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소아기 류마티스 관절염에 대한 임상적 고찰 -3. 다수관절형-
한윤수 ( Youn Soo Hahn ),박정숙 ( Jeong Sook Park ),김중곤 ( Joong Gon Kim ) 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.1
Objective: The purpose of this study was to analyse clinical manifestations and laboratory findings in childhood patients with polyarticular-onset juvenile rheumatoid arthritis (JRA). Methods: Eleven cases of polyarticular JRA who were diagnosed and treated in the Department of Pediatrics, Seoul National University Children`s Hospital from June 1988 to May 1995 were investigated for clinical manifestations and laboratory findings. Results: 1) There were 6 males and 5 females and their ages of onset were 4 years to 15.1 years(mean 10.9 years). 2) Systemic manifestations were not observed, but low-grade fever was noted in 5 patients. 3) The involvement of joints was symmetric in 9 patients and asymmetric in 2 patients. 4) The most commonly affected joints were knees and ankles, followed by proximal interphalangeal joints of hand, shoulder, elbow, temporomandibular joint, and other joints. 5) Roentgenographic changes of joints were detected in 6 patients and bone scan in 7 patients showed increased uptake in the involved joints. 6) The main laboratory findings observed were microcytic and hypochromic anemia (64%), thrombocytosis (82%), elevated eryhtrocyte sedimentation rate (100%), positive or increased C-reactive protein (100 %), positive rheumatoid factor(RF) (18%), positive antinuclear antibody (ANA) (27%). RF was positive in 2 girls with later age of onset and the pattern of immunofluorescent ANA were all homogeneous. 7) Nonsteroid antiinflammatory drugs (NSAIDs) were used most frequently and steroid with or without sulfasalazine was tried in 4 patients unresponsive to NSAIDs. 8) At last follow-up, 6 cases(55%) were classified as functional class I, 4 cases(36%) as class II, and 1 case(9%) as class III. Conclusion: These data showed the clinical manifestations and laboratory findings of polyarticular-onset juvenile rheumatoid arthritis in Korean children.
아토피 천식 소아에서 기관지확장제 반응과 천식 조절 및 호기 NO 농도 사이의 연관성
박주현 ( Jooh Yun Park ),이윤경 ( Youn Kyung Lee ),김헌 ( Heon Kim ),한윤수 ( Youn Soo Hahn ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1
Purpose: Because bronchodilator response (BDR) is variable among asthmatic patients, there are practical limitations in using BDR to assess asthma control. We investigated the relationships of BDR with asthma control status and fractional exhaled nitric oxide (FeNO) in children with atopic asthma. Methods: One hundred ninety-one patients aged 8 to 16 years with atopic asthma were enrolled. Pulmonary function tests including BDR and FeNO were serially measured 10 times or more over 2 years when subjects were not receiving controller medications. During the last year of follow-up, the loss of asthma control was assessed in all participants. Results: We identified 114 children (60%) with at least 1 positive BDR (≥12%) over the 2-year observation period. Higher levels of BDRs and higher rates of positive BDRs were associated with lower lung function and lower methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second). The loss of asthma control occurred in 106 of individuals (93%) who had positive BDRs, as compared to 52 of 77 (68%) with negative BDRs (P<0.001). There was no difference in FeNO levels between individuals with positive and negative BDRs. However, among children with negative BDRs, those developing the loss of asthma control had higher maximal FeNO levels and higher rates of FeNO>21 parts per billion than those who maintained asthma control (all P<0.001). Conclusion: Positive BDRs are linked to a higher probability of asthma control loss in children with atopic asthma. In addition, high FeNO is associated with asthma control loss in asthmatic children with negative BDRs.
