규폐결핵 환자에서 단백 전기영동과 면역 글로부린 측정을 통한 immunity에 관한 연구

Abstract

The silicosis is an occupational lung disease that occurred mainly in the coal miner due to inhalation of silica dust. Many opinions of the pathogenesis of the silicosis were proposed, but in recent, immunological aspect was considered. In order to study of immune mechanism of silicotuberculosis, the author selected 63 patients of silicotuberculosis, (15 patients of silicosis category Ⅰ., 21 patients of silicosis category Ⅱ., 27 patients of silicosis category Ⅲ., 5 patients of minimal tuberculosis, 39 patients of moderate advanced tuberculosis, 19 patients of far advanced tuberculosis) who treated at Ewha Womans University Hospital from october 1981 to september 1982, and measured the amount of serum proteins with their fractions, electrophoresis and the amount of immunoglobulin. The results were as follows: 1. The mean of serum concentration of albumin was significantly decreased (p<0.01) in silicotuberculosis(3.59±0.33gm/dl) than in control group(3.93±0.21gm/dl). There were inverse correlation of serum albumin levels with severity of the tuberculosis, but not silicosis. 2. α_(1) globulin level in silicotuberculosis and in normal control group were 0.25±0.10 gm/dl and 0.24±0.08 gm/dl respectively, and there were no significant difference. α_(2) globulin level was significantly decreased(p<0.05) in silicotuberculosis (0.71±0.15 gm/dl) than in control group (0.76±0.09 gm/dl). 3. β globulin level was significantly decreased (p<0.01) in silicotuberculosis (0.85±0.15 gm/dl) than in control group (0.95±0.11 gm/dl). 4. γ globulin levels were significantly increased (p<0.01) in silicotuberculosis (1.69±0.42 gm/dl) than in control group (1.24±0.21 gm/dl). There were significant correlation of serum γ globulin levels with severity of the silicotuberculosis. 5. The A/G ratio was significantly decreased (p<0.01) in silicotuberculosis (l.03±0.21) than in control group (l.23±0.18). There were significant correlation of A/G ratio with severity of the tuberculosis, but not silicosis. 6. Ig G levels in silicotuberculosis(1,324±592 mg/dl) were somewhat higher than in those control group(1,218±108 mg/dl) but there was no significant difference. Ig A levels were significantly increased(p<0.01) in silicotuberculosis (289±123 mg/dl) than in control group (223±38 mg/dl). There were significant correlation of serum Ig A levels with the severity of the tuberculosis and silicosis. 7. C_(3) levels in silicotuberculosis and in normal control group were 38.6±21 mb/dl and 37.5±10 mg/dl respectively, and there was no significant difference. 8. Tests for ANA were negative in the all of the 35 silicotuberculosis and test for RA factor revealed positive in 17.1% of the silicotuberculosis.;규폐증은 광산등의 분진작업에 종사하는 근로자들에게서 silica(silicon dioxide)입자를 흡입함으로써 발생하는 직업병으로 이 규폐증의 발생기전에는 여러가지 학설들이 제창되었으나 최근에는 면역학설이 다른 어느 학설보다도 유력시되고 있다. 저자는 규폐결핵환자의 면역상태를 파악하기 위하여 1981년 10월부터 1982년 9월까지 이화대학병원 내과에 입원하여 규폐결핵으로 진단된 환자 63명을 대상으로 총단백 전기영동에 의한 단백분획상, 각종 면역글로부린량 및 자가항체를 측정하여 다음과 같은 결과를 얻었다. 1. 혈청 albumin은 대상군(3.59±0.33 gm/100mg)이 대조군(3.93±0.21gm/100ml)에 비하여 의의있게 감소되었으며(p＜0.01), 결핵의 정도가 심할수록 감소되는 경향을 보였으나 규폐의 정도와는 무관하였다. 2. α_(1)globulin은 대상군(0.25±0.10 gm/100ml)이 대조군(0.24±0.08gm/100ml)에 비하여 의의있는 변화가 없었으나 α_(2)globulin은 대상군(0.71±0.15gm/100ml)이 대조군에 비하여 의의있게 감소되었다(p＜0.05). 3. βglobulin은 대상군(0.85±0.15 gm/100 ml) 이 대조군 (0.95±0.11gm/100ml)에 비하여 의의있게 감소되었다(p＜0.01). 4. γglobulin은 대상군(1.69±0.42gm/100ml)이 대조군(1.24±0.21 gm/100ml)에 비하여 의의있게 증가되었으며(P＜0.01), 규폐와 결핵의 정도가 심할수록 증가되는 경향을 보였다. 5. A/G 비는 대상군(1.03±0.21)이 대조군(1.23±0.18)에 비하여 의의있게 감소되었으며(p＜0.01), 규폐의 정도에 따른 변화는 의의가 없었으나 결핵의 정도가 심할수록 감소되었다(p＜0.05). 6. IgG는 대상군(1324±592 mg/100mg)이 대조군(1218±108mg/100ml)에 비하여 증가되는 경향을 보였으나 의의는 없었고, IgA는 대상군(289±123mg/100ml)이 대조군(223± 38mg/100ml)에 비하여 의의있게 증가되었으며(p＜0.01), 규폐와 결핵의 정도가 심할수록 의의있게 증가되었다(p<0.05). 7. 혈청 C_(3)치는 대상군(158±74mg/100ml)이 대조군(124±35mg/100ml)에 비하여 의의있게 증가되었으며(p＜0.01), 규폐와 결핵의 심한정도와는 관계가 없었다. 혈청 C_(4)치는 대상군(38.6±21mg/100ml)과 대조군(37.5±10mg/100ml) 사이에 유의한 차이는 없었다. 8. ANA는 총대상군에서 음성을 나타냈고 RA factor는 대상군의 17.1 %에서 양성율을 나타냈다.