pissn: 2288-42 eissn: 2288-4 Allergy Asthma Respir Dis 3(6):4-416, November 215 http://dx.doi.org/.4168/aard.215.3.6.4 ORIGINAL ARTICLE 봄, 여름에호발하는소아호흡기바이러스감염 : 보카바이러스를중심으로한임상양상비교 곽광진, 1 김여향, 2 최희정 1 1 계명대학교의과대학소아과학교실, 2 경북대학교의과대학소아과학교실 Clinical characteristics of respiratory viral infection in children during spring/summer: focus on human bocavirus Kwang Jin Kwak, 1 Yeo Hyang Kim, 2 Hee Joung Choi 1 1 Department of Pediatrics, Keimyung University School of Medicine, Daegu; 2 Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea Purpose: We evaluated the clinical characteristics of respiratory viruses that were frequently found in children during spring/summer, namely, human bocavirus (), human metapneumovirus (hmpv), parainfluenza virus (PIV), and human rhinovirus (hrv). Methods: This study enrolled patients with acute lower respiratory infection in whom respiratory virus reverse transcriptase polymerase chain reaction was performed between March 213 and August of 213. We retrospectively reviewed the medical records to collect the patients data. Results: A total of 96 patients were enrolled and divided into 5 categories: in 19 patients (19.8%), hmpv in 18 patients (18.8%), PIV in 16 patients (16.7%), hrv in 2 patients (2.8%), and negative result in 23 patients (24.%). The mean age of the patients was 8.2 ± 5.9 months (median, 7.5 months; range, 1 24 months), and the male-to-female ratio was 1.1:1. The most common diagnoses were acute bronchiolitis (62.5%) and pneumonia (3.2%). Compared to other patients, those with were older (12.3 ± 4.9 months, P=.1) and more frequently diagnosed with acute bronchiolitis (P=.5). In addition, they showed higher incidences of tachypnea and rales (P=.39 and P=.35, respectively), and were more frequently treated with oxygen and systemic steroids (P=.44 and P=.1, respectively) than the other patients. Conclusion: We compared respiratory viruses in children during spring/summer and found that may have more severe clinical manifestations than other viruses. (Allergy Asthma Respir Dis 215;3:4-416) Keywords: Respiratory infection, Human bocavirus, Child 서론소아의급성호흡기감염은아주흔한질병으로 6% 9% 에서바이러스에의해발생되며, 1-3 호흡기바이러스의검출률과그임상양상은검출지역, 계절, 방법과대상집단에따라다양하게나타난다. 과거부터원인호흡기바이러스로호흡기세포융합바이러스, 파라인플루엔자바이러스, 인플루엔자바이러스, 아데노바이러스등이잘알려져있다. 4 또한상기도감염의주된원인으로알려진라이노바이러스도최근에는하기도감염의중요한원인으로생각되며 천식환자의증상악화에관계된다고한다. 