2006년 초등학생의 알레르기 질환 유병률의 전국적 역학조사

지혜미 ( Hye Mi Jee ),김경원 ( Kyung Won Kim ),김창수 ( Chang Soo Kim ),손명현 ( Myung Hyun Sohn ),신동천 ( Dong Cheon Shin ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.2

목적: 세계적으로 최근 알레르기질환의 발생이 증가추세를 보이고 있으며 이에 국가 간의 유병률 비교를 위한 국제적 ISAAC 연구가 진행되었다. 국내에서도 국제 ISAAC 연구에 동참하여 1995년과 2000년에 초등학생과 중학생을 대상으로 전국적 역학조사를 수행하였다. 본 연구는 2006년 전국적 역학조사를 통하여 우리나라 초등학생의 알레르기질환의 유병률과 그 변화추이를 알아보고자 하였다. 방법: 2006년 가을철(10-11월)에 전국 15개 지역 438개교 초등학생 37,365명을 대상으로 천식, 아토피피부염, 비염에 대하여 ISAAC 연구와 동일한 내용의 설문지를 이용하여 역학조사를 시행하였다. 설문지는 대상 초등학생의 학부모가 답변하도록 하였다. 결과: 설문조사의 응답률은 66.5%였다. 설문조사에 응답한 초등학생의 연령은 6세에서 13세(평균 10.65±1.34세)였으며 남아가 43.62%, 여아가 56.38%였다. 천식의 경우 일생 동안 천명의 유병률은 10.53%, 지난 12개월 동안 천명의 유병률은 4.7%, 일생 동안 천식 진단의 유병률은 7.81%, 최근 1년간 천식 치료의 유병률은 2.51%였다. 아토피피부염의 경우 일생 동안 아토피피부염의 가려운 증상의 유병률은 20.99%, 지난 12개월 동안 접히는 부위의 가려운 피부염 증상 유병률은 15.91%, 일생 동안 아토피피부염의 진단유병률은 28.22%, 최근 1년간 아토피피부염으로 치료받은 유병률은 13.91%를 나타내었다. 비염의 경우 일생 동안 비염 증상의 유병률은 37.7%, 지난 12개월 동안 비염 증상의 유병률은 32.8%, 일생 동안 알레르기비염 진단 유병률은 27.94%,최근 1년간 알레르기비염 치료 유병률은 21.44%를 나타내었다. 결론: 2006년 우리나라 초등학생의 천식의 유병률은 이전에 비해 감소하였고 알레르기비염과 아토피피부염의 유병률은 증가하였다. 이는 전세계적인 알레르기 질환의 유병률 변화추이와 유사한 결과를 보였다. Purpose: The prevalence and morbidity of asthma, allergic rhinitis and atopic dermatitis are increasing worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) was a standardized method to evaluate the prevalence of these diseases, and to compare it between countries. Using the standardized protocol, proposed by ISAAC Steering Committee, the prevalence of allergic diseases in Korean children was reported in 1995 and 2000. In this study, we aimed to evaluate the prevalence and changing patterns of morbidity of allergic diseases in Korean children for recent 10 years. Methods: From October 2006 to November 2006, Korean ISAAC written questionnaires were completed by the parents of 37,365 children attending 438 elementary schools in Seoul and 14 provinces. The questionnaires consisted of the questions about wheezing, rhinitis and eczema. Results: The prevalences of wheeze, ever, wheezing, last 12 months, diagnosis of asthma, ever and treatment of asthma, last 12 months were 10.53%, 4.7%, 7.81% and 2.51%, respectively. The prevalences of rhinitis, ever, rhinitis, last 12 months, diagnosis of allergic rhinitis, ever and treatment of allergic rhinitis, last 12 months were 37.7%, 32.8%, 27.94% and 21.44%, respectively. And prevalences of itchy eczema, ever, itchy flexural eczema, last 12 months, diagnosis of atopic dermatitis, ever and treatment of atopic dermatitis, last 12 months were 20.99%, 15.91%, 28.22% and 13.91%, respectively. Conclusion: From the results of this study, the prevalence of asthma decreased slightly compared to previous studies. In contrast, the prevalences of allergic rhinitis and atopic dermatitis are still increasing in Korean children in 2006. [Pediatr Allergy Respir Dis(Korea)2009;19:165-172]

