영유아 급성 설사의 영양 공급: 탈수 치료 후 연령별 식이요법을 중심으로

추미애,최병호,Chu, Mi Ae,Choe, Byung-Ho 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.suppl1

The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.

Respiratory syncytial virus에 의한 급성 세기관지염에서 혈청 내 surfactant protein-D 상승의 의의

추미애 ( Mi Ae Chu ),이은주 ( Eun Joo Lee ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Purpose: Collectin family is an important component of innate immunity, of which surfactant protein (SP)-D and mannose-binding lectin (MBL) are the most characterized. We examined SP-D and MBL in young children with acute respiratory syncytial virus (RSV) bronchiolitis. Methods: Sixty-three children (≤24 months of age) admitted with the first RSV bronchiolitis during 2 epidemics and followed for 1 year after discharge were enrolled. The patients were defined as severe group when they had 2 of followings during admission: hypoxemia (<92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and >7 days of hospital stay. All children were evaluated if they had recurrent wheezing during follow-up. SP-D and MBL were measured using enzyme-linked immunosorbent assay in serum collected on admission and compared with controls. Their levels were evaluated in relation to the symptom severity during admission and recurrence of wheezing after discharge. Results: Serum SP-D increased significantly in the patients (P<0.01), but MBL showed no difference compared to the controls. SP-D levels were significantly higher in severe group compared with nonsevere group (P<0.05). SP-D levels in the patients with recurrent wheezing after discharge were significantly higher than in those without (P<0.05). MBL showed no difference in relation to the symptom severity or recurrence of wheezing. Conclusion: Our study showed that serum SP-D was associated with the severity of RSV bronchiolitis and suggests that it might be a biomarker of lung injury and recurrence of wheezing illnesses in the young children admitted with their first RSV bronchiolitis. (Allergy Asthma Respir Dis 2013;1:235-240)

Respiratory syncytial virus에 의한 급성 세기관지염에서 혈청 내 surfactant protein-D 상승의 의의

추미애 ( Mi Ae Chu ),이은주 ( Eun Joo Lee ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3

Purpose: Collectin family is an important component of innate immunity, of which surfactant protein (SP)-D and mannose-binding lectin (MBL) are the most characterized. We examined SP-D and MBL in young children with acute respiratory syncytial virus (RSV) bronchiolitis. Methods: Sixty-three children (≤24 months of age) admitted with the first RSV bronchiolitis during 2 epidemics and followed for 1 year after discharge were enrolled. The patients were defined as severe group when they had 2 of followings during admission: hypoxemia (<92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and >7 days of hospital stay. All children were evaluated if they had recurrent wheezing during follow-up. SP-D and MBL were measured using enzyme-linked immunosorbent assay in serum collected on admission and compared with controls. Their levels were evaluated in relation to the symptom severity during admission and recurrence of wheezing after discharge. Results: Serum SP-D increased significantly in the patients (P<0.01), but MBL showed no difference compared to the controls. SP-D levels were significantly higher in severe group compared with nonsevere group (P<0.05). SP-D levels in the patients with recurrent wheezing after discharge were significantly higher than in those without (P<0.05). MBL showed no difference in relation to the symptom severity or recurrence of wheezing. Conclusion: Our study showed that serum SP-D was associated with the severity of RSV bronchiolitis and suggests that it might be a biomarker of lung injury and recurrence of wheezing illnesses in the young children admitted with their first RSV bronchiolitis. (Allergy Asthma Respir Dis 2013;1:235-240)

소아 천식군과 영유아 천명군에서 혈청 내 가용성 ST2 상승의 의의

추미애 ( Mi Ae Chu ),이형직 ( Hyung Jik Lee ),이은주 ( Eun Joo Lee ),홍석진 ( Suk Jin Hong ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4

Purpose: Soluble ST2 (sST2) has been reported to regulate Th2 response. In this study, serum levels of sST2 and other cytokines were measured in recurrent early wheezers and asthmatic children. We aimed to investigate if there are any differences or similarities in Th1 or Th2 response between those two patient groups. Methods: Fifty-nine patients admitted with exacerbation of wheezing or asthma were enrolled. Two patient groups were defined: children with atopic asthma (≥6 years, n=21) and recurrent early wheezers (≤2 years, n=38). Recurrent early wheezers were divided based on their atopic status: 19 were atopic and 19 were nonatopic. sST2, interleukin (IL) 33, IL-5, and interferon (IFN)-γ were measured in serum samples collected on admission. Cytokine levels in both patient groups were compared with their age-matched controls and evaluated the relationship with blood eosinophils, serum IgE levels, and also with the severity of symptom. Results: sST2 and IL-5 were significantly increased both in asthmatic children (P=0.02, P=0.004) and recurrent early wheezers (P=0.01, P=0.001) compared to their age-matched controls. IL-5 was significantly higher in atopic wheezers compared with nonatopic wheezers (P=0.04). Severity score showed a positive correlation with sST2 and IFN-γ in asthmatic children, but only with IFN-γ in early wheezers. There was an inverse correlation between sST2 and blood eosinophil counts both in asthmatic children and atopic recurrent wheezers. Conclusion: Our study suggests that sST2 might regulate allergic inflammation by suppressing eosinophilia and play an important role in pathophysiology of acute exacerbation of wheezing or asthma both in asthmatic children and early wheezers. (Allergy Asthma Respir Dis 2013;1:314-320)