5 199년대에중합효소연쇄반응 (polymerase chain reaction, PCR) 기술이개발되면서, 2년대이후로메타뉴모바이러스, 보카바이러스, 신종코로나바이러스가새롭게발견되어많은연구가이루어지고있다. 6 특히보카바이러스는스웨덴에서 25년첫보고가된단일가닥 DNA (single-stranded DNA) 바이러스로, 아직배양법이확립되지않아분자생물학적방법으로만진단이가능하다. 7 또한다른바이러스와중복감염의빈도가높아, 실제적인호흡기감염의원인인지아닌지에대한의문이많았다. 8 하지만최근보카바이러스 Correspondence to: Hee Joung Choi http://orcid.org/-2-7119-4194 215 The Korean Academy of Pediatric Allergy and Respiratory Disease Department of Pediatrics, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, The Korean Academy of Asthma, Allergy and Clinical Immunology Korea This is an Open Access article distributed under the terms of the Creative Tel: +82-53-25-7524, Fax: +82-53-25-7783, E-mail: joung756@dsmc.or.kr Commons Attribution Non-Commercial License Received: July 1, 215 Revised: August 3, 215 Accepted: September 2, 215 (http://creativecommons.org/licenses/by-nc/3./). 4 http://www.aard.or.kr
곽광진외 봄, 여름의소아호흡기바이러스감염 Allergy Asthma Respir Dis 의검출량이많은경우증상이더심하게나타나고중복감염여부가증상에차이를주지않는다는연구를통해보카바이러스가소아호흡기감염의한원인으로중요시되고있다. 9, 소아의호흡기바이러스는 11 12 월을중심으로한겨울철에높은검출률을보이고, 가장흔히검출되는바이러스는호흡기세포융합바이러스이다. 3,11 상대적으로바이러스의검출이적은봄, 여름계절에는파라인플루엔자, 메타뉴모바이러스, 보카바이러스가많은빈도를보이는데 1,2 이시기호흡기바이러스에대한연구는많이이루어지지않고있다. 이에저자들은봄, 여름에호발하는파라인플루엔자, 메타뉴모바이러스, 보카바이러스와함께연중비슷한빈도로검출되는라이노바이러스를포함하여연구를진행하였다. 이들의호흡기감염의임상양상과검사소견을포함한특징을살펴보고, 보카바이러스를중심으로다른호흡기바이러스와의차이를비교하였다. 대상및방법 대상환아들은입원당일혈액을채취하여백혈구수, 중성구, 림프구및호산구분획, 적혈구침강속도, C 반응성단백등을검사하였다. 입원중환아의임상경과에따라서치료를시행하였고, 산소포화도가 92% 이하인경우에산소를공급해주었다. 12 그리고환아에서증상정도에따라수액공급, 산소공급, 기관지확장제흡입치료, 항생제주사등의치료이후에도호흡음이호전되지않을때, 전신스테로이드를사용하였다. 13 입원하였을때환아의성별, 나이, 임상증상, 이학적검사소견과입원중치료방법및경과, 혈액검사소견, 흉부방사선소견, 최종진단명등을의무기록을통하여후향적으로조사하였다. 3. 통계분석결과치의통계분석은 IBM SPSS Statistics ver. 21. (IBM Co., Armonk, NY, USA) 을사용하였다. 각군간의비교는 chi-square test와 Mann-Whiney test를사용하였고, P값이.5 미만인경우통계학적으로유의성이있는것으로판정하였다. 1. 연구대상 213년 3월부터 8월까지계명대학교동산의료원에기침을동반한급성하기도호흡기감염으로입원한소아중호흡기바이러스역전사중합효소연쇄반응검사 (respiratory virus reverse transcriptase polymerase chain reaction, RV RT-PCR) 를시행한환아를대상으로하였다. 호흡기바이러스역전사중합효소연쇄반응검사결과에따라보카바이러스양성군, 메타뉴모바이러스양성군, 파라인플루엔자바이러스양성군, 라이노바이러스 A 양성군으로구분하였고, 역전사중합효소연쇄반응검사를시행하였으나바이러스가검출되지않은경우를음성군으로구분하였다. 바이러스가검출되더라도두종류이상의바이러스가중복검출된경우는대상에서제외하였다. 혈액검사에서세균감염이확인되거나, 흉부가슴사진에서세균성감염의가능성이높은소견을보인경우도대상에서제외하였다. 또한호흡기질환이아닌다른만성질환을이전부터가지고있었던경우도대상에서제외하였다. 본연구는계명대학교동산병원임상연구윤리위원회의심의를통과하였다 (IRB No. 214-11-45). 2. 