대한치과교정학회지 (The korean journal of orthodontics)

  • 제40권4호
  • /
  • Pages.227-238
  • /
  • 2010
  • /
  • 2234-7518(pISSN)
  • /
  • 2005-372X(eISSN)
대한치과교정학회 (The Korean Association Of Orthodontists)
권호 표지
DOI QR코드

DOI QR Code

저신장 소아에서 성장호르몬 치료가 두개안면골 성장에 미치는 영향

The effect of growth hormone treatment on craniofacial growth in short stature children

  • 정성호 (영남대학교 대학원 의학과) ;
  • 김진욱 (영남대학교 의과대학 치과학교실) ;
  • 박용훈 (영남대학교 의과대학 소아청소년과학교실) ;
  • 황충주 (연세대학교 치과대학 교정학교실) ;
  • 이희경 (영남대학교 의과대학 치과학교실)
  • Chung, Sung-Ho (Graduate School Department of Medical Science, Yeungnam University) ;
  • Kim, Jin-Wook (Department of Dentistry, College of Medicine, Yeungnam University) ;
  • Park, Yong-Hoon (Department of Pediatrics, College of Medicine, Yeungnam University) ;
  • Hwang, Chung-Ju (Department of Orthodontics, College of Dentisrty, Yonsei University) ;
  • Lee, Hee-Kyung (Department of Dentistry, College of Medicine, Yeungnam University)
  • 투고 : 2010.01.26
  • 심사 : 2010.06.09
  • 발행 : 2010.08.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

저신장이란 같은 연령 및 성별 소아들의 표준 신장 평균치에서 -2.0 SD 이하인 경우를 말한다. 본 연구의 목적은 저신장 소아의 두개안면골격의 특성을 분석하고, 성장호르몬 치료가 신장을 성장시킴과 동시에 두개안면골격에 어떤 영향을 주는지 알아보고자 함이다. 영남대학교 의과대학 부속병원 소아청소년과에서 저신장으로 진단받은 소아를 대상으로 성장 호르몬 치료 전 그리고 치료 후 1년, 2년 후 총 3회 측모 두부 방사선 규격 사진의 촬영을 시행하였다. 대조군은 경북대학교 치의학전문대학원 교정과에 소장된 한국인 평균 신장의 2 표준오차 내의 아동들을 대상으로 측모 두부 방사선 규격사진을 2년마다 10년간 촬영한 자료를 이용하여 저신장 소아의 연령과 성별을 기준으로 짝진 표집(paired sampling)을 하였다. 성장 호르몬 치료 전 저신장 소아는 작고 후퇴된 하악골과 편평한 두개저를 가지는 것으로 나타났다. 성장 호르몬 치료 후 anterior, posterior cranial base length, upper posterior facial height, lower anterior facial height, posterior total facial height, mandibular ramus length, mandibular corpus length와 overall mandibular length 성장량이 정상군에서의 2년 성장량과 비교했을 때 유의하게 큰 것으로 나타났으며 각도 계측에서는 saddle angle, mandibular plane angle과 ANB변화량이 정상군에서의 2년 성장량과 비교했을 때 큰 변화를 보이며 정상군의 평균치를 따라잡는 경향을 보였다. 성장 호르몬 치료는 불균형적인 성장의 징후 없이 정상화를 향한 성장(따라잡기 성장)을 나타내었으며 이는 특히 하악과두의 성장과 후안면고경의 성장을 촉진시켜 저신장 소아의 convex한 profile을 완화하는 것으로 판단된다.

Objective: The purpose of this study was to analyze the effect of growth hormone treatment (GHT) on craniofacial growth in children of short stature. Methods: Nineteen untreated children of short stature were referred from the Pediatric Department, Yeungnam University Hospital as a subject group. All subjects had lateral cephalograms taken before, after 1 year and after 2 years of growth hormone treatment. As a reference group, we selected 19 normal children with paired sampling who matched the subjects' age and sex, from the Department of Orthodontics, Kyungpook National University Hospital. Results: Before GHT, anterior cranial base length and upper posterior facial height, posterior total facial height, mandibular ramus length, and mandibular corpus length were significantly smaller in the reference group. In angular craniofacial measurements, saddle angle and mandibular plane angle were larger. SNA and SNB were smaller in the reference group. After two years of GHT, growth hormone accelerated growth in several craniofacial components. The posterior total facial height, the anterior, posterior cranial base length, and the mandibular ramus length were increased. And the difference in mandibular plane angle and ANB values compared with the reference group was decreased. Conclusions: GHT over 2 years leads to a craniofacial catch-up growth tendency, which is pronounced in interstitial cartilage and condylar cartilage.

