Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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가와사끼병 환아에서 흉부 X-선 검사의 변화와 혈중 Tumor Necrosis Factor-α에 대한 연구

Chest X-ray Findings and Serum Tumor Necrosis Factor-αLevels in Patients with Kawasaki Disease

  • 김지영 (이화여자대학교 의과대학 동대문병원 소아과) ;
  • 권정현 (이화여자대학교 의과대학 동대문병원 소아과) ;
  • 김경효 (이화여자대학교 의과대학 동대문병원 소아과) ;
  • 유정현 (이화여자대학교 의과대학 동대문병원 방사선과) ;
  • 홍영미 (이화여자대학교 의과대학 동대문병원 소아과)
  • Kim, Ji Young (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Kwon, Jung Hyun (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Kim, Kyung Hyo (Department of Pediatrics, College of Medicine, Ewha Womans University) ;
  • Yu, Jung Hyun (Department of Radiology, College of Medicine, Ewha Womans University) ;
  • Hong, Young Mi (Department of Pediatrics, College of Medicine, Ewha Womans University)
  • 투고 : 2005.01.18
  • 심사 : 2005.03.07
  • 발행 : 2005.05.15
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초록

목 적 : 가와사끼병에서 흉부 X-선 검사에서 변화가 나타나는 빈도, 변화 양상, 염증성 cytokine과의 관계를 알아보고자 하였으며, 가와사끼병 환아에서 흉부 X-선 검사에서 이상 소견이 있을 때 염증 정도를 예측할 수 있는지 알아보기 위하여 본 연구를 시행하였다. 방 법 : 2003년 1월부터 2004년 5월까지 이화의대 동대문병원 소아과에서 가와사끼병으로 진단된 환아 84명을 대상으로 흉부 X-선 검사 결과를 동일 방사선과 전문의가 판독하였다. 흉부 X-선에서 정상 소견을 보이는 군과 비정상 소견을 보이는 두군으로 나누어, 발병 당시 각 군의 관상동맥 확장 정도, 혈청 TNF-${\alpha}$, Mycoplasma 항체, 혈색소, 백혈구, 혈소판, 적혈구 침강속도와 C 반응 단백을 비교 연구하였다. 결 과 : 대상 환아 84명 중에서 흉부 X-선 검사에서 이상 소견을 보인 경우는 43명(51.2%)이었다. 흉부 X-선 검사에서 기관지주위둘러쌈(peribronchial cuffing) 22.4%, 그물결절음영 17.7%, 과도통기(hyperaeration) 8.2%, 폐포경화 3.5%, 흉막삼출 1.2%, 무기폐 1.2%에서 관찰되었다. 흉부 X-선 검사에서 정상 소견을 보인 군과 비정상 소견을 보인 두 군에서 평균 연령, 성별과 발열 기간은 유의한 차이가 없었으며, 혈색소, 백혈구, 혈소판, 적혈구 침강 속도와 C 반응 단백도 두 군에서 유의한 차이가 없었다. 양측 관상동맥 직경은 두 군에서 유의한 차이는 없었고, 혈중 TNF-${\alpha}$ 농도도 두 군간에 유의한 차이가 없었다. 비정상 소견을 보인 군에서 Mycoplasma 항체가를 측정한 결과 12.5%에서 1 : 320 이상의 양성을 보였다. 결 론 : 가와사끼병으로 진단된 환아에서 흉부 X-선 검사의 이상 유무로 염증의 심한 정도를 판단하는 것은 제한점이 있다. 가와사끼병 환아에서 Mycoplasma와의 관련성에 대해서는 향후 더 연구가 필요하리라 생각된다.

