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1 pissn: eissn: (3): , July ORIGINAL ARTICLE 한국정상소아의폐기능검사추정정상치 박철휘 1, 김효빈 1, 정영호 2,3, 이은 2,3, 양송이 2,3, 서주희 4, 권지원 3,5, 김형영 6, 김병주 7, 이소연 8, 송대진 9, 장광천 10, 김우경 11, 심정연 12, 홍수종 2,3 1 인제대학교상계백병원소아청소년과, 2 울산대학교서울아산병원소아천식아토피센터 소아청소년과, 3 알레르기질환표준화연구센터, 4 원자력병원소아청소년과, 5 분당서울대병원소아청소년과, 6 고신대학교병원소아청소년과, 7 인제대학교해운대백병원소아청소년과, 8 한림대학교평촌성심병원소아청소년과, 9 고려대학교구로병원소아청소년과, 10 국민건강보험공단일산병원소아청소년과, 11 인제대학교서울백병원소아청소년과, 12 성균관대학교강북삼성병원소아청소년과 Predicted normal values of pulmonary function tests in normal Korean children Chul Hyue Park 1, Hyo-Bin Kim 1, Young Ho Jung 2,3, Eun Lee 2,3, Song I Yang 2,3, Ju-Hee Seo 4, Ji-Won Kwon 3,5, Hyung-Young Kim 6, Byoung-Ju Kim 7, So Yeon Lee 8, Dae Jin Song 9, Gwang Cheon Jang 10, Woo Kyung Kim 11, Jung Yeon Shim 12, Soo-Jong Hong 2,3 1 Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul; 2 Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Childhood Asthma Atopy Center, Seoul; 3 Research Center for Standardization of Allergic Disease, Seoul; 4 Deparment of Pediatrics, Korea Cancer Center Hospital, Seoul; 5 Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam; 6 Department of Pediatrics, Kosin University College of Medicine, Busan; 7 Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan; 8 Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang; 9 Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul; 10 Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang; 11 Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul; 12 Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Purpose: Pulmonary function tests are useful and important methods for evaluating patients with respiratory diseases. To assess lung function, we need to establish normal values of lung function, which vary according to population, age, gender and growth, particularly in children. This study was undertaken to establish normal predicted values of pulmonary function tests and to predict renewed reference values by spirometry in Korean school children. Methods: Spirometric forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 25% to 75% of FVC (FEF25%-75%), and peak expiratory flow rate (PEFR) were measured in 406 healthy elementary school children (age, 6 12 years old) in May, Multiple linear regression analysis was performed for each spirometric parameter against age, height, weight and body surface area (BSA) separately for boys and girls, and derived reference equations and coefficients for all the spirometric parameters. Results: All the measured spirometric parameters were significantly