성조숙증 및 조기사춘기 여아에서 체질량지수가 성선자극호르몬 방출호르몬 자극에 의한 황체화호르몬 농도 증가에 미치는 영향
The Influence of Body Mass Index on Luteinizing Hormone Levels after Gonadotropin-Releasing Hormone Stimulation in Girls with Precocious and Advanced Puberty
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목적: 본 연구는 중추성 성조숙증 및 조기사춘기 여아에서 체질량지수가 GnRH 자극검사 시 LH 최고농도에 미치는영향을 알아보고자 시행되었다. 방법: GnRH 자극검사상 사춘기 반응을 보인 7세에서 9세 사이의 여아 113명을 대상으로 의무기록을 후향적으로 검토하였다. 진단시 역연령, 골연령, 신장, 체중, 체질량지수, LH와 FSH의 기저 및 최고농도, 기저 에스트라디올 농도를조사하였다. 결과: LH 최고농도는 체중 표준편차점수와 체질량지수 표준편차점수와 음의 상관관계를 보였고 FSH 기저 및 최고농도와 양의 상관관계를 보였다. 다중회귀분석 결과 체질량지수 표준편차점수는 LH 최고농도에 영향을 미치는 의미 있는 결정인자였다. LH 최고농도의 사분위수를 기준으로 4군으로 나누었을 때 LH 최고농도가 가장 높은 군의 체질량지수는 LH 최고농도가 가장 낮은 군의 체질량지수 보다 의미 있게 낮았다. 결론 : 성조숙증 및 조기사춘기 여아에서 체질량지수가 높을수록 GnRH 자극검사 시 LH 최고농도는 감소한다. 따라서 여아에서 성조숙증 진단시 체질량지수에 의한 영향을 고려하여야 할 것으로 보인다.
Abstract
Purpose: The aim of this study was to investigate the influence of body mass index (BMI)on the level of peak luteinizing hormone (LH) after gonadotropin-releasing hormone (GnRH) stimulation in girls with central precocious puberty (CPP) and advanced puberty (AP). Methods: This study conducted a retrospective review of the medical records of 113 girls (7 to 9 years old; 24 CPP, 89 AP) who underwent a GnRH stimulation test. The following parameters were evaluated: chronologic age (CA), bone age (BA), the difference between BA and CA (BA-CA), height, weight, BMI, and the levels of basal LH,peak LH, basal follicle stimulating hormone (FSH), peak FSH, and basal estradiol. Results: The peak LH level was negatively correlated with weight-standard deviation score (SDS) and BMI-SDS; furthermore, the peak LH level was positively correlated with both basal and peak FSH levels. Using multivariate analysis, BMI-SDS was found to be a significant factor in predicting peak LH levels after GnRH administration. When the subjects were divided into four groups by quartile of peak LH level, the mean BMI-SDS of the highest LH group was significantly lower than the mean BMI-SDS of the lowest LH group. Conclusion: LH levels rise after GnRH administration is blunted in precocious and advanced pubertal girls with high BMI. The impact of BMI on the GnRH stimulation test should be considered when evaluating sexual precocity in girls.
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