포스타 : 불임 및 생식내분비학 ; 습관성 유산환자의 면역학적 특성과 면역글로불린의 치료효과

백은찬,송지홍,노건웅,박애자,이미경,김은성,김문영,류현미,전종영,강인수 대한산부인과학회 1999 대한산부인과학회 학술대회 Vol.84 No.-

포스타 : 내분비,불임학 ; 체외수정시술 환자의 우울과 불안에 관한 연구

백은찬,김경희,조정현,강성호,전종영,김선숙 대한산부인과학회 1993 대한산부인과학회 학술대회 Vol.72 No.-

포스타 : 난소 호르몬변화에 따른 인체난소 표면 상피세포의 미세구조에 관한 연구

백은찬,김세광,송찬호,홍순원,권태정 대한산부인과학회 1991 대한산부인과학회 학술대회 Vol.68 No.-

반복 자연유산 발생 시기의 개인에 따른 주기성에 관한 연구

전종영,강인수,백은찬,유근재,송지홍,노건웅 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.8

1996년 3월부터 1997년 5월까지 성균관대학교 의과대학 삼성제일병원 산부인과 불임클리닉을 내원한 환자들 중, 2회 이상의 반복유산을 경험한 환자 49명 중에서 임 신소실 시기가 개개인에서 어떤 주기성이 존재하는지를 살펴보았다. 한 개인에서 유산시기의 일정함을 보기 위 하여, 두 번째 이상의 각각의 유산시기에서 첫 번째 유산 시기와의 차값의 평균값을 2주 이하로 설정하고 유산시 기의 주기성이 존재하는 지를 본 결과, 77.5%(38/49)가 2 주 이하를 보였고, 유산되는 주수를 유산시기에 따라 그 래프로 본 결과 대체적으로 한 개인은 일정한 시기에 유 산이 일어남을 보여주고 있다. 본 연구의 결과에서 습관 성 유산환자에서 개인마다 일정한 시기에 유산을 하는 특징을 보인다는 결론을 얻었다. 이러한 결과는 면역학 적으로 발생과정의 배아나 태아가 일정 시기에 발현하 는 특정한 항원에 대한 면역반응에 의한다는 설명이 가 능성 있는 가설이 되겠다. During the second or third trimester of pregnancy, a consensus exists that intrauterine fetal death may develop repeatedly around the gestational period of previous fetal death. The purpose of the study was to determine whether or not the gestational week at which the pregnancy was terminated spontaneously is repeated similarly in the following pregnancies during first trimester of pregnancy. A retrospective analysis of 123 abortions in 49 patients with a history of two or more consecutive spontaneous abortion during 1996-1997 was performed. The mean age was 29.1 year old and mean number of abortion was 2.5 times. In these patients, most (90.2%) of the abortions occurred between 6-13 weeks. The gestational weeks when the abortion occurred was repeated within two weeks compared to the first abortion in 77.5% (38/49) of the patients. Gestational week of the second pregnancy loss was correlated with that of the first pregnancy loss (r=0.66, p<0.001, linear regression analysis). These data suggest that there seems to be an individually different critical period during which the pregnancy is lost repeatedly. It is speculated that unknown fetal/placental antigen (s) expressed during the organogenesis may be involved in the immunologic rejection of the fetus.

월경 주기에 따른 자궁내막조직내 일산화질소 생성효소의 발현

홍성란,홍수정,백은찬,유근재,송지홍,송인옥,최범채,궁미경,손일표,전종영,강인수,박인서 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.6