correlated with age, height, weight, and BSA. FVC was higher in boys aged 6 10 years than girls at ages matched. Height showed the highest correlation coefficient for all the spirometric parameters followed by BSA, weight and age in both genders. The normal predicted values of FVC and FEV1 at 130 cm in this study using renewed reference equations were approximately in the middle compared to previous studies. Conclusion: We reported here the renewed reference equations for normal predicted values of pulmonary function tests with high coefficients of determination based on updated data in healthy Korean children. ( 2014;2: ) Keywords: Reference equation, Spirometry, Reference value, Pulmonary function, Children 서론폐기능검사는폐의생리학과폐질환의역학적연구에이용되어왔으며임상에서폐기능의객관적평가를통해호흡기질환의진단과치료에이용되고있다. 폐기능검사는제한성, 폐쇄성폐질환의 진단뿐만아니라다양한유발검사를통해특정폐질환의진단에도움을주고있으며, 호흡기증상이있는경우폐질환의중증도에대한객관적평가와치료의경과판정에이용될수있다. 또한기질적폐질환뿐만아니라근육마비와같은폐외질환에의한호흡기증상에도유용하다. 1) Correspondence to: Hyo-Bin Kim Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul , Korea Tel: , Fax: , hbkim@paik.ac.kr This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare, Republic of Korea (A092076). Received: September 2, 2013 Revised: October 16, 2013 Accepted: October 17, The Korean Academy of Pediatric Allergy and Respiratory Disease The Korean Academy of Asthma, Allergy and Clinical Immunology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (

2 Park CH, et al. Expected normal values of pulmonary function test 소아에서폐기능검사는대상연령이제한적이고피검자의협조정도에따라결과가일관적이지못하다는단점이있으나흉부 X선과다른검사에서이상을보이지않는호흡기질환에서도유용하게시행할수있으며, 환자의치료효과와질병의경과를평가할수있다는장점을가지고있다. 2) 최근소아에서천식과알레르기질환의유병률이증가하면서폐기능검사가더욱중요해지고있으며비교적간편하게시행할수있는폐기능검사가개발되고있다. 폐기능검사는피검사자의실측치를평가하기보다는건강인에서구한추정정상치의백분율로표시하게되며추정정상치는연령, 신장, 체중, 성별, 체표면적, 인종등에따라차이가있다. 1,3) 소아를대상으로폐기능검사항목의추정정상치에대한보고들이있었으나 3-15) 국내보고는 1998년이후최근자료는없어본연구에서는이런신체계측치를이용한추정정상치를계산할수있는회귀방정식을각폐기능검사항목별로제시하고자하였다. 또한, 시간이지남에따라소아들의신체계측에변화가있듯이이에영향을받는폐기능검사도변화가생겼을수있는데, 1967년대한소아과학회와보건복지부의공동연구로한국소아청소년신체발육및표준치제정사업이시작된이후매 10년단위로소아발육표준치측정조사가추진되어왔으며 2007년질병관리본부와대한소아과학회가 2007 한국소아청소년성장도표 를완성하였으나, 16) 소아의폐기능정상예측치에대한연구는 1998년이후로는없었으므로국내소아청소년의성장변화를반영하는새로운폐기능정상예측치가필요하다. 저자들은알레르기질환표준화사업의일환으로 2012년에서울지역초등학생소아에서연령, 신장, 체중, 성별, 체표면적에따른추정정상치를얻고과거의연구들과비교해보고자본연구를시행하였다. m 2 으로, 체표면적은다음의공식으로환산하였다. 17) 체표면적 = 체중 (kg) 신장 (cm) 3,600 설문조사를시행하여천식증상과진단의과거력, 최근호흡기감염의여부, 출생시재태연령과체중, 간접흡연력을조사하였다. 폐기능측정에는 spirometry (Microspiro HI-298, Tokyo, Japan) 를사용하였다. 측정전대상소아에게검사방법을충분히교육시킨후, 안정시킨다음, 기립자세에서 mouth-piece 를물리고호흡을최대한깊게들이마신후가능한세게, 빠르게, 6초이상내쉬게하여유량-기량곡선 (flow-volume curve) 을얻었다. 