Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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천식 환아에서 흡입용 스테로이드의 사용이 골밀도와 골대사에 미치는 영향

Effects of inhaled corticosteroids on bone mineral density and bone metabolism in children with asthma

  • 최익선 (고려대학교 의과대학 소아과학교실,고려대학교 안암병원 환경보건센터) ;
  • 변정혜 (고려대학교 의과대학 소아과학교실,고려대학교 안암병원 환경보건센터) ;
  • 이승민 (고려대학교 안암병원 환경보건센터) ;
  • 라경숙 (고려대학교 의과대학 소아과학교실,고려대학교 안암병원 환경보건센터) ;
  • 오연정 (고려대학교 의과대학 소아과학교실) ;
  • 유영 (고려대학교 의과대학 소아과학교실,고려대학교 안암병원 환경보건센터) ;
  • 이기형 (고려대학교 의과대학 소아과학교실) ;
  • 정지태 (고려대학교 의과대학 소아과학교실,고려대학교 안암병원 환경보건센터)
  • Choi, Ic Sun (Department of Pediatrics,Environmental Research Center, Korea University Anam Hospital) ;
  • Byeon, Jung Hye (Department of Pediatrics,Environmental Research Center, Korea University Anam Hospital) ;
  • Lee, Seung Min (Environmental Research Center, Korea University Anam Hospital) ;
  • La, Kyong Suk (Department of Pediatrics,Environmental Research Center, Korea University Anam Hospital) ;
  • Oh, Yeon-Joung (Department of Pediatrics, Korea University Anam Hospital) ;
  • Yoo, Young (Department of Pediatrics,Environmental Research Center, Korea University Anam Hospital) ;
  • Lee, Kee Hyoung (Department of Pediatrics, Korea University Anam Hospital) ;
  • Choung, Ji Tae (Department of Pediatrics,Environmental Research Center, Korea University Anam Hospital)
  • 투고 : 2009.02.28
  • 심사 : 2009.05.12
  • 발행 : 2009.07.15
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초록

목 적 : 소아 천식에서 흡입용 스테로이드의 장기간 사용이 골밀도와 골대사에 미치는 영향에 대해 알아보고자 하였다. 방 법 : 고려대학교 안암병원 소아청소년과에서 천식으로 진단되어 최소 6개월 이상 ICS를 사용 중인 만 6세에서 12세 사이의 환아(ICS군: 26명)를 대상으로 하였다. 대조군으로 연령 및 성별이 일치하면서 LTRA만을 사용한 천식 환아(LTRA군: 15명)와 골밀도에 영향을 미칠 만한 기저 질환이 없는 정상 소아(정상군: 30명)를 선정하여 이중 에너지 X-선 흡수법으로 요추와 대퇴골 상부에서 골밀도를 측정하고, 골대사에 대한 영향은 혈청 골-특이 알칼리인산효소(BALP)를 측정하여 평가하였다. 결 과 : ICS군의 요추 골밀도는 $0.57{\pm}0.07g/cm^2$으로 LTRA군($0.55{\pm}0.06g/cm^2$) 및 정상군($0.58{\pm}0.07g/cm^2$)과 유의한 차이를 보이지 않았고(P=0.254), 대퇴골 상부의 골밀도도 ICS군에서 $0.70{\pm}0.07g/cm^2$로 LTRA군($0.66{\pm}0.06g/cm^2$)및 정상군($0.70{\pm}0.07g/cm^2$)과 유의한 차이가 없었다(P=0.297). 골밀도 Z-점수 또한 세 군에서 유의한 차이를 보이지 않았다(요추: ICS군 $-0.22{\pm}0.78$ vs. LTRA군 $-0.16{\pm}0.47$ vs. 정상군 $-0.19{\pm}0.83$, P=0.963; 대퇴골 상부: ICS 군 $-0.12{\pm}0.93$ vs. LTRA군 $0.16{\pm}0.59$ vs. 정상군 $-0.04{\pm}0.67$, P=0.560). 혈청 BALP 농도는 ICS군과 LTRA군에서 정상군에 비해 유의하게 높은 소견을 보였다(P=0.021). ICS군에서 ICS의 최근 6개월간 사용량, 총 축적 용량, 사용 기간, 투여 시작 연령과 골밀도 Z-점수는 유의한 상관관계를 보이지 않았다(모두 P>0.05). 결 론 : 천식 환아에서 저용량의 ICS 사용은 골밀도에 유의한 영향을 미치지 않음을 확인하여, ICS의 부작용에 대한 과도한 우려를 막고 치료 순응도를 높이는데 도움이 될 것으로 생각한다.

Purpose : Inhaled corticosteroids (ICS) are used as first-line agents for the treatment of persistent asthma; however, their use is accompanied by apprehension of potential systemic adverse effects. This study aimed to assess the effects of ICS on bone mineral density (BMD) and bone metabolism in children with asthma. Methods : From February 2008 to September 2008, 26 asthmatic children treated with ICS (ICS group), 15 asthmatic children treated with leukotriene receptor antagonist (LTRA) (LTRA group), and 30 healthy children (Control group) were selected from the Korea University Anam Hospital. BMD and serum bone-specific alkaline phosphatase (BALP) levels were measured. The asthmatic children underwent spirometry and methacholine bronchial challenge test. Results : There were no significant differences in BMD in the lumbar spine (P=0.254) and proximal femur (P=0.297) among the 3 groups. The serum BALP levels were significantly higher in both the ICS (P=0.017) and LTRA (P=0.025) groups than in the Control group. None of the parameters pertaining to ICS use, such as the mean daily dose during the last 6 months, the total cumulative dose, duration of use, and age of commencement of use, showed significant correlations with BMD (P>0.05 for all parameters). Conclusions : We demonstrated that a low dose of ICS does not exert any significant adverse effect on bone metabolism in asthmatic children. These findings support the current recommendations with regard to the use of ICS for asthmatic children.

키워드

과제정보

연구 과제번호 : Environmental Research Center Project

연구 과제 주관 기관 : Ministry of Environment

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