소아에서 폐기능검사

지혜미 ( Hye Mi Jee ),신윤호 ( Youn Ho Shin ),한만용 ( Man Yong Han ) 대한천식알레르기학회(구 대한알레르기학회) 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Pulmonary function testing (PFT) is an important and fundamental method in the evaluation and treatment of respiratory diseases. Airway responsiveness assessed using histamine or methacholine by PFT is meaningful for the diagnosis of asthma. Spirometry is simple, and has been the most commonly used technique. However, in younger or uncooperative children, other commercially available tools such as impulse oscillometry (IOS), gas dilution, and plethysmography have been used. IOS is a noninvasive method that allows the measurement of airway mechanics (resistance [R] and reactance [X]) with minimal patient cooperation. Functional residual capacity (FRC) is one of the most important measurements obtained by gas dilution. Plethysmography is a gold standard to measure airway resistance and useful for lung function testing in infants. The purpose of this review is to help pediatric physicians being familiar with PFT techniques used in young children by discussing their principles, clinical applications, limitations, and current accessibility in Korea. (Allergy Asthma Respir Dis 2014;2:3-7)

소아 수면무호흡에서 상기도의 역할

지혜미 ( Hye Mi Jee ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.1

Obstructive sleep apnea (OSA) is characterized by a disorder of breathing with prolonged partial and/or complete airway obstruction which causes frequent arousal during sleep. The prevalence of OSAS is approximately 2%-3.5% in children. It is mainly caused by enlarged tonsils and adenoids. Obesity, craniofacial abnormality, and neuromuscular disease are also relevant predisposing factors. Snoring is the most common presenting complaint in children with OSA, but the clinical presentation varies according to age. The pathogenesis of OSA is complex and involved in multifactorial, relative roles of anatomic and neurohumoral factors. The role of the nose is considered a component of the pathophysiology of OSA. It is unlikely that the first manifestation of OSA is intermittent snoring with nasal obstruction, often considered a coincidental finding. Childhood OSA should be diagnosed and treated, if clinically suspected, because various symptoms, signs, and consequences can be improved with proper management. Adenotonsillec-tomy is the first-line treatment modality in pediatric OSA with adenotonsillar hypertrophy. In addition, treatment of allergic rhinitis, nonallergic rhinitis, and other structural problems of the nasal cavity, if it is needed, may be included in the treatment of OSA. (Allergy Asthma Respir Dis 2017:5:3-7)

알레르기 환자에서 TLR9 ligand인 CpG-ODN 자극에 의한 IFN-α 분비와 TLR9 발현

한만용,지혜미,김형윤,이초애,조효진,황성규,김규언,Han, Man Yong,Jee, Hye Mi,Kim, Hyeong Yoon,Lee, Cho Ae,Cho, Hyo-Jin,Hwang, Seong-Gyu,Kim, Kyu-Earn 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.9

