testo미숙아에서의 17- α-hydroxy progesterone 값에 대한 연구
Study of 17- α-hydroxy Progesterone in Preterm Infants
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초록
목적: 미숙아를 치료하는데 있어 17-α-hydroxy progesterone (17-OHP) 값이 높은 것을 경험하게 되는데, 본 연구는 미숙아에 있어서 재태연령 및 출생체중별 17-OHP값의 특징 및 추적검사상의추이에 대해 분석하고자 하였다. 방법: 2008년6월부터 2010년 6월까지 서울아산병원에서 출생한재태연령 37주 미만의 1,039명의 미숙아들을 대상으로 하였다. 생후3일에서 7일 사이에 실시한 신생아 선천성대사이상질환 선별검사(neonatal screening test, NST)에서의 17-OHP값을 조사하였고, 결과가 12 ng/mL 이상일 경우 2-4주 간격으로 정상이 될 때까지 혈청17-OHP값을 추적하였다. 결과: 총 1,039명의 대상 중에서 76명에서 첫 17-OHP값이 12 ng/mL이상의 비정상결과가 나왔고 이중49명에서 정상이 될때까지 추적하였다. 1,039명의 NST에서의 17-OHP값을 재태연령별로 보았을때 평균 24-26주(n=20) 26.4±21.2 ng/mL (1.8-80.0), 27-28주(n=39) 14.8±14.6 ng/mL (1.1-70.9), 29-30주(n=54) 7.6±7.3 ng/mL (1.0-42.5), 31-32주(n=86) 5.1±5.8 ng/mL (1.0-38.2), 33-34주(n=186) 4.5±3.9 ng/mL (1.0-29.9), 35주(n=249) 4.7±4.4 ng/mL (1.0-40.9), 36주(n=404) 3.6±2.3 ng/mL (1.0-17.1)이었다. 출생체중별로 보았을 때 1,000 g 미만 14.8±17.0 ng/mL (1.0-80.0), 1,000-1,250g 10.4±13.1 ng/mL (1.0-70.9), 1,250-1,500 g 6.0±7.2 ng/mL (1.0-42.5), 1,500-2,000 g 4.3±4.2 ng/mL (1.0-36.7), 2,000-2,500 g 4.5±3.7 ng/mL (1.0-38.2), 2,500 g 이상 4.0±2.9 ng/mL (1.0-25.9)이었다. 17-OHP값은 재태연령 및 출생체중과 음의 상관관계를 보였다. 17-OHP값이 감소하기까지 추적검사를 시행한 횟수는 평균 2.9±1.9회였고, 정상화가 될 때까지 평균 67.2±49.0일이 소요되었다. 결론: 17-OHP값은 재태연령 및 출생체중과 음의 상관관계를 보였고 본 연구에서 제시한 재태연령과 출생체중에 따른 백분위 값은미숙아에서 17-OHP값의 추적하는데 있어 유용한 지침이 될것이다.
Abstract
Purpose: In preterm infants, neonatologists often encounter abnormally high level of 17-α-hydroxy progesterone (17-OHP), however as there is no normative reference level for Korean preterm neonates, repeated tests for 17-OHP are conducted until the level reaches the normal value of term infants. The aim for the study is to investigate the longitudinal follow up of 17 OHP levels according to gestational age. Methods: The samples for 17-OHP were obtained as tandem mass spectrometry (TMS) by heel prick between the 3rd and 7th day of life from 1,040 preterm infants who were born at Asan Medical Center from June 2008 to June 2010. If initial 17-OHP level was abnormal (>12 ng/mL), the serum levels were followed every 2-4 weeks until normalization. Results: The mean levels of 17-OHP obtained from initial TMS according to gestational age were as follows: 24-26 weeks (26.4±20.7 ng/mL, n=20); 27-28 weeks (14.8±14.6 ng/mL, n=39); 29-30 weeks (7.6±7.3 ng/mL, n=54); 31-32 weeks (5.1±5.8ng/mL, n=86); 33-34 weeks (4.6±3.9 ng/mL, n=186); 35 weeks (5.0±5.5 ng/mL, n=251); and 36 week (3.6±2.3 ng/mL, n=403). The mean and 99.5 percentile 17-OHP levels correlated inversely with gestational age. Those 63 infants (mean gestational age 28.6±4.1 weeks) whose initial 17-OHP levels were abnormally high, all became normalized at mean of 67.2±49.0 days. The mean number of follow-up was 2.9±1.9 times (range: 1-7 times) until normalization. Conclusion: The 17-OHP levels correlated inversely with gestational age and the number of false-positive results in the absence of congenital adrenal hyperplasia is high among preterm population. The percentile values presented here for 17-OHP in relation to gestational age could serve as a useful guideline for 17-OHP level follow up.
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