－S 116 －
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메타콜린 상부기도과민성과 상부기도폐쇄의 원인에 대한 연구
전남대학교병원 알레르기내과 박동진, 최인선, 김연주, 조대호, *김영일, 한의령
천식이 의심되는 증상이 있어서 메타콜린 기관지유발시험을 시행한 환자 중 많은 수가 상부기도과민성(UHR)이 있다고 알려져 있다. 기관지 과민성(BHR)이 여러 가지 자극에 의해 FEV1이 저하되는 하부기도 폐쇄양상을 보이는 것과 같이 UHR도 발작 때 MEF50/MIF50가 1 이상 증가되는 상부기도 폐쇄양상(UAO)을 나타낸다. 메타콜린 기관지유발시험에서 UHR 또는 UAO가 나타나서 상부기도 병변이 의심되는 환자 들이 많으나 그 원인에 대한 연구는 드문 실정이므로 이에 메타콜린 유발시험을 시행한 경우들의 자료를 분석하였다. BHR이 있어서 조기에 유발이 종료되어 UHR을 알 수 없었던 경우를 제외하고 분석하였을 때 남자 29명(32.6%), 여자 60명(67.4%)으로 여자에서 유의하게 많았다 (p<0.05). 증상은 기침 74.2%, 호흡곤란 48.3%, 천명 37.1%, 알레르기비염 증상 35.2%, 후비루증후군 13.6%, 위식도역류증상 4.5% 순이었다.
부비동 X선 사진 이상소견은 56.2%에서 보였고, BHR 33.7%, 위식도역류 검사에서는 8.0%에서 양성반응으로 나타났다. 남자는 여자보다 연령이 유의하게 낮았고(44.0±3.2 대 51.4±1.8세, p<0.05), 흡연자가 유의하게 많았으며(p<0.001), 혈청 총 IgE치가 유의하게 높고(389 대 115 IU/mL, p<0.01), 알레르기 피부시험에 대한 양성률이 유의하게 높았다(76.9% 대 31.4%, p<0.001). 이상으로 UHR 또는 UAO가 있는 환자의 원인은 만성 기침의 원인과 유사하며, 성별에 따라 빈도와 원인이 차이가 있다고 생각된다.
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Multiple approaches of assessing stress in rheumatoid arthritis
1Department of Allergy and Rheumatology, 2Department of Family Practice, Ajou University School of Medicine, Suwon, Korea
*Hyoun-Ah Kim1, Jeong-Moon Yun1, Ja-Young Jeon1, Mu-Jeong Kim1, Jun-Mo Sung1, Sat-Byul Park2, Chang-Hee Suh1
A growing body of research indicates that the stress system and its interactions with the immune system play a pivotal role in rheumatoid arthritis (RA). However, most of the investigations in RA that involve the stress system tend to focus on the interrelationships between neuroendocrine and immune function. Therefore, we aim to explore the multiple aspects of stress system in RA patients compared to osteoarthritis (OA). Salivary samples were prospectively collected from RA patients (n=85) and OA patients as disease controls (n=26).
Salivary cortisol levels (µg/dL) as a marker of the hypothalamic-pituitary adrenal axis were measured by competitive immunoassay and salivary α-amylase levels (U/mL) as a maker of the sympathoadrenal medullary activity were measured by quantitative enzyme kinetic method.
Depression was assessed by the Beck Depression Inventory (BDI) and short-term analysis of heart rate variability (HRV) was performed for measure of autonomic nervous system. The RA patients also evaluated for clinical and laboratory parameters. The salivary cortisol levels of the RA group (0.15 ± 0.22 µg/dL) were higher than those of the OA group (0.07± 0.07 µg/dL), however there were no statistical significance.
There was no difference in salivaryα-amylase levels between the RA (83.68 ± 93.20 U/mL) and OA (84.86 ± 93.00 U/mL). And there was no significant difference to BDI between the two study groups. In HRV, mean heart rate and ratio between low and high frequencies (LF/HF) was significantly increased in RA than OA (p=0.012, p=0.006). The salivary cortisol levels were higher in RA patients with rheumatoid factor than those without (p=0.039). A significant correlation was found between the levels of salivary cortisol and the duration of morning stiffness (r=0.378, p<0.001). In comparison of HRV according to disease duration in RA, LF/HF was significantly higher in recent-onset RA patients (disease duration <1year) compared to RA patients with disease duration ≥1year. HRV data suggest an increase in sympathetic tone in patients with RA compared to OA and in patients with RA of disease duration ≥1year compared to recent-onset RA patients.