목적: 정상여성의 자궁내막 조직에서 NOS 효소군이 발현되는지를 살펴보고, 월경 주기에 따라 NOS 발현 양상 및 정도에 차이가 있는지 알아보고자 한다. 방법: 정상여성 30예를 대상으로 월경 주기에 따라 자궁내막 생검을 시행하여 얻은 조직을 이용하여 eNOS, iNOS, bNOS 에 대한 면역조직화학 염색을 하였다. 염색 정도는 영상분석기를 이용하여 평가 하였는데 평균 광학농도[average optical density]에 따라 염색이 안된 세포는 0, 검게 염색된 세포는 255로 판정하였다. 결과: 자궁내막 조직에서 eNOS와 iNOS의 발현을 관찰할 수 있었으나 bNOS의 발현은 관찰할 수 없었다. eNOS 염색 정도는 분비기 중기[65.5±0.9, 61.9±0.9: 자궁내막 선상피세포, 기질세포]나 분비기 후기[66.4±1.6, 60.8±1.5]에 증식기[54.1±0.6, 52.0±0.8]에 비해서 통계적으로 의의 있게 강하게 염색되었다[p$lt;0.01]. iNOS 염색 정도도 eNOS와 마찬가지로 분비기 중기[68.2±1.1, 64.7±1.1]나 분비기 후기[70.7±1.7, 66.9±2.0]에 증식기[63.0±0.9, 60.7±0.7]에 비해서 통계적으로 의의 있게 강하게 염색되었다[p$lt;0.01]. 또한 분비기 후기에는 분비기 중기와 비교하여 eNOS와 iNOS가 약간 강하게 염색되는 경향을 보였다. 결론: 정상 여성의 자궁 내막조직에서 자궁내막 선상피세포나 기질세포에 상관없이 eNOS와 iNOS가 발현될 뿐 아니라 월경 주기에 따라 차이를 보이는 결과를 통해서 자궁내막의 생리작용을 위한 국소적인 조절에 NO가 관여한다는 것을 알 수 있다. 특히 eNOS와 iNOS가 분비기 후기에 강하게 발현되는 양상을 관찰함으로써 월경을 위한 자궁내막의 변화에도 NO가 관련될 수 있을 것으로 생각된다. Objective: This study was designed to determine the expression of nitric oxide synthase [NOS] isoforms in the endometrium of fertile women and to evaluate their cyclic changes during the menstrual cycle. Methods: The expression of NOS isoforms was examined by immunohistochemistry and image analysis in endometrial tissues of 30 fertile women according to their menstrual cycles. Results: The expression of endothelial NOS [eNOS] and inducible NOS [iNOS] was observed in the endometrium. However, the expression of neuronal NOS [bNOS] wasn`t detected. The mean staining intensities of eNOS and iNOS in glandular epithelium was significantly stronger than that in stromal cells. Cyclic changes of eNOS and iNOS expression were also noted in the endometrium. The mean staining intensities of eNOS and iNOS in endometrium of the secretory phase was significantly stronger than that of the proliferative phase. And the mean staining intensities of eNOS and iNOS in endometrium of the late secretory phase was stronger tendency than that of the mid secretory phase. Conclusions: This study demonstrated that the expression of eNOS and iNOS was changed in phase dependent manner during the menstrual cycle, implying a physiologic role for nitric oxide in the local control of endometrial function. The strong expression of eNOS and iNOS in endometrium of the late secretory phase suggested that NO may play a role in the process of menstruation.

습관성 유산 환자 혈청에서 종양 괴사인자 - 알파 측정

강인수,최범채,백은찬,유근재,이종표,조동희 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Pregnancy must be considered as a successful allotransplant and certain forms of recurrent spontaneous abortions(RSA) are probably due to $quot;transplant rejection$quot;. Tumor necrosis factor-alpha(TNF-α)may play a key role in the rejection of transplants as elevated TNF-α serum levels have been found in organ transplantation patients during acute rejection crisis(Herrmann and Mertelsmann 1989). In this study, we measured the serum levels of TNF-α to elucidate the relationship between TNF-α and RSA, and to evaluate the value of TNF-α as a new prognostic marker in RSA. Sixty-seven women visited to Samsung Cheil Hospital from November, 1994 to August, 1995 of whom 15 were diagnosed as healthy and nonpregnant(Group A), 29 were dignosed as having RSA(Group B), 15 were diagnosed as pregnant with no complications(Group C), and 8 were of diagnosed as having an abortion between the 6th and 12th week of pregnancy(Group D). The blood levels of TNF-α were measured by use of QuantikineTM HS Immunoassay kit with a sensitivity of 0.125 pg/mL for the benchtop assay(R&D systems). The average serum level(Mean ± SEM) of TNF-α in Group A, B, C and D were 1.89 ± 0.18 pg/ml, 2.95 ± 0.46 pg/mL, 2.42 ± 0.26 pg/mL, and 3.55 ± 1.31 pg/mL, respectively. The level of TNF-α in pregnant women was relatively higher than that of non-pregnant women, however, no stastically significant differences were observed between these two groups. In the total study population, neither age nor number of prior pregnancy losses significantly correlated with TNF-α serum levels. There was no difference between women who had abortions caused by known etiology and those who successfully carried to 28 weeks(2.450.68 pg/ml versus 2.420 ± 6 pg/mL). However, women who had abortions caused by unknown etiology showed an increase in serum TNF-α compared to women with normal pregnancies(4.65 ± 2.59 pg/mL versus 2.42 ± 0.26 pg/mL, relatively). Similarly, women with a history of unexplained recurrent abortion were more likely to secrete TNF-α than healthy, nonpregnant women(4.11 ± 0.93 pg/mL versus 1.89 ± 0.18 pg/mL, p < 0.05). These data suggest that unexplained recurrent abortion might be correlated with increased serum TNF-α levels.

