Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Correlation between Bronchostenosis and Changes in the Levels of Interferon-γ and Transforming Growth Factor-β during the Treatment in patients with Endobronchial Tuberculosis

기관지 결핵 치료 후의 기관지 협착 발생과 Interferon-γ 및 Transforming Growth Factor-β 농도 변화의 연관성

  • Kim, Ki Uk (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Lee, Su Jin (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Lee, Jae Hyung (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Cho, Woo Hyun (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Jung, Kyung Sik (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Joe, Jin Hoon (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Kim, Yun Seong (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Lee, Min Ki (Department of Internal Medicine, College of Medicine, Pusan National University) ;
  • Kim, Yeong Dae (Department of Thoracic Surgery, College of Medicine, Pusan National University) ;
  • Choi, Young Min (Medical Research Institute of Pusan National University Hospital) ;
  • Park, Soon Kew (Department of Internal Medicine, College of Medicine, Pusan National University)
  • 김기욱 (부산대학교 의과대학 내과학교실) ;
  • 이수진 (부산대학교 의과대학 내과학교실) ;
  • 이재형 (부산대학교 의과대학 내과학교실) ;
  • 조우현 (부산대학교 의과대학 내과학교실) ;
  • 정경식 (부산대학교 의과대학 내과학교실) ;
  • 조진훈 (부산대학교 의과대학 내과학교실) ;
  • 김윤성 (부산대학교 의과대학 내과학교실) ;
  • 이민기 (부산대학교 의과대학 내과학교실) ;
  • 김영대 (부산대학교 의과대학 흉부외과학교실) ;
  • 최영민 (부산대학교병원 의학연구소) ;
  • 박순규 (부산대학교 의과대학 내과학교실)
  • Received : 2004.09.13
  • Accepted : 2004.12.01
  • Published : 2005.01.30
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Abstract

Background : Endobronchial tuberculosis often complicates bronchostenosis, which can cause dyspnea due to an airway obstruction, and can be misdiagnosed as bronchial asthma or lung cancer. This study investigated the possible correlation between the $interferon-{\gamma}$($IFN-{\gamma}$) and transforming growth $factor-{\beta}$($TGF-{\beta}$) levels in the serum and bronchial washing fluid and the treatment results in endobronchial tuberculosis patients. Methods : Sixteen patients, who were diagnosed as endobronchial tuberculosis using bronchoscopy, and 10 healthy control subjects were enrolled in this study. The $IFN-{\gamma}$ and $TGF-{\beta}$ levels were measured in the serum and bronchial washing fluid of 16 endobronchial tuberculosis patients before and after treatment using the ELISA method. The endobronchial tuberculosis patients were divided into those who showed bronchial fibrostenosis after treatment and those who did not. Results : The $IFN-{\gamma}$ and $TGF-{\beta}$ levels in the bronchial washing fluid in endobronchial tuberculosis patients were elevated comparing to the control (p<0.05). After treatment, 7 of the 16 endobronchial tuberculosis patients showed bronchial fibrostenosis and the other 9 cases healed without this sequela. In the patients with fibrostenosis after treatment, the initial serum $TGF-{\beta}$ level was lower than the patients without fibrostenosis after treatment (p<0.05). Moreover, the serum $TGF-{\beta}$ level after treatment further decreased comparing to the patients without fibrostenosis after treatment(p<0.05). Conclusion : Elevated $IFN-{\gamma}$ and $TGF-{\beta}$ levels in the bronchial washing fluid in endobronchial tuberculosis patients are believed to be related to the pathogenesis of endobronchial tuberculosis. The decreased initial serum $TGF-{\beta}$ level and the change in the serum $TGF-{\beta}$ level after treatment are believed to be involved in bronchial fibrostenosis during the course of the disease.

연구배경 : 기관지 결핵의 주요 합병증인 기관지 협착은 기도폐쇄에 의한 호흡곤란을 초래하거나 천식이나 폐암으로 오인되는 등의 임상적 문제를 가진다. 본 연구는 기관지 결핵 환자를 대상으로 치료 후 기관지 협착이 발생한 군과 발생하지 않은 군간에 치료 전후의 $IFN-{\gamma}$ 및 $TGF-{\beta}$의 혈청 및 기관지 세척액 농도를 비교함으로써 $IFN-{\gamma}$ 및 $TGF-{\beta}$의 농도와 기관지 협착 발생과의 연관성을 알아보고자 하였다. 대상 및 방법 : 기관지 내시경을 통한 세균학적 검사 및 조직검사로 기관지 결핵으로 진단받은 16명의 환자를 대상으로 치료 전후에 기관지 세척술을 포함한 기관지 내시경술을 시행하였으며 $IFN-{\gamma}$와 $TGF-{\beta}$의 혈청 및 기관지 세척액에서의 농도를 측정하였다. 동일한 방법으로 건강한 성인 대조군 10명에서 혈청 및 기관지 세척액의 $IFN-{\gamma}$와 $TGF-{\beta}$ 농도를 측정하였다. 결 과 : 기관지 결핵 환자군에서 대조군에 비해 기관지 세척액의 $IFN-{\gamma}$(108.55 pg/ml vs undetectable, median)와 $TGF-{\beta}$ 농도(60.80 pg/ml vs undetectable, median)가 유의하게 증가되어 있었다(p<0.05). 치료 후 시행한 기관지 내시경 소견에서 섬유화로 인한 기관지 협착이 남은 환자가 7명 이었고 나머지 9명은 후유증 없이 치유된 소견을 보였다. 기관지 협착을 보인 환자군이 협착이 남지 않은 군에 비해 치료 전의혈청 $TGF-{\beta}$ 농도(847.67 pg/ml vs 1140.30 pg/ml, median)가 낮았으며 또한 치료 후에 더 많이 감소하였다(${\Delta}381.08pg/ml$ vs ${\Delta}191.47pg/ml$, median)(p<0.05). 결 론 : 증가된 기관지 세척액의 $IFN-{\gamma}$와 $TGF-{\beta}$ 농도는 기관지 결핵의 발생기전과 관련이 있을 것으로 생각되며 치료 경과에서 섬유화로 인한 기관지 협착의 발생 유무는 혈청 $TGF-{\beta}$의 치료 전 농도 및 치료 후 농도 변화와 연관성이 있을 것으로 추정된다.

Keywords

References

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