Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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가와사끼병에서 고빌리루빈혈증의 관련인자에 대한 임상적 고찰

Clinical factors causing hyperbilirubinemia in patients with Kawasaki disease

  • 문경희 (원광대학교 의과대학 소아과학교실) ;
  • 김옥란 (원광대학교 의과대학 소아과학교실) ;
  • 유승택 (원광대학교 의과대학 소아과학교실) ;
  • 홍명은 (원광대학교 의과대학 소아과학교실) ;
  • 이창우 (원광대학교 의과대학 소아과학교실) ;
  • 최두명 (원광대학교 의과대학 소아과학교실) ;
  • 오연균 (원광대학교 의과대학 소아과학교실) ;
  • 김종덕 (원광대학교 의과대학 소아과학교실) ;
  • 윤향석 (원광대학교 의과대학 소아과학교실)
  • Moon, Kyung Hee (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Kim, Ok Ran (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Yu, Seung Taek (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Hong, Myung Eun (Department of Pediatrics, Wonkwang University School of Medi) ;
  • Lee, Chang Woo (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Choi, Du Young (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Oh, Yeon Kyun (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Kim, Jong Duk (Department of Pediatrics, Wonkwang University School of Medicine) ;
  • Yoon, Hyang Suk (Department of Pediatrics, Wonkwang University School of Medicine)
  • 투고 : 2006.05.25
  • 심사 : 2006.10.02
  • 발행 : 2007.01.15
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초록

목 적 : 고빌리루빈혈증과 황달, 담낭수종 등은 가와사끼병의 일부에서 발생한다. 이 경우에 복통과 식욕부진, 복부팽만 등이 나타나 입원 기간이 길어질 수도 있다. 가와사끼병 급성기의 임상과정에서 고빌리루빈혈증의 관련인자가 있는가를 알아보고자 본 연구를 시행하였다. 방 법 : 1997년 1월부터 2004년 12월까지 만 8년간 원광대학병원 소아과에 입원하여 가와사끼병으로 치료받았던 282명의 환자를 대상으로 후향적으로 조사하였다. 나이와 성별, 발열-입원 기간, 치료-해열 기간, 입원 당시의 백혈구수, 혈소판수, ESR, CRP, AST, ALT치와 무균성 농뇨 등을 정상빌리루빈군(A)(n=269)과 고빌리루빈혈증군(B)(n=13)으로 나누어 비교 분석하였다. 통계처리는 Mann-Whitney test와 Fisher's exact test, logistic 회귀분석으로 하였다. 결 과 : 13 례(4.6%)에서 고빌리루빈혈증을 보였고 B군에서 나이와 ALT치가 높았다(P값 각각 0.003, 0.018). 백혈구 증가증이 있었던 경우와 AST/ALT치가 동시에 상승한 경우에는 고빌리루빈혈증의 발현 빈도가 더 높았다(P값 각각 0.007, 0.042). 짧은 발열-입원 기간과 고연령층이 고빌리루빈혈증에 영향을 주는 요인으로 분석되었다(P값 각각 0.007, 0.003). 반면에 ESR, CRP, 혈소판수, AST, ALT, 무균성 농뇨, 치료-해열 기간 등은 영향을 주지 않았다. 결 론 : 소아기의 가와사끼병에서 짧은 발열-입원 기간과 고연령층 환자군이 고빌리루빈혈증의 발현에 영향을 주는 인자로 분석되었다.

Purpose : Hyperbilirubinemia, jaundice and gallbladder hydrops are unusual manifestations of Kawasaki disease (KD). In this case, abdominal pain, anorexia and abdominal distension may follow eventfully. We reviewed the clinical and laboratory data to investigate the causative factors of hyperbilirubinemia in patients with KD. Methods : Two-hundred eighty two children diagnosed and hospitalized with KD were identified by searching patients' charts. Cases were included in the study if diagnosed between January 1997 and December 2004. We reviewed clinical data, age, sex, duration from the onset of fever to admission and duration from start of treatment to defervescence. Clinical and laboratory data were compared between normal (A) and hyperbilirubinemia (B) groups. Results : Thirteen patients (4.6 percent) showed hyperbilirubinemia. In the hyperbilirubinemia group, age and initial ALT value were higher than group A (P=0.003, 0.018 respectively). Duration from the onset of fever to admission and age were relative risk factors in hyperbilirubinemia (P=0.007, 0.003 respectively) in patients with KD. Conclusion : Shorter duration from the onset of fever to admission and older age group were relative risk factors of hyperbilirubinemia in patients with KD.

키워드

과제정보

연구 과제 주관 기관 : 원광대학교

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