목 적 : 알레르기 환자와 정상인에서 형질세포양 수지상세포의 분포, TLR9 mRNA 양과 $IFN-{\alpha}$의 분비능에 차이가 있는지 알아보고자 하였다. 방 법 : 19명의 알레르기 환자와 17명의 건강한 성인을 대상으로 하였다. 말초혈액단핵세포를 채취하여 Lineage Cocktail(CD3, CD14, CD16, CD19, CD20, CD56)음성, HLA-DR 양성이면서 CD123양성을 유세포 분석기로 분석하였다. 말초혈액단핵세포에 TLR9 작용제(agonists)인 CpG-ODN 2216과 음성 대조를 위해 CpG-ODN 2206으로 자극하고 24시간 후 상청액을 추출하여 $IFN-{\alpha}$의 농도를 측정하였다. 또한 real time RT-PCR을 이용하여 TLR9 mRNA 정량분석을 시행하였다. 결 과 : 말초혈액단핵세포에서 형질세포양 수지상세포의 분포는 알레르기 환자가 평균 $0.1{\pm}0.04%$, 대조군이 평균 $0.25{\pm}0.23%$이었다. TLR9 mRNA 상대적인 양을 나타내는 ${\Delta}{\Delta}Ct$는 알레르기 환자에서 $1.29{\pm}0.41$이었고 대조군은 $1.25{\pm}0.23$이었다. TLR9 리간드인 CpG-ODN 2216 자극에 따른 $IFN-{\alpha}$의 분비능은 알레르기 환자에서 $911{\pm}829pg/mL$ 이었고 대조군에서 $1,095{\pm}888pg/mL$ 이었다. 이 세 결과에서 통계적인 차이는 없었다. 결 론 : TLR9을 통한 신호전달이 알레르기 환자의 면역반응을 대표하지는 않는 것으로 보이며, 향후 더 자세한 TLR9의 역할에 대한 연구가 필요하다. Purpose:The aim of this study is to explore the effect of the Toll-like receptor 9 (TLR9) expressed in plasmacytoid dendritic cells (pDCs) that respond to antigen to Th2 immune deviation in allergic patients. Methods:Subjects consisted of 19 allergic patients and 17 healthy volunteers. Skin prick tests and nasal provocation tests were performed for the two groups. Peripheral blood mononuclear cells (PBMCs) were collected from subjects and analyzed for the Lineage Cocktail (CD3, CD14, CD16, CD19, CD20, CD56) (-), HLA-DR (+), and CD123 (+) using flow cytometry. In addition, we analyzed TLR9 mRNA by reverse transcriptase-polymerase chain reaction. The level of $interferon-{\alpha}$ ($IFN-{\alpha}$) of the PBMCs following stimulation with the TLR9 ligand CpG-ODN 2216 was also evaluated. Results:Analyses of CD123 (+) revealed a nearly similar distribution for the classical pDC markers in the allergic group ($0.1%{\pm}0.04%$) and in the controls ($0.25%{\pm}0.23%$). The mRNA levels of TLR9 on PBMCs were not different between the allergic group and the controls ($1.29{\pm}0.41$ vs. $1.25{\pm}0.23$, respectively). Additionally, the level of $IFN-{\alpha}$ in PBMCs exposed to stimuli of the TLR9 ligand CpG-ODN 2216 was not significantly different between the two groups ($911{\pm}829$ vs. $1,095{\pm}888pg/mL$, respectively). Conclusion:We found no evidence that TLR9-dependent immune responses in human pDCs are associated with allergic status.

3세 남아에서 발견된 급성 간질성 폐렴 1례

김신혜 ( Shin Hye Kim ),이수현 ( Soo Hyun Lee ),지혜미 ( Hye Mi Jee ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김명준 ( Myung Joon Kim ),조상호 ( Sang Ho Cho ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2008 소아알레르기 및 호흡기학회지 Vol.18 No.4

급성 간질성 폐렴은 기저질환이 없이 갑작스런 하기도 증상 및 조직병리검사에서 미만성 폐포손상을 보이는 소아에서 매우 드문 간질성 폐질환 중 하나이다. 저자들은 3개월 간 기침증상을 보여 특별한 치료 없이 지내다가 갑작스런 증상악화로 내원한 환아에 대하여 특발성 간질성 폐질환에 대한 감별질환에 대한 검사를 진행하였으나 특이소견을 발견하지 못하였고 인공호흡기 치료 및 고용량 스테로이드 요법 및 hydroxychloroquine치료에도 불구하고 입원 23일만에 사망한 후 사후 폐조직 검사에서 급성 간질성 폐질환으로 진단된 증례 1례를 경험하였기에 보고하는 바이다. Acute interstitial pneumonia (AIP) is one of the interstitial lung diseases characterized by rapid development of progressive dyspnea with cough and histopathologically diffuse alveolar damage by unknown cause. Because the overall onset is around 55 years of age, very few pediatric cases have been reported since 1986 when the first AIP was introduced. It has so poor prognosis that mortality rate is over 70% although intensive care is supplied. We experienced a 3-year-old boy whose clinical progress and radiologic findings were typical with acute interstitial pneumonia which was confirmed by necropsy, showing diffuse alveolar damage with proliferation of fibroblasts and inflammatory cell infiltrates. We herein present a case with a with a brief review of literature. [Pediatr Allergy Respir Dis(Korea) 2008;18:358-363]

소아 천식과 호산구성 기관지염에서 혈관 내피세포 성장인자(VEGF)의 의의

김경원 ( Kyung Won Kim ),지혜미 ( Hye Mi Jee ),이경은 ( Kyung Eun Lee ),박여훈 ( Yeo Hoon Park ),최봉석 ( Bong Seok Choi ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.2

