Pediatric Infection and Vaccine

  • 제21권1호
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  • Pages.43-52
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  • 2014
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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소아 급성 위장관염의 중증도 평가를 위한 기존 중증도 점수척도들의 비교

Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children

  • 최지현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정태웅 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김성준 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정주영 (인제대학교 의과대학 소아과학교실) ;
  • 김민성 (가톨릭대학교 의과대학 소아과학교실) ;
  • 한승범 (가톨릭대학교 의과대학 소아과학교실) ;
  • 강진한 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김상용 (가톨릭대학교 의과대학 소아과학교실) ;
  • 임정우 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김황민 (연세대학교 의과대학 소아과학교실) ;
  • 박재홍 (부산대학교 의과대학 소아과학교실) ;
  • 조대선 (전북대학교 의과대학 소아과학교실) ;
  • 마상혁 (창원파티마병원 소아과) ;
  • 정혜숙 (질병관리본부 국립보건연구원 백신연구과) ;
  • 천두성 (질병관리본부 국립보건연구원 백신연구과) ;
  • 고대균 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김종현 (가톨릭대학교 의과대학 소아과학교실)
  • Choi, Jee-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Jung, Tae Woong (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Kim, Seong Joon (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Chung, Ju-Young (Department of Pediatrics, College of Medicine, Inje University of Pusan) ;
  • Kim, Min-Sung (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Han, Seung Beom (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Kang, Jin-Han (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Kim, Sang Yong (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Rhim, Jung Woo (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Kim, Hwang-Min (Department of Pediatrics, College of Medicine, Yonsei University of Wonju) ;
  • Park, Jae Hong (Department of Pediatrics, College of Medicine, Busan National University) ;
  • Jo, Dae Sun (Department of Pediatrics, College of Medicine, Chonbuk National University of Jeonju) ;
  • Ma, Sang Hyuk (Changwon Fatima Hospital) ;
  • Jeong, Hye-Sook (Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention) ;
  • Cheon, Doo-Sung (Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention) ;
  • Koh, Dae Kyun (Department of Pediatrics, College of Medicine, The Catholic University of Seoul) ;
  • Kim, Jong-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Seoul)
  • 투고 : 2013.10.18
  • 심사 : 2013.12.15
  • 발행 : 2014.04.25
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초록

목적: 급성 위장관염으로 입원한 소아 환자들의 중증도를 여러 척도로 평가하여 각 척도간의 차이를 비교하고, 원인 바이러스가 밝혀진 예를 따로 분류하여 원인 병원체에 따른 임상양상 및 중증도의 차이를 알아보고자 하였다. 방법: 전향적으로 전국 8개 지역 9개 의료기관의 소아청소년과에 급성 위장관염으로 진단받아 입원한 5세 미만의 환자를 대상으로 Vesikari 척도, Clark 척도, 수정 Flores 척도로 중증도를 평가하였다. 연구군으로부터 수집된 분변 검체로 로타바이러스, 장 아데노바이러스는 효소면역법으로, 노로바이러스, 아스트로바이러스, 사포바이러스는 RT-PCR 방법으로 검출하였다. 결과: 최종 연구 대상군은 총 214례로 남녀비는 1.58:1이고, 연령층은 6개월 미만이 35명(16.4%), 6-23개월이 105명(49.1%), 24-59개월이 74명(34.5%)이었다. Vesikari 척도와 Clark 척도간 일치율은 0.521 (P<0.001)이고, '중증'인 경우가 Vesikari 척도는 60.7%, Clark 척도는 2.3%로 Clark 척도가 '중증' 평가에 더욱 엄격하였다. 결론: 급성 위장관염의 중증도를 평가하는 각 척도들간에는 차이가 있었다. 각 연구자들의 결과를 객관적으로 비교하기 위해서는 척도를 하나로 통일하거나 각 척도들의 평가기준을 모두 조사하여 각 척도의 중증도를 동시에 얻는 것이 필요하다.

Purpose: This study aimed to evaluate the disease severity of children suffering from gastroenteritis using different scales. The results are compared and subsequently classified on the basis of the type of virus causing the disease in order to investigate the differences in clinical characteristics and disease severity according to pathogen. Method: This study was conducted prospectively with patients under 5 years of age diagnosed with acute gastroenteritis and hospitalized at 9 medical institutions in 8 regions across the Republic of Korea. Disease severity was evaluated using the Vesikari Scale, the Clark Scale, and the modified Flores Scale. Fecal samples collected from patients were used to detect rotavirus and enteric adenovirus by enzyme immunoassay, and for RT-PCR of norovirus, astrovirus, and sapovirus. Results: There were a total of 214 patients with a male : female ratio of 1.58 : 1, of which 35 were under the age of 6 months (16.4%), 105 were aged 6-23 months (49.1%), and 74 were aged 24-59 months (34.5%). The rate of concordance between the Vesikari and Clark Scales was 0.521 (P<0.001) and, in severe cases, the Vesikari Scale was 60.7% and Clark Scale was 2.3%, indicating that the Clark Scale was stricter in the evaluation of severe cases. Conclusions: In children with gastroenteritis, there were differences in disease severity based on the scale used. Therefore, to achieve consistent results among researchers, either only a single scale or a measure of all scales should be used to determine disease severity.

