국내 중부지역 아나필락시스 환자의 임상적 특성 연구

노의정,정은희,이미희,이수진,윤유숙,이재호,우성일,한윤수,박준수,김한진 대한 소아알레르기 호흡기학회 2008 Allergy Asthma & Respiratory Disease Vol.18 No.1

Purpose:Anaphylaxis is a medical emergency requiring immediate recognition and treatment. Despite the serious nature of these reactions, there is no universal agreement on the definition and there have been few epidemiologic studies of anaphylaxis in children. The purpose of the study is to investigate the causative agents, presenting signs and symptoms and course of disease in children suitable for established diagnostic criteria for anaphylaxis in the middle area of South Korea. Methods:We identified potential episodes of anaphylaxis occuring between March 1994 and October 2007 from the university hospitals in the middle area of South Korea. We reviewed all patients' medical records diagnosed with anaphylaxis and other related diagnoses. From chart review, we retrospectively collected demographic and epidemiologic data. Results:We identified 40 patients with anaphylaxis. Patients' ages ranged from 2 months to 17 years, with a mean age of 6.6 years. A causative agent was recognized in 84.5%. The inciting agent included foods in 26 cases (65%), medication in 7 cases (17.5%) and bee sting in 1 case (2.5%). Mucocutaneous manifestations were the most common, respiratory symptoms were in 35 patients, cardiovascular symptoms were in 8 patients, and gastrointestinal symptoms were in 5 patients. Conclusion:We found some cases of anaphylaxis which had misdiagnosed as urticaria or angioedema using the established diagnostic criteria. Therefore, clinicians must accurately know the criteria of anaphylaxis and make an effort to identify cases of anaphylaxis with a high suspicion. Also, we found the epidemiology, causative agents, and symptoms and treatments of anaphylaxis in the middle area of South Korea. Our data will be the basis for anaphylactic studies in South Korea. Purpose:Anaphylaxis is a medical emergency requiring immediate recognition and treatment. Despite the serious nature of these reactions, there is no universal agreement on the definition and there have been few epidemiologic studies of anaphylaxis in children. The purpose of the study is to investigate the causative agents, presenting signs and symptoms and course of disease in children suitable for established diagnostic criteria for anaphylaxis in the middle area of South Korea. Methods:We identified potential episodes of anaphylaxis occuring between March 1994 and October 2007 from the university hospitals in the middle area of South Korea. We reviewed all patients' medical records diagnosed with anaphylaxis and other related diagnoses. From chart review, we retrospectively collected demographic and epidemiologic data. Results:We identified 40 patients with anaphylaxis. Patients' ages ranged from 2 months to 17 years, with a mean age of 6.6 years. A causative agent was recognized in 84.5%. The inciting agent included foods in 26 cases (65%), medication in 7 cases (17.5%) and bee sting in 1 case (2.5%). Mucocutaneous manifestations were the most common, respiratory symptoms were in 35 patients, cardiovascular symptoms were in 8 patients, and gastrointestinal symptoms were in 5 patients. Conclusion:We found some cases of anaphylaxis which had misdiagnosed as urticaria or angioedema using the established diagnostic criteria. Therefore, clinicians must accurately know the criteria of anaphylaxis and make an effort to identify cases of anaphylaxis with a high suspicion. Also, we found the epidemiology, causative agents, and symptoms and treatments of anaphylaxis in the middle area of South Korea. Our data will be the basis for anaphylactic studies in South Korea.