키워드

참고문헌

  1. Brown T. Skeletal maturity and facial growth assessment. Aust Orthod J 1970;2:80-7.
  2. Scammon RE. Measurement of the body in childhood. In: Harris JA, Jackson CM, Patterson DG, Scammon RE editors. The measurement of man. Minneapolis: University of Minnesota; 1930
  3. Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab 2008;93:4210-7. https://doi.org/10.1210/jc.2008-0509
  4. Spiegel RN, Sather AH, Hayles AB. Cephalometric study of childeren with various endocrine diseases. Am J Orthod 1971;59:362-75. https://doi.org/10.1016/0002-9416(71)90232-6
  5. Kjellberg H, Beiring M, Wikland KA. Craniofacial morphology, dental occlusion, tooth eruption, and dental maturity in boys of short stature with or without growth hormone deficiency. Eur J Oral Sci 2000;108:359-67. https://doi.org/10.1034/j.1600-0722.2000.108005359.x
  6. Hwang CJ, Cha JY. Orthodontic treatment with growth hormone therapy in a girl of short stature. Am J Orthod Dentofacial Orthop 2004;126:118-26. https://doi.org/10.1016/j.ajodo.2003.07.013
  7. Nanda RS. The rate of growth of several facial components measured from serial cephalometric roentgenograms. Am J Orthod 1955;41:658-73. https://doi.org/10.1016/0002-9416(55)90112-3
  8. Bjork A, Helm S. Prediction of the age of maximum pubertal growth in body height. Angle Orthod 1967;37:134-43.
  9. Baughan B, Demirjian A, Levesque GY, Lapalme-Chaput L. The pattern of facial growth before and during puberty, as shown by French-Canadian girls. Ann Hum Biol 1979;6:59-76. https://doi.org/10.1080/03014467900003371
  10. Isaksoon OG, Lindahl A, Nilsson A, Isgaard J. Mechanism of the stimulatory effect of growth hormone on longitudinal bone growth. Endocr Rev 1987;8:426-38. https://doi.org/10.1210/edrv-8-4-426
  11. Bajpai A, Menon PS. Growth hormone therapy. Indian J Pediatr 2005;72:139-44. https://doi.org/10.1007/BF02760699
  12. Rongen-Westerlaken C, vd Born E, Prahl-Andersen B, von Teunenbroek A, Manesse P, Otten BJ, et al. Effect of growth hormone treatment on craniofacial growth in Turner's syndrome. Acta Paediatr 1993;82:364-8. https://doi.org/10.1111/j.1651-2227.1993.tb12698.x
  13. Bergersen EO. The male adolescent facial growth spurt: its prediction and relation to skeletal maturation. Angle Orthod 1972;42:319-38.
  14. Graber TM. Orthodontics: principles and practice. 3rd ed. Philadelphia: W.B. Saunders; 1972. p. 27-128.
  15. Coben SE. Growth concepts. Angle Orthod 1961;31:194-201.
  16. Sohn BW, Kim HS. A semilongitudinal study on cranial base, maxillary and mandibular growth of Korean children aging 7 to 17 years old. Korean J Orthod 1999;29:23-35.
  17. Hunter CJ. The correlation of facial growth with body height and skeletal maturation at adolescence. Angle Orthod 1966;36:44-54.
  18. Van Erum R, Mulier M, Carels C. Verbeke G, de Zegher F. Craniofacial growth in short children born smail for gestational age: effect of growth hormone treatment. J Dent Res 1997; 76: 1579-86. https://doi.org/10.1177/00220345970760091001
  19. Pirinen S, Majurin A, Lenko HL, Koski K. Craniofacial features in patients with deficient and excessive growth hormone. J Craniofac Genet Dev Biol 1994;14:144-52.
  20. Ranly DM. A synopsis of craniofacial growth. 2nd ed. Norwalk, Conn.: Appleton & Lange; 1984. p. 124-41.
  21. Tanaka T, Satoh M, Yasunaga T, Horikawa R, Tanae A, Katsumata N, et al. When and how to combinc growth hormone with a luteinizing hormone-releasing hormone analogue. Acta Paediatr Suppl 1999;88:85-8. https://doi.org/10.1111/j.1651-2227.1999.tb14359.x

피인용 문헌

  1. Severe trismus due to bilateral coronoid process hyperplasia in growth hormone therapy patient: a case report vol.38, pp.4, 2010, https://doi.org/10.5125/jkaoms.2012.38.4.249