1형 당뇨병 환자에서 생리주기 이상
Menstrual Disorders in Patients with Type I Diabetes Mellitus
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목 적:최근 1형 당뇨 여아에게서 사춘기 발달이 늦거나, 생리 이상의 빈도가 높다는 연구 결과가 있었다. 본 연구에서는 한국에서 사춘기 연령의 1형 당뇨 여아에서 정상 사춘기 여아와 비교하였을 때 사춘기 지연 및 생리 이상의 빈도에 차이가 있는지 알아보고, 그 원인을 규명하고자 한다. 방 법:2006년 이후 연세대학교 세브란스 어린이병원 소아청소년과에서, 1형 당뇨병으로 진단받은 만 10세에서 17세 사이의 여아 43명을 대상으로 하였고, 정상 대조군은 같은 연령의 만성 기저 질환이 없는 정상 여아 56명을 선정하였다. 모든 대상자의 신장 및 몸무게를 측정하고, 생리 주기 및 기간, 생리 불순 및 무월경 여부 등에 대해 설문조사를 하였으며, 당뇨 환자에게는 혈당 조절 정도와 에스트로겐의 농도를 측정하였다. 결 과:당뇨환자와 정상 대조군의 평균 연령의 유의한 차이는 없었다. 당뇨 환자와 정상 대조군 사이에 사춘기 발달 시기의 유의한 차이는 없었으나, 희발 생리는 1형 당뇨 환자와 정상 대조군에서 각각 21.21%, 2.08% 로 당뇨 환아에서 더 높았고, 무월경은 1형 당뇨 환자에서 20.59%로 정상 대조군 2.08% 에 비해 높았다. 1형 당뇨 환자 중, 당화혈색소가 높을수록 사춘기가 지연되는 경향을 보였고, 사춘기 시작 이전에 당뇨가 발병한 경우 유방 발달 시기는 사춘기 시작 이후에 발병한 군보다 약 9개월, 초경 시기는 약 14.8개월 가량 늦었다. 당뇨 환자에서 LH 및 FSH의 농도는 정상 사춘기 여아에 비해 증가되었고, 이는 무월경이 있을수록 더욱 높았다. 또한 당뇨 환자에서 혈중 E2의 농도는 정상 사춘기 여아에 비해 의미 있게 낮았고, 무월경이 있을 경우에는 더 낮았다. 결 론:본 연구에서는 사춘기 시기 당뇨 여아에서 사춘기 이전에 당뇨가 발병했을 경우, 당화혈색소가 높을수록 사춘기 발달이 늦어지고 생리 불순이 많았으며, 이는 혈중 E2농도 저하나 작용 기전 저하 때문으로 생각되며, 그 기전에 대해 추후 연구가 필요하다.
Abstract
Purpose:This study compares the prevalence of pubertal menstrual disorders in type 1 diabetes mellitus (DM) patients with that in normal subjects. Methods:A questionnaire was used to obtain data on pubertal development and menstrual history from 43 type 1 DM patients, who were diagnosed at the pediatrics department of Severance Children’s Hospital, Yonsei University, and 56 normal control subjects. We evaluated the estrogen levels in all type 1 DM patients. Results:The age at onset of puberty did not significantly differ between the 2 groups. However, the prevalence of oligomenorrhea in type 1 DM patients (21.21%) was significantly higher than that in the control group (2.08%; P˂0.05). In addition, the incidence of amenorrhea in type 1 DM patients (20.59%) was significantly higher than that in the control group (2.08%; P˂0.05 ). Pubertal development in type 1 DM patients was delayed due to elevated levels of glycosylated hemoglobin (HbA1c). The delay (9 months) in pubertal development in the patients diagnosed with type 1 DM at prepubertal ages was shorter than that (14.8 months) in the patients diagnosed with type 1 DM at postpubertal age (P˂0.05). The level of LH, FSH were higher and E2 level was lower in DM patients compared to control group, especially in diabetics with amenorrhea (P˂0.05). Conclusion:We observed a high frequency of delayed pubertal development and menstruation irregularities in patients who were diagnosed with type 1 DM at the prepubertal age or in type 1 DM patients with high levels of HbA1c. This finding can be attributed to the decreased plasma levels of E2 or due to the decreased E2 activity in patients with type 1 DM. Further evaluation of hormonal changes in type 1 DM patients is essential.
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