연구방법호흡기바이러스검사는입원당일멸균된흡인용튜브를이용하여비인두분비물을채취하여시행되었다. 역전사중합효소연쇄반응검사 (RV 12 ACE Detection, Seegene, Seoul, Korea) 법으로메타뉴모바이러스, 아데노바이러스 A F, 코로나바이러스 229E/OC43, 파라인플루엔자바이러스 1/2/3, 인플루엔자바이러스 A/B, 라이노바이러스, 호흡기융합세포바이러스 A/B, 그리고보카바이러스의 12가지바이러스에대해검사하였다. 결과 1. 대상환자군의분포및특징대상기간동안기침을동반한급성하기도호흡기감염으로입원한소아중호흡기바이러스역전사중합효소연쇄반응검사를시행한환아는총 137명이었다. 이들중보카바이러스군은 19명 (19.8%), 메타뉴모바이러스군은 18명 (18.8%), 파라인플루엔자군은 16명 (16.7%), 라이노바이러스군은 2명 (2.8%) 이었고, 바이러스가검출되지않은음성군은 23명 (24.%) 으로, 총 96명의환아들이연구에포함되었다. 전체환아의평균연령은 8.2±5.9개월 ( 중위수, 7.5개월 ; 범위, 1 24개월 ) 이었고, 남아 5명 (52.1%), 여아 46명 (47.9%) 이었다. 보카바이러스군의평균연령은 12.3±4.9개월로메타뉴모바이러스군, 라이노바이러스군과음성군에비해의미있게많았다 (P <.5) (Table 1). 각군에서성별분포는의미있는차이를보이지않았다. 2. 임상양상검사소견전체환아의임상진단은세기관지염이 6명 (62.5%) 으로가장많았고, 폐렴이 29명 (3.2%) 으로두번째로많았다. 그외에기관지염이 3명, 크룹이 4명이었다. 각바이러스별임상진단의분포에서도세기관지염이모든군에서가장많은빈도를보였다 (Fig. 1). 그중보카바이러스군에서세기관지염의빈도가 89.5% 로파라인플루엔자군과음성군보다의미있게높았다 (P<.5). 입원당시 38 C 이상의열을보인빈도는각군에서차이가없었으나, 입원전열이있었던기간은라이노바이러스군에서음성군보다더짧았고 (P<.5), 입원후열이호전되는기간은각군에서차 http://dx.doi.org/.4168/aard.215.3.6.4 411
Allergy Asthma Respir Dis Kwak KJ, et al. Respiratory viral infection in children during spring/summer Table 1. Comparison of clinical manifestations according to causing viruses Variable hmpv PIV hrv Negative Total No. of patients 19 (19.8) 18 (18.8) 16 (16.7) 2 (2.8) 23 (24.) 96 () Age (mo) 12.3± 4.9 II 6.6± 6.1 8.8± 5.7 7.9± 6.1 5.9± 5.1 8.2± 5.9 Sex Male:female 9: 11:7 11:5 11:9 8:15 5:46 Clinical findings Fever (> 38 C) 9 15 54 Duration of fever prior to admission (day) 1.3± 1.4 1.8± 1.8 2.1± 1.8 1.± 1.6 II 2.1± 2.6 1.7± 1.9 Duration until fever subside (day).6±.8.7±.9.8± 1.2.8± 1.2 1.1± 1.1.8± 1. Duration of cough (day) 5.4± 6.4 6.2± 3.2* 3.6± 2.2 8.4± 9.7 7.± 6.7 6.3± 6.5 Tachypnea 9 II 2 6 6 4 27 Grunting 4 1 3 2 1 11 Stridor 1 1 2 2 3 9 Rale 15 12 7 8 14 56 Wheezing 12 8 7 9 46 Decreased aeration 11 8 7 12 48 Abnormal chest radiography 11 11 12 12 15 61 Treatment Oxygen supply 7 1 1 4 6 19 Duration of oxygen use (day).9± 1.4.1±.5.3±.8.7± 1.7 1.3± 2.5.7± 1.6 Systemic steroid 14 II 5 5 8 7 39 Inhaled steroid 11 13 9 13 12 58 Ventilator use 1 1 ICU care 3 1 2 7 6 19 Admission duration (day) 5.2± 1.3 5.3± 1.5 4.6± 1.4 5.9± 2.8 6.3± 5. 