비만아에서 조기 동맥경화증 지표들의 변화

노의정,윤정민,임재우,천은정,고경옥 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.4

Purpose : The prevalence of obesity in children is increasing rapidly. Epidemiologic studies suggest that obesity induced atherosclerosis may start in childhood. We investigated whether obese children show early abnormalities of the arterial wall and endothelial dysfunction. Methods : Thirty-eight obese children(14-16 years old of age, male, body mass index 29.40±3.18 kg/m2) and forty-five age and sex-matched healthy control children(body mass index 18.43±1.01 kg/ m2) were enrolled. Their carotid artery intima-media thickness(IMT) and brachial artery flow- mediated dilation(FMD) response were measured by high-quality ultrasound system, and compliance, distensibility, stiffness index, incremental elastic modulus and wall stress were calculated by equation. In addition, we looked at the relations between these arterial features and metabolic cardiovascular risk factors. Results : The obese children had significantly increased IMT(0.52±0.09 mm vs 0.40±0.07 mm, P< 0.001) and markedly impaired FMD(7.35±7.78 percent vs 20.34±16.81 percent, P<0.001) than the healthy controls. But the compliance and distensibility were lower, and the stiffness index, incremental elastic modules and wall stress were higher in the obese group than the control group, but not statistically significantly. Body mass index was highly associated with increased IMT(r=0.612, P< 0.001) and reduced FMD(r=-0.414, P<0.001). Conclusion : We showed the deleterious effect of child obesity on both early functional and structural atherosclerotic markers. The ultrasonic findings will be used for screening and follow up markers to identify high-risk patients among obese children. 목 적 : 비만증은 소아과 영역에서 비교적 흔한 영양장애이며 우리나라에서도 현저히 증가되고 있고, 비만으로 인한 성인의 동맥경화증은 대부분 소아시기부터 시작된다는 것이 알려져 있다. 또한 경동맥의 기계적 특성과 상완동맥의 내피세포 기능 변화를 조사함으로써 동맥경화증의 발생과 진행에 예측 인자로 사용할 수 있다. 따라서 본 저자들은 비만아들이 이러한 혈관 이상과 내피세포 기능 이상을 보이는지 측정을 하여 알아보았다.방 법 : 14-16세의 38명의 비만아를 대상군으로 하였고 같은 성별과 연령의 45명의 건강한 소아를 대조군으로 하였다. 고해상도 초음파를 이용하여 경동맥의 내중막 두께와 혈관 내피세포에 의존적인 혈류 의존성 상완 동맥 확장능을 측정하였으며, 경동맥의 유순도와 신전도, 경직도, 증분 탄성률, 확장기 혈관벽 중압은 공식으로 계산하여 두 군간에 차이가 있는지 조사해 보았다.결 과 : 비만아가 정상아보다 내중막 두께가 유의 있게 증가되어 있었고, 혈류 의존성 확장능은 현저하게 감소되어 있었다. 유순도, 신전도, 경직도는 두 군간 차이가 없었다. 또한 비만 정도가 심할수록, 혈압이 높을수록 내중막 두께는 증가하였으며, 비만이 독립적으로 내피세포 기능 이상을 초래함을 알 수 있었다.

선천성 매독에 동반된 백색 폐렴 2례

노의정,홍경식,장영표,이영석,정은희 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.3

선천성 매독은 매독에 감염된 산모로부터 태반을 통하여 태아에 감염을 일으켜 여러 장기에 임상소견을 보일 수 있는데 드물게 폐를 침범하기도 한다. 매독이 완전히 근절되지 않고 꾸준히 보고되고 있는 점을 고려하여 선천성 매독의 발생에 관심을 기울여야 한다. 선천성 매독이 의심되며, 호흡기 증상이 있는 신생아에서 흉부 방사선 소견상 간질성 침범과 함께 다발성 결절성 병변이 의심되고, 특히 이를 흉부 고해상도 전산화 단층촬영에서 정확하게 확인한다면 백색 폐렴을 진단하는데 도움을 받을 수 있겠다. 저자들은 근래 비교적 발생이 드문 백색 폐렴을 동반한 선천성 매독 2례를 경험하였으며, 그동안 보고된 바 없는 백색 폐렴의 흉부 고해상도 전산화 단층촬영 소견과 함께 이를 보고하는 바이다. Congenital syphilis is a completely preventable disease, but it still occurs. It usually involves multiple organs, which may cause neurological or skeletal disabilities or death in the fetus or newborn. Although lung involvement is rare in congenital syphilis, we should consider pneumonia alba when respiratory symptoms or radiologic findings are abnormal. We first report herein two cases of pneumonia alba with high resolution computerized tomography (HRCT) findings.

