천식 환아에서 집먼지진드기 항원 감작과기도과민성 및 폐기능과의 관계 = Relationship between Sensitization toIndividual Aeroallergen, Bronchial Hyperresponsiveness andPulmonary Function in Atopic Asthmatic Children

다국어 초록 (Multilingual Abstract)

Purpose : Atopy and specific immunogloguline(Ig)E to individual aeroallergen are considered a hallmark of allergic diseases, including asthma. However, the association between these parameters and lung function or bronchial hyperresponsiveness(BHR) is still controversial in previous studies.
Methods : A total of 234 atopic asthmatic children was recruited in this study. The amounts of total IgE and specific IgE were determined by employing the CAP system FEIA (Pharmacia Diagnostics, Uppsala, Sweden). Specific IgE was focused on two major inhalant allergens in Korea, Dermatophagoides pteronyssinus(Der p) and Dermatophagoides farinae (Der f). To evaluate BHR, methacholine and exercise challenge tests were performed.
Results : In the atopic asthmatic group, total IgE correlated negatively with methacholine PC20 and positively with a maximum percentage fall in FEV1 after exercise. Specific IgE to Der f strongly correlated with a maximum percentage fall in FEV1 after exercise in atopic asthmatics, particularly exercise-induced asthma(EIA)(r=0.176, P=0.007 and r=0.199, P=0.011, respectively) and specific IgE to Der p weakly correlated with a maximum percentage fall in FEV1 after exercise only in EIA-positive children with atopic asthma(r=0.140, P=0.073), while neither of them correlated with methacholine PC20(P>0.05). However FEV1, FVC, and FEF25-75% were not associated with total IgE and specific IgE to Der p or Der f regardless of positivity of EIA in atopic asthmatic children.
Conclusion : The severity of atopy and sensitization to house dust mites are significantly correlated with BHR, especially challenged by exercise but not pulmonary function in atopic asthmatic children.

국문 초록 (Abstract)

목 적 : 기관지 천식의 중요한 위험인자 총 IgE 및 알레르겐 특이 IgE와 기관지 천식의 임상적 특징인 기도과민성이나 폐기능과의 연관성 유무는 아직 논란이 있으며 특히 소아 천식 환자에서는 잘 알려져 있지 않아 본 저자들은 그 관련성을 알아보고자 이 연구를 시행하였다.방 법 : 1998년 3월부터 2005년 4월까지 서울아산병원 소아알레르기 클리닉을 내원하여 천식을 진단 받은 환아들 중 Der p 혹은 Der f 집먼지진드기 항원에 감작된 234명의 아토피 천식 환아를 대상으로 하였다. 대상 환아는 운동유발시험 양성 유무에 따라 운동유발성 천식이 있는 환아와 운동유발성 천식이 없는 환아로 다시 구분하여 혈청 총 IgE, 총 호산구수, Der p 및 Der f 특이 IgE 농도, 메타콜린 PC20, 운동유발 후 FEV1의 최대 감소율, 폐기능 지표(FVC, FEV1, FEF25-75%)를 비교하였고, 혈청 총 IgE 및 집먼지진드기 특이 IgE와 기도과민성 및 폐기능 사이의 상관관계를 평가하였다.결 과 : 아토피 천식 환자에서 총 IgE 및 집먼지진드기 특이 IgE는 폐기능 지표와 모두 상관관계를 보이지 않았다. 그러나 총 IgE는 메타콜린 PC20와 운동유발 후 FEV1 최대 감소율과 각각 유의한 상관관계를 보였다. Der f 특이 IgE는 운동유발성 천식 유무와 상관없이 모든 아토피 천식 환아에서 운동유발 후 FEV1의 최대 감소율과 유의한 상관관계가 관찰되었고(r= 0.199, P=0.011), Der p 특이 IgE는 운동유발성 천식이 있는 환아에서만 약한 상관관계를 보였다.(r=0.140, P=0.073) 그러나 메타콜린 PC20는 두 특이 IgE와는 모두 상관관계를 보이지 않았다. 운동유발성 천식이 없는 환아에서는 총 IgE와 특이 IgE는 기도과민성과 폐기능 지표 모두 연관성이 관찰되지 않았다. 결 론:본 연구에서는 아토피 천식 환자들에서 집먼지진드기에 대한 감작과 폐기능 감소와의 연관성은 관찰되지 않았으나 기도 염증과 연관된 기도과민성을 반영하는 운동유발에 의한 기도과민성과 의미 있는 관련성을 보여 앞으로 더 많은 환아군을 대상으로 연구가 진행되어야 할 것으로 생각된다

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