소아 천식군과 영유아 천명군에서 혈청 내 가용성 ST2 상승의 의의

추미애 ( Mi Ae Chu ),이형직 ( Hyung Jik Lee ),이은주 ( Eun Joo Lee ),홍석진 ( Suk Jin Hong ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),정혜리 ( Hai Lee Chung ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4

Purpose: Soluble ST2 (sST2) has been reported to regulate Th2 response. In this study, serum levels of sST2 and other cytokines were measured in recurrent early wheezers and asthmatic children. We aimed to investigate if there are any differences or similarities in Th1 or Th2 response between those two patient groups. Methods: Fifty-nine patients admitted with exacerbation of wheezing or asthma were enrolled. Two patient groups were defined: children with atopic asthma (≥6 years, n=21) and recurrent early wheezers (≤2 years, n=38). Recurrent early wheezers were divided based on their atopic status: 19 were atopic and 19 were nonatopic. sST2, interleukin (IL) 33, IL-5, and interferon (IFN)-γ were measured in serum samples collected on admission. Cytokine levels in both patient groups were compared with their age-matched controls and evaluated the relationship with blood eosinophils, serum IgE levels, and also with the severity of symptom. Results: sST2 and IL-5 were significantly increased both in asthmatic children (P=0.02, P=0.004) and recurrent early wheezers (P=0.01, P=0.001) compared to their age-matched controls. IL-5 was significantly higher in atopic wheezers compared with nonatopic wheezers (P=0.04). Severity score showed a positive correlation with sST2 and IFN-γ in asthmatic children, but only with IFN-γ in early wheezers. There was an inverse correlation between sST2 and blood eosinophil counts both in asthmatic children and atopic recurrent wheezers. Conclusion: Our study suggests that sST2 might regulate allergic inflammation by suppressing eosinophilia and play an important role in pathophysiology of acute exacerbation of wheezing or asthma both in asthmatic children and early wheezers.

소아에서 연쇄상 구균 감염 후 급성 사구체 신염의 임상양상의 변화

최병호,추미애,홍은희,황현희,조민현,고철우,Choi, Byung-Ho,Chu, Mi-Ae,Hong, Eun-Hui,Hwang, Hyun-Hee,Cho, Min-Hyun,Ko, Cheol-Woo 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

목 적 : 최근 연쇄상 구균 감염 후 급성 사구체 신염(APSGN)의 빈도가 증가됨이 보고되고 있다. 본 연구는 최근 15년간 APSGN으로 진단된 환아의 임상양상의 변화를 알아보기 위해 시행되었다. 방 법 : 1992년 1월부터 2006년 12월까지 경북대병원 소아청소년과에서 APSGN으로 진단받은 63례를 대상으로 하여 진료 기록을 후향적으로 조사하였다. 2000년을 기준으로 1992-2000년에서 발병한 33례와 2001-2006년에 발생한 30례로 구분하여 임상 양상의 차이를 비교하였다. 그리고 나이, 성별, 단백뇨 정도, 육안적 혈뇨 유무, 항생제 사용 여부 등으로 구분하여 임상 양상을 서로 비교하였다. 결 과 : 대상 환자 63명 중 남자는 41명, 여자는 22명이었고 발병 당시 연령은 평균 7년 11개월이었다. 전체의 87%에서 인후염이 선행하였고 평균 12일 후 급성 사구체 신염으로 이행되었다. 육안적 혈뇨는 40례에서, 고혈압은 41례에서 있었다. 신염 발생 후 고혈압은 평균 7.8일, 육안적 혈뇨는 11.3일, 현미경적 혈뇨는 3.5개월 후 소실되었다. 2000년 전후 발병군을 비교하면 2000년 이후 발생군의 ASO치가 유의하게 높았다.(P=0.009) 다른 임상 양상은 유의한 차이가 없었다. 연령, 성별, 단백뇨 정도, 육안적 혈뇨 유무, 항생제 사용 여부 등은 신염 후의 고혈압과 혈뇨의 지속기간, 혈청 보체의 회복 기간과 유의한 상관관계가 없었다. 결 론 : 2000년 이후 발병된 APSGN은 ASO치의 차이를 제외하면 2000년 이전 발병군의 임상 양상과 유사하였다. 이러한 ASO 값의 차이와 APSGN의 빈도 증가 연관성을 규명하기 위한 더 큰 규모의 연구가 필요할 것으로 생각된다. Purpose : Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. Methods : Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. Results : Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8$\pm$8.2 days, gross hematuria within 11.3$\pm$17.2 days and microscopic hematuria within 3.5$\pm$3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. Conclusion : Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.