노력성폐활량 (forced vital capacity, FVC), 1초간노력성호기량 (forced expiratory volume in one second, FEV 1), 노력성중간호기유량 (forced expiratory flow at 25% to 75% of FVC, FEF 25%-75%), 최대호기속도 (peak expiratory flow rate, PEFR) 를측정하였고, 같은방법으로 3번검사를실시하여가장높은측정치를택하였다. 3. 통계분석자료는 SPSS ver (SPSS Inc., Chicago, IL, USA) 통계프로그램을이용하여분석하였다. 성별과연령에따른폐기능검사항목간의비교는 t-test를시행하였고, 각각의폐기능검사항목에대한단순회귀방정식을선형회귀분석을시행하여구하였으며각신체계측치와의상관계수를구하여어떠한변수가영향을미치는지를검정하였다. 또한각폐기능검사항목에대한중회귀분석을시행하여연령, 신장, 체중, 체표면적이폐기능검사항목들에미치는영향에대하여검정하였다. 대상및방법 결과 1. 연구대상 2012년 5월에서울에위치한 1개초등학교에서 6세에서 12세사이의초등학생 1,365명중학생과보호자의동의하에폐기능검사를 1,128 명에서시행하였다. 이중미숙아, 천식을진단받은적이있거나최근 12개월이내에천명증상이있었던경우, 급성또는만성호흡기질환이있는경우, 비만 ( 연령별로체질량지수 95 백분위수이상 ), 간접흡연력이있는소아는제외한, 정상소아 406명 ( 남아 189명, 여아 217명 ) 을대상으로연구를시행하였다. 본연구는사전에부모나보호자에게안내문을배포하여조사내용에대해설명한후동의서를받았으며서울아산병원임상연구심의위원회 (Institutional Review Board) 의승인하에진행되었다. 2. 연구방법동일인에의하여신장, 체중을측정하였으며, 체질량지수는 kg/ 1. 대상의특성 대상군은총 406 명으로남아 189 명, 여아 217 명이었다 (Table 1). 평균연령은 9.22±1.68 세 ( 범위, 세 ) 로남녀간에차이가 Table 1. Characteristics of the study subjects Characteristic Male (n= 189) Female (n= 217) P-value Age (yr) 9.12± ± Height (cm) ± ± Weight (kg) 33.44± ± FVC (L) 1.94± ± FEV1 (L) 1.78± ± FEF25%-75% (L) 2.16± ± PEFR (L/sec) 4.06± ± Values are presented as mean± standard deviation. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25%-75%, forced expiratory flow at 25% to 75% of FVC; PEFR, peak expiratory flow rate

3 박철휘외 한국정상소아의폐기능검사추정정상치 없었다 (P = 0.292). 신장과체중모두남녀간에유의한차이는없었다 (P = 0.428, P = 0.979). 폐기능검사항목들에서 FVC는남학생들에서 1.94±0.48 L로여학생들의 1.83±0.47 L보다높았다 (P = 0.015). 반면에 FEF 25%-75% 는남학생들에서 2.16±0.61 L/sec로여학생들의 2.33±0.73 L/sec 보다유의하게낮았다 (P = 0.011). FEV 1 과 PEFR은남녀간에차이가없었다 (P = 0.233, P = 0.147). 이를좀더연령별, 성별로나누어보았을때 (Table 2), FVC는 6세부터 10세사이에서는연령별로남학생이여학생보다유의하게증가되어있으나 11세이상에서는성별간차이가없었다. FEV 1 은 6세에서만남학생에서여학생에비해증가되어있으나 (P<0.001) 7세이상에서는차이가없었다. FEF 25%- 75% 는 6 12세사이의소아에서는남녀간에연령별로유의한차이가없었으며 PEFR은 6세와 8세에서만남학생들이여학생들보다유의하게높았다 (P = 0.014, P = 0.026). 2. 연령과신체계측치에따른폐기능검사항목의회귀방정식폐기능검사각각의항목 (FVC, FEV 1, FEF 25%-75%, PEFR) 에대하 여연령과신체지표 ( 신장, 체중, 체표면적 ) 에대한남녀각각의회귀방정식과상관계수를구하였으며이는 Table 3과같았다. 남녀모두에서 FVC, FEV 1, FEF 25%-75%, PEFR에대한설명력은신장이가장높았고체표면적이다음을이었다. 폐기능검사항목들중남학생과여학생에서설명력은신장에따른 FEV 1 이각각 0.818과 0.805로가장높았다. 남녀각각에서연령, 신장, 체중, 체표면적을변수로폐기능검사각항목에대한다중회귀방정식과설명력을구하였고이는 Tables 4, 5와같았다. 모든경우의회귀방정식은 P<0.001로유의하였고, 남녀모두에서 4가지변수를모두사용하는경우가장설명력이높았다. 모든폐기능검사항목에있어서체표면적에관한추정치의표준오차가커서체표면적을제외하고 3가지변수를사용한경우와 4가지변수를모두사용한경우의설명력은거의차이가없었다. 다중회귀방정식에서 FEV 1, PEFR은남자가설명력이높았으며 FVC, FEF 25%-75% 는여자가설명력이높았다. 신장을단일변수로사용한경우, FEV 1 외에는모두여자에서설명력이높았다. Table 2. Mean values of spirometric parameters Age (yr) No. FVC (L) FEV1 (L) FEF25%-75% (L/sec) PEFR (L/sec) Male Female P-value Male Female P-value Male Female P-value Male Female P-value ± ± 0.19 < ± ± 0.19 < ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Values are presented as mean± standard deviation. