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만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수와 태반 염증성 병변의 관련성에 관한 연구

THE RELATIONSHIP BETWEEN AMNIOTIC FLUID WHITE BLOOD CELL COUNT AND INFLAMMATORY LESIONS OF THE PLACENTA IN WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES

오경준|이성윤|박교훈|김시내|정희정|이정연|정은하
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2011.02|Obstetrics & Gynecology Science|제54권 제2호|pp. 79-85

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참고문헌

키워드

백혈구White blood cell양수Placenta태반염증성 병변만삭 전 조기양막파수Amniotic fl uidInfl ammatory lesionsPreterm premature rupture of membranes
주제분류산부인과학

초록

목적만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수와 태반 염증성 병변의 존재 및 정도와의 관련성을 확인하고자 한다. 연구방법만삭 전 조기양막파수로 입원한 단태임신 임신부 중 양수 내 백혈구 수 측정 및 양수 배양검사를 위해 경복부 양수천자가 시행되고, 양수천자 후 72시간 내에 조기분만(임신 24.0-35.6주 사이)되었으며, 태반의 조직학적 검사가 시행된 90명의 임신부를 대상으로 하였다. 결과조직학적 융모양막염의 빈도는 32%였으며 양성 양수 배양인 경우는 21%였다. 태반 염증성 병변이 존재하는 경우는 존재하지 않는 경우에 비하여 양수 내 백혈구 수가 유의하게 많았다. 양수 내 백혈구 수는 교란변수의 영향을 보정한 후에도 태반 염증성 병변의 존재와 유의한 관련성을 나타내었다. 또한 양수 내 백혈구 수는 각각의 태반 부위별 염증 정도가 심할수록 유의하게 증가하였다. 태반 염증성 병변존재를 가장 잘 예측할 수 있는 양수 백혈구 수의 절단치는 25개/mm3였고 이때 민감도 62%, 특이도 77%를 나타내었다. 결론만삭 전 조기양막파수 임신부에서 양수 내 백혈구 수는 태반의 염증성 병변의 존재 및 정도와 유의한 관련성을 가지고 있으며 산전에 이의 존재 유무를 예측할 수 있는 독립적 인자이다.

Abstract

Objective To examine the relationship between amniotic fluid (AF) white blood cell (WBC) count and the presence and severity of infl ammatory lesions of the placenta in women with preterm premature rupture of membranes (PPROM). Methods This retrospective cohort study included 90 consecutive women with PPROM (24.0-35.6 weeks) who met the following criteria:singleton gestation; transabdominal amniocentesis performed to obtain AF for culture and WBC count; delivery within 72 hours of amniocentesis; placental histologic examination after preterm delivery. Results The prevalence of histologic chorioamnionitis was 32% (29/90) and that of positive amniotic fluid culture was 21% (19/90). Patients with histologic chorioamnionitis had a signifi cantly higher AF WBC count than those without this lesion. Logistic regression analysis demonstrated that AF WBC count had a significant relationship with histologic chorioamnionitis after controlling for gestational age and AF culture. The median AF WBC count increased signifi cantly according to the higher severity of infl ammation in each type of placental histologic section. According to receiver operating characteristic curve analysis, the best cut-off value of AF WBC count for predicting histological chorioamnionitis was 25 cells/mm3, with a sensitivity of 62% and a specifi city of 77%. Conclusion Both the presence and greater severity of infl ammatory lesions of the placenta are associated with an elevated AF WBC count. AF WBC count is an important and independent predictor for infl ammatory lesions of the placenta in women with PPROM.

참고문헌 (23)

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