진성 성조숙증에서 GnRH agonist의 용량에 따른 최종예측 성인신장 개선 효과의 차이에 관한 연구
Evaluation of Efficacy of GnRH Agonist on Predicted Adult Height (PAH) in Patients with Central Precocious Puberty Using Two Different Dosages
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목 적:진성 성조숙증의 치료에서 GnRHa는 효과적이고 안전한 약제로 널리 이용되고 있다. GnRHa 치료의 효과는 약제의 역가, 용량, 투여 경로, 투여 기간 및 순응도에 따라 달라질 수 있는데 적정 용량에 대해서는 아직까지 논란이 되고 있다. 본 연구에서는 두 가지 다른 용량으로 치료받은 진성 성조숙증 여아에서 GnRH agonist가 최종성인예측신장에 미치는 치료 효과의 차이를 분석해 보고자 하였다. 방 법:총71명의 진성 성조숙증 여아를 대상으로 하여 의무기록을 후향적으로 분석하였다. GnRHa의 용량에 따라 Group 1 (80-100 μg/kg/4주) 37명(52.1%), Group 2 (100-110 μg/kg/4주) 34명(47.9%)으로 분류하였으며 치료 시작과 종료시의 역연령과 골연령, 신장, 치료 전후 1년간의 성장 속도, 예측성인신장, GnRH자극검사, FSH, LH, E2를 포함한 호르몬 검사 수치를 조사하여 GnRHa의 용량에 따른 최종성인예측신장 개선 효과를 분석하였다. 결 과:역연령과 골연령은 치료 전에 각각 8.2±1.26세, 10.7±0.61세였으며 치료 후에 각각 10.7±0.61세, 11.7±0.50세로 골연령/역연령의 비가 감소하였다. 치료 용량에 따른 두 군 간의 치료 전후의 역연령, 골연령, 치료 기간의 차이는 없었다. 두 군 모두에서 치료 후 골연령/역연령 비와 Height SDS, 성장 속도가 의미있게 감소하였으며 예측성인신장은 증가하였다(P˂0.05). ΔPAH, ΔBA/CA, ΔHeight SDS와 치료 후 성장속도는 두군 사이에 유의한 차이를 보이지 않았고 GnRHa의 용량에 따른 유의한 상관관계를 보이지 않았다(P˃0.05). 결 론:GnRHa 용량의 증가에 따른 예측 성인 신장의 증가는 보이지 않아 80-100 μg/kg의 용량이 진성 성조숙증의 치료에 적절한 것으로 사료된다. 향후 많은 수의 환자를 대상으로 사춘기의 진행을 억제하면서 사춘기 전의 성장 속도를 유지할 수 있는 최소 용량에 대한 연구가 필요하겠다.
Abstract
Purpose:Depot gonadotropin releasing hormone agonist (GnRHa) has been widely used for the treatment of central precocious puberty (CPP). The effectiveness of GnRHa depends on potency, dosage, route of administration, duration of treatment, and compliance. There is a controversy about optimal doses of GnRHa. This study aimed to compare the efficacy of GnRHa on improvement of PAH in girls with CPP using two different dosages. Methods:Seventy-one girls with CPP were included in this study. The patients were categorized into two groups depending on the dosage of GnRHa; group 1 (80-100 μg/kg/4 wk) and group 2 (100-110 μg/kg/4 wk). The clinical parameters such as chronological age (CA), bone age (BA), duration of treatment, height, growth velocity, predicted adult height (PAH), and endocrine assay including GnRH stimulation test, luteinizing hormone, follicle stimulating hormone, and E2 at the start and the end of treatment were obtained to analyze the efficacy of GnRHa according to dosage. Results:CA and BA at the start of treatment were 8.2±1.26 yr and 10.7±0.61 yr, while CA and BA at the end of treatment were 10.7±0.61 yr and 11.7±0.50 yr, respectively. CA and BA before and after treatment, and duration of treatment were similar between two groups. BA/CA, Height SDS, growth velocity (cm/r) were decreased while PAH was significantly increased in both groups (P˂0.05). There were no significant differences inΔPAH,ΔBA/CA,ΔHeight SDS and growth velocity between two groups (P˃0.05). Conclusion:Higher dose (100-110 μg/kg/4 wk) of GnRHa group was not associated with higher PAH in girls with CPP, compared with the group with dose of 80-100 μg/kg/4 wk. Therefore, the results indicates that the dose of 80-100 μg/kg/4 wk is sufficient for treatment of CPP, necessitating further study with lesser dose to identify the optimal dose.
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