목적: 혈관 내피세포 성장인자(Vascular endothelial growth factor, VEGF)는 기도개형에 중심적인 역할을 하며, 혈관의 투과성을 증가시켜 천식에서 기도 벽의 부종에 기여할 뿐 아니라 기관지과민성에 관여하는 것으로 알려져 기관지 천식의 중요한 매개물질로 주목받고 있다. 본 연구에서는 천식 및 호산구성 기관지염 환아에서 이러한 VEGF의 임상적인 의의와 기관지과민성 및 폐기능에 미치는 영향에 대해 알아보고자 하였다. 방법: 만 6세에서 14세 사이의 278명을 대상으로 하였다. 천식 환아는 117명, 호산구성 기관지염환아는 77명, 대조군은 84명이었다. 전체 대상자에서 폐기능 검사, 메타콜린 흡입 유발시험, 피부 단자 시험을 시행하였고, 혈액 내 호산구수, 혈청 총 IgE, ECP, 유도 객담 내 호산구수 및 유도 객담 상층액의 ECP, VEGF 농도를 측정하였다. 결과: 천식군의 유도 객담 VEGF 농도는 89.04 (29.95-178.09) pg/mL, 호산구성 기관지염군은 25.30 (11.02-80.23) pg/mL, 대조군은 37.37(16.56-71.30) pg/mL로 천식군에서 호산구성 기관지염군과 대조군에 비해 의미있는 증가를 보였다(P=0.0003). 또한 유도 객담 VEGF 농도는 유도객담 내 ECP 농도와 유의한 양의 상관관계를 나타내었으나(r=0.524; P<0.0001), 유도 객담 내 호산구수와는 관련이 없었다. 또한 유도 객담 내VEGF는 FEV1, (r=-0.252; P=0.001) 및 post-bronchodilator FEV1 (r=-0.181; P=0.038)와 의미있는 음의 상관관계를 나타내었다. 결론: VEGF는 소아 천식에서 기도 내 호산구 활성화와 연관이 있는 것으로 생각되며, 특히 유도 객담 VEGF는 호산구성 기도 염증의 정도 및 기류제한을 반영하는 보조적인 지표가 될 수 있을 것으로 생각된다. Purpose: Vascular endothelial growth factor (VEGF) is an important mediator of airway inflammation and remodeling in asthma. We aimed to explore whether VEGF is expressed at elevated levels in asthmatic airways or eosinophilic bronchitis (EB) and associated with eosinophilic inflammation, pulmonary function, and airway hyperresponsiveness (AHR) in children. Methods: One hundred seventeen asthmatic children, 77 children with EB, and 84 healthy children were enrolled. Sputum supernatants were collected and VEGF and eosinophil cationic protein (ECP) levels were measured. Results: Asthmatic children had significantly higher levels of VEGF in induced sputum [89.04 (29.95-178.09) pg/mL] compared to children with EB [25.30 (11.02-80.23) pg/mL] and healthy children [37.37 (16.56-71.30) pg/mL; P=0.0003]. VEGF in sputum positively correlated with sputum ECP (r=0.524; P<0.0001). Negative significant correlations were found between sputum VEGF and FEV1, (r=-0.252; P=0.001) or post-bronchodilator FEV1 (r=-0.181; P=0.038) whereas nonsignificant correlations were found between sputum VEGF and sputum eosinophils. Conclusion: Our findings suggest that VEGF is associated with activated eosinophils in the asthmatic airway, but not EB. Sputum VEGF could be a supportive marker that represents activation of airway eosinophils and persistent airflow limitation in asthmatic children. [Pediatr Allergy Respir Dis(Korea) 2009;19:173-182]

천식 환아에서 호기산화질소(exhaled nitric oxide)와 폐기능 및 기도과민성의 연관성

최봉석 ( Bong Seok Choi ),지혜미 ( Hye Mi Jee ),박여훈 ( Yeo Hoon Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.3

