원인불명의 습관성 유산 환자에서 말초혈액 자연살해세포의 증가가 임신초기 자궁혈류의 변화에 미치는 영향

구화선 ( Hwa Seon Koo ),이현정 ( Hyun Jeong Yi ),이민영 ( Min Young Lee ),안현숙 ( Hyun Suk Ahn ),최민혜 ( Min Hye Choi ),성나영 ( Na Young Sung ),황유임 ( Yu Im Hwang ),송인옥 ( In Ok Song ),궁미경 ( Mi Kyoung Koong ),강인수 ( In 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.7

Objective: To evaluate whether increased peripheral blood inflammatory immune cell can induce decrease of uterine blood flow in patients with unexplained recurrent spontaneous abortion (RSA). Methods: This study designed prospectively 33 pregnant women between 5 to 7 gestational weeks with a history of unexplained RSA included in this study. 47 normal pregnant women between 5 to 7 gestational weeks without history of infertility and/or RSA included as a control. Peripheral blood natural killer (pbNK) (CD3-/56+) fractions among peripheral blood monocyte (PBMC) were checked by flow cytometry. Uterine color-pulsed Doppler trans-vaginal ultrasound for evaluation of uterine radial artery RI was checked. Uterine radial artery resistance index (RI) compared between study and control group. After then, uterine radial artery RI was compared between high pbNK cell fraction above 12.1% among PBMC and normal pbNK cells fraction below 12.1%, Correlation between pbNK cell fraction to uterine radial artery RI was also evaluated, Results: Uterine radial artery RI in early pregnancy was significantly higher in patients with RSA than that of normal control (0.60 ± 0.14 vs. 0.54 ± 0.12, P = 0.039). Especially, the mean value of uterine radial artery RI in RSA patients with elevated pbNK cells was significantly increased than that of normal control (0.62 ± 0.13 vs. 0.54 ± 0.12, P=0.029). Otherwise, pbNK cell fractions among PBMC displayed strong positive correlation to uterine radial artery RI (Pearson`s correlation coefficient P=0.001, r = 0.667). Conclusion: Increased pbNK cells can evoke decreased uterine blood flow by their pro-inflammatory action on micro vascular structure such as uterine radial artery. This can be a one causative mechanism of inducing spontaneous abortion by increased NK cells. But, larger scaled study is needed for clarify our results.

불임 또는 습관성 유산 환자에서 중격자궁의 치료가 임신에 미치는 영향

구화선,차선화,양광문,배주연,안현숙,한애라,박찬우,강인수,궁미경,이경상,Koo, Hwa-Seon,Cha, Sun-Hwa,Yang, Kwang-Moon,Bae, Ju-Youn,Ahn, Hyun-Suk,Han, Ae-Ra,Park, Chan-Woo,Kang, Inn-Soo,Koong, Mi-Kyoung,Lee, Kyung-Sang 대한생식의학회 2010 Clinical and Experimental Reproductive Medicine Vol.37 No.4

