특발성 진성 성조숙증 여아에서 1년간의 성선자극호르몬 방출호르몬 효능약제 치료 전후 비만도의 관계
The Relationship between Initial Body Mass Index and Body Mass Index after One Year of Gonadotropin-Releasing Hormone Agonist Therapy in Idiopathic True Precocious Puberty Girls
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목 적:특발성 진성 성조숙증으로 성선자극호르몬 방출호르몬 효능약제 치료를 받는 여아에서 치료 전후의 비만도 사이의 연관성을 알아보고자 하였다. 방 법:2000년부터 2010년까지 서울대병원에서 특발성 성조숙증으로 진단받고 1년 이상 성선자극호르몬 방출호르몬 효능약제 치료를 받은 99명의 여아를 대상으로 하였다. 치료 시작 시와 1년 후의 신장, 체중, 골연령, 체질량지수를 측정하고 Bayley-Pinneau method로 예측성인키를 구하였으며, 치료 전후의 체질량지수 표준점수 사이의 연관성을 분석하였다결 과:1년간 GnRHa 투여 후 BMI_zs는 정상 체중군에서만 증가하였고 과체중/비만군에서는 유의한 변화를 보이지 않았다. 치료 시작시의 BMI_zs와 ∆BMI_zs는 음의 상관관계를 보였다(r=-0.501, P˂0.001). PAH_zs는 정상 체중군(∆PAH_zs=0.30)에서 과체중/비만군(∆PAH_zs=0.66)에 비해 증가량이 작았으나(P=0.02), 치료 시작 당시의 BMI_zs와 ∆PAH_zs가 상관관계를 보이지는 않았다. ∆BA-CA, ∆Ht_zs는 정상 체중군과 과체중/비만군 사이 유의한 차이가 없었다. BMI_zs가 증가한 군과 변화 없거나 감소한 군을 비교했을 때 두 군 사이 ∆BA-CA, ∆Ht_zs, ∆PAH_zs의 유의한 차이는 없었다. 다중회귀분석 결과에서도 ∆BMI_zs는 치료 시작시의 BMI_zs와 음의 상관관계를 보였고, 이 외에 치료 시작 시 역연령, 골연령, 골연령-역연령값, 키, 약용량과는 유의한 연관성을 보이지 않았다. 결 론:정상 체중이었던 환아들에서 1년간 GnRH agonist 치료 후 비만도가 증가하였으며, 치료 전 비만도가 낮을수록 치료 후 비만도는 더 많이 증가하였다.
Abstract
Purpose:The aim of this study is to evaluate the relationship between initial body mass index (BMI) and BMI after gonadotropin-releasing hormone agonist (GnRHa) treatment in idiopathic true precocious puberty girls. Methods:The subjects were 99 idiopathic true precocious puberty girls treated with GnRHa for more than 1 year. The patients were categorized into two groups according to initial BMI; normal weight group (BMI˂85 percentile) and overweight/obesity group (BMI≥85 percentile). We investigated chronologic age (CA), bone age (BA), BA advancement (BA-CA), height (Ht), Ht-standard deviation score (Ht_zs), BMI, BMI_zs, predicted adult height (PAH), and PAH_zs before initiation of GnRHa treatment and 1 year later. Results:Baseline CA, BA, BA-CA, Ht_zs, and PAH showed no differences between normal weight group and overweight/obesity group. BMI_zs increased only in normal weight group, and ∆BMI_zs was negatively correlated with initial BMI_zs (r = -0.501, P ˂0.001). PAH_zs increased less in normal weight group (∆PAH_zs=0.30) than in overweight/obesity group (∆PAH_zs=0.66) (P =0.02), but there was no correlation between initial BMI_zs and ∆PAH_zs. ∆BA-CA and ∆Ht_zs were not different between two groups either. Comparing patients with increased BMI_zs with those whose BMI_zs decreased or remained the same, there were no differences in ∆BA-CA, ∆Ht_zs, and ∆PAH_zs. On multiple regression analysis, ∆BMI_zs was negatively correlated with initial BMI_zs, and it showed no correlation with CA, BA, BA-CA, height, and dose of GnRHa. Conclusion:BMI_zs increased after 1yr of GnRHa treatment in idiopathic true precocious puberty girls whose initial BMI_zs was normal, and its increment was negatively correlated with initial BMI_zs.
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