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25%-75%, forced expiratory flow at 25% to 75% of FVC; PEFR, peak expiratory flow rate. Table 3. Prediction equations and square of regression coefficients for each spirometric parameter Variable Male FVC (L) FEV1 (L) FEF25%-75% (L/sec) PEFR (L/sec) Prediction equation r 2 Prediction equation r 2 Prediction equation r 2 Prediction equation r 2 Age (yr) Y= 0.210A Y= 0.193A Y= 0.223A Y= 0.441A Height (cm) Y= 0.036H Y= 0.033H Y= 0.037H Y= 0.068H Weight (kg) Y= 0.043W Y= 0.038W Y= 0.041W Y= 0.076W Body surface area (m 2 ) Y= 2.086B Y= 1.871B Y= 2.042B Y= 3.782B Female Age (yr) Y= 0.230A Y= 0.219A Y= 0.295A Y= 0.476A Height (cm) Y= 0.036H Y= 0.034H Y= 0.045H Y= 0.075H Weight (kg) Y= 0.040W Y= 0.038W Y= 0.052W Y= 0.083W Body surface area (m 2 ) Y= 1.975B Y= 1.871B Y= 2.555B Y= 4.111B FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25%-75%, forced expiratory flow at 25% to 75% of FVC; PEFR, peak expiratory flow rate; r 2, square of regression coefficient. A, age (yr); H, height (cm); W, weight (kg); B, body surface area (m 2 )

4 Park CH, et al. Expected normal values of pulmonary function test Table 4. Multiple linear regression equations for spirometric parameters with variables of the physical measurements in male subjects Parameter Regression equation r 2 SEE P-value FVC Y= 0.016A H W 0.905B A, 0.018; H, 0.012; W, 0.043; B, < Y= 0.017A H W A, 0.018; H, 0.004; W, < Y= 0.013A H A, 0.018; H, < Y= 0.036H H, < Y= 0.078A W A, 0.017; W, < FEV1 Y= 0.006A H W 1.911B A, 0.016; H, 0.010; W, 0.036; B, < Y= 0.007A H W A, 0.015; H, 0.003; W, < Y= 0.006A H A, 0.015; H, < Y= 0.033H H, < Y= 0.086A W A, 0.015; W, < FEF25%-75% Y= 0.029A H W 6.286B A, 0.036; H, 0.024; W, 0.085; B, < Y= 0.024A H 2.62E 05W A, 0.036; H, 0.007; W, < Y= 0.024A H A, 0.036; H, < Y= 0.037H H, < Y= 0.127A W A, 0.031; W, < PEFR Y= 0.154A H 0.146W B A, 0.048; H, 0.032; W, 0.113; B, < Y= 0.162A H 0.002W A, 0.048; H, 0.009; W, < Y= 0.162A H A, 0.048; H, < Y= 0.068H H, < Y= 0.311A W A, 0.041; W, < r 2, square of regression coefficient; SEE, standard error of the estimates; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25%-75%, forced expiratory flow at 25% to 75% of FVC; PEFR, peak expiratory flow rate; A, age (yr); H, height (cm); W, weight (kg); B, body surface area (m 2 ). 3. 국내외폐기능검사추정정상치와의비교본연구에서 FVC, FEV 1 의신장에대한회귀방정식을국내외연구결과들과비교하였다 (Table 6). 