중합효소 연쇄반응(Polymerase Chain Reaction)과 형광직접교잡법(Fluorescent in Situ Hybridization)을 이용한 착상전 수정란에서의 성의 구별

최수경,전종영,강인수,백은찬,김미란,류현미,이호준 대한산부인과학회 1995 대한산부인과학회 학술대회 Vol.75 No.-

난소기능평가를 위한 Gonadotropin Releasing Hormone Agonist Stimulation Test (GAST)의 효용성에 관한 연구

김미란,송인옥,연혜정,최범채,백은찬,궁미경,손일표,이진우,강인수,Kim, Mee-Ran,Song, In-Ok,Yeon, Hye-Jeong,Choi, Bum-Chae,Paik, Eun-Chan,Koong, Mi-Kyoung,Song, Il-Pyo,Lee, Jin-Woo,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2

Objectives: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. Design: Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. Materials and Methods: After blood sampling for basal FSH and estradiol $(E_2)$ on cycle day two, 0.5ml (0.525mg) GnRH agonist ($Suprefact^{(r)}$, Hoechst) was injected subcutaneously. Serum $E_2$ was measured 24 hours later. Initial $E_2$ difference $({\Delta}E_2)$ was defined as the change in $E_2$ on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by ${\Delta}E_2$; group A (n=30):${\Delta}E_2$<40 pg/ml, group B (n=52): 40 pg/ml${\leq}{\Delta}E_2$<100 pg/ml, group C (n=20): ${\Delta}E_2{\leq}100$ pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-ET was followed. Ratio of $E_2$ on day of hCG injection over the number of ampules of gonadotropins used ($E_2hCGday$/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as $E_2$ hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. Results: Mean age $({\pm}SEM)$ in group A, B and C were $33.7{\pm}0.8^*,\;31.5{\pm}0.6\;and\;30.6{\pm}0.5^*$, respectively ($^*$: p<0.05). Mean basal FSH level of group $A(11.1{\pm}1.1mlU/ml)$ was significantly higher than those of $B(7.4{\pm}0.2mIU/ml)$ and C $(6.8{\pm}0.4mIU/ml)$ (p<0.001). Mean $E_2hCGday$ of group A was significantly lower than those of group B or C, i.e., $1402.1{\pm}187.7pg/ml,\;3153.2{\pm}240.0pg/ml,\;4078.8{\pm}306.4pg/ml$ respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: $38.6{\pm}2.3,\;24.2{\pm}1.1\;and\;18.5{\pm}1.0$ (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: $6.4{\pm}1.1,\;15.5{\pm}1.1\;and\;18.6{\pm}1.6$, respectively (p<0.0001). By stepwise multiple regression, only ${\Delta}E_2$ showed a significant correlation (r=0.68, p<0.0001) with $E_2HCGday$/Amp, while age or basal FSH level were not significant. Likewise, only ${\Delta}E_2$ correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). Conclusions: These data suggest that initial $E_2$ difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial $E_2$ difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.

