Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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미숙아에서의 선천 부신 과형성에 대한 선별검사의 해석

Interpretation of screening for congenital adrenal hyperplasia in preterm infants

  • 정혜림 (서울대학교 의과대학 소아과학교실) ;
  • 신충호 (서울대학교 의과대학 소아과학교실) ;
  • 양세원 (서울대학교 의과대학 소아과학교실) ;
  • 윤경아 (서울대학교 의과대학 소아과학교실) ;
  • 이영아 (서울대학교 의과대학 소아과학교실) ;
  • 박소은 (서울대학교 의과대학 소아과학교실) ;
  • 최창원 (서울대학교 의과대학 소아과학교실) ;
  • 김병일 (서울대학교 의과대학 소아과학교실) ;
  • 최중환 (서울대학교 의과대학 소아과학교실) ;
  • 송정한 (서울대학교 의과대학 검사의학교실)
  • Chung, Hye Rim (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Shin, Choong Ho (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Yang, Sei Won (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Yun, Kyong Ah (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Lee, Young Ah (Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea) ;
  • Park, So Eun (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Choi, Chang Won (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Kim, Byung Il (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Choi, Jung Hwan (Department of Pediatrics, Seoul National University, College of Medicine) ;
  • Song, and Junghan (Department of Laboratory Medicine, Seoul National University, College of Medicine)
  • 투고 : 2008.01.22
  • 심사 : 2008.03.27
  • 발행 : 2008.06.15
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초록

목 적 : 미숙아에서는 선천 부신 과형성에 대한 선별검사의 위양성률이 높으나 이에 대한 추적관찰의 기준이 명확하지 않다. 이에 저자들은 소집단에서의 선별검사 결과를 통해 미숙아에서의 선천 부신 과형성에 대한 선별검사의 해석 방법 및 합리적인 추적관찰의 방법을 알아보고자 하였다. 방 법 : 2005년 1월부터 2007년 6월까지 서울대학교 병원 및 분당 서울대학교 병원에서 태어난 미숙아 중, 생후 7일 이내에 전혈에서의 17-OHP를 효소 면역측정법으로 검사한 427명을 대상으로 하였다. 이들에서 17-OHP 값과 재태 기간, 출생체중, 전신적 질환 및 출생 전에 투여 받은 덱사메타손과의 관계를 분석하였고, 17-OHP의 변화의 경향을 알아보았다. 결 과 : 대상 미숙아들의 17-OHP 선별검사의 값은 매우 다양하였다(범위 0.1-143.3 ng/mL). 17-OHP 선별검사 값은 재태 기간(r=-0.535, P<0.01), 출생체중(r=-0.435, P<0.01), 5분 Apgar 점수(r=-0.431, P<0.01)와 유의한 음의 상관관계가 있었다. 17-OHP 선별검사 값은 출생 후 신생아 호흡 곤란 증후군(P<0.05), 동맥관 개존증(P<0.01) 또는 기관지폐 형성 이상(P<0.01)이 있었던 군에서 유의하게 높았으며, 생후 1주 이내에 치료가 필요한 저혈압이 있었던 미숙아에서 유의하게 높았다(P<0.05). 17-OHP 선별검사 값은 선별검사 7일 이내에 산모가 덱사메타손 투여 받은 군에서 투여 받지 않은 군에 비해 유의하게 낮았다(P<0.05). 17-OHP 값이 안정범위까지 감소하는데 걸리는 시간의 정중값은 42일이었으며, 이 기간은 재태 기간과 유의한 음의 상관관계가 있었고(r=-0.541, P<0.01), 기관지폐 형성 이상이 있었던 경우에 유의하게 연장되었다(P<0.01) 전체 대상 중 추적 관찰 시 선천 부신 과형성으로 확진된 경우는 없었다. 결 론 : 미숙아에서의 17-OHP 선별검사 값은 그 편차가 매우 크며, 재태 기간이 어릴수록 높은 경향이 있고 출생 전 dexamenthasone 투여 및 출생 후 질환에 의해 영향을 받는다. 미숙아의 선별검사를 해석할 때에는 이를 고려해야 하며, 혈액 검사의 수치와 미숙아의 임상 양상을 종합하여 추적관찰의 방법을 결정해야 할 것으로 생각한다.

Purpose : This study was undertaken to identify factors that influence 17-OHP levels in preterm infants and to suggest a reasonable follow-up schedule of screening for congenital adrenal hyperplasia (CAH) in preterm infants. Methods : The 17-OHP concentrations in filter paper blood spots of 427 preterm infants were obtained. The effects of gestational age (GA), systemic diseases, and antenatal dexamethasone on screening and follow-up 17-OHP values were investigated. Results : The screening 17-OHP values were markedly variable (range: 0.1-143.3 ng/mL). The screening 17-OHP levels were negatively correlated with GA (r=-0.535, P<0.01). In infants with GA<32 weeks, the screening 17-OHP levels were significantly higher in sick infants or infant with hypotension than in healthy infants. The screening values of prenatal dexamethasone-treated infants had a tendency to be low. In infants with initial 17-OHP values ${\geq}20ng/mL$, the intervals until rescreening 17-OHP <10 ng/mL or serum 17-OHP <20 ng/mL were negatively correlated with GA (r=-0.541, P<0.01) and were prolonged in infants with bronchopulmonary dysplasia (P<0.01). None of the preterm infants were confirmatively diagnosed with CAH. Conclusion : The 17-OHP values of preterm infants were influenced by GA, prenatal dexamethasone, and postnatal diseases. Because the 17-OHP values of preterm infants were markedly variable, a follow-up schedule should be developed considering both 17-OHP values and clinical status.

키워드

참고문헌

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피인용 문헌

  1. Adrenocortical Function in Preterm Infants vol.22, pp.3, 2008, https://doi.org/10.5385/nm.2015.22.3.124
  2. Purity assignment of 17α-hydroxyprogesterone by mass balance method to establish traceability in measurement vol.32, pp.6, 2019, https://doi.org/10.5806/ast.2019.32.6.225