국내연구에서 FVC의예측치는남자에서는키 130 cm에서 Lim 등, 3) Youn 등, 4) Cha 등 5) 의보고보다낮게나타났으나 Nam 등, 6) Cho 등 7) 의보고보다는높게나타났다. 여자에서는 Lim 등, 3) Youn 등 4) 의보고보다는낮게, Cha 등, 5) Nam 등, 6) Cho 등 7) 의보고보다는높게나타났다. FEV 1 의예측치는남자에서는신장 130 cm에서 Lim 등, 3) Cha 등 5) 의보고보다낮으나 Youn 등, 4) Nam 등, 6) Cho 등 7) 의보고보다높았다. 여자에서는신장 130 cm에서 Lim 등, 3) Youn 등, 4) Cha 등 5) 의보고보다는낮게, Nam 등, 6) Cho 등 7) 의보고보다는높게나타났다. 국외다른연구들과비교하였을때, FVC, FEV 1 의예측치는신장 130 cm에서남녀모두 Jeng 등 15) 의연구를제외하고모두낮은것으로나타났다 ) 고찰본연구는 2012년에국내정상초등학생을대상으로폐기능검사를시행하여폐기능검사에영향을미치는연령, 신장, 체중, 체표면적에따른폐기능검사항목별회귀방정식을다시구하였다. 그중신장이가장각폐기능검사항목에대한설명력이가장높았고, 과거 의국내외연구들과비교하여차이가있어이를비교정리하였다. 여러요인들중신장이폐기능검사와가장상관관계가높은것으로여러연구에서보고되었다. 3,4,18,19) 본연구에서도폐기능검사의각종목에대해남녀모두신장이가장설명력이높았고체표면적이두번째로설명력이높았다. 그다음은남자에서는연령, 체중순으로, 여자에서는체중, 연령순으로설명력이높았다. 소아의성장에따라폐기능의측정치는증가하게된다. 12세이하에서는나이보다신장이폐기능과더높은상관관계를가진다. 여자는 20세까지, 남자는 25세까지연령의증가와폐기능의증가가상관관계를가지며이후연령이증가하더라도폐기능은증가하지않는다고하였다. 20) 어린연령에서는신장의증가에따라폐기능이선형관련성을보이고, 연령이증가함에따라신장은폐기능과지속적인양의상관관계를보이는데반해, 연령이많아지면폐기능과연령은점차음의상관관계를보이게된다. 21,22) 본연구에서대상자의연령은 6 세에서 12세까지로연령과폐기능측정치는양의상관관계를보였다 (FVC, r 2 = 0.764; FEV 1, r 2 = 0.785; FEF 25%-75%, r 2 = 0.647; PEFR, r 2 = 0.740). 체중의증가가폐의성숙으로인한폐기능의증가를초래하나일정수준을넘어서면비만에의해폐기능이감소한다는 muscularityobesity 효과에대한연구가있으나, 23) 본연구에서는체질량지수가 95 백분위수이상의비만인경우대상자에서제외하였으므로체중 190

5 박철휘외 한국정상소아의폐기능검사추정정상치 Table 5. Multiple linear regression equations for spirometric parameters with variables of the physical measurements in female subjects Parameter Regression equation r 2 SEE P-value FVC Y= 0.027A H 0.005W B A, 0.017; H, 0.011; W, 0.037; B, < Y= 0.027A H W A, 0.017; H, 0.003; W, < Y= 0.025A H A, 0.018; H, < Y= 0.036H H, < Y= 0.111A W A, 0.015; W, < FEV1 Y= 0.030A H W B A, 0.016; H, 0.010; W, 0.035; B, < Y= 0.031A H W A, 0.016; H, 0.003; W, < Y= 0.029A H A, 0.016; H, < Y= 0.034H H, < Y= 0.110A W A, 0.014; W, < FEF25%-75% Y= 0.049A H W 6.012B A, 0.041; H, 0.026; W, 0.086; B, < Y= 0.048A H W A, 0.041; H, 0.008; W, < Y= 0.043A H A, 0.041; H, < Y= 0.045H H, < Y= 0.132A W A, 0.032; W, < PEFR Y= 0.073A H 0.024W B A, 0.052; H, 0.033; W, 0.112; B, < Y= 0.073A H W A, 0.052; H, 0.010; W, < Y= 0.069A H A, 0.053; H, < Y= 0.074H H, < Y= 0.245A W A, 0.042; W, < r 2, square of regression coefficient; SEE, standard error of the estimates; FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25%-75%, forced expiratory flow at 25% to 75% of FVC; PEFR, peak expiratory flow rate; A, age (yr); H, height (cm); W, weight (kg); B, body surface area (m 2 ). 이증가함에따라폐기능측정치는양의상관관계를보였다 (FVC, r 2 = 0.826; FEV 1, r 2 = 0.827; FEF 25%-75%, r 2 = 0.670; PEFR, r 2 = 0.735). 폐기능에영향을미치는인자들에대한많은연구들이있다. 체표면적과폐기능의상관관계에대한보고 24) 와흉곽용량과폐기능의상관관계를보고한연구도있다. 