5.5± 2.9 Values are presented as number (%), mean± standard deviation or number., human bocavirus; hmpv, humanmetapneumonvirus; PIV, parainfluenza virus; hrv, human rhinovirus; ICU, intensive care unit. *P<.5, compared with. P<.5, compared with hmpv. P<.5, compared with PIV. P<.5, compared with hrv. II P<.5, compared with negative result. % 9 8 7 6 5 4 3 2 Croup Bronchitis Pneumonia Bronchiolitis hmpv PIV hrv Negative Fig. 1. Diagnosis of the patients according to causing virus. The most common clinical diagnosis was acute bronchiolitis, and the other diagnoses were pneumonia, bronchitis and croup., human bocavirus; hmpv, human metapneumonvirus; PIV, parainfluenza virus; hrv, human rhinovirus. 이를보이지않았다 (Table 1). 입원전기침의기간은메타뉴모바이러스군이보카바이러스군과파라인플루엔자군보다길었다 (P<.5). 진찰소견에서빈호흡을보인경우는보카바이러스군이메타뉴모바이러스군과음성군보다많았다 (P<.5). 청진에서수포음이들리는경우는보카바이러스군에서파라인플루엔자군과라이노바이러스군보다많았으나 (P<.5), 천명이나협착음이들리는경우는각군에서차이를보이지않았다. 혈액검사에서는산소포화도와전체백혈구수는각군간차이를보이지않았으나, 보카바이러스군에서메타뉴모바이러스군과파라인플루엔자군보다높은호중구분획을보였고, 메타뉴모바이러스군, 파라인플루엔자군, 라이노바이러스군보다낮은림프구분획을보였으며, 모든군보다높은호산구분획을보였다 (P<.5) (Table 2). 메타뉴모바이러스군에서보카바이러스군보다높은적혈구침강속도를보였고 (P<.5), C 반응성단백은각군간의차이를보이지않았다. 412 http://dx.doi.org/.4168/aard.215.3.6.4
곽광진외 봄, 여름의소아호흡기바이러스감염 Allergy Asthma Respir Dis Table 2. Comparison of laboratory findings according to causing viruses Variable hmpv PIV hrv Negative No. of patients 19 (19.8) 18 (18.8) 16 (16.7) 2 (2.8) 23 (24.) O2 saturation (SpO2) (%) 96.3± 4.5 92.3± 23.1 92.± 24.6 97.9± 2.4 78.6± 38.3 White blood cell count (/mm 3 ) 12,915± 4,765 12,4± 3,914,459± 9,275 12,271± 3,588,954± 4,7 Neutrophil proportion (%) 52.7± 19. 39.± 16.3 35.6± 18.6 43.4± 21.5 42.4± 14.3 Lymphocyte proportion (%) 31.1± 16.2 II 47.4± 15. 48.7± 16.9 42.6± 16.8 44.6± 12.4 Eosinophil proportion (%) 3.1± 2.2 II 1.1± 1.1 2.± 2.4 1.7± 1.5 2.± 1.7 Erythrocyte sedimentation rate (mm/hr) 14.8± 9.5 33.9± 28.8* 24.8± 2.5 18.2± 15.9 19.9± 14.1 C-reactive protein (mg/dl) 1.2± 2.1 1.± 1.4 2.± 2.2 1.± 1.3 1.1± 1.3 Values are presented as number (%) or mean± standard deviation, human bocavirus; hmpv, humanmetapneumonvirus; PIV, parainfluenza virus; hrv, human rhinovirus. *P<.5, compared with. P<.5, compared with hmpv. P<.5, compared with PIV. P<.5, compared with hrv. II P<.5, compared with negative result. P =.1 14 12 12.3±4.9 45 4 35 3 Male Female 41 36 Age (mo) 8 6 7.3±6.8 Number 25 2 4 2 15 5 9 A B Fig. 2. Age (A) and gender (B) of the patients with human bocavirus () and the others. The patients with human bocavirus were older than other patients (P=.1) (A), but there was no gender difference (B). 