Purpose : Kawasaki disease(KD) is a multisystemic inflammatory vasculitis of unknown etiology. Many complications other than cardiovascular involvement have been recognized in KD. However, there have been few reports published concerning involvement of the lungs in this disease. The purpose of this study was to examine the relationship between serum TNF-${\alpha}$, the degree of coronary artery dilatation and chest X-ray(CXR) findings. In addition, we have investigated serum anti-Mycoplasma antibody(AMA) titers in patients with KD who have abnormal CXR findings. Methods : Eighty four patients with KD were included in this study(group I; 41 patients with normal CXR fndings, group II; 43 patients with abnormal CXR findings). Serum levels of TNF-${\alpha}$ and AMA titer were measured. Results : We reviewed the CXR findings and clinical courses of 84 patients with Kawasaki disease and found abnormal CXR findings in 43 patients(51.2 percent). Peribronchial cuffing was the most frequent abnormality(22.4 percent). In the group with abnormal CXR findings(group II), a statistical difference was not noted in age, sex, duration of fever, hemoglobin, WBC, platelet, ESR, and CRP levels and incidence of coronary arterial lesions as compared with the group having normal CXR findings(group I). No difference was noted in serum TNF-${\alpha}$ level between group I and group II. 2 patients(12.5 percent) of 16 KD patients with abnormal CXR findings have positive AMA titer(above 1 : 320). Conclusion : Most of the abnormal CXR findings in KD patients were peribronchial cuffing. The abnormal CXR findings in KD patients did not mean severe inflammations. It is difficult to consider that CXR abnormalities are related to coronary arterial lesions. In addition, further study on the relationship between Mycoplasma infection and Kawasaki disease is needed.

키워드

참고문헌

  1. Suzuki H, Demura S, Tone S, Iizuka T, Koike M, Hirayama K, et al. Effects of immunoglobulin and gamma-interferon on the production of tumour necrosis factor-\alpha and interleukin-1\beta by peripheral blood monocytes in the acute phase of Kawasaki disease. Eur J Pediatr 1996;155:291-6 https://doi.org/10.1007/BF02002715
  2. Freeman AF, Shulman ST. Recent developments in Kawasaki disease. Curr Opin Infect Dis 2001;14:357-61 https://doi.org/10.1097/00001432-200106000-00017
  3. Kim DS. Serum interleukin-6 in Kawasaki disease. Yonsei Med J 1992;33:183-8 https://doi.org/10.3349/ymj.1992.33.2.183
  4. Suzuki H, Noda E, Miyawaki M, Takeuchi T, Uemura S, Koike M. Serum levels of neutrophil activation cytokines m Kawasaki disease. Pediatr Int 2001;43:115-9 https://doi.org/10.1046/j.1442-200x.2001.01362.x
  5. Gupta M, Noel GJ, Schaefer M, Friedman D, Bussel J, Johann-Liang R. Cytokine modulation with immune \gamma-globulin in peripheral blood of normal children and its implications in Kawasaki disease treatment. J Clin Immunol 2001;21:193-9 https://doi.org/10.1023/A:1011039216251
  6. Eberhard BA, Andersson U, Laxer RM, Rose V, Silverman ED. Evaluation of the cytokine response in Kawasaki disease. Pediatr Infect Dis J 1995;14:199-203 https://doi.org/10.1097/00006454-199503000-00006
  7. Takeshita S, Nakatani K, Kawase H, Seki S, Yamamoto M, Sekine I, et al. The role of bacterial lipopolysaccharidebound neutrophils in the pathogenesis of Kawasaki disease. J Infect Dis 1999;179:508-12 https://doi.org/10.1086/314600
  8. Sakaguchi M, Kato H, Nishiyori A, Sagawa K, Ito K. Characterization of CD4 + T helper cells in patients with Kawasaki disease: Preferential production of tumor necrosis factor- $alpha$ by V${beta}$ 2- or V${beta}$ 8- CD4 + T helper cells. Clin Exp Immunol 1995;99:276-82 https://doi.org/10.1111/j.1365-2249.1995.tb05545.x
  9. Furukawa S, Matsubara T, jujoh K, Yone K, Sugawara T, Sasai K, et al. Peripheral blood monocyte/macrophages and serum tumor necrosis factor in Kawasaki disease. Clin Immunol Immunopathol 1988;48:247-51 https://doi.org/10.1016/0090-1229(88)90088-8
  10. Maury CP, Salo E, Pelkonen P. Elevated circulating tumor necrosis factor-alpha in patients with Kawasaki disease. J Lab Clin Med 1989;113:651-4
  11. Sato N, Sagawa K, Sasaguri Y, Ion O, Kato H. Immunopathology and cytokine detection in skin lesions of patients with Kawasaki disease. J Pediatr 1993;122:198-203 https://doi.org/10.1016/S0022-3476(06)80113-7
  12. Kamizono S, Yamada A, Higichi T, Kato H, Itoh K. Analysis of tumor necrosis factor-\alpha production and polyrnorphil of tumor necrosis factor-\alpha gene in individuals with a history of Kawasaki disease. Pediatr Int 1999;41:341-5 https://doi.org/10.1046/j.1442-200x.1999.01085.x
  13. Umezawa T, Saji T, Matsuo N, Odagiri K. Chest x-ray findings in acute phase of Kawasaki disease. Pediatr Radiol 1989;20:48-51 https://doi.org/10.1007/BF02010633
  14. Kuhn JP. Disorders of pulmonary circulation. In: Kuhn JP, Slovis TL, Haller JO. Caffey's pediatric diagnostic imaging. 10th ed. Philadelpia : Mosby, 2004:1073-95
  15. Kuhn JP. Disease of the airways and abnormalities of pulmonary aeration. In: Kuhn JP, Slovis TL, Haller JO. Caffey's pediatric diagnostic imaging. 10th ed. Philadelpia : Mosby, 2004:929-82
  16. Unizel Y, Hashkes PJ, Kassem G, Gottesman G, Wolach B. Unresolving pneumonia as the main manifestation of atypical Kawasaki disease. Unizel Y, Hashkes PJ, Kassem G, Gottesman G, Wolach B. Unresolving pneumonia as the main manifestation of atypical Kawasaki disease. Arch Dis Child 2003;88:940-2 https://doi.org/10.1136/adc.88.10.940
  17. Managoli S, Chaturvedi P. Kawasaki disease with coronary artery aneurysm and symptomatic pneumonia. Indian Pediatr 2003;40:1106-7
  18. Uramoto K, Ikawa A, Ri K, Watanabe C, Suzuki A, Kiguchi H, et al. Study of chest X -ray findings in Kawasaki disease. Shoni Naika 1978;10:32-5
  19. Voynow JA, Schanberg L, Sporn T, Kredich D. Pulmonary complications associated with Kawasaki disease. J Pediatr 2000;140:786-7 https://doi.org/10.1067/mpd.2002.pd124772
  20. Amano S, Hazama F, Kubagawa H, Tasaka K, Haebara H, Hamashima Y. General pathology of Kwasaki disease on the morphological alterations corresponding to the clinical manifestation. Acta Pathol Jpn 1980;30:681-9
  21. Suzuki H, Noda E, Miyawaki M, Takeuchi T, Uemura S, Koike M. Serum levels of neutrophil activation cytokines in Kawasaki disease. Pediatr Int 2001;43:115-9 https://doi.org/10.1046/j.1442-200x.2001.01362.x
  22. Matsubara T, Furukawa S, Yabuta K. Serum levels of tumor necrosis factor, interleukin 2 receptor and interferongamma in Kawasaki disease involved coronary artery lesions. Clin Immunol immunopathol 1990;56:29-36 https://doi.org/10.1016/0090-1229(90)90166-N
  23. Wang JN, Wang SM, Liu CC, Wu JM. Mycopalsma pneumoniae infection associated with Kawasaki disease. Acta Pediatr 2001;90:594-5 https://doi.org/10.1111/j.1651-2227.2001.tb00810.x
  24. Leen C, Ling S. Mycoplasma infection and Kawasaki disease. Arch Dis Child 1996;75:266-7