Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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비타민 D 결핍성 구루병 영.유아의 임상적 특징

Clinical characteristics of vitamin D deficiency rickets in infants and preschool children

  • 허경 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 우미경 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 윤정림 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 심규홍 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 최명재 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 박미정 (인제대학교 의과대학 상계백병원 소아청소년과)
  • Huh, Kyoung (Department of Pediatrics, Inje University College of Medicine) ;
  • Woo, Mi Kyeong (Department of Pediatrics, Inje University College of Medicine) ;
  • Yoon, Jung Rim (Department of Pediatrics, Inje University College of Medicine) ;
  • Shim, Gyu Hong (Department of Pediatrics, Inje University College of Medicine) ;
  • Chey, Myoung Jae (Department of Pediatrics, Inje University College of Medicine) ;
  • Park, Mi Jung (Department of Pediatrics, Inje University College of Medicine)
  • 투고 : 2009.11.12
  • 심사 : 2010.01.14
  • 발행 : 2010.02.15
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초록

목 적 : 최근 전적인 모유수유, 일조량의 감소, 미숙아의 증가로 인해 비타민 D 결핍성 구루병이 증가 추세로 보고되고 있으나 국내 연구는 부족한 상태이다. 본 연구에서는 비타민 D 결핍성 구루병으로 진단된 아동들의 임상적 특징에 대하여 조사하였다. 방 법 : 상계백병원 소아과에 내원하여 비타민 D 결핍성 구루병으로 진단된 아동(n=35) 및 모유수유환아의 모친(n=11)을 대상으로 임상 특징을 분석하였다. 혈액 내 $25-OHD_3$농도가 15 ng/mL 미만인 경우 비타민 D 결핍증으로, 15 ng/mL 이상 30 ng/mL 미만인 경우 비타민 D 불충분증으로 정의하였다. 결 과 : 대상 환아는 총 35명(남아22명, 여아 13명)이었다. 평균 진단 연령은 $7.4{\pm}7.1$개월(범위: 0.1-29.8개월)이였다. 전체 환아의 51%가 비타민 D 결핍상태였으며 나머지는 불충분상태였다. 전체의 80%가 무증상 구루병으로 진단되었으며 83%가 12개월이 하의 영아였다. 전체 환아 중 57%가 모유수유 중이었으며 29%가 철결핍성 빈혈이 동반되었다. 모유수유아 중 45%가 비타민 D 결핍 상태였으며 모친의 90%가 결핍 혹은 불충분상태였다. 전체 아동의 93%가 방사선 검사상 구루병의 소견이 있었으며 비타민 D 불충분 상태에서도 방사선학 검사상 모두 구루병 소견을 보였다. 결 론 : 비타민 D 결핍성 구루병이 의심되는 경우 수부 방사선 및 $25-OHD_3$검사를 동시에 시행하는 것이 도움이 될 것으로 사료되며 고위험군의 구루병 예방을 위한 국가적 관심, 역학 조사와 이에 대한 지침이 마련되어야 한다.

Purpose : Vitamin D deficiency rickets is a significant public health problem that results from insufficient exposure to sunlight and inadequate vitamin D supplementation. The purpose of this study is to identify the clinical characteristics of vitamin D deficiency rickets in infants. Methods : Data of 35 infants diagnosed as vitamin D deficiency rickets at Sanggye-Paik Hospital, Seoul, Korea, from March 2007 to May 2009 were reviewed. Children with plasma 25-hydroxyvitamin D levels <15 ng/mL and 15-30 ng/mL were considered to have vitamin D deficiency and vitamin D insufficiency, respectively. Results : Thirty-five infants (22 boys, 13 girls) were diagnosed with rickets. Mean age at diagnosis was $7.4{\pm}7.1$ months (range: 0.1-29.8 months). Eighteen infants (51%) were vitamin D deficient and seventeen infants (49%) were insufficient. Twenty-eight of all (80%) diagnosed as subclinical rickets. Twenty-nine infants (83%) were below the age of 12months. Twenty infants (57%) had breastfed and ten infants (29%) had iron deficiency anemia. Nine of breastfed infants (45%) were vitamin D deficient and ten of their mothers were vitamin D insufficient. Overall, radiographic evidence of rickets was present in 93% of the cases. Radiographic sign of rickets was evident even in vitamin D insufficient state. Conclusion : It is important for the clinician to screen for subclinical vitamin D deficiency rickets in inadequately supplemented infants by pairing 25-hydroxyvitamin D levels with wrist radiographs. A nationwide epidemiological study of vitamin D deficiency rickets must be conducted and evidence-based national guidelines must be defined to prevent rickets.

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피인용 문헌

  1. Prevalence of 25-hydroxyvitamin D deficiency in Korean adolescents: association with age, season and parental vitamin D status vol.17, pp.1, 2010, https://doi.org/10.1017/s1368980012004703
  2. Nutritional rickets around the world: an update vol.37, pp.2, 2010, https://doi.org/10.1080/20469047.2016.1248170