골반장기 탈출증 환자의 스테로이드 대사

Abstract

Objective : To identify 1) whether the endogenous steroid hormone metabolism in patients with pelvic organ prolapse was different from that of normal women, 2) the relationship between endogenous steroid hormone metabolites and the stage of the pelvic organ prolapse. Methods : Twenty postmenopausal women who were clinically diagnosed as having pelvic organ prolapse and 20 volunteer postmenopausal women not having pelvic organ prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of the endogenous steroids and the degree of pelvic organ prolapse. Urinary profiles of the endogenous steroids were assayed by gas chromatography-mass spectrometry. Results : The ages of the patients and control group were 64.6±6.5 and 63.5±3.9 years, and the Body Mass Index (BMI) was 23.96±3.14 and 24.11± kg/m^2 in patients and in normal subjects, respectively. The number of patients in each stage were 4 in stage Ⅰ, 4 in stage Ⅱ, 6 in stage Ⅲ and 6 in stage Ⅳ. 5-androstene-3β, 16β, 17β-triol (5-AT), 11β-hydroxy androstenedione (An) and 17β-estradiol were significantly increased in patients with pelvic organ prolapse over that of the control group (0.76±0.67 vs 0.06±0.03 μmole/g creatinine; p=0.002, 1.16±0.83 vs 0.65±0.23 μmole/g creatinine; p=0.04, 15.08±9.81 vs 8.53±6.19 μmole/g creatinine; p=0.04). However, tetrahydrocortisone (THE) was significantly increased in the control group over that in patients having pelvic organ prolapse (9.80±6.21 vs 5.22±4.89 μmole/g creatinine; p=0.04). The androgen metabolites, 5-AT and THE significantly correlated with the POP-Q stage (R=0.418; p=0.027, R=0.46; p=0.016). Among the estrogen metabolites, 17β-estradiol was correlated to the POP-Q stage but not mathematically significantly (R=0.38; p=0.05) and the 17β-estradiol/extrone ratio weakly correlated to pelvic organ prolapse stage (R=0.14l p=0.49,), by showing a low correlation coefficiency. Conclusion : The urinary concentrations of 17β-estradiol, 5-AT and 11β-hydroxy an increased in patients with pelvic organ prolapse over that of the control group and 5-AT, THE and 17β-estradiol showed a relationship to the progression of pelvic organ prolapse in Korean women. The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of pelvic organ prolapse.