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조기 사춘기 여아에서 생식샘 자극호르몬 분비호르몬 유사체 단독치료와 성장호르몬 병합치료가 예측성인신장에 미치는 효과

The Effect of Gonadotropin Releasing Hormone Agonist with or without Growth Hormone Treatment on Predicted Adult Height in Girls with Early Puberty

노승림|정민호|김준범|서병규|이병철
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2007.06|Annals of Pediatric Endocrinology & Metabolism|제12권 제1호|pp. 21-25

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참고문헌

주제분류소아과학

초록

목 적 : 최근 키가 작은 조기 사춘기 여아에서 사춘기 진행을 억제함으로써 성인신장을 개선하려는 연구가 계속되고 있다. 이에 조기 사춘기 여아에서 생식샘 자극호르몬 분비호르몬 유사체(GnRH agonist) 단독치료와 성장호르몬(GH) 병합치료가 이들의 예측성인신장에 미치는 효과를 알아보고자 이 연구를 시도하였다. 방 법 : 조기 사춘기 여아 28명을 대상으로 GnRH agonist 단독치료군(18명)과 GnRH agonist와 GH의 병합치료군(10명)으로 나누어 평균 18개월(12-36개월)동안 치료하였다. GnRH agonist 치료는 Leuprolide acetate (30- 90 mcg/kg)를 4주에 1회, GH치료는 0.1 IU/kg/day의 용량을 일주일에 6-7회 주사하였다. 치료 시작 시와 치료 후의 골연령, 신장 및 표준편차, 예측성인신장, 표적키를 비교하였다. 결 과 : 치료시작 전과 후에서 역연령, 골연령, 체중, 표적키, 성성숙도는 두군 간에 차이가 없었다. GnRH agonist 단독치료군에서 치료 후 예측성인신장은 157.1±6.2 cm로 표적키 157.1±3.7 cm와 같았고 치료 전 예측성인신장 156.0±6.5 cm 보다는 약간 개선되었으나 유의한 차이는 아니었다. 한편 GnRH agonist와 GH 병합치료군에서 치료 후 예측성인신장은 158.5±4.6 cm로 표적키 156.2±3.6 cm보다 약간 컸으나 유의한 차이를 보이지 않았는데 치료 전 예측성인신장 154.2±7.4 cm보다는 유의하게 개선됨을 알 수 있었다(P<0.05). 결 론 : 조기 사춘기 여아에서 예측성인신장을 개선하기 위해서는 GnRH agonist 단독요법보다는 GnRH agonist와 GH 병합요법이 더 효과적임을 알 수 있었다.

Abstract

Purpose : Many recent studies have been performed to improve adult height in short normal girls with early puberty by arresting rapid pubertal progression. We evaluated the effect of combined therapy with growth hormone (GH) and gonadotropin releasing hormone agonist (GnRHa) on predicted adult height in girls with early puberty, comparing them with a group treated with GnRHa alone. Methods : Twenty eight girls with early puberty were classified into two groups and treated for an average 18 months. Group I of 18 girls was treated with GnRHa alone (leuprolide acetate; dosage: 30- 90 mcg/kg, s.c. every 28 days) and group II of 10 girls was treated in combination with GH (dosage: 0.1 IU/kg, s.c. 5-7 days/week). Two groups were compared in terms of bone age, height, sexual maturity, and predicted adult height at the start and after the treatment. Results : Two groups were not significantly different from each other in chronologic age, bone age, weight, target height, and sexual maturity before and after treatment. After treatment, group I showed predicted adult height (157.1±6.2 cm) which was comparable to target height (157.1±3.7 cm) and was not significantly higher than predicted adult height before treatment (156.0±6.5). On the contrary, group II showed predicted adult height (158.5±4.6 cm) which was comparable to target height (156.2±3.6 cm), but significantly higher than predicted adult height before treatment (154.2±7.4 cm) (P<0.05). Conclusions : GH and GnRHa combination treatment is more effective than GnRHa treatment alone to improve predicted adult height in girls with early puberty.

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