소아 만성 B형간염에서 라미부딘 치료 후 연령에 따른 B형간염바이러스 표면항원 소실률 비교

김정미 ( Jung Mi Kim ),최병호 ( Byung Ho Choe ),추미애 ( Mi Ae Chu ),조승만 ( Seung Man Cho ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.2

라미부딘 내성 소아 청소년 만성 B형 간염에서 Entecavir 치료 경험

조승만,최병호,추미애,김정미,Cho, Seung-Man,Choe, Byung-Ho,Chu, Mi-Ae,Kim, Jung-Mi 대한소아소화기영양학회 2010 Pediatric gastroenterology, hepatology & nutrition Vol.13 No.1

목 적: 라미부딘에 내성을 보인 소아 청소년 만성 B형 간염에서 엔테카비어 단독요법의 바이러스 억제효과를 확인하고자 하였다. 방 법: 라미부딘에 내성을 보이는 소아 청소년 만성 B형 간염 환자 23명 중 6명(남 4, 나이 15.1~24.6세, 평균 17.5세)에게 엔테카비어 1 mg으로 치료하였으며 (평균 13.4개월, 1~21.1개월) 아데포비어로 치료한 11명과 비교하였다. 치료 시작 후 HBV DNA 역가가 1 $log_{10}$ 이하, 2 $log_{10}$ 이하, 357 IU/mL 이하로 감소하는데 걸리는 기간을 각각 구하여 서로 비교하였다. 결 과: HBV DNA 역가가 2 $log_{10}$ IU/mL 이상 감소하는데 걸린 기간은 각각 2.4${\pm}$2.3개월, 9.2${\pm}$7.3개월로 (p=0.025) 두 군 간에 유의한 차이가 있었다. HBV DNA 역가가 1 $log_{10}$ IU/mL 이상 감소하는데 걸린 기간 및 357 IU/mL 이하로 감소하는데 걸린 기간은 두 군 간에 유의한 차이가 없었다. 결 론: 라미부딘 내성 소아 청소년 만성 B형 간염에서 엔테카비어 단독요법은 아데포비어 단독요법과 비교해 볼 때 HBV DNA 역가가 2 $log_{10}$ IU/mL 이상 감소하는데 걸린 기간이 유의하게 짧았다. 특별한 부작용은 관찰되지 않았다. 엔테카비어의 치료 효과를 알기 위하여 더 많은 환자를 대상으로 한 장기 치료가 필요하다. Purpose: To estimate the viral suppressive effect of entecavir monotherapy in Korean children and adolescents with lamivudine-resistant chronic hepatitis B (CHB). Methods: One milligram of entecavir was administered once daily to 6 patients (4 boys; mean age, 17.5 years; range, 15.10~24.6 years) with lamivudine-resistant CHB for a mean duration of therapy of 13.4 months (range, 1~21.1 months). The therapeutic results were compared with 11 patients who received adefovir (0.3 mg/kg/day [maximal dose 10 mg]) for at least 12 months (mean, 33.4 months; range, 12.4~58.3 months). The serum HBV DNA level and serologic markers were measured every 2 months. Results: The interval to a HBV DNA titer decrement (>1 $log_{10}$) was 1.2${\pm}$0.2 and 4.4${\pm}$5.2 months (p=0.185) for the entecavir and adefovir groups, respectively. The interval to a HBV DNA titer decrement (>2 $log_{10}$) was 2.4${\pm}$2.3 and 9.2${\pm}$7.3 months (p=0.025), for the entecavir and adefovir groups, respectively. Conclusion: The therapeutic efficacy of entecavir was favorable in children and adolescents, especially in shortening the interval to a >2 $log_{10}$ decrement in the HBV DNA titer. Long-term follow up is needed to determine the therapeutic efficacy of entecavir for lamivudine-resistant CHB in children and adolescents.

