Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

선천성 심장질환을 가진 환자의 최종 키

Final height of patients with congenital heart disease

  • 이순주 (전남대학교 의과대학 소아과학교실) ;
  • 조영국 (전남대학교 의과대학 소아과학교실) ;
  • 마재숙 (전남대학교 의과대학 소아과학교실)
  • Lee, Soon Joo (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Cho, Young Kuk (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Ma, Jae Sook (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital)
  • 투고 : 2009.08.11
  • 심사 : 2009.10.05
  • 발행 : 2010.02.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 선천성 심장질환을 가진 소아에서 성장장애를 보이는 것은 잘 알려져 있다. 그러나 선천성 심장질환을 가진 환자들의 최종 키에 관한 연구는 미비한 실정이다. 본 연구에서는 선천성 심장질환을 가진 환자에서 최종 키와 그 당시 체중을 분석하여 선천성 심장질환과 성장과의 관련성을 알아보고자 하였다. 방 법 : 2000년 11월부터 2009년 3월까지 전남대학교병원 소아과에 내원한 환자중 선천성 심장질환을 가지고 있고 내원당시 만 19세 이상인 환자들을 대상으로 하였다. 성장에 영향을 줄 수 있는 전신 질환이 동반된 환아는 제외하였다. 최종 키와 체중은 만 19세 이상의 키와 그 당시의 체중으로 하였고 진료 기록지를 후향적으로 조사하였다. 선천성 심장질환군과 정상의 성장을 비교분석하였다. 연구 대상을 청색증과 비청색증 심장질환군으로 분류하였고, 심장 질환의 종류, 진단시기, 수술 유무, 수술시기에 따라 분류하여 각 군의 최종 성장을 비교 분석하였다. 결 과 : 대상 환아는 전체 105명으로 남자는 58명, 여자는 47명이었다. 대상 남자의 평균키은 $170.9{\pm}7.5cm$, 평균 체중은 $62.7{\pm}11.3kg$ 이었고, 여자의 평균키은 $159.4{\pm}6.4cm$, 평균체중은 $52.2{\pm}7.8kg$ 이었다. 남자에서 통계적으로 유의하게 정상에 비해 키와 체중의 낮은 평균치을 보였다. 3백분위수 미만의 심한 성장장애를 보인 경우는 키에서는 남자 5명(8.6%)이었고, 여자 4명(8.5%), 체중에서는 남아 9명(15.5%), 여아 8명(17.0%)이었다. 남녀 모두에서 청색증군이 비청색증군에 비해 최종 신장의 평균치가 낮은 소견을 보였으나 남아의 체중만이 통계적으로는 유의하였다. 심장 질환별 비교에서는 남자의 체중만이 통계학적으로 유의하게 질환별 차이를 보였고 동맥관 개존군에서 가장 높은 값, Follot 4징군에서 가장 낮은 값을 보였다. 결 론 : 선천성 심장질환을 가진 남자에서 정상 소아에 비하여 최종 키와 당시 체중의 성장장애를 보였다. 따라서 심장질환을 가진 환자에서는 질환의 주의 깊은 관찰을 통하여 필요시 적절한 시기에 치료가 시행되어야겠고, 치료 이후에도 성장의 정기적인 추적관찰을 통해 성장 부진의 소견이 확인되면 성장에 대한 치료를 시도하는 것이 바람직할 것으로 여겨진다.

Purpose : Growth impairment is usually observed in children with congenital heart disease (CHD). Studies on the final height and weight of this population are insufficient. Our aim was to evaluate the final height of children with CHD and to identify the relationship between CHD and growth. Methods : We recorded the values of final height and weights of 105 CHD patients (age, <19 years) who visited Chonnam National University Hospital between November 2000 and March 2009, and we reviewed the medical records. Results : The mean values of weight and height of male CHD patients were significantly lower than those of the normal subjects. Patients with severe growth impairment (below the third percentile of normal) included 5 males (8.6%) and 4 females (8.5%) with height less than normal and 9 males (15.5%) and 8 females (17.0%) with weight less than normal. The mean growth of the patients in the cyanotic heart disease group was lower than that of normal subjects, but a statistically significant difference was noted in the weights of males. In a comparative study based on the type of CHD, a significant difference was noted in weights of males. Patients with patent ductus arteriosus and those with tetralogy of Fallot had the highest and lowest mean values of weight, respectively. Conclusion : Growth impairment was more evident in children with CHD than normal children. Patients should be treated during an optimal time frame. Thus, CHD patients should be treated if follow-up studies indicate growth impairment.

