가와사키병 환자에서 면역글로불린 투여 전 후 호모시스테인, tumor necrosis factor-alpha 혈중 농도에 대한 연구- 가와사키병 환아에서 호모시스테인, tumor necrosis factor-alpha 혈중 농도 비교 분석 - = Serum homocysteine and tumor necrosis factor-alpha levels after intravenous gammaglobulin treatment in patients with Kawasaki disease

다국어 초록 (Multilingual Abstract)

Purpose : Homocysteine is a strong and independent risk factor for cardiovascular disease. The deleterious effects of homocysteine included endothelial dysfunction, arterial intimal-medial thickening, wall stiffness and procoagulant activity. However, the precise mechanism responsible for homocysteine release in children with coronary artery disease is still unknown. The purpose of this study was to investigate serum homocysteine and tumor necrosis factor(TNF)-α levels and identify whether these levels had any association with the development of coronary artery lesions in Kawasaki disease(KD).
Methods : Serum homocysteine and TNF-α levels were measured in 24 KD patients(group 1, eight patients with normal coronary artery; group 2, 16 patients with coronary artery lesions) and 21 controls(group 3, 10 afebrile controls; group 4, 11 febrile controls). Blood samples were drawn from each study group before and after intravenous immunoglobulin(IVIG) therapy and in the convalescent stage.
Results : The homocysteine levels before IVIG therapy were significantly higher in group 1 than in group 3, and in group 2 than in group 3 and 4. The TNF-α levels before IVIG therapy were significantly higher in group 2 than group 3 and 4. Serum homocysteine and TNF-α levels were highest in group 2 before IVIG therapy. In the acute KD patients, serum homocysteine levels correlated significantly with TNF-α levels.
Conclusion : The increased serum homocysteine levels in the acute stage increase the susceptibility to coronary arterial lesions in KD. TNF-α may also play an important role in the formation of coronary arterial lesions in KD.

국문 초록 (Abstract)

목 적 : 호모시스테인은 성인에서 관상동맥 질환을 포함한 심혈관 질환의 독립적인 위험 인자로서, 혈관 내피세포 손상과 혈액 응고 촉진, 혈전 형성 등의 기전으로 동맥경화증의 위험을 증가시킨다고 알려져 있으나 이러한 호모시스테인이 소아에 미치는 영향은 아직까지 연구된 바가 없다. TNF-α는 전염증성 사이토카인으로서 혈관 내피세포 손상과 관상동맥의 염증 반응을 초래한다. 본 연구에서는 호모시스테인이 가와사키병의 관상동맥 합병증에 미치는 영향과 TNF-α의 연관성에 대해 알아보고자 하였다.
방 법 : 가와사키병 환아 24명(관상동맥 확장이 없는 군(1군) : 8명, 관상동맥 확장이 있는 군(2군) : 16명)에 대한 임상 양상과 면역글로불린 투여 전과 후, 회복기에서의 호모시스테인과 TNF-α 혈중 농도를 비교하였다. 대조군은 같은 시기에 내원한 열이 없는 정상 소아(3군 : 10명)와 열성 질환 소아(4군 : 11명)로 정하였다.
결 과 : 면역글로불린 투여 전의 호모시스테인은 1군(14.0±7.0 mol/L)에서 3군(5.9±1.1 mol/L)에 비해 유의하게 높았으며(P<0.05), 2군(17.4±8.0 mol/L)에서는 3군(5.9±1.1 mol/L)과 4군(9.2±2.0 mol/L) 각각에 비해 유의하게 높았다(P<0.05). TNF-α에서도 면역글로불린 투여 전 2군(858.4±934.0 pg/mL)이 3군(8.0±1.1 pg/mL)과 4군(54.1±146.3 pg/mL)에 비해 유의하게 높았다(P<0.05). 2군에서 시간 경과에 따른 호모시스테인과 TNF-α를 비교해 보면 면역글로불린 투여 전에 각각 17.4±8.0 mol/L, 858.4±934.0 pg/mL로 가장 높았고, 면역글로불린 투여 후와 회복기로 갈수록 감소하였다. 또한 가와사키병 급성기에서 호모시스테인과 TNF-α는 양의 상관관계를 가진다(r=0.488, P<0.05).
결 론 : 호모시스테인의 혈중 농도가 높을수록 가와사키병에서 관상동맥 병변이 발생할 가능성이 더 높았으며 TNF-α와 같은 사이토카인도 관상동맥 병변의 형성에 중요한 역할을 할 것으로 생각된다.

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