키워드

참고문헌

  1. Boschi-Pinto C, Velebit L, Shibuya K. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 2008;86:710-7. https://doi.org/10.2471/BLT.07.050054
  2. Midthun K, Kapikian AZ. Rotavirus vaccines: an overview. Clin Microbiol Rev 1996;9:423-34.
  3. Ahn SE, Lim HC, Kim HM, Uh Y, Seok SW. Comparing the cause and symptom severity of children with acute gastroenteritis. Korean J Pediatr Infect Dis 2008;15:138-45.
  4. Bass DM. Rotaviruses, caliciviruses, and astroviruses. In: Kliegman RM, Stanton BF, St. Geme III JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders Press, 2011:1134-7.
  5. Division of Enteric Viruses and Hepatitis Viruses, Korea Centers for Disease Control and Prevention. Laboratory surveillance of viral acute gastroenteritis, 2005-2008. Pub Health Wkly Rep KCDC 2010;3:90-2.
  6. Hall AJ, Rosenthal M, Gregoricus N, Greene SA, Ferguson J, Henao OL, et al. Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005. Emerg Infect Dis 2011;17:1381-8.
  7. Ruuska T, Vesikari T. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis 1990;22:259-67. https://doi.org/10.3109/00365549009027046
  8. Clark HF, Borian FE, Bell LM, Modesto K, Gouvea V, Plotkin SA. Protective effect of WC3 vaccine against rotavirus diarrhea in infants during a predominantly serotype 1 rotavirus season. J Infect Dis 1988;158:570-7. https://doi.org/10.1093/infdis/158.3.570
  9. Rennels MB, Glass RI, Dennehy PH, Bernstein DI, Pichichero ME, Zito ET, et al. Safety and efficacy of high-dose rhesus-human reassortant rotavirus vaccines-report of the National Multicenter Trial. United States Rotavirus Vaccine Efficacy Group. Pediatrics 1996;97:7-13.
  10. Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med 2006;354:11-22. https://doi.org/10.1056/NEJMoa052434
  11. Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 2006;354:23-33. https://doi.org/10.1056/NEJMoa052664
  12. Givon-Lavi N, Greenberg D, Dagan R. Comparison between two severity scoring scales commonly uses in the evaluation of rotavirus gastroenteritis in children. Vaccine 2008;26:5798-801. https://doi.org/10.1016/j.vaccine.2008.08.030
  13. Reisinger KS, Block SL. Characteristics of an ideal rotavirus vaccine. Clin Pediatr (Phila) 2008;47:555-63. https://doi.org/10.1177/0009922808314903
  14. King CK, Glass R, Bresee JS, Duggan C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003;52(RR-16):1-16.
  15. El-Radhi AS, Barry W. Thermometry in paediatric practice. Arch Dis Child 2006;91:351-6. https://doi.org/10.1136/adc.2005.088831
  16. Park KS, Jeong HS, Baek KA, Lee CG, Park SM, Park JS, et al. Genetic analysis of norovirus GII. 4 variants circulating in Korea in 2008. Arch Virol 2010;155:635-41. https://doi.org/10.1007/s00705-010-0627-y
  17. Jeong AY, Jeong HS, Jo MY, Jung SY, Lee MS, Lee JS, et al. Molecular epidemiology and genetic diversity of human astrovirus in South Korea from 2002 to 2007. Clin Microbiol Infect 2011;17:404-8. https://doi.org/10.1111/j.1469-0691.2010.03263.x
  18. Park SH, Kim EJ, Oh SA, Kim CK, Choi SS, Cho SJ, et al. Viral agents associated with acute gastroenteritis in Seoul, Korea. Clin Lab 2011;57:59-65.
  19. Lewis KD, Dallas MJ, Victor JC, Ciarlet M, Mast TC, Ji M, et al. Comparison of two clinical severity scoring systems in two multi-center, developing country rotavirus vaccine trials in Africa and Asia. Vaccine 2012;30(1 Suppl):A159-66. https://doi.org/10.1016/j.vaccine.2011.07.126
  20. Infectious diseases, In : Ahn HS. Hong CE's textbook of pediatrics. 10th ed. Seoul: Mirae-N Co., 2012:470-2.
  21. Zhang S, Chen TH, Wang J, Dong C, Pan J, Moe C, et al. Symptomatic and asymptomatic infections of rotavirus, norovirus, and adenovirus among hospitalized children in Xian, China. J Med Virol 2011;83:1476-84. https://doi.org/10.1002/jmv.22108
  22. Nakanishi K, Tsugawa T, Honma S, Nakata S, Tatsumi M, Yoto Y, et al. Detection of enteric viruses in rectal swabs from children with acute gastroenteritis attending the pediatric outpatient clinics in Sapporo, Japan. J Clin Virol 2009;46:94-7. https://doi.org/10.1016/j.jcv.2009.06.014
  23. Wiegering V, Kaiser J, Tappe D, Weissbrich B, Morbach H, Girschick HJ. Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients. Int J Infect Dis 2011;15:e401-7. https://doi.org/10.1016/j.ijid.2011.02.006

피인용 문헌

  1. 일개 이차 병원에서 치료한 소아 급성 세균성 위장염 원인 및 특징 vol.24, pp.2, 2014, https://doi.org/10.14776/piv.2017.24.2.95