연령에 따른 골수의 과립백혈구 보존능 변화에 관한 연구

Abstract

골수의 과립 백혈구 보존능(Marrow granulocyte Reserve, MGR)이란 골수에서의 과립백혈구 저장소로서 스트레스에 의해 골수에서 말초혈액으로 유리되어 정상적인 과립백혈구 기능을 하는 골수의 과립백혈구 저장 능력을 나타낸다. 본 연구는 prednisolone투여후 투여전보다 증가된 말초혈액의 과립백혈구수로 골수의 과립백혈구 보존능을 측정하여, 골수기능 저하를 초래하는 약물의 투여시, 약물의 용량이나 치료 간격을 정하는 지표로 삼을수 있는지를 알아보기 위하여 연령에 따라 골수의 과립구 보존능의 변화를 측정하였다. 본 연구는 24세부터 75세까지의 68예를 대상으로 prednisolone 40mg을 경구 투여하기전과 투여후 5시간에 정맥혈의 전체 백혈구수와 백혈구의 감별수치로부터 과립백혈구수의 증가를 측정하여 다음과 같은 결과를 얻었다. 1) 68예에서 prednisolone 투여전 과립백혈구수의 범위는 1036∼884/㎣, 평균은 3768±1419/㎣였으며, prednisolone 투여 5시간 후의 과립백혈구 증가의 범위는 170-8745/㎣, 평균은 2700土1535/㎣였다. 2) 골수의 과립백혈구 보존능은 말초혈액의 과립백혈구수와 상관관계가 없었다(r=-0.158, 0.1<p<0.2). 3) 골수의 과립백혈구 보존능은 연령이 증가함에 따라 유의하게 감소되었다(r=-0.536, p<0.001). 이상의 결과로 골수의 과립백혈구 보존능을 쉽게 측정하여 골수기능에 영향을 미치는 약제를 투여하였을때 골수기능 저하를 예측하거나 판단할 수 있으며 이를 이용하여 약물의 용량이나 치료간격을 결정하는데 참고 지표로 이용할 수 있을것으로 생각된다.;The frequency of bone marrow depression is relatively high in old aged patients who receive anticancer chemotherapy. Due to the bone marrow depression during anticancer chemotherapy, either therapy delay or drug dosage reduction is often required. The marrow granulocyte reserve (MGR) is the granulocyte pool in the bone marrow. From this pool, granulocytes are released to the peripheral blood upon receiving any stress. In this research, the variation of the marrow granulocyte reserve depending on age has been studied. The marrow granulocyte reserve was determined by the measurement of the increased granulocyte count in the peripheral blood after administration of prednisolone. One of the important purposes of this study is to make a guideline for deciding proper dosage and therapy interval of the drugs which causes bone marrow depression. In 68 patients whose age were distributed from 24 to 75, both the total and differential leucocyte count were measured 5 hours later after oral administration of 40mg of the prednisolone and were compared with those measured immediately before the administration of the prednisolone. The measurement results are summarized as follows: 1) The distribution of the initial granulocyte count in 68 patients before prednisolone administration were from 1036/㎣ to 1848/㎣, and the average and standard deviation were 3768/㎣ and 1419/㎣, respectively. After prednisolone administration, the distribution of increment of the granulocyte count were from170/㎣ to 8745/㎣, and the average and standard deviation of the increment were 2700/㎣ and 2535/㎣, respectively. 2) There was no correlation between the marrow granulocyte reserve and the initial granulocyte count in the peripheral blood (r=-0.158, 0.1<p<0.2). 3) The marrow granulocyte reserve drops significantly as age increases (r=-0.536, p<0.001). In conclusion, it is believed that the measurement of the marrow granulocyte reserve can be useful either to predict or determine the level of the bone marrow depression during oral administration of drugs which affect the function of the bone mallow. In addition, the measurement of MGR can be used as an indicator to determine the proper dosage and treatment interval depending on age of a patient.