급성 호흡기 감염으로 입원한 소아에서 호흡기 감염의 원인 : 중복검출의 임상적 의미

노의정,장영표,김재경,임인수,박귀성,정은희 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.6

Purpose : To determine the prevalence and clinical features of codetected respiratory etiological agents for acute respiratory infection in hospitalized children. Methods : Nasopharyngeal aspirates were obtained from hospitalized children with acute respiratory infection at Dankook University Hospital from September 2003 through June 2005. Immunofluorescent staining and culture were used for the detection of respiratory viruses (influenza virus [IFV] types A, B; parainfluenza virus [PIV] types 1, 2, 3; respiratory syncytial virus [RSV]; adenovirus [AdV]). Polymerase chain reaction (PCR) assays were used for Mycoplasma pneumoniae (MP) and Chlamydia trachomatis (CT) detection, and PCR and culture were performed for enterovirus detection. Acid-fast staining and culture were performed for tuberculosis detection. The demographic and clinical characteristics were reviewed retrospectively from the patients medical records. Results : Evidence of two or more microbes was found in 28 children: RSV was detected in 14, PIV 3 in 10, AdV in 10, MP in 8, PIV 2 in 8, CT in 4, and PIV 1 in 3. Codetected agents were found as follows: RSV+PIV 2, 6 patients; AdV+MP, 4 patients; AdV+PIV, 3 patients; RSV+MP, 3 patients; PIV 1+PIV 3, 3 patients. Distinct peaks of codetected agents were found in epidemics of MP and each respiratory virus. Conclusion : The codetected infectious agents were RSV, PIV, AdV, and MP, with distinct peaks found in epidemics of MP and each respiratory virus. Although advances in diagnostic methods have increased the prevalence of codetection, its clinical significance should be interpreted cautiously. 목 적 : 최근 호흡기 감염의 원인에 대한 검사 방법의 발달로 중복검출에 대한 높은 비율이 보고되고 있다. 이에 소아에서의 급성 호흡기 감염의 원인으로 중복검출에 대한 임상 양상과 그 특징에 대해 알아보고자 하였다. 방 법 : 2003년 9월부터 2005년 6월까지 단국대학교병원 소아과에 급성 호흡기 증상으로 입원한 환아들을 대상으로 의무기록지를 후향적으로 조사하였다. 비인두 흡인물의 호흡기 바이러스(AdV, RSV, PIV 1, 2, 3, IFA, IFB)의 항원과 배양 검사, 혈청의 MP 항체 측정(1:640 이상 혹은 4배 이상의 항체 상승시 양성으로 함), 비인두 흡인물의 MP PCR, CT 항원의 PCR 검사, enterovirus PCR 및 배양검사, 객담의 항산균 도말 염색 및 배양 검사를 받은 환아들 중 2가지 이상에서 양성으로 나온 환아들의 임상 양상에 대해서 조사하였다. 결 과 : 1) 호흡기 감염의 원인에 대한 검사에서 2가지 이상의 양성을 보인 환아는 총 28명이었으며 남아가 17명이었고, 평균 나이는 2년 3개월(19일-13세), 6개월 미만이 11명이었다. 2) 중복검출의 원인 중 RSV가 14례, PIV 3 10례, AdV 10례, MP 8례, PIV 2가 7례, CT, PIV 3가 각각 3례였다. 중복검출되는 원인으로 RSV+PIV 2 6례, AdV+MP 4례, AdV+PIV 3, RSV+MP, PIV 1+PIV 3가 각각 3례였다. 3) 임상 진단으로 폐렴 19례, 세기관지염 16례, 후두염이 3례였으며, 4) MP, 호흡기 바이러스의 각각의 유행 시기에 이들에 의한 중복검출이 있었다. 결 론 : 소아의 급성 호흡기 감염의 원인에 대한 중복검출은 영아에서 흔하며, 원인으로 RSV, PIV, AdV, MP가 많았다. MP, 호흡기 바이러스의 각각의 유행 시기에 이들에 의한 중복 검출률의 빈도가 증가함을 볼 수 있었다. 호흡기 감염의 원인에 대한 검사 방법의 발달로 중복 검출률이 높아지고 있어 이의 임상적 의미에 대한 연구가 더 필요하다고 사료된다.

