골반장기탈출증 환자에서 스테로이드 대사 이상

Abstract

Objective: To identify 1) whether endogenous steroid hormone metabolism in patients with pelvic organ prolapse was different from that of normal women, 2) relationship between endogenous steroid hormone metabolites and the stage of the pelvic organ prolapse.

Methods: Twenty postmenopausal women who were clinically diagnosed of having pelvic organ prolapse and 20 voluntary postmenopausal women without pelivc organ prolapse were included in the study. We compared urinary profile of the endogenous steroids between the two groups and investigated the relationship between urinary profiles of the endogenous steroids and the degree of pelivc organ prolapse. Urinary profiles of the endogenous steroids were assayed with gas chromatography-mass spectrometry.

Results: The ages of the patients and control group were 64.6±6.5 and 63.5±3.9 years old, the Body Mass Index(BMI) were 23.96±3.14 and 24.11±2.73㎏/㎡ 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 An and 17β-Estradiol were significantly increased in patients with pelvic organ prolapse than 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). But Tetrahydrocortisone (THE) was significantly increased in control group than patients with pelvic organ prolapse (9.80±6.21 vs 5.22±4.89 μmole/g creatinine; p=0.04). In androgen metabolites, 5-AT and THE were significantly correlated to POP-Q stage (R=0.418; p=0.027, R=0.46; p=0.016). Among the estrogen metabolites, 17β-estradiol was correlated to POP-Q stage even not significantly (R=0.38; p=0.05) and 17β-Estradiol/Estrone was weakly correlated to pelvic organ prolapse stage (R=0.14; p=0.49) with low correlation coefficiency.

Conclusion: The urinary concentrations of 17β-Estradiol, 5-AT and 11β-Hydroxy An increased in patients with pelvic organ proapse than control group and 5-AT, THE and 17β-estradiol were relatively related to progression of pelvic organ prolapse in Korean women. The metabolites of endogenous steroid hormones could serve as contributing factors for the pathogenesis of pelvic organ prolapse.