한국 영유아에서 영양학적 구루병의 임상적 특징
Clinical Characteristics of Nutritional Rickets in Korean Infants
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목 적: 선진국에서도 영양학적 구루병의 빈도가 증가하고 있는 것 같다. 저자들은 최근 진단된 영양학적 구루병을 가진 영유아를 분석하여 그 임상적 특징을 연구하였다. 방 법: 2007년 1월부터 2009년 6월까지 15 증례의 임상적 혹은 무증상적으로 비타민 D 부족이나 결핍 상태 혹은 방사선 소견에서 구루병의 소견을 보이는 경우를 의무기록을 중심으로 분석하여, 흔한 소아과적 문제로 진료중 알칼리인산화효소가 증가된 1군 6례(4.5±5.2개월), 골격계의 이상을 보이는 2군 5례(21.7±10.1개월), 그리고 저칼슘혈증 경련을 보인 3군 4명(5.7±4.5개월)으로 분류하였다. 이 3군의 임상적 특징을 분석하고 각 군 사이에 연령과 혈청 칼슘, 인, 알칼리인산화효소, 25OHD, 그리고 PTH를 비교하였다. 결 과: 이환아들의 연령은 평균 10.5개월이었으며, 이들의 평균 혈중 25OHD는 16.5±9.9 ng/mL로 비타민 D 결핍 상태였다. 3군의 2명을 제외하고는 모두 모유수유중이거나 6개월 이상 완전모유수유만을 했던 영유아였다. 1군은 비교적 어리고 2명의 부당경량아를 포함하고 있으며, 알칼리인산화효소가 가장 높고 25OHD는 낮았으며(15.3±6.2 ng/mL) 방사선 사진의 변화는 경도였다. 2군은 내반슬을 보이는 4명과 저신장을 보인 1명으로, 연령이 의미 있게 높았고(P=0.018) 25OHD는 비교적 양호하나(23.0±11.6 ng/mL) 방사선 소견은 가장 좋지 않았다. 3군은 2명의 부당경량아가 포함되어 있으며 비교적 어린 나이이며 25OHD가 가장 낮았고(10.3±9.4 ng/mL) 혈청 칼슘이 의미 있게 낮았다(5.7±4.5 mg/dL, P=0.016). 1군과 3군의 일부는 연령이 아주 낮아, 이 영아들은 적절한 양의 비타민 D를 공급받지 못했다는 점 이외에도, 산모의 비타민 D 결핍으로 몸에 비타민 D가 저장되지 않은 상태에서 태어났다는 것을 의미한다. 결 론: 한국 소아에서 영양학적 구루병은 3가지의 임상 상태로 나타나고, 모유수유를 하는 영아뿐 아니라 산모도 비타민 D의 보충이 필요하다.
Abstract
Purpose: The prevalence of nutritional rickets in developed countries appears to be rising. We studied cases of recently diagnosed nutritional rickets in Korean infants to investigate the clinical characteristics of this condition. Methods: We studied the medical records of 15 patients (10.5±10.5 mo) with clinical and subclinical nutritional rickets diagnosed between January 2007 and June 2009 and grouped them according to their clinical presentation. Group I (n=6, 4.5±5.2 mo) included patients who were asymptomatic and had increased levels of serum alkaline phosphatase (ALP); group II (n=5, 21.7±10.1 mo), patients with skeletal abnormalities; and group III (n=4, 5.7±4.5 mo), patients with hypocalcemic seizure. These groups were compared for age and serum levels of calcium, phosphorus, ALP, 25-hydroxy vitamin D (25OHD), and parathyroid hormone (PTH). Results: The serum 25OHD level was 16.5±9.9 ng/mL. All but 2 patients were being breast-fed or had been breast-fed for more than 6 months. Infants in group I were relatively young, with 2 small for gestational age (SGA) infants, and showed the highest serum levels of ALP with low serum levels of 25OHD (15.3±6.2 ng/mL), but mild radiologic changes. Group II infants (including 4 with bow leg and 1 with short stature) were significantly older (P=0.018) with relatively higher levels of 25OHD (23.0±11.6 ng/mL) but worse radiologic findings as compared to other groups. Group III infants were relatively young including 2 SGA and had the lowest 25OHD levels (10.3±9.4 ng/mL) and significant hypocalcemia (P=0.016, 5.7±4.5 mg/dL), but mild radiologic changes. The fact that group I and III were very young implies that not only were these infants supplied with inadequate amounts of vitamin D, but many began life with small stores of vitamin D as a result of maternal vitamin D deficiency. Conclusion: Nutritional rickets manifested in 3 different clinical forms, and vitamin D should be supplemented in breast-feeding infants as well as pregnant women.
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