3. 치료및예후산소치료가필요했던경우는보카바이러스군에서메타뉴모바이러스군과파라인플루엔자군보다많았고 (P<.5), 산소치료를시행한기간도보카바이러스군에서메타뉴모바이러스군보다길었다 (P<.5) (Table 1). 또한전신성스테로이드치료를받은환자도보카바이러스군에서다른군들에비해모두의미있게많았다 (P<.5). 흡입용스테로이드사용에는각군의차이를보이지않았다. 인공호흡기가필요했던환자는각군에서차이를보이지않았으나, 중환자실입실이필요했던환자는라이노바이러스군에서메타뉴모바이러스군보다의미있게많았다 (P<.5). 또한총입원기간은각군의차이를보이지않았다. 중환자실에서치료가필요했던 19명환아들의임상양상을살펴본결과, 중환자실치료가필요했던환아들에서그렇지않은환아들보다여아의비율이더많았고 (P =.12), 빈호흡과끙끙거리는증상을많이보였다 (P =., P =.38). 또한입원중산소치료를더많은빈도에서, 더오래시행받았고 (P =., P =.), 총 입원기간도더길었다 (P =.14). 하지만진단병명이나연령, 스테로이드의사용이나인공호흡기의사용에는의미있는차이를보이지않았다. 4. 보카바이러스와그외환자들의비교보카바이러스와그외환자들을비교해보면, 보카바이러스군에서다른환자들에비해나이가의미있게많았고 (P =.1), 성별분포는차이를보이지않았다 (Fig. 2). 임상진단에서세기관지염의빈도가다른환자들보다의미있게높았다 (P =.5). 진찰소견에서빈호흡과수포음이보카바이러스군에서다른환자들에비해의미있게많이관찰되었고 (P =.39, P =.35), 천명음과호흡음감소소견도보카바이러스군에서많이관찰되었지만통계학적인유의성은보이지않았다 (P =.1, P =.35) (Fig. 3). 혈액검사에서는보카바이러스군에서다른환자들에비해전체백혈구수치는차이를보이지않았지만, 높은호중구분획과호산구분획, 그리고낮은림프구분획을보였다 (P =.16, P =.1, P =.1). 입원후치료과정에서산소의사용이보카바이러스군에서다른환자들보 http://dx.doi.org/.4168/aard.215.3.6.4 413
Allergy Asthma Respir Dis Kwak KJ, et al. Respiratory viral infection in children during spring/summer % 9 8 7 6 5 4 3 2 P =.39 Tachypnea Grunting Stridor P =.35 Fig. 3. The percentage of the patients with human bocavirus () and the other patients according to clinical manifestations. The patients with human bocavirus showed more incidence of tachypnea and rale than other patients (P=.39, P=.35). Rale Wheezing Decreased aeration Abnormal chest radiography % 8 7 6 5 4 3 2 P =.44 Oxygen supply P =.1 Systemic steroid Inhaled steroid Ventilator care Intensive care Fig. 4. The percentage of the patients with human bocavirus () and the other patients according to management. The patients with human bocavirus were more commonly treated with oxygen and systemic steroid than other patients (P=.44, P=.1). 다더많았고 (P =.44), 전신성스테로이드사용또한더많았다 (P =.1) (Fig. 4). 고찰보카바이러스는감기나중이염의상기도감염부터천명을동반한하기도감염까지일으키는소아호흡기감염의중요한원인이다. 8 또한심한저산소증이나폐쇄성기관지염을일으키거나, 소아천식환자에서급성악화의원인이되기도한다. 14,15 각국에서보고된보카바이러스의검출률은무증상대상인경우에 1.1% 로낮았고, 천명을보인경우 19% 까지높았으며, 평균적으로 5% 5.5% 정도로나타났다. 16-19 국내에서는 26년처음보고되었고, 2 이후여러연구를통해호흡기감염과관련된유병률이전연령층에서는 4.8%, 소아에서는 8.% 12.2% 로보고하고있다. 3,9,21,22 특히 6개월에서 2세이하에서높은비율로확인되었다. 보카바이러스의유행시기는지역에따라차이를보이는데, 겨울철이나봄철에유행한다는외국의보고와다르게, 8 국내에서는주로 5월에서 7월사이에가장높은빈도로검출되었다. 21,22 전체호흡기바이러스의검출빈도를살펴보면대체적으로호흡기세포융합바이러스가가장흔했고, 그다음으로는보고마다순위가다르다. 