25) 본연구에서체표면적은폐기능과양의상관관계를보였으며신장보다는설명력이낮으나연령과체중보다높은설명력을보였다. 흉곽의용량은흉위측정을통해폐기능과의연관성을비교연구할수있겠으나본연구에서는시행하지않았다. 성별에따른폐기능의차이에대한국내보고 9,10) 와국외보고 26) 에서사춘기이전남녀에서 FVC와 FEV 1 은동일신장을기준으로남자가여자보다크다. 그러나사춘기이전의여자가같은나이의남자에비해폐용적에대한기도크기의비가더크며이로인한기도저항의감소로여자가남자에비해호흡기질환이적다는보고가있다. 27,28) 또한기도저항의감소로인해 3 6세여자에서남아보다높은 PEFR을보인다는보고가있다. 29) 본연구에서도 6 10세까지남자가여자에비해 FVC가유의하게높았으나 (P<0.05), FEV 1 은 6세에서만, PEFR은 6세와 8세에서만남자가여자보다유의하게높은측정치를나타내었고그외의연령에서는모두성별에의한차이를보이지않았다. 이런결과는국내외다른연구결과와크게다르지않았다. 3,4,6,9,26) 폐기능의정상치는연령, 신장, 체중, 체표면적, 성별, 인종이외에도많은요소가관여하며대기오염, 흡연, 사회경제적여건에대한보고도있다. 이산화황이높은지역에서실시한소아의폐기능검사에서 max expiratory flow volume 이유의하게감소하는데이는기관지내경의변화로인한것으로설명하기도하고, 30) 어머니의흡연이소아의폐기능에미치는악영향에대한보고도있다. 31) 그외에도많은사회경제적요인이폐기능에영향을줄것으로사료된다. 본연구에서는간접흡연력이있는소아를연구대상에서제외하였으나거주지역, 대기오염, 기타사회경제적요인의영향에대해서는타연구들과비교하지는못하였다. 따라서국내외여러폐기능정상치에관련한보고들이있으나이러한차이나선택된연구대상의지역적, 인종적, 사회경제적차이등에의하여결과에차이가있을것으로생각된다. 본연구는서울에위치한 1개초등학교학생을대상으로하여자료가제한적이지만, 본연구의목적이정상소아의폐기능의정상참고치를제시하고자한것이므로폐기능에영향을줄수있는인자들을최대한제거하여폐기능이정상인소아들을대상으로하고자하였고, 그과정에서대상자수가감소하였다는문제가있으나폐기능의정상참고치제시에필요한최소한의인원 2) 을충족하고있으며좀더정상소아에근접하였다는점에서의미가있다. 향후더욱광범위한대상을포함하고신체계측치외에폐기능에영 191

6 Park CH, et al. Expected normal values of pulmonary function test Table 6. Comparison of predicted values of FVC and FEV1 with previous studies Parameters Gender Domestic reports Foreign reports Authors No. Regression equation Value at 130 cm Authors No. Regression equation Value at 130 cm FVC Male Cho et al. 7) (1992) H Knudson et al. 20) (1983) 0.041H Yoon et al. 4) (1993) 1, H Ip et al. 11) (2000) Ln (H) Lim et al. 3) (1994) H Nystad et al. 12) (2002) H Cha et al. 5) (1994) H Torres et al. 13) (2003) 48 39H Nam et al. 6) (1998) H Al-Riyami et al. 14) (2004) Ln (H) This study H Jeng et al. 15) (2009) H Female Cho et al. 7) (1992) H Knudson et al. 20) (1983) 0.043H Yoon et al. 4) (1993) H Ip et al. 11) (2000) Ln (H) Lim et al. 3) (1994) H Nystad et al. 12) (2002) H Cha et al. 5) (1994) H Torres et al. 13) (2003) H Nam et al. 6) (1998) H Al-Riyami et al. 14) (2004) Ln (H) This study H Jeng et al. 15) (2009) H FEV1 Male Cho et al. 7) (1992) H Knudson et al. 20) (1983) 0.035H Yoon et al. 4) (1993) 1, H Ip et al. 11) (2000) Ln (H) Lim et al. 3) (1994) H Nystad et al. 12) (2002) H Cha et al. 5) (1994) H Al-Riyami et al. 14) (2004) Ln (H) Nam et al. 6) (1998) H Jeng et al. 15) (2009) H This study H Female Cho et al. 7) (1992) H Knudson et al. 20) (1983) 0.034H Yoon et al. 4) (1993) H Ip et al. 11) (2000) Ln (H) Lim et al. 3) (1994) H Nystad et al. 12) (2002) H Cha et al. 5) (1994) H Al-Riyami et al. 14) (2004) Ln (H) Nam et al. 6) (1998) H Jeng et al. 15) (2009) H This study H FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; H, height (cm). 