소아 아토피 천식 환자에서 호기 NO 농도와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성
김정옥 ( Jeong Ok Kim ),우성일 ( Sung Il Woo ),한윤수 ( Youn Soo Hahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.1
목적: FeNO는 천식 환자에서 기도 염증을 반영하는 것으로 알려져 있다. 이 연구에서는 FeNO와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성에 대해 알아보고자 하였다. 방법: 아토피 천식으로 진단되고 연구 시작 전 흡입 스테로이드를 최소 1개월 이상 사용하지 않은 8세 이상 16세미만의 소아 123명을 대상으로 하였다. 8-12세 소아에서는 childhood asthma control test (C-ACT) 점수를 12세 이상의 소아에서는 asthma control test (ACT) 점수를 측정하였으며, 모든 소아에 대해 폐기능검사와 FeNO 측정을 실시하였다. 결과: 아토피 천식 소아에서 FeNO의 기하학적 평균(19.2 parts per billion [ppb]; 95% CI, 17.2-21.4)은 정상 소아들 (7.5 ppb; 95% CI, 7.0-8.0)에 비해 유의하게 높았다. (P<.001) ACT 점수나 C-ACT 점수는 대상군 소아의 82%에서 20점 이상이었으며, %FEV1, FEV1/FVC, %FEF25-75%와 유의한 상관관계를 나타내었다. 그러나 FeNO는 천식 조절 점수나 폐기능검사 결과와 유의한 상관관계를 보이지 않았다. 나이, 성별, 신체질량지수 또는 부모 흡연 여부에 따른 FeNO의 차이는 관찰되지 않았다. 결론: 소아 아토피 천식 환자에서 FeNO는 천식 조절점수나 폐기능검사 결과와 연관성을 보이지 않았다. 따라서 소아 아토피 천식 환자에서 천식 조절 점수 측정이나 폐기능검사와 함께 기도 염증 정도를 반영하는 FeNO의 측정이 필요하다고 판단된다. Purpose: Fractional exhaled nitric oxide (FeNO) has been proposed as a tool for assessing airway inflammation in patients with atopic asthma. We evaluated the relationship between FeNO with asthma control test (ACT) scores and spirometry values in children with atopic asthma. Methods: One hundred twenty-six children with atopic asthma, 8-16 years of age, were included in the study. None of the participants received regular controller therapy for at least 4 weeks before the study. The ACT (for children >12 years of age) or the Childhood Asthma Control Test (C-ACT; for children between the ages of 8 and 11 years of age), FeNO measurements and pulmonary function tests were performed. Results: The geometric mean of the FeNO in children with atopic asthma (16.1 parts per billion [ppb]; 95% CI, 14.5-17.8 ppb) was significantly higher than that healthy controls (7.5 ppb; 95% CI, 7.0-8.1 ppb; P<0.001). ACT or C-ACT scores were >20 in 82% of enrolled patients and correlated with the %FEV1, FEV1/FVC, and %FEF25-75. However, FeNO was not related to %FEV1, FEV1/FVC, %FEF25-75, and scores for asthma controls. FeNO levels in asthmatic children were not significantly different with respect to age, gender, BMI, and tobacco exposure. Conclusion: FeNO was not related to the spirometry values and scores for asthma control. Measurement of FeNO may be a complementary tool in the assessment of asthma control. [Pediatr Allergy Respir Dis(Korea) 2011;21:24-31]
집먼지진드기에 대한 면역요법 시행 유무에 따른 항원 특이 Th 및 Tc 림프구 반응의 차이
강미란(Mi Ran Kang),김미경(Mi Kyung Kim),한윤수(Youn Soo Hahn) 대한천식알레르기학회 1999 천식 및 알레르기 Vol.19 No.5
Background: Allergen-specific immunotherapy ( IT ) can be an important adjunctive therapy in the treatment of allergic disorders. Although a number of studies have shown that cytokine pro- duction by T cells may be modified by IT, IT-induced chsnges at the single cell level in allergen -specific Th ( T helper ) and Tc ( cytotoxic T ) responses have not been reported. Objective : The objectives of the present study were ( 1 ) to demonstrate differences in the house dust mite(HDM)-induced cytokine production patterns of Th and Tc cells between un- treated and treated HDM allergic patients and ( 2 ) to determine whether there are differences between child and adult patients in Th and Tc cell responses to HDM. Method: This study included twenty Dermatophagoides farinae (Df)-sensitive asthmatics ( ten children and ten adults ), of which five children and five adults received immunotherapy to Df over a 1.5- to 3-year period. Peripheral blood mononuclear cells ( PBMC ) were isolated from pe- ripheral blood of each patient and cultured in the presence of IL-2 ( 10ng/ml ) and Df extract (100ug/ml) for 6 days. After harvesting cultured cells, Th and Tc cell frequencies were deter- mined by a multiparameter cytokine flow cytometric assay that allows simultaneous determina- tion of intracellular IFN-r and IL-4 in CD4+ or CD8+ cells. Results : Predominant Th2 responses to Df were observed in all untreated child patients, three untreated adult patients, and two treated adult patients. On the other hand, predominant Thl responses to Df were observed in all treated child patients, two of untreated adult patients, and three of treated adult patients. Predominant Tcl responses to Df were observed in all groups of patients. However, Tcl responses were more prominent in adults than in children and in treated adult patients than in untreated adult patients. In children, there were no differences in predom- inant Tcl responses except in one treated child, in whom more prominent Tcl response was ob- served.