목적: 호기산화질소는 하기도 염증의 지표로 천식의 진단, 중증도 평가, 및 추적관찰의 도구로써 의미가 있다고 보고되고 있으나 아직 논란이 있다. 폐기능 검사는 천식의 진단 및 치료, 관리에 많이 이용되고 있으며, 기도과민성은 천식의 중요한 특징으로 메타콜린 유발검사나 기관지 확장제 투여 후 폐기능 검사 등으로 평가한다. 본 연구에서는 천식 환아에서 호기산화질소가 반영하는 기도염증과 폐기능 및 기도과민성의 연관성에 대해 알아보고자 하였다. 방법: 2007년 6월부터 2008년 10월까지 세브란스 어린이병원으로 내원하여 천식으로 진단받은 환아 121명과 대조군 81명을 대상으로 하였다. 4주 이내에 스테로이드 등의 조절제를 사용하였거나 급성 호흡기 감염이 있었던 경우는 제외하였다. 전체군을 대상으로 호기산화질소농도, 폐기능 검사, 기관지 확장제 투여 후 폐기능 검사, 메타콜린 유발검사, impulse oscillometry (IOS)검사를 시행하였다. 호기산화질소와 다른 검사 결과값들과의 연관성에 대해 분석하였으며 각 군 간의 호기산화질소를 비교 분석하였다. 결과: 호기산화질소는 천식군[28.3(15-55.75) ppb]에서 대조군[20(12.35-39.7) ppb]보다 높은 결과를 보였다.(P=0.015) 호기산화질소는 폐기능 검사와는 FEF25-75 (%pred)에 대해서만 약한 연관성을 보였다.(r=-0.169, P=0.022) 기도가역성을 나타내는 dFEV1 (r=0.23, P=0.001), dR5 (r=-0.148, P=0.044)에서 호기산화질소와 유의한 연관성을 보였다. 메타콜린 유발검사상 PC20값과 호기산화질소는 음의 상관관계를 보였다.(r=-0.318, P<0.001) 결론: 호기산화질소는 기도염증 및 기도과민성을 반영하는 보조적인 표지자로서 천식 진단 및 추적 관찰 도구로써 유용할 것으로 생각되나, 폐기능을 직접적으로 반영하지는 않는 것으로 생각된다. Purpose: Exhaled nitric oxide (eNO) has been proposed as a non-invasive marker for airway inflammation in asthma. Pulmonary function tests have been widely used in the diagnosis and management of asthma. Airway hyperresponsiveness (AHR) is one of the major features in asthma and usually assessed by the methacholine challenge test. The purpose of the present study was to assess the possible relationship between eNO and pulmonary function/AHR in asthmatic children. Methods: There were 121 asthmatic children and 81 controls in the study. The eNO level was measured, the methacholline challenge test, spirometry, impulse oscillometry (IOS) and assessment of their bronchodilator responses were performed on all subjects. Results: The asthma group had a higher eNO value than the control group [28.3 (15-55.75) vs. 20 (12.35-39.7) ppb, P=0.015]. The eNO level correlated positively with dFEV1 (r=0.230, P=0.001). It correlate inversely with dR5 (r=-0.149, P=0.036), eNO with PC20 (r=-0.318, P<0.001) and with FEF25-75 (r=-0.17, P=0.015), but not with FEV1. Conclusion: This study suggests that eNO values may reflect AHR, as well as airway inflammation, but not pulmonary function. [Pediatr Allergy Respir Dis(Korea) 2009;19:291-299]

분만 방법이 소아 알레르기질환의 유병률에 미치는 영향

이용주 ( Yong Ju Lee ),지혜미 ( Hye Mi Jee ),김병주 ( Byoung Ju Kim ),김효빈 ( Hyo Bin Kim ),유진호 ( Jin Ho Yu ),이소연 ( So Yeon Lee ),김우경 ( Woo Kyung Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ),홍수종 ( Soo Jong 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.3

Purpose: It has been suggested that caesarean section is a risk factor for allergic diseases under the ``hygiene hypothesis``, but it remains controversial. In this study, we examined the association between mode of delivery and development of allergic diseases. Methods: The Korean International Study of Asthma and Allergies in Childhood questionnaire was used to survey 8,404 elementary and middle-school students in Seoul between April and October 2008. We categorized children into a caesarean section group and a vaginal delivery group, and surveyed the prevalence of asthma, allergic rhinitis, and atopic dermatitis. Results: No differences in the prevalence of "wheeze ever" (P=0.418), "wheezing the last 12 months" (P=0.152), and "diagnosis of asthma ever" (P=0.382) were observed between the caesarean section group and the vaginal delivery group. The prevalence of "rhinitis ever" (P=0.609), "rhinitis the last 12 months" (P=0.788), and "diagnosis of allergic rhinitis ever" (P=0.700) was also similar between the two groups. The prevalence of "itchy eczema ever" (P=0.065), "itchy eczema last 12 months" (P=0.381), and a "diagnosis of atopic dermatitis ever" (P=0.162) also did not show any differences between the two groups. However, in subjects with a family history of allergic disease, the caesarean section group had the higher prevalence of "diagnosis of asthma ever" (11.3% vs. 9.2%, P=0.032) than that in the vaginal delivery group. Conclusion: We found an association between mode of delivery and the subsequent development of asthma in children with a family history of allergic disease in Seoul, Korea. [Pediatr Allergy Respir Dis(Korea) 2011;21:197-206]

