가족력이 있는 뚜레장애환자에 있어서 인간조직적 합성항원(HLA)

Abstract

[영문]

[한글]

인간조직적합성항원(human histocompatibility antigen. HLA)이 뚜레장애의 유전적 표

지로서 의미가 있는지 알아보고자 1987년 7월부터 1989년 8월까지 연세대학교 의과대학

세브란스병원 뚜레클리닉애 내원한 환자중 DSM-III-R 진단기준및 뇌파검사, 코너스 과잉

운동장애척도(Conner's hyperactivity scale), Leyton obsessional inventory(LOI), 유사

그림찾기검사(matching familiar figure test) (MFFT), continuous performance test(CPT

), 지능검사, Achenbach's child behavior check list(CBCL), 손잡이(handedness)를 이용

하여 뚜레장애라고 진단된 환자를 대상으로 하였다. 이들 중 HLA 항원검사를 할 수 있었

던 환자는 73명이었다. 환자들의 가족 중에 뚜레장애, 만성운동틱장애, 만성음성틱장애,

강박신경증, 주의력결핍과잉운동장얘, 강박신강증적경향을 조사하였다. "가족력이 있는군

"은 주의력결핍과잉운동장애, 강박신경증적경향 이외의 나머지 네가지중 하나가 가족 중

에있고, "가족력이 없는군"은 여섯가지 중 가족력이 하나도 발견되지 않은 군이다. 정상

대조군은 건강한 성인 남녀중 혈연관계가 없는 kidney donor 291명 이었다.

HLA 항원 검사는 보완된 Terasaki 방법인 Amos 방법으로 수행하였고, 통계처리는 chi-s

quare test로 하였고 Type-I 오차를 배제 하기 위하여 P값 교정을 했다.

정상대조군과 비교했을 때, HLA-A11 (P<0.05), HLA-A26(10) (P<0.005)가 전체 뚜레 환

자군에서 빈번하였고, HLA-A24(9) (p<0.01), HLA-B13 (p<0.05) 빈도는 낮았다.

가족력이있는 군에서는 HLA-B14 (p<0.05) 정상대조군보다 증가하였고, HLA-A24(9) (p<0

.05)는 빈도가 감소했다. HLA-B16 (p<0.05), HLA-DR4 (p<0.005)가 가족력이 없는 군에서

정상대조군 보다 감소했고, HLA-Cwl(p<0.05)는 감소하였다. 그러나 P값 교정이후에는 통

계학적으로 의미있는 HLA 항원은 없었으며, 또한 가족력이 있는 뚜레장애 환자에서도 특

이한 HLA 유형이 발견 되지 않았다. 결론적으로 뚜레장애의 유전적 표지로서 HLA 항원의

상관관계는 향후 더 연구 해야 할 것으로 사료된다.

Histocompatibility antigen in Tourett's disorder patients with positive family

history

Min Sook Park

Department of Medical Science The Graduate School Yonsei University

(Directed by Professor Ho Young Lee. M.D)

73 Tourette's dosorder (TD) patients who were diagnosed by the criteria of

DSM-III-R criteria have been enrolled to this study. To define whether TD was

related to HLA type, comparative analysis has been done with 291 healthy normal

subjects. The total patients were divided into two groups, one with positive family

history and the other with negative family history. The former included those

patients with family histories of the one or more tic disorders and obsessive

compulsive disorder (OCD) (all were 31), and the latter included patients without

any histories of tic disorders, OCD, attention deficit hyperactivity disorder and

obsessive compulsive character traits (all were 29). The normal control group

composed of 291 healthy living unrelated kidney donors of both sex. HLA typings

were done by modified Terasaki(Amos) method.

The frequenciess of HLA were analysed by chi-square test and p value was

estimated by multiplying the number of the tested antigens to avoid the Type 1

error.

HLA-All(P<0.05), HLA-A26(10)(p<0.005) were increased in frequency in total

Tourette's disorder patient group when compared to normal controls, HLA-A24(9)

(p<0.01), HLA-B13(P<0.05) were decreased in total Tourette's patients when compared

to the normal control group. HLA-Bl4(p<0.05) was increased in patients with

positive family history group and HLA-A24(9)(p<0.05) was decreased when each of

them were compared to normal control group. HLA-Bl6(p<0.05) and HLA-DR4(p<0.005)

were found to be increased in negative family history group and HLA-Cwl(P<0.05)

were decreased when each of them were compared to normal control group. But all the

findings were insignificant when p-value was corrected. Therefore, there seems to

be no significant HLA subtype representing as genetic markers of the Tourette's

disorder patient. Furthermore. no specific HLA subgroup represent the Tourette's

disorder patient with family histories. Further research is necessary with more

senstive HLA detecting device.