키워드

참고문헌

  1. Korean Society of Pediatric Endocrinology. Pediatric endocrinology. 2nd ed. Seoul: Kwang-Moon Publishing Co, 2004:36-56
  2. Feldt RH, Strickler GB, Weidman WH. Growth of children with congenital heart disease. Am J Dis Child 1969;117:573–9
  3. Weintraub RG, Menahem S. Early surgical closure of a large ventricular septal defect: influence on long-term growth. J Am Coll Cardiol 1991;18:552-8 https://doi.org/10.1016/0735-1097(91)90614-F
  4. Linde LM, Rasof B, Dunn OJ. Longitudinal studies of intellectual and behavioral development in children with congenital heart disease. Acta Paediatr Scand 1970;59:169-76 https://doi.org/10.1111/j.1651-2227.1970.tb08984.x
  5. Sholler GF, Celermajer JM. Cardiac surgery in the first year of life: the effect on weight gains of infants with congenital heart disease. Aust Paediatr J 1986;22:305-8
  6. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25 https://doi.org/10.3345/kjp.2008.51.1.1
  7. Mehrizi A, Drash A. Growth disturbance in congenital heart disease. J Pediatr 1962;61:418-29 https://doi.org/10.1016/S0022-3476(62)80373-4
  8. Rosenthal GL, Wilson PD, Permutt T, Boughman JA, Ferencz C. Birth weight and cardiovascular malformations: a population- based study. The Baltimore-Washington Infant Study. Am J Epidemiol 1991:133:1273–81
  9. Cheung MM, Davis AM, Wilkinson JL, Weintraub RG. Long term somatic growth after repair of tetralogy of Fallot: evidence for restoration of genetic growth potential. Heart 2003;89:1340–3 https://doi.org/10.1136/heart.89.11.1340
  10. Schuurmans FM, Pulles-Heintzberger CF, Gerver WJ, Kester AD, Forget PP. Long-term growth of children with congenital heart disease: a retrospective study. Acta Paediatr 1998;87:1250–5 https://doi.org/10.1080/080352598750030933
  11. Jackson M, Poskitt EM. The effects of high-energy feeding on energy balance and growth in infants with congenital heart disease and failure to thrive. Br J Nutr 1991;65:131–43 https://doi.org/10.1079/BJN19910075
  12. Schwarz SM, Gewitz MH, See CC, Berezin S, Glassman MS, Medow CM, et al. Enteral nutrition in infants with congenital heart disease and growth failure. Pediatrics 1990;86:368–73
  13. Leitch CA. Growth, nutrition and energy expenditure in pediatric heart failure. Prog Pediatr Cardiol 2000;11:195–202 https://doi.org/10.1016/S1058-9813(00)00050-3
  14. Ackerman IL, Karn CA, Denne SC, Ensing GJ, Leitch CA. Total but not resting energy expenditure is increased in infants with ventricular septal defects. Pediatrics 1998;102:1172–7 https://doi.org/10.1542/peds.102.5.1172
  15. Forchielli ML, McColl R, Walker WA, Lo C. Children with congenital heart disease: a nutrition challenge. Nutr Rev 1994;52:348–53 https://doi.org/10.1111/j.1753-4887.1994.tb01359.x
  16. Marin OE, Glassman MS, Schoen BT, Caplan DB. Safety and efficacy of percutaneous endoscopic gastrostomy in children. Am J Gastroenterol 1994;89:357-61
  17. Varan B, Tokel K, Yilmaz G. Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Arch Dis Child 1999;81:49-52 https://doi.org/10.1136/adc.81.1.49
  18. Baum D, Beck R, Kodama A, Brown B. Early heart failure as a cause of growth and tissue disorders in children with congenital heart disease. Circulation 1980;62:1145–51
  19. Eskedal LT, Hagemo PS, Seem E, Eskild A, Cvancarova M, Seiler S, et al. Impaired weight gain predicts risk of late death after surgery for congenital heart defects. Arch Dis Child 2008;93:495-501 https://doi.org/10.1136/adc.2007.126219
  20. Barton JS, Hindmarsh PC, Preece MA. Serum insulin-like growth factor 1 in congenital heart disease. Arch Dis Child 1996;75:162–3 https://doi.org/10.1136/adc.75.2.162
  21. Soliman AT, Madkour A, Galil MA, El Zalabany M, Aziz SM, Ansari BM. Growth parameters and endocrine function in relation to echocardiographic parameters in children with ventricular septal defect without heart failure. J Trop Pediatr 2001;47:146–52 https://doi.org/10.1093/tropej/47.3.146
  22. D$\"{u}$ndar B, Ak$\c{c}$oral A, Saylam G, Unal N, Me$\c{s}$e T, H$\"{u}$dao$\check{g}$lu S, et al. Chronic hypoxemia leads to reduced serum IGF-I levels in cyanotic congenital heart disease. J Pediatr Endocrinol Metab 2000;13:431–6 https://doi.org/10.1515/JPEM.2000.13.4.431
  23. Cohen MI, Bush DM, Ferry RJ Jr, Spray TL, Moshang T Jr, Wernovsky G, et al. Somatic growth failure after the Fontan operation. Cardiol Young 2000;10:447–57
  24. Jacobs EG, Leung MP, Karlberg JP. Postnatal growth in southern Chinese children with symptomatic congenital heart disease. J Pediatr Endocrinol Metab 2000;13:387–401 https://doi.org/10.1515/JPEM.2000.13.4.387
  25. Peterson RE, Wetzel GT. Growth failure in congenital heart disease: where are we now? Curr Opin Cardiol 2004;19:81–3 https://doi.org/10.1097/00001573-200403000-00002
  26. Baum D, Beck RQ, Haskell WL. Growth and tissue abnormalities in young people with cyanotic congenital heart disease receiving systemic-pulmonary artery shunts. Am J Cardiol 1983;52:349–52 https://doi.org/10.1016/0002-9149(83)90137-6
  27. Sasaki H, Baba K, Nishida Y, Waki K, Konishi N, Mawatari H, et al. Treatment of children with congenital heart disease and growth retardation with recombinant human growth hormone. Acta Paediatr 1996;85:251–3 https://doi.org/10.1111/j.1651-2227.1996.tb14005.x