하지만전체적으로라이노바이러스의빈도가두번째로많았던외국의논문들에비해서국내보고에서는라이노바이러스의빈도는낮고보카바이러스의빈도가높아호흡기세포융합바이러스다음으로두번째로많이검출되기도하였다. 2,3,22-25 최근국내연구에서는이와대조적으로라이노바이러스가가장많고, 보카바이러스가네번째로많이검출되기도하였다. 9 이번연구를진행하면서 213년 3월부터 214년 2월까지, 1년간의바이러스검출률도살펴보았다. 두가지이상의바이러스가중복감염된경우를포함하여가장많이검출된바이러스부터나열하면, 호흡기세포융합바이러스, 라이노바이러스, 파라인플루엔자바이러스, 보카바이러스, 그리고인플루엔자바이러스등의순이었다. 하지만본연구의대상기간인 213년 3월부터 8월까지살펴본결과는라이노바이러스, 보카바이러스, 호흡기세포융합바이러스, 메타뉴모바이러스, 파라인플루엔자바이러스, 그리고인플루엔자바이러스등의순서였다. 이를통해봄, 여름시기에상대적으로보카바이러스의빈도가높게나타나는것을확인할수있었다. 또한이들의중복감염빈도는보카바이러스 2.8%, 라이노바이러스 2%, 인플루엔자바이러스 %, 메타뉴모바이러스 5.3%, 그리고호흡기세포융합바이러스 4.8% 로, 보카바이러스에서중복감염의빈도가높음을확인할수있었다. 소아의호흡기바이러스의감염은 3개월에서 24개월사이에집중되어나타나고, 나이가많아지면서그빈도가감소한다. 3 특히호흡기세포융합바이러스가다른바이러스들에비해어린 3개월미만의영아에서많이발견되는것은잘알려져있다. 보카바이러스와메타뉴모바이러스는라이노바이러스와비슷하거나조금높은연령대에서주로검출되며, 파라인플루엔자바이러스는이들보다조금낮은연령에서많이검출된다. 2,3,22 이와는다르게보카바이러스가호흡기세포융합바이러스처럼 1세미만에서흔하다는보고도있었다. 25 이전연구에서보고된보카바이러스감염의평균연령이 19.2개월에서 36.2개월인데비해서 17,21 이번연구에서는보카바 414 http://dx.doi.org/.4168/aard.215.3.6.4
곽광진외 봄, 여름의소아호흡기바이러스감염 Allergy Asthma Respir Dis 이러스군의평균연령이 12.3±4.9개월로다소낮았고, 전체환아들의평균연령도 8.2±5.9개월로낮았다. 또한보카바이러스군의평균나이가다른군에비해의미있게많았다. 이는본원에서 3세이하의소아에서주로호흡기바이러스역전사중합효소연쇄반응검사를시행하였고, 연장아일수록급성호흡기감염으로입원하는빈도가적어, 대상환아의연령범위가 1 24개월로제한되었기때문이라고생각된다. 이번연구에서전체대상환아의임상진단은세기관지염과폐렴이가장많았다. 소아하기도감염의이전연구들에서바이러스에따른임상진단의빈도를보면, 보카바이러스에서는폐렴과세기관지염의빈도가비슷하게나타나거나, 21,26 폐렴이더많은빈도를보인다고하였다. 9 이와는대조적으로이번연구에서는세기관지염이폐렴에비해많이나타났고, 다른군에비해세기관지염의빈도가의미있게높았다. 메타뉴모바이러스는이전연구들에서도폐렴의빈도가많다고알려져있고, 1,2 본연구에서도보카바이러스에비해서폐렴의빈도가높게나타났다. 파라인플루엔자바이러스는크룹에서많이검출된다고알려져있고, 2 본연구에서도파라인플루엔자군에서다른군에비해서크룹환자의빈도가높았다. 각바이러스간의임상양상이나혈액검사를비교한여러연구들을살펴보면, 라이노바이러스가열의기간, 저산소증의빈도, 입원기간이짧고, 보카바이러스는호흡기세포융합바이러스와비슷한임상양상을보인다고한연구가있는반면, 25 보카바이러스가호흡기세포융합바이러스보다천명이덜하고, 라이노바이러스보다저산소증이덜하다는연구도있었다. 27 또보카바이러스에서라이노바이러스보다백혈구수가의미있게높다는연구도있었고, 28 보카바이러스와호흡기세포융합바이러스, 라이노바이러스를비교한연구에서는각바이러스간에열, 증상의기간, 백혈구수치, C 반응성단백의차이를보이지않는다고도하였다. 17 국내에서보카바이러스양성군과음성군으로구별하여비교한연구에서는보카바이러스양성군에서더많은빈도의흉부함몰과천명음, 높은호흡기증상점수, 긴입원기간을보고하였다. 9 이번연구에서는라이노바이러스군에서입원전발열기간이짧았고, 파라인플루엔자군에서입원전기침의기간이짧게나타났다. 보카바이러스군에서다른환자들과비교하여많은빈도의빈호흡과수포음이관찰되었고, 혈액검사에서높은호중구분획과낮은림프구분획을보였으며, 입원치료중산소의사용, 전신성스테로이드의사용이의미있게더많았다. 이를통하여보카바이러스군이호흡기증상이더심하고, 염증반응이더심하게나타났음을알수있다. 이번연구에서보카바이러스군이다른환자들에비해서세기관지염의빈도가높았던것이더많은전신성스테로이드사용에일부영향을주었으리라생각한다. 본연구의제한점으로는 (1) 일개대학병원에서시행된연구로지역적한계가있으며, 짧은기간으로대상환아수가적었다. (2) 3차 병원에서입원한환아를대상으로하여비교적증상이심한환아 들이포함되었고, 이로인해전체급성바이러스의임상양상을대 표하지는못한다는것이다. (3) 보카바이러스는중복감염의비중 이높음에도불구하고본연구에서는중복감염이임상양상에미 치는영향이다루어지지못하였다. (4) 후향적연구의제한점으로 환자의임상양상에대한중증도점수를측정하지못하여, 좀더객 관적인평가가이루어지지못하였다. 