소아 그레이브스병 관해의 예측 지표
Remission Predictors of Graves' Disease in Children
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목 적:갑상샘 기능 항진증은 갑상샘 호르몬이 과다하게 생산되어 증상을 나타내는 질환으로 소아에서 원인의 대부분은 그레이브스병이다. 치료법으로는 여러 가지가 있으며 아직 정립되어 있지 않지만 항갑상샘제가 초기 치료로 대부분 이용된다. 그러나 항갑상샘제로 치료 시 관해를 이루기 위해 많은 시간이 소요되며 부작용의 위험성도 상대적으로 높고 재발도 흔한 편이다. 이에 저자들은 항갑상샘제 투여 2년 후 관해를 이루게 될 가능성을 알려주는 지표에 대해서 알아보고자 하였다. 방 법:2002년 1월 1일부터 2008년 12월 31일까지 7년간 아주대학교 의과대학 소아청소년과에서 그레이브스병으로 진단받은 환아를 대상으로 2년 간의 치료를 통해 관해를 유지하고 있는 군과 그렇지 못한 군으로 나누어 진단시와 치료 3개월 이후의 갑상샘 기능상태, 갑상샘 항체인 ATA, AMA, TBII를 후향적으로 조사하였다. 결 과:전체 환아 41명 중 남아 8명, 여아 33명이었다. 치료 2년 동안 관해는 8례에서 보였고 이 중 재발은 3례에서 발생하였다. 결국, 2년 이상 관해를 보인 환아는 5명이었다. 관해를 보인 군과 그렇지 않은 군과의 비교에서 진단시 free T4와 T3 값은 유의한 차이를 보이지 않았으나 TSH는 0.11±0.04과 0.04±0.04 mIU/L 으로 유의한 차이를 보였다(P=0.04). 갑상샘 항체 ATA의 값은 관해군에서 189.6±103.2 U/mL, 그렇지 않은 군에서 520.4±677.1 U/mL으로 유의한 차이를 보였다(P=0.01). AMA 값과 TBII 값은 두 군간에 유의한 차이가 없었다(P=0.17, P=0.58). 치료 3개월 이후 ATA 값은 비관해군에서 583.3±763.9 U/mL로 관해군의 211.2±147.0 U/mL에 비해 유의하게 높았다(P=0.02). 결 론: 그레이브스병에서 관해를 예측할 수 있는 지표로 진단시 TSH값과 항티로글로불린항체값을 이용할 수 있음을 알 수 있었으며 향후 더 많은 환자를 대상으로 전향적 연구가 필요할 것으로 생각된다.
Abstract
Purpose:Antithyroid drug treatment is usually recommended as the initial treatment for children with Graves' disease. However, achieving remission with medical therapy usually requires many years of treatment, the risk for adverse reactions is relatively high and relapse is common after discontinuation of medication. There is therefore a debate about how Graves' disease should be treated in children. The aim of this study was to identify predictors of remission during 2 years from quitting of antithyroid drug. Methods:We retrospectively studied children who had been treated for Graves' disease with antithyroid medication. We compared the children who achieved remission after two years with those who had persistent disease, to determine the variables associated with remission. Results:41 patients were enrolled, of whom five (12.2%) achieved remission and the rest (87.8%) could not achieve remission until the last visit. There were no significant differences in T3, free T4, antimicrosomal antibody (AMA), or thyroid stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) between the two groups at presentation. However, the remission group had a significantly higher titer of TSH (P =0.04) and a significantly lower titer of antithyroglobulin antibody (ATA) (P=0.01) than the non-remission group at presentation. The non-remission group had higher ATA concentrations 3 months after treatment with antithyroid medication than the remission group did (P=0.02). Conclusion:TSH and ATA concentrations at presentation can be used to stratify patients according to the likelihood of remission during 2 years from quitting of antithyroid drug.
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