소아에서 혈청 면역글로불린 A와 알레르기질환과의 연관성

박진석 ( Jin Seok Park ),한영익 ( Young Ik Han ),한만용 ( Man Yong Han ),지혜미 ( Hye Mi Jee ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Purpose: IgE is associated with allergic disease. However, insufficient research has been carried out regarding the levels of serum IgA in children with allergic disease. The purpose of this study was to evaluate the levels of serum immunoglobulin in Korean chil￢dren with allergic disease and to identify significant correlations between such diseases and serum IgA levels. Methods: We evaluated 338 children who visited the Pediatric Allergy Clinic, CHA Bundang Medical Center from March 2007 to July 2013. We assessed factors, such as sex, age, and family history of allergic diseases. Laboratory tests, including serum IgG, A, and M, total IgE, and specific IgE, were carried out on all patients. In addition, we compared serum IgA levels in allergic Korean children with normal reference ranges. Results: The median (interquartile range) of serum IgA values was 31.1 mg/dL (14.3-50.6 mg/dL) in cases of food allergy and 44.3 mg/dL (25.7-94.2 mg/dL) in cases of atopic dermatitis. The serum IgA levels were lower in allergic Korean children aged 9-12 months and 25-72 months than in the normal mean reference values. Relationships between age and serum IgA levels were statis￢tically significant in allergic children. Conclusion: Our study suggests that serum IgA levels might be lower in allergic children than in the normal mean reference values. In order to understand this mechanism, normal levels for IgA in Korean children must be determined.(Allergy Asthma Respir Dis 2015;3:109-115)

2016-2017년 겨울철 급성모세기관지염으로 입원한 영아의 임상 양상과 호흡기 세포융합 바이러스 유전적 변이

연동건 ( Dong Keon Yon ),민채연 ( Chae-yeon Min ),하은교 ( Eun Kyo Ha ),지혜미 ( Hye Mi Jee ),정영호 ( Young-ho Jung ),이경석 ( Kyung Suk Lee ),신윤호 ( Youn Ho Sheen ),한만용 ( Man Yong Han ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.2

Purpose: Circulating patterns of predominant respiratory syncytial virus (RSV) genotypes in the community may be helpful in understanding molecular epidemiology and predicting future outbreaks of the RSV genotype. We investigated the association of genetic variations in RSV with acute severe bronchiolitis in infants. Methods: We reviewed medical records of infants younger than 1 year of age hospitalized due to acute bronchiolitis between November 2016 and February 2017. Subjects were classified as severe or mild based on the use of mechanical or noninvasive ventilation. The associations between severity of the disease, sex, age at admission, oxygen saturation at admission and laboratory test results were analyzed. RSV sequence analysis was performed in the severe group. Results: Among 114 infants, 80 underwent respiratory viral polymerase chain reaction using nasopharyngeal swab; of these, 53 (66.3%) showed positive for RSV. Of the 53 RSV-positive samples, 9 were categorized as the severe group and 44 were categorized as the mild group. Male sex, young age, longer duration of admission, minimum SaO₂ at admission and bronchiolitis severity score were significantly correlated with disease severity in the severe group than in the mild group (all variables, P<0.001). Phylogenetic and sequence analysis in the severe group revealed 8 RSV-A, ON1 genotype and 1 RSV-B, BA4 genotype. Conclusion: Phylogenetic types of RSV in subjects of the severe group were RSV-A, ON1 genotype or RSV-B, BA4 genotype which were prevalent in the Korean community at the same time. Our study showed that disease severity was not significantly associated with RSV genotypic evolution or antigenic drift in Korea during winter season 2016-17. (Allergy Asthma Respir Dis 2018;6:110-115)