하지만이번연구를통하여봄, 여름에흔히발견되는보카바이 러스, 메타뉴모바이러스, 파라인플루엔자바이러스와라이노바이 러스의임상적인특징을알아보았고, 보카바이러스군에서다른군 보다대상환아의연령이많고, 세기관지염의빈도가많음을확인 하였다. 또한, 진찰소견에서빈호흡, 나음이더많이관찰되고, 산 소치료가많고, 그기간도길며, 정맥스테로이드사용의빈도가더 높음을알수있었다. 이를통하여봄, 여름에호발하는호흡기바이 러스중보카바이러스가다른바이러스에비해서더심한임상양 상을보일수있음을알수있었다. 향후전향적인대규모연구를통 해더객관적인지표에의한비교분석이필요할것으로생각한다. REFERENCES 1. Kim KH, Lee JH, Sun DS, Kim YB, Choi YJ, Park JS, et al. Detection and clinical manifestations of twelve respiratory viruses in hospitalized children with acute lower respiratory tract infections : focus on human metapneumovirus, human rhinovirus and human coronavirus. Korean J Pediatr 28;51:834-41. 2. Lim JS, Woo SI, Kwon HI, Baek YH, Choi YK, Hahn YS. Clinical characteristics of acute lower respiratory tract infections due to 13 respiratory viruses detected by multiplex PCR in children. Korean J Pediatr 2;53: 373-9. 3. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2-25. Clin Infect Dis 26;43:585-92. 4. Yun BY, Kim MR, Park JY, Choi EH, Lee HJ, Yun CK. Viral etiology and epidemiology of acute lower respiratory tract infections in Korean children. Pediatr Infect Dis J 1995;14:54-9. 5. Papadopoulos NG, Moustaki M, Tsolia M, Bossios A, Astra E, Prezerakou A, et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis. Am J Respir Crit Care Med 22;165:1285-9. 6. Jartti T, Jartti L, Ruuskanen O, Soderlund-Venermo M. New respiratory viral infections. Curr Opin Pulm Med 212;18:271-8. 7. Allander T, Tammi MT, Eriksson M, Bjerkner A, Tiveljung-Lindell A, Andersson B. Cloning of a human parvovirus by molecular screening of respiratory tract samples. Proc Natl Acad Sci U S A 25;2:12891-6. 8. Jartti T, Hedman K, Jartti L, Ruuskanen O, Allander T, Soderlund-Venermo M. Human bocavirus-the first 5 years. Rev Med Virol 212;22:46-64. 9. Ahn JG, Choi SY, Kim DS, Kim KH. Human bocavirus isolated from children with acute respiratory tract infections in Korea, 2-211. J Med Virol 214;86:211-8.. Deng Y, Gu X, Zhao X, Luo J, Luo Z, Wang L, et al. High viral load of human bocavirus correlates with duration of wheezing in children with severe lower respiratory tract infection. PLoS One 212;7:e34353. http://dx.doi.org/.4168/aard.215.3.6.4 415
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