A Case of Hypersensitivity to Mosquito Bite Associated with Epstein- Barr Viral Infection and Natural Killer Cell Lymphocytosis

노의정,정은희,장영표,명나혜,지영구,서민,강진한 대한의학회 2010 Journal of Korean medical science Vol.25 No.2

Hypersensitivity to mosquito bites (HMB) is a disorder characterized by a necrotic skin reaction and generalized symptoms subsequent to mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer cell leukemia/lymphoma. We describe here a Korean child who had HMB associated with chronic EBV infection and natural killer cell lymphocytosis. A 5-yr-old boy was suffered from necrotic skin lesions on the right ear lobe. Type A EB virus was detected from hlood cells and bone marrow biospy recognized hemophagocyrosis.

Molecular identification and clinical features of enteroviral infection in children of central Korea: An overview of enteroviral epidemiology between spring 2005 and autumn 2006

노의정,진용만,장영표,박우성,박귀성,지영미,정은희 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.11

Purpose:Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. Methods:From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. Results:Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions:There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea. Purpose:Enteroviruses (EVs) are commonly known to cause infection, especially in infants and children. This report presents an overview of enterovirus epidemiology in central Korea. Methods:From the spring of 2005 to the autumn of 2006, we collected the cerebrospinal fluid (CSF) and stool samples from the pediatric patients with a febrile illness or suspected meningitis who were admitted to hospitals in central Korea. In order to test for EVs, cell lines were derived from pretreated susceptible specimen, and the cytopathic effects were observed. Seminested real time-polymerase chain reaction (RT-PCR) and direct sequencing were performed for genotypic and phylogenetic analyses. Results:Of the 305 patients examined, 51 (16.7%) tested positive for EV. Of these 51 patients, 44 showed the following serotypes: Echovirus (ECV) 18 (18 cases, 35.2%), Coxsackievirus B (CVB) 5 (13 cases, 25.4%), ECV25 (5 cases, 9.8%), ECV9 (4 cases, 7.8%), ECV5 (3 cases, 5.8%), and EV74 (1 case, 1.9%). In 2005, between June and August, ECV18 and CVB5 were mostly responsible for the enteroviral infections among the patients in central Korea. In 2006, between July and August, ECV25 was mostly the cause of enteroviral infection. Conclusions:There is a need for continuous surveillance of enteroviral infection and its clinical manifestations, particularly for EV74, which was first identified in Korea.