향을줄수있는여러인자들을추가로고려한대규모연구가진행 되어야할것으로생각된다. 결론적으로, 2012 년 5 월에서울지역의정상초등학생을대상으 로폐기능검사를시행하여국내소아의폐기능정상예측치를구할 수있는설명력이높은회귀방정식을구하였고이를이용하여호흡 기질환의진단과평가에이용하고자하였다. 향후국내전체소아 를대변할수있는대규모연구가필요할것으로생각된다. REFERENCES 1. Ruppel GL, Enright PL. Pulmonary function testing. Respir Care 2012; 57: Beydon N, Davis SD, Lombardi E, Allen JL, Arets HG, Aurora P, et al. An official American Thoracic Society/European Respiratory Society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007;175: Lim DH, Kim JH, Park JH, Choi JW, Kim SK, Son BK. Normal predicted values of pulmonary function test in Korean primary school-aged children. J Korean Pediatr Soc 1994;37: Yoon KA, Lim HS, Koh YY, Kim H. Normal predicted values of pulmonary function test in Korean school-aged children. J Korean Pediatr Soc 1993;36: Cha IA, Kim KS, Kim YW, Kim KB. Normal predicted vlues of pulmonary function test in children. J Korean Pediatr Soc 1994;37: Nam SY, Kim KH, Hong YM, Kim GH. Normal predicted values of pulmonary function test in healthy Korean children. J Korean Pediatr Soc 1998;41: Cho A, Lee KH, Yoon HS. Expected normal values of pulmonary function test in normal children (ages 6 years through 12 years). Allergy 1992; 12: Yoon JS, Choi EY, Lee HS, Ahn YM. A study of predicted values of peak expiratory flow rates in primary school children. J Korean Pediatr Soc 1991;34: Yang SY, Na MJ, Choi WH, Kim KW. Expected normal values of pulmonary function test in pediatric age 1. by spirometry. J Korean Pediatr Soc 1989;32: Lim SY, Lee KY. A study on predicted values of peak expiratory flow rate (PEER) in primary school children. J Korean Pediatr Soc 1986;29: Ip MS, Karlberg EM, Karlberg JP, Luk KD, Leong JC. Lung function reference values in Chinese children and adolescents in Hong Kong. I. Spirometric values and comparison with other populations. Am J Respir Crit Care Med 2000;162(2 Pt 1):

7 박철휘외 한국정상소아의폐기능검사추정정상치 12. Nystad W, Samuelsen SO, Nafstad P, Edvardsen E, Stensrud T, Jaakkola JJ. Feasibility of measuring lung function in preschool children. Thorax 2002;57: Torres LA, Martinez FE, Manco JC. Correlation between standing height, sitting height, and arm span as an index of pulmonary function in 6-10-year-old children. Pediatr Pulmonol 2003;36: Al-Riyami BM, Al-Rawas OA, Hassan MO. Normal spirometric reference values for Omani children and adolescents. Respirology 2004;9: Jeng MJ, Chang HL, Tsai MC, Tsao PC, Yang CF, Lee YS, et al. Spirometric pulmonary function parameters of healthy Chinese children aged 3-6 