Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 특발혈소판감소자색반병에서 면역글로불린 투여 후 호중구수치의 변화

Change of neutrophil count after treatment of intravenous immunoglobulin in children with idiopathic thrombocytopenic purpura

  • 박준영 (부산대학교 의과대학 소아과학교실) ;
  • 박지애 (부산대학교 의과대학 소아과학교실) ;
  • 박성식 (부산대학교 의과대학 소아과학교실) ;
  • 임영탁 (부산대학교 의과대학 소아과학교실)
  • Park, Jun Young (Department of Pediatrics, Pusan National University College of Medicine) ;
  • Park, Ji Ae (Department of Pediatrics, Pusan National University College of Medicine) ;
  • Park, Seong Shik (Department of Pediatrics, Pusan National University College of Medicine) ;
  • Lim, Young Tak (Department of Pediatrics, Pusan National University College of Medicine)
  • 투고 : 2007.12.04
  • 심사 : 2008.01.09
  • 발행 : 2008.02.15
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초록

목 적 : 본 연구는 소아 급성 ITP에서 IVIG 치료 후 호중구 감소의 빈도와 정도 및 경과 등을 알아보기 위하여 시행되었다. 방 법 : 2001년 1월부터 2006년 6월까지 부산대학교병원에서 급성 ITP로 진단받은 소아 환자 총 54례를 대상으로 하였다. 이중 IVIG를 투여한 군이 42례, Anti-D Ig을 투여한 군이 12례이었으며, 각각의 투여 후에 백혈구 및 호중구 수를 비교하였다. 또한 IVIG의 투여 방법 및 투여 횟수에 따른 백혈구 및 호중구 수도 비교하였다. 결 과 : IVIG 투여 군과 Anti-D Ig 투여 군에서 투여 직전의 백혈구 및 호중구 수의 차이는 없었으나, 투여 후에는 IVIG 투여군에서 42례 중 32례(76.2%)가 투여 전에 비해 호중구 수가 50% 이상 감소하였고, 투여 종료 후 1일째에 호중구수가 최저로 감소하였다. 한편 Anti-D Ig 투여군에서는 12례 중 2례(16.7 %)만이 투여 전 호중구 수에 비해 50% 이상으로 감소하였다. 첫 번째 IVIG 투여군(42례)과 재투여군(7례)에서 호중구 수의 감소는 통계학적인 차이가 없었다. IVIG 투여 방법에 따른 호중구 수의 감소는 5일간 투여군과 2일간 투여군 사이에 통계학적인 차이가 없었다. 면역글로불린 투여 후에 발생한 호중구 감소는 평균 투여 종료 7일 후에 39례 중 38례(97%)에서 자연적으로 회복되었다. 결 론 : 소아 ITP 환자에서 IVIG 투여 후에 호중구 감소가 비교적 흔하게 발생되며, 이는 일시적인 현상으로 대부분 자연적으로 회복되는 것으로 생각된다.

Purpose : The aim of this study was to investigate the incidence and course of neutropenia following intravenous immunoglobulin (IVIG) therapy in children with idiopathic thrombocytopenic purpura (ITP). Methods : From January 2001 to June 2006, fifty-four patients with ITP were enrolled in this study. Forty-two of 54 patients were treated with IVIG, while the other 12 were treated with anti-D immunoglobulin (Anti-D Ig). Post-treatment absolute neutrophil counts (ANC) were compared between patients who received IVIG and those who received Anti-D Ig. Comparison of post-treatment ANC between patients who treated with two different IVIG regimens (400 mg/kg/day for 5 days and 1 g/kg/day for 2 days) was also performed. Results : Pretreatment ANC were not significantly different between the two treatment groups. After treatment with IVIG, 32 out of 42 patients (76.2%) showed more than 50% decrease of ANC from the baseline. On the other hand, only 2 out of 12 patients (16.7%) showed more than 50% decrease of ANC from the baseline after treatment Anti-D Ig. No significant difference was observed in the decline of ANC between the first IVIG treatment (42 patients) and repeated IVIG treatment groups (7 patients). There was no statistical difference in post-treatment ANC between patients who treated with two different IVIG regimens. The neutropenia induced by IVIG had resolved spontaneously in 38 out of 39 patients (97%) after several days. Conclusion : Neutropenia following IVIG administration may not be an uncommon finding in children with ITP. It seems to be transient and self limited.

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참고문헌

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