국내 유통되는 인플루엔자 백신에서 ELISA에 의한 계란 단백의 정량적 비교

노의정,김재경,정은희 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.4

Purpose : Influenza infection is a major public health concern, especially in young children and in high risk groups such as patients. Traditionally, influenza vaccines are produced from infertilized eggs. Therefore, patients with severe egg allergy can show adverse reactions after vaccination and be dalayed in active immunization. The aim of this study was to determine the ovalbumin concentration of a commercially available influenza vaccines in Korea. Methods : The ovalbumin content in each vaccine was determined by enzyme linked immunosorbent assay. The ovalbumin content was compared among the different manufactures, the different lot numbers and the same lot numbers of vaccines. The microtiter plates coated with goat anti-chicken egg albumin antibody were inoculated with serial diluted vaccines and ovalbumin. After incubation with horse radish peroxidase-conjugate rabbit anti-ovalbumin, absorbance was read at 450 nm and fitted to the standard curve. Results : The highest ovalbumin content was 101.24 ng/mL, and the lowest ovalbumin content was 21.23 ng/mL. The amount of ovalbumin differed not only among the different vaccines, but also different lot numbers of individual vaccines and even the same lot numbers of vaccines. Conclusion : In none of the vaccines tested in our study, ovalbumin content reached the maximum values for ovalbumin (1.2 µg/mL). Therefore, in severe egg allergic patients, our results provide the useful information on influenza vaccination. 목 적 : 인플루엔자는 매년 중대한 영향을 끼치는 질병이므로 특히 소아와 같은 고위험군에서는 인플루엔자 예방접종이 강조된다. 인플루엔자 백신은 계란 단백을 함유하므로 계란 알레르기 환자에게 투여시 심각한 부작용을 우려하여 적극적인 백신투여가 이루어지지 못한다. 따라서 본 연구에서는 국내 유통되는 인플루엔자 백신의 계란 단백의 정량을 분석하고자 한다. 방 법 : 2004년, 2005년, 2006년에 국내 유통되고 있는 인플루엔자 백신을 각 회사별로 같은 lot 번호별로, 다른 lot 번호별로 준비하여 각 백신에 포함된 ovalbumin이 coating되어 있는 microtiter plates에 백신 원액부터 2배로 단계 희석한 백신과 ovalbumin을 분주하였고, 2차 항체로 horse radish peroxidase-conjugate rabbit anti-ovalbumin을 분주하였다. 450 nm에서 흡광도를 측정한 후 standard curve를 통해 ng/mL로 변환시켰다. 결 과 : 백신에 가장 많이 측정된 ovalbumin 농도는 101.24 ng/mL였고, 가장 낮은 농도는 21.23 ng/mL였다. ovalbumin 농도는 제약 회사간 차이를 보였고, 같은 제조회사에서 같은 년도에 제작되었지만 다른 lot 번호를 가진 백신의 ovalbumin 농도가 모두 달랐으며 같은 lot 번호를 가진 백신에서도 ovalbumin 농도는 차이를 보였다. 결 론 : 본 인구에서 조사한 국내 유통되고 있는 백신에 함유되어 있는 ovalbumin의 양은 모두 1.2 µg/mL 이하로 측정되었다. 따라서 심각한 계란 알레르기가 있는 환자에서 본 연구 결과는 인플루엔자 백신 접종시 참고자료가 될 수 있겠다.

천식으로 입원한 소아에서 호흡기 바이러스 감염의 유병률

노의정 ( Eui Jung Roh ),진용만 ( Yong Man Jin ),정은희 ( Eun Hee Chung ),임인수 ( In Soo Rheem ),김재경 ( Jae Kyung Kim ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.4

Background: Respiratory viral infections are common exacerbating factors for asthma in children. Recently the detection of respiratory viruses can be improved by using molecular biology techniques, which providing a method capable of detecting an increasing number of viruses. Objective: The aim of this study was to evaluate the causative viral infections and their seasonal trends in children who were admitted with the exacerbation of their asthma by multiplex polymerase chain reaction (PCR) assay. Method: Nasopharyngeal aspirates were obtained from hospitalized asthmatic children at Dankook University Hospital from November 2005 through Febraury 2007. Multiplex PCR assay was used for the detection of respiratory viruses. The demographic and clinical characteristics were reviewed retrospectively from the patients`` medical records. Result: During the study period, 58 were hospitalized due to acute asthma exacerbations. Of these, infectious agents were detected in 38 (65.5%) of the patients. Resipiratoy syncytial virus was detected in 18 (31%), influenza virus in 10 (17.2%), rhinovirus in 7 (12.1%), coronavirus in 5 (8.6%), adenovirus in 4 (6.9%), parainfluenza virus in 5 (8.6%) and human metapneumovirus in 2 (3.4%). Conclusion: It is suggested that the causative virus in hospitalized children with asthma exacerbations follow may the epidemic of respiratory virus in hospitalized children with respiratory infection. (Korean J Asthma Allergy Clin Immunol 2007;27:241-247)

데이터 기반 크리프 시뮬레이션을 위한 가우시안 프로세스 회귀 방법 적용

노의정(Uijeong Ro),김상엽(Sangyeop Kim),김용휘(Yonghwi Kim),이택상(Taeksang Lee),김문기(Moon Ki Kim) 대한기계학회 2022 대한기계학회 춘추학술대회 Vol.2022 No.11

어류폐기물과 빵폐기물 사일리지의 혐기성 소화처리를 위한 최적 혼합비

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