years in Taiwan. Pediatr Pulmonol 2009;44: Korea Centers for Disease Control and Prevention, Division of Chronic Disease Surveillance, Committee for the Development of Growth Standard for Korean Children and Adolescents; Korean Pediatric Society, Committee for School Health and Public Health Statistics Korean Children and Adolescents Growth Standard (commentary for the development of 2007 growth chart). Cheongwon: Korea Centers for Disease Control and Prevention, Division of Chronic Disease Surveillance, Gehan EA, George SL. Estimation of human body surface area from height and weight. Cancer Chemother Rep 1970;54: Primhak RA, Biggins JD, Tsanakas JN, Hatzimichael A, Milner RD, Karpouzas JG. Factors affecting the peak expiratory flow rate in children. Br J Dis Chest 1984;78: Morse M, Schlutz FW, Cassels DE. The lung volume and its subdivisions in normal boys years of age. J Clin Invest 1952;31: Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis 1983;127: Thurlbeck WM. Postnatal human lung growth. Thorax 1982;37: Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981;123: Schoenberg JB, Beck GJ, Bouhuys A. Growth and decay of pulmonary function in healthy blacks and whites. Respir Physiol 1978;33: Peabody FW, Wentworth JA. Clinical studies of the respiration. IV. The vital capacity of the lungs and its relation to dyspnea. Arch Int Med 1917; 20: Lundsgaard C, Van Slyke DD. Studies of lung volume. I: relation between thorax size and lung volume in normal adults. J Exp Med 1918;27: Dockery DW, Berkey CS, Ware JH, Speizer FE, Ferris BG Jr. Distribution of forced vital capacity and forced expiratory volume in one second in children 6 to 11 years of age. Am Rev Respir Dis 1983;128: Leeder SR, Swan AV, Peat JK, Woolcook AJ, Blackburn CR. Maximum expiratory flow-volume curves in children: changes with growth and individual variability. Bull Eur Physiopathol Respir 1977;13: Taussig LM, Cota K, Kaltenborn W. Different mechanical properties of the lung in boys and girls. Am Rev Respir Dis 1981;123: Taussig LM. Maximal expiratory flows at functional residual capacity: a test of lung function for young children. Am Rev Respir Dis 1977;116: Zapletal A, Jech J, Paul T, Samanek M. Pulmonary function studies in children living in an air-polluted area. Am Rev Respir Dis 1973;107: Tager IB, Weiss ST, Munoz A, Rosner B, Speizer FE. Longitudinal study of the effects of maternal smoking on pulmonary function in children. N Engl J Med 1983;309:

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386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon