Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Epidemic acute interstitial pneumonia in children occurred during the early 2006s

2006년 초에 유행한 소아 급성 간질성폐렴

  • Cheon, Chong Kun (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jin, Hyun-Seung (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Eun Kyeong (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Kim, Hyo Bin (Department of Pediatrics, Inje University Sanggye Paik Hospital) ;
  • Kim, Byoung-Joo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Jinho (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seong Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Soo-Jong (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, June Dong (Department of Pediatrics, Seoul National University College of Medicine)
  • 전종근 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 진현승 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 강은경 (서울대학교 의과대학 소아과학교실) ;
  • 김효빈 (인제의대 상계백병원 소아과학교실) ;
  • 김병주 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 유진호 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박성종 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 홍수종 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박준동 (서울대학교 의과대학 소아과학교실)
  • Received : 2007.10.21
  • Accepted : 2007.12.29
  • Published : 2008.04.15
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Abstract

Purpose : This study was aimed to analyze the clinical characteristics of patients with acute interstitial pneumonia who had presented similar clinical patterns from March to June, 2006 and to describe our experience of treatment and to identify risk factors associated with prognosis. Methods : The clinical characteristics, radiologic and histopathologic findings and response to steroids of 15 patients (non-survival group [n=7] and survival group [control, n=8]) with acute interstitial pneumonia were investigated through the review of medical records. Results : The mean age of the patients was 26 (range: 3-48) months. Cough, cyanosis and fever were frequent symptoms. The most frequent radiologic findings on admission were pneumomediastium and extensive ground glass opacity. Surgical lung biopsy was performed on 8/15 (53.3%) patients and diffuse alveolar damage was found. Mechanical ventilation was applied for 9/15 (60.0%) patients for 40 (range: 1-99) days. Five patients in survival group received steroid treatment and 7 patients in non-survivial group (P=0.20). One patient in survival group received steroid pulse treatment and 4 patients in non-survival group (P=0.12). Seven patients died all of respiratory failure. The survival rate was 53.4%. Conclusion : The patients with acute interstitial pneumonia which occurred on spring 2006 showed high mortality because of rapidly and extensively progressing pulmonary fibrosis and air leakage. Therefore, we should consider surgical lung biopsy and steroid application earlier. We should recognize this acute interstitial pneumonia occurring on spring in domestics and need to investigate the cause and treatment in large scale.

목 적 : 이 연구의 목적은 2006년 3월에서 6월 사이에 비슷한 임상 양상을 보인 급성 간질성폐렴 환자들이 집중적으로 발생하였기에 이들의 임상적 특성을 분석하고 그 치료법의 경험을 기술하고 예후와 관련 있는 인자를 확인하는 것이다. 방 법 : 서울아산병원과 서울대학교병원에 입원한 15례의 급성 간질성폐렴 환아를 대상으로 7명의 사망군과 8명의 생존군(대조군)으로 나누어 임상적 특징, 방사선 및 병리학적 소견, 스테로이드 치료의 반응을 비교하기 위해 의무기록지를 재고하여 후향적으로 연구하였다. 결 과 : 총 15명의 환자 중 남아 11명, 여아 4명이었고, 나이는 26(3-48)개월이였다. 발병시 초기증상은 12명이 기침, 4명이 청색증, 3명이 발열이 있었다. 내원 당시 호흡수는 42(26-70)회/분으로 빈호흡이었다. 비인두 흡인배양 검사상 corona virus 229 E 가 2례로 가장 많았다. 입원당시 흉부 방사선 소견은 폐종격동기흉이 7/15명(46.7%)으로 가장 많았고, 흉부 전산화단층촬영 소견은 유리질막 음영이 13/15명(86.6%)으로 가장 많았다. 외과적 폐조직생검은 8/15명(53.3%)이 입원 6 (0-43)일째 시행을 받았고, 이중 기질화 미만성 폐포손상이 가장 흔한 소견이었다. 인공환기요법은 입원 1 (1-6)일째 9/15명(60.0%)에서 시행되었고 40(1-99)일간 지속되었다. 스테로이드 치료는 생존군에서 5/8명(62.5%)이 받았고 사망군에서 7/7명(100.0%)이 받았으며, 두 군간에 차이가 없었다(P=0.20). 고용량 스테로이드 치료는 생존군에서 1/8명(12.5%), 사망군에서 4/7명(57.1%)이 받았으며, 두 군간에 차이가 없었다(P=0.12). 사망한 7명의 환자는 입원 31 (21- 96)일째 모두 호흡부전으로 사망하였고, 생존률은 8/15명(53.4%)였다. 결 론 : 2006년 봄에 발생한 급성 간질성폐렴 군은 폐종격동기흉 및 폐기흉을 동반하는 특징을 보이며 급속히 진행하고 광범위한 폐 섬유화로 높은 사망률과 합병증을 보이므로 조기에 적극적인 조직검사와 스테로이드 치료를 고려해 볼 수 있다. 이에 저자들은 계절적으로 봄철에 발생한 소아 급성 간질성폐렴의 원인과 그 치료에 대한 전국적인 규모의 연구가 필요할 것으로 생각되며 이 질환에 대한 의료인의 인지가 필요하다고 생각된다.

Keywords

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