만삭임신부에서 조기양막파수 C-Reactive Protein과의 관계에 관한 연구

Abstract

Premature rupture of the membranes (PROM), both in term and preterm pregnancy, causes considerable perinatal morbidity and mortality. The cause of PROM in preterm pregnancy is thought to be related to clinical or subclinical infection. The literature has conflicting reports as to the predictive value of C-reactive protein (CRP) in chorioamnionitis, with some confirmatory reports as well as refuting report. The purpose of this study was to evaluate the usefulness of CRP determinations in term pregnancy patients with PROM at the time of admission. 34 cases with PROM and 50 cases with intact membrane were taken part in and analyzed in this study. The results were as follows: 1. There was no significant difference in demographic characteristics (age, gravity, parity and gestational age) between the study and the control group patient. 2. Positive CRP was significantly associated with PROM in term pregnancy. 3. The patients with PROM in term pregnancy had significantly higher C-section rate than control group. 4. The sensitivity and specificity of the CRP were acceptable (74% and 92% respectively). 5. The C-reactive protein test appears to be more accurate in predicting premature rupture of membrane when compared to white blood cell and differential counts. This suggests a relationship between CRP and PROM in term pregnancy and it should be opened for further study for CRP.;조기양막파수는 만삭임신이나 만삭전(preterm)임신에서 모두 주산기 이환과 사망의 주요 원인이 되어왔다. 만삭전 조기양막파수의 원인으로 임상적 혹은 준임상적(Subclinical) 감염이 가장 중요하게 생각되고 있으며 이를 알아내는 표지물질로 C-Reactive Protein(CRP)에 대한 많은 연구가 진행되고 있다. 이에 본 연구는 양막이 파수되지 않고 진통을 주소로한 군(50예)과 만삭임신환자중 양막파수를 주소로한 군(34예)을 분류하여 만삭임신에서의 조기양막파수와 CRP와의 관계를 연구한 결과 다음과 같은 결론을 얻었다. 1. 조기양막파수군에서 CRP양성율은 양막파수가 되지 않은 군에 비해 유의성 있게 높았다(P<0.001) 2. CRP검사의 민감성(Sensitivity)과 특이성(Specificity)은 각각 74%와 92%였다. 3. 양막파수가 있는 경우는 양막파수가 되지않은 군에 비해 제왕절개술율이 유의성있게 높았고 (P<0.001), 아두골반불균형에 의한 것이 가장 많았다. 4. CRP 검사는 조기양막파수를 예측하는데 백혈구수나 감별혈구계산(differential count) 보다 훨씬 유의하였다(양성예측도 86%).