소아 아토피 천식 환자에서 실내 흡입 알레르겐 특이 IgE 농도와 총 IgE 농도 및 기도 과민성 사이의 연관성
우성일 ( Sung Il Woo ),임정숙 ( Jeong Sook Lim ),한윤수 ( Youn Soo Hahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2009 소아알레르기 및 호흡기학회지 Vol.19 No.1
목적: 아토피 천식 소아에서 실내 흡입 알레르겐에 대한 특이 IgE의 농도의 총 IgE 농도에 대한 기여도를 분석하고, 특이 IgE 농도와 기도 과민성 및 폐기능 사이의 관계를 알아보고자 하였다. 방법: 청주 지역에 거주하는 5-16세의 아토피 천식 소아 232명을 대상으로 하였다. 주요 실내 알레르겐인 Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Alternaria, 바퀴, 개 상피항원, 고양이 상피항원에 대한 혈청 특이 IgE 농도와 총 IgE 농도를 측정하였다. 집먼지진드기에 감작된 180명의 소아에서 %FEV1과 메타콜린 PC20을 측정하였다. 결과: 혈청 특이 IgE 양성률은 Der p (90.0%)와 Der f (92.7%)를 포함한 집먼지진드기에 대해 가장 높았으며, Alternaria에 대한 양성률(21.6%)은 두 번째로 높았다. Der p와 Der f 특이 IgE 농도가 총 IgE 농도에서 차지하는 비율은 다른 흡입 알레르겐에 비해 월등히 높았으며,(P<0.001) Der f가 Der p보다 높은 비율을 차지하였다.(P<0.001) 특이 IgE 농도와 총 IgE 농도 사이에서 Der p (r=0.677, P<0.001), Der f (r=0.657, P<0.001)로 유의한 상관관계를 보였다. Der f에 대한 특이 IgE의 농도가 높을수록 기도 과민성이 높은 비율로 관찰되었고 FEV1은 감소하였다. 결론: 청주 지역 소아 아토피 천식 환자의 대다수에서 관찰된 총 IgE의 상승은 집먼지진드기에 대한 IgE 반응에 의하였으며 집먼지진드기 특이 IgE 농도는 기도 과민성과 폐기능 감소와 유의한 관련성을 나타내었다. Purpose: We assessed the relationship of indoor aeroallergen specific IgE levels with total IgE level, airway hyperresponsiveness (AHR) and lung function in children with atopic asthma. Methods: Two hundred twenty-eight children with atopic asthma in Cheongju area were studied. Sera were assayed for total IgE and specific IgE antibodies to important indoor allergens including Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Alternaria, cats, dogs, and cockroaches. One hundred eighty children sensitized to house dust mites (HDMs) were evaluated for %FEV1 and methacholine PC20. Results: Serum specific IgE to HDMs presented the highest prevalence (90.0% for Der p and 92.7% for Der f), followed by specific IgE to Alternaria (21.6%). A contribution of >10% of the total was only common for IgE antibody to Der p or Der f. The level of specific IgE to Der p (r=0.677, P<0.001) or Der f (r=0.657, P<0.001) was significantly correlated with total IgE level. Higher level of Der f-specific IgE was associated with higher incidence of AHR and FEV1 decline. Conclusion: Concentration of specific IgE antibody produced to HDMs provides an explanation for the higher total IgE levels found in a major portion of children with atopic asthma and has a close relationship with AHR and lung function. [Pediatr Allergy Respir Dis (Korea) 2009;19:47-56]
소아 아토피천식 환자에서 메타콜린 PC20와 천식 조절 상태 사이의 연관성
윤신애 ( Shin Ae Yoon ),윤지용 ( Ji Yong Yoon ),김헌 ( Heon Kim ),한윤수 ( Youn Soo Hahn ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1
Purpose: Although methacholine PC20 helps clinicians to identify asthma, there are practical limitations in using methacholine PC20 to assess asthma control. We assessed the relationship between methacholine PC20 levels and asthma control status in child patients with atopic asthma. Methods: We enrolled 153 children of 8 to 15 years of age with atopic asthma and measured methacholine PC20 of these children when their asthma was controlled. We followed up these patients for more than 2 years with measurements of asthma control score, lung function, bronchodilator response (BDR), and fractional exhaled nitric oxide (FeNO). Results: The geometric mean of methacholine PC20 in the study population was 2.81 mg/mL. Lower methacholine PC20 was found to be associated with lower lung function, higher rate of BDR greater than 12%, higher level of BDR, higher rate of FeNO levels greater than 23 ppb, higher FeNO, higher numbers of asthma aggravation per year, and higher rate of asthma control test scores of 19 or less. Conclusion: These data provide evidences that the degree of methacholine PC20 is linked to disease severity in children with atopic asthma. Thus, regular and close monitoring of asthma control should be required for patients with lower levels of methacholine PC20. (Allergy Asthma Respir Dis 1(1):35-40, 2013)