체외수정시술후 질식초음파로 확인된 정상임신에 있어서 산모의 연령이 임신의 결과에 미치는 영향

전종영,강인수,궁미경,손일표,백은찬,연혜정,유근재,이종표,송지홍,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

In infertile patients, the pregnancy loss rate after demonstration of fetal heart beat ranges about 7 % to 11 %, which is relatively higher than that of normal population(about 1.5∼3.3 %). But scanty data are available in evaluation of the influence of maternal age on pregnancy outcomes in IVF-ET patients. Thus, this study was done to assess the imp-act of maternal age on pregnancy loss rate after the early sonographic detection of fetal cardiac activity following IVF-ET. Pregnancy outcomes of 338 IVF-ET cycles from January 1, 1994 through December 31, 1995 were analyzed. Trans vaginal ultrasonography was done serially from the day 21 postconception and the presence of fetal heart activity was documented using a Samsung 125-MAX scanner with a 6.5-MHz transvaginal probe. Logistic regression analysis was done to determine the possible effects of various independent factors such as treatment pr- otocol, infertility factors, basal LH, FSH and E2, multifetal pregnancy reduction, and age of the wife, on probability of spontaneous pregnancy loss after confirmation of positive fetal heart beat. The overall pregnancy loss rate was 8.0 %(27/338). The probability of pregnancy loss after positive fetal heart beat increased with age of the wife(logistic regression analysis, P<0.05). The probability of spontaneous pregnancy loss at a given age was expressed as the following formula:probability=ex/(1+ex), in which χ=-3.9+0.2×age. The older women age over 35 had approximately twice the pregnancy loss rate compared to the younger women;14.9 %(7/47) vs. 6.9 %(20/291). The pregnancy loss rate after multifetal pregnancy reduction was 9.8 %(6/61), which was not significantly different from tht 7.6 %(21/277) without multifetal pregnancy reduction(p>0.05). We conclude that spontaneous pregnancy loss rate after documentation of fetal cardiac activity increases as a function of the maternal age and a profound effect was observed after age 35. Thus, older patients should be counselled on the higher risk of spontaneous pregnancy loss.

미세난관복원수술 후 누적 임신율에 관한 임상적 고찰

홍수정,전종영,궁미경,백은찬,유근재,송지홍,현우영,이문섭,함경렬,이경상 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

목적: 미세난관복원수술에 영향을 미치는 인자와 추적 관찰 기간 중 누적 임신율과 임신가능성을 알아보고자 하였다. 연구 방법: 1993년 4월부터 1995년 3월까지 삼성제일병원 불임클리닉에서 한 사람의 수술자에 의해 미세난관복원수술을 받은 119명을 대상으로 logistic regression analysis와 life-table analysis를 하였다. 결과: 추적 관찰된 대상의 전체 임신율은 77.9%(67/86)이였고 여기에는 생화학적 임신 1.2%, 자궁외임신 4.7%, 자궁내임신 72.1%이 포함된다. 임신율에 영향을 미치는 인자는 수술 후 난관 길이와 추적 관찰기간이었다. 수술 후 24개월 내에 임신할 가능성은 0.75이었고 수술 후 임신되기까지의 median interival은 6.6개월이었다. 결론: 수술 후 24개월 내에 임신할 가능성은 0.75이고, 수술 후 난관 길이가 임신율에 미치는 중요한 인자였으며 추적 관찰기간이 길수록 누적 임신율은 증가하였다. Objective: To evaluate what factors can influence the pregnancy outcome of the patients who underwent microsurgical of tubal sterilization and to calculate cumulative preganncy rate and probability of pregancny by period of follow-up. Design: Retrospective clinical study. Patient(s): One hundred nineteen patients who had sterilized and had operated microsurgical tubal reversal by one operator in our hospital between April 1993 and March 1995. Main Outcome Measure(s): Clinical characteristics of patients, influencing factors and cumulative pregnancy rates by logistic regression analysis and life-table analysis. Results: Pregancny outcomes were identified in 72.3% of the total patients (86/119). The overall pregancny rate was 77.9% (67/86), which included biochemical pregnancy (1/86, 1.2%), ectopic pregnancy (4/86, 4.7%) and intrauterine pregnancy (62/86, 72.1%). The factors influencing pregnancy outcome in this study by logistic regression analysis were tubal length after operation and interval from operation to achieving pregnancy. The probability that pregnancy would occur within first 24 months in total patients was 0.75. The median interval from tubal reversal to pregnancy was 6.6 months. Conclusion: The overall probability of pregnancy was 0.75 within first 24 months. The tubal length reconstructed after operation was the major factor affecting the pregnancy outcome according to result of this study.