제대혈 단핵세포의 냉동 전ㆍ후의 염색체 핵형분석의 실험적 연구

구기영(Ki Young Ku),추미애(Mi Ae Chu),김지윤(Ji Yoon Kim),이건수(Kun Soo Lee) 대한의학유전학회 2008 대한의학유전학회지 Vol.5 No.1

목적 : 염색체 검사는 의학의 많은 영역과 혈액종양학 분야에서 중요한 역할을 하고 있다. 세포의 기능을 잘 유지하면서 장기간 보관할 수 있는 가장 효과적인 방법은 냉동보존(cryopreservation)으로 알려져 있으며, 이는 미래에 신기술을 적용할 수 있고 회귀연구를 가능하게 한다. 이에 본 연구에서는 제대혈에서 분리된 단핵세포의 냉동전과 해동후의 염색체 검사 결과를 비교하고자 한다. 방법: 실험에 대한 동의서를 획득한 제대혈 1례가 검사되었다. Ficoll-Hypaue로 단핵세포를 분리하였고, DMSO 등 냉동보존을 위한 전처리 후 프로그램 냉동기(Cryomed 1010, 미국)로 냉동하여 질소탱크(-196℃)에 3일간 보관하였고, 급속 냉동 후 염색체 검사를 시행하였다. 냉동전과 해동후의 염색체 핵형을 분석하였다. 결과: 1례의 제대혈은 3군으로 나누어, 냉동 전 배양과정 없던 CB-1군은 염색체 핵형 검사가 판독 불가능하였으며, 냉동 전 3일간 배양 후 냉동보관을 하였던 CB-2와 CB-3군은 냉동전과 해동후의 염색체 핵형이 판독 가능하였고, 서로 일치하였다. 결론 : 검체의 분포 불균형과 검체 수가 적다는 제한점이 있으나, 제대혈에서 냉동전과 해동후의 염색체 핵형이 일치하는 결과에서 제대혈 단핵세포의 유전적 안정성과 장기간 보관의 가능성을 예측할 수 있을 것으로 사료된다. Purpose : The ability to perform chromosome analysis of cryopreserved cord blood mononuclear cells is important for future retrospective studies. We compared the karyotypes of cryopreserved cells with cells before cryopreservation. Methods : One cord blood (CB) sample was obtained from normal healthy volunteer. Karyotype analysis was performed before cryopreservation. After mononuclear cell separation with Ficoll-Hypaque, the mononuclear cells were cryopreserved by programmed controlled-rate freezer and then transferred into the liquid nitrogen (-196℃) for 3 days. After rapid thawing, cytogenetic analysis was performed as the same method for each sample by different conditions. The samples were divided by three groups. The first group was no culture before cryopreservation, the second group was 72 hours culture before cryopreservation, but no 24 hours culture after thawing and the third group was 72 hours culture before cryopreservation and 24 hours culture after thawing. Results : The chromosome analysis was successful in the second and third groups of CB sample. Conclusion : The successful result from CB samples may suggest the usefulness of long-term cryopreservation for retrospective study in various clinical settings including hematologic malignancies.

단일 의료기관에서 경험한 학동기 소아 및 청소년 결핵의 임상 양상

양승호 ( Seung Ho Yang ),추미애 ( Mi Ae Chu ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김진경 ( Jin Kyung Kim ),최은진 ( Eun Jin Choi ),이경훈 ( Kyung Hoon Lee ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.3

Purpose: In the present study, we investigated the clinical characteristics of tuberculosis in school-age children and adolescents, which is important as a reservoir for future disease burden. Methods: Ninety patients, aged from 6 to 18 years, who were diagnosed and treated with tuberculosis during the period from January 2005 to July 2011, were enrolled. We retrospectively analyzed the medical records and investigated clinical characteristics of the patients. Results: Eight patients were 6 to 12 (9%) and 82 were over 13 years of age (91%). There was a significantly higher percentage of males than females in the latter age group (P <0.01). Route of infection was not confirmed in 74 patients, and 16 patients were diagnosed through the school or military medical examinations with no clinical symptoms. Seventy patients (78%) were presented with pulmonary tuberculosis. Chronic persistent coughing was the most common presenting symptom, and both upper lobes were most frequently involved. Nineteen patients over 13 years of age had adult-type cavitary tuberculosis. The positive results for acid-fast smears or cultures were not high, and the rate of positive tuberculin skin test was 88%. The most frequent adverse effects of anti-tuberculosis treatment were hepatotoxicity, hyperuricemia, and gastrointestinal disorders. The duration of the treatment was much prolonged in 8 patients who had drug-resistant tuberculosis. Conclusion: Our study showed that pulmonary tuberculosis should be suspected in the adolescents who have prolonged respiratory symptoms. It also indicates that pulmonary tuberculosis in adolescents has similar characteristics to tuberculosis in adults, which suggests the potential important role of adolescent tuberculosis in community disease transmission.