptoms were observed in patients with asthma (P<0.05) and those with wheezing during admission. (P<0.01) The highest IgM titer was observed in asthmatic children with recurrent M. pneumoniae pneumonia. Conclusion: Our study shows that significantly higher specific IgM titer in the children with recurrent M. pneumoniae pneumonia comparing with their counterparts, which was more prominent in asthmatic patients. Further studies are needed to evaluate the clinical significance of an increased serum antibody level in recurrent M. pneumoniae pneumonia. [Pediatr Allergy Respir Dis(Korea) 2009;19:282-290]