조혈모세포이식 후 내분비학적 이상 없는 환아의 최종 성인키
Final Adult Height of Children with Normal Endocrine Function
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목 적 : 본 연구의 저자들은 소아기 동종 조혈모세포 이식 후 내분비학적 이상이 없던 환아들의 최종 성인키에 대한 분석을 하고자 하였다. 방 법 : 조혈모세포이식을 시행 받고 장기간 추적 관찰을 한 28명의 환아를 분석하였다. 환아들의 이식 시 평균 연령은 12.3세 였다. 고형종양, 유전적 질환, 이식 전후 내분비학적 이상을 가진 환아는 제외되었다. 마지막 외래 방문 시 평균 나이는 18.8세 였다 . 키는 표준편차점수로 환산하여 표시하였고, 이식 시 키를 최종 성인키 및 중간 부모키와 비교하였다. 이식 후 최종 성인키에 영향을 주는 위험인자에 대해 분석하였다. 결 과 : 환아들의 이식 전 키 SDS와 비교해 최종 성인키 SDS는 유의하게 감소되었다(P=0.003). 한명을 제외한 나머지 모든 환아들의 최종 성인키는 정상 키 분포의 -2.0 SDS이내에 도달하였다. 최종 성인키 SDS와 조혈모세포이식 시 키 SDS의 차이(Δ-height SDS)를 비교한 결과에서는 남아가 -0.98±0.5 SDS이었고 여아는 -0.10±0.6 SDS이었다(남아와 여아 각각 P<0.01, P=0.53). 남아가 여아에 비하여 키 SDS의 유의한 감소가 있었다(Mann-Whitney U test, P=0.001). 일차 질환의 종류, 이식 시 나이, 전신 방사선조사 유무, 급성 이식편대숙주병 유무 등은 최종 성인키에 영향을 주지 않았다. 결 론 : 소아기 조혈모세포이식 후 내분비학적 이상이 없던 환아들의 최종 성인키는 감소되었으나, 대부분 환아들은 정상 키 SDS (-2.0 SDS 이상)에 도달하였다. 그러나 조혈모세포이식을 받은 소아에서는 성장장애를 조기에 발견, 치료관리 하려는 계속적인 노력이 필요하다.
Abstract
Purpose : We analyzed the final adult height of patients without endocrine dysfunction who underwent hematopoietic stem cell transplantation (HSCT) during the childhood. Methods : We evaluated the final height of 28 long term survivors (13 males, 15 females) who underwent HSCT at the mean age of 12.3 years. Patients who had solid tumors, inherited diseases and endocrine dysfunction before or after HSCT were excluded. The mean age at last visit was 18.8 years. Height values were expressed in standard deviation score (SDS). Height at HSCT was compared with final height as well as mid-parental height. We analyzed the risk factors for affecting final adult height of patients. Results : There was a decrease in final height SDS compared to pre-transplantation height SDS (P= 0.003). All patients except one reached an adult height above -2.0 SDS of normal population. The difference between the height SDS at HSCT and the final height was -0.98±0.5 SDS in boys and -0.10±0.6 SDS in girls (P<0.01, and P=0.53 respectively). A significant decrease in height SDS was found in male (Mann-Whitney U test, P=0.001). The type of primary diseases, age at HSCT, total body irradiation, acute graft-versus-host disease did not influence the final height . Conclusion : Despite the decrease in final height SDS after HSCT during childhood, the majority of patients without endocrine dysfunction spontaneously reached on a normal adult height range (above -2.0 SDS). Therefore, careful monitoring of growth after HSCT during childhood is warranted to detect the growth velocity decrease.
참고문헌 (15)
- Kersey J.H, "Historical background to hematopoietic stem cell transplantation. In : Atkinson K, Champlin R, Ritz J, Fibbe WE, Ljungman P, Brenner ML, editors. Clinical bone marrow and blood stem cell transplantation.", pp.1~10 (2004), Cambridge : Cambridge University Press
- Girl N, "Long-term complications following BMT in children.", J Pediatr Child Health, 29, pp.201~205 (1993)
- Sanders J.E, "Growth and development following bone marrow transplantation for leukemia.", Blood, 68, pp.1129~1135 (1986)
- Cicognani A, "Longitudinal growth and final height in longterm survivors of childhood leukemia.", Eur J Pediatr, 153, pp.726~730 (1994)
- Brauner R, "Growth and growth hormone secretion after bone marrow transplantation.", Arch Dis Child, 68, pp.453~463 (1993)
- Cohen A, "Final height of patients who underwent bone marrow transplantation for hematological disorders during childhood: a study by the working party for late effects EBMT.", Blood, 93, pp.4109~4115 (1999)
- Bakker B, "Patterns of growth and body proportions after total-body irradiation and hematopoietic stem cell transplantation during childhood.", Pediatr Res, 59, pp.259~264 (2006)
- Glucksberg H, "Clinical manifestations of graft- versus-host disease in human recipients of marrow from HLA-matched sibling donors.", Transplantation, 18, pp.295~304 (1974)
- Greulich W, "Radiographic atlas of skeletal development of the hand and the wrist." (1959), Stanford: Stanford University Press
- Willi S.M, "Growth in children after bone marrow transplantation for advanced neuroblastoma compared with growth after transplantation for leukaemia or aplastic anaemia.", J Pediatr, 120, pp.726~732 (1992)
- Cohen A, "Final height of patients who underwent bone marrow transplantation during childood.", Arch Dis Child, 74, pp.437~440 (1999)
- Couto-Silva A.C, "Final height and gonad function after total body irradiation during childhood.", Bone Marrow Transplant, 38, pp.427~432 (2006)
- Fletcher B.D, "Radiation induced bone abnormalities after bone marrow transplantation for childhood leukemia.", Radiology, 191, pp.231~235 (1994)
- Clement-De Boers A, "Final height and hormonal function after bone marrow transplantation in children.", J Pediatr, 129, pp.544~550 (1996)
- Bleakley M, "Growth and development of the pediatric recipient. In:Atkinson K, Champlin R, Ritz J, Fibbe WE, Ljungman P, Brenner ML, editors. Clinical bone marrow and blood stem cell transplantation.", pp.1357~1373 (2004), Cambridge:Cambridge University Press