극소 저체중출생아에서 대사성 골질환 발생의 생화학적 예측 인자
Biochemical Markers as Predicting Factor for Metabolic Bone Diseases in Very Low Birth Weight Infants
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목 적: 최근 극소 저체중출생아들의 생존율이 증가하면서 대사성 골질환의 유병률도 증가하는 추세이다. 이에 저자들은 미숙아 대사성 골질환을 예측하는 인자로써 출생 후 시기에 따른 혈청 생화학 검사의 유용성을 알고자 하였다. 방 법: 2003년 3월부터 2008년 12월까지 일신 기독 병원 신생아 집중 치료실에 입원하였던 출생체중 1500 g 미만 환아들을 대상으로 의무 기록지를 통해 후향적으로 분석하였다. 생후 4주에 손목의 단순 방사선 촬영을 통해 대사성 골질환군과 대조군을 설정하였다. 생화학 검사로 ALP, 인, 칼슘을 출생 첫날, 생후 일주일째, 생후 4주째 검사하여 비교하였다. 비타민 D는 생후 4-5주에 측정하였다. 결 과: 대상 환아 104명의 평균 재태주수와 출생체중은 30+6±2.0주, 1,308.2±136.7 g이었다. 전체 대상군 중 31 (29.8 %)명에서 대사성 골질환이 발생하였다. 생후 첫날 실시한 생화학 검사에서 대사성 골질환군은 ALP (438.1±129.1 U/L vs 360.5±122.8 U/L)가 증가하여 있었다(P˂0.05). 생후 일주일째 생화학 검사에서 대사성 골질환군은 칼슘(11.0±1.7 mg/dL vs 10.3±1.7 mg/dL)은 증가하여 있었고, 인(3.2±1.2 mg/dL vs 4.1±1.3 mg/dL)은 감소하여 있었다(P˂0.05). 출생 4주째 실시한 생화학 검사에서 대사성 골질환군의 ALP (1397.6±635.6 U/L vs 789.0±573.0 U/L)는 증가하여 있었고(P˂0.05), 인(4.2 ±2.0 mg/dL vs 5.4±1.8 mg/dL)과 비타민 D (17.7±7.2 ng/mL vs 30.0±15.5 ng/mL)는 감소하여 있었다(P˂0.05). 대사성 골질환 발생의 위험 인자를 평가하기 위해 실시한 로지스틱 회귀분석에서 대사성 골질환은 남아, 출생체중이 작은 경우, 진단 시점까지 총 정맥 영양 기간이 긴 경우 발생이 많았다. 생화학 검사에서 생후 4주째 비타민 D 결핍이 있는 경우 대사성 골질환의 발생이 증가하였고, 이는 생후 4주째 ALP 수치 증가와 일치하는 양상을 보였다. 결 론: 극소 저체중출생아에서 대사성 골질환은 높은 빈도를 보였다. 생후 4주째 ALP 수치가 증가하여 있는 극소 저체중출생아에서 비타민 D 결핍과 대사성 골질환의 발생에 대한 주의를 기울이고, 적극적인 의학적 개입이 필요하리라 생각된다.
Abstract
Purpose: The aim of present study was to assess the utility of serum biochemical markers for predicting the metabolic bone disease (MBD) in very low birth weight infants (VLBWI). Methods: Medical records of 104 VLBWI from 2003 to 2008 were reviewed in this retrospective study. Study patients were divided in MBD and control group according to the finding of wrist radiography performed at 4 weeks of life. We compared the serum biochemical markers including alkaline phosphate (ALP), calcium (Ca), phosphate (P) between two groups at birth, 1 and 4 weeks of life. The value of serum vitamin D (Vit. D) was measured at 4-5 weeks of life. Results: The mean gestational age and birth weight of study patients were 30+6±2.0 weeks and 1,308.2±136.7 g. The incidence of MBD was 28.9% (31/104). At birth, higher values of serum ALP (438.1±129.1 mg/dL vs 360.5±122.8 mg/dL) were found in MBD group. At 1 week of life, higher values of serum Ca (11.0±1.7 mg/dL vs 10.3±1.7 mg/dL) and lower values of serum P (3.2±1.2 mg/dL vs 4.1±1.3 mg/dL) were found in MBD group. At 4 weeks of life, higher values of serum ALP activities (1,397.6±635.6 U/L vs 789.0±573.0 U/L), lower values of serum P (4.2±2.0 mg/dL vs 5.4±1.8 mg/dL) and Vit. D (17.7±7.2 ng/mL vs 30.0±15.5 ng/mL) were found in MBD group. Risk factors of MBD were male and Vit. D deficiency with high ALP at 4 weeks of life. Conclusion: These results suggest that high ALP concentrations at 4 weeks of life may predict MBD with Vit. D deficiency in VLBWI.
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