목적: 중격자궁은 흔하게 보고되는 선천성 자궁기형 중 하나이며 여성의 생식능력에 미치는 영향에 대해 아직 이견이 많고, 따라서 치료의 필요성에 대해서도 아직 정립되지 않았다. 본 연구에서는 중격자궁의 존재 및 치료 여부가 생식수행에 미치는 영향에 대해 알아보고자 하였다. 연구방법: 2008년 1월부터 2009년 12월까지 불임 또는 습관성 유산을 주소로 제일병원 산부인과를 방문하여 자궁난관 조영술을 시행한 총 2,838명의 환자들 중 중격자궁이 진단된 44명의 환자들을 대상으로 하였으며, 이 중 27명은 자궁경 하 자궁중격 절제술을 시행 받았으며, 17명은 진단 후 추가적인 치료를 받지 않았다. 대조군은 동일 기간 내에 자궁기형이 진단되지 않은 환자 42명을 나이를 고려 후 무작위 선정하였다. 연구 대상군의 임신율, 자연유산율, 그리고 생존분만율 등에 대한 의무기록을 후향적으로 분석하였으며, 대상군들의 평균 추적 관찰 기간은 진단 후 21.8개월 이었다. 결과: 추적 관찰 기간 중 자궁경 하 질식 자궁중격 절제술을 시행 받은 환자 (n=27)의 55.6% (15/27)가 임신에 성공한 반면 치료를 받지 않은 환자 (n=17)의 약 23.5% (4/17)만이 임신에 성공하여 치료받은 군에서 통계적으로 의미있는 높은 수치를 보였다 (p<0.05). 한편 생존분만율은 치료를 받은 환자군 및 자궁기형이 진단되지 않은 불임 또는 습관성 유산 환자 (대조군, n=42)에서 각각 75%와 84.6%를 보인 반면 치료 받지 않은 군에서는 50% (2/4)를 보여 치료 받지 않은 중격자궁 환자에서 낮은 경향을 보이지만 통계학적 의미는 없었다. 결론: 중격자궁이 생식수행에 미치는 영향은 자연유산 등 산과적 합병증 뿐 아니라 오히려 임신력의 저하에 더 큰 악영항을 미칠 수 있으며 불임 환자에서 중격자궁의 존재 시 적극적인 치료가 임신성공률의 향상에 도움이 될 것으로 생각 되지만 보다 명확한 결론을 위해 규모가 크고 관찰 기간이 긴 대단위 연구가 필요 할 것으로 생각된다. Objective: The aim of this study was to evaluate the influences of uterine septum and their elimination on the reproductive outcomes in women who have history of recurrent spontaneous abortion (RSA) and/or infertility. Methods: The medical records of reproductive outcomes in patients who have had history of RSA and infertility who were diagnosed with uterine septum only by hysterosalpingogram (HSG) between January 2008 and December 2009 were retrospectively analyzed. The subjects who have had severe male factor, tubal factors, other uterine factors, endocrine abnormalities, peritoneal factors, and abnormal karyotyping among both partners were excluded. In 27 patients, confirmation of diagnosis by laparoscopy and elimination of uterine septum by trans-vaginal hysteroscopy was done. Seventeen patients were strongly suspected to uterine septum on HSG but tried to get pregnancy without any other procedure for evaluation and management of uterine anomaly. Age matched 42 patients who have history of RSA and/or infertility and diagnosed to normal HSG finding at same period were randomly selected as control. The medical records of reproductive outcomes were analyzed and compared between groups. Results: The mean time of observation after diagnosis was 21.8 months (10 to 32). 55.6% (15/27) of patients in patients who received trans-vaginal hysteroscopic uterine septotomy were success to get pregnancies and was significantly higher than that of 17 patients who did not receive proper management (23.5%, 4/17, p<0.05). In control population, 40.5% (17/42) were success to pregnancies and the differences were not statistically significant compared to both two study groups. The live birth rate which was excluded pregnancy loss by abnormal fetal karyotyping and congenital anomaly were 75% (9/12) in treated septated uterus group and 84.6% (11/13) in control group each which have no statistically significant different. In patients with septated uterus who did not receive proper management showed lower delivery rate (50%, 2/4) than that of other groups but was not statistically significant. Conclusion: According to present data, women with a uterine septum have an increased chance of successful pregnancy with improved obstetric outcome after proper management of the uterine cavity. And these results were showed in patients with no regard to their reproductive history. But, in case of failed to receive proper management, uterine septum can affect not only pregnancy ongoing but successful pregnancy too.

The effect of captafol on the hematological value, erythrocyte membrane and plasma biochemical value in vitro

김성훈,황화선,차신우,한상섭,노정구,Kim, Sung-hoon,Hwang, Hwa-seon,Cha, Shin-woo,Han, Sang-seop,Roh, Jung-koo The Korean Society of Veterinary Science 1993 大韓獸醫學會誌 Vol.33 No.3

Captafol은 phthalimide계통의 항진균제로써 difolatan이란 상품명으로 개발되어 과일, 채소의 탄저병 및 원목 등의 곰팡이 구제에 널리 사용되고 있는 것으로 국내에서도 두번째로 많이 생산, 사용되는 품목이나 독성실험에 관한 보고는 거의 없는 상태이다. 이에 본 연구에서는 captafol 자체에 대한 독성기전의 일부를 확인하고자 동물체내에서 일어나는 여러가지 대사작용이 배제된 시험관내에서 실험을 수행하였다. 랫트 혈액을 후대정맥으로 부터 채혈하여 4개의 시험관에 $2.5m{\ell}$씩 분주한 후 captafol 농도가 $0.1{\times}10^{-4}M$, $1{\times}10^{-3}M$, $1{\times}10^{-2}M$이 되도록 한 ethanol용액 $25{\mu}{\ell}$씩 넣고 $CO_2$ incubator에서 2시간 동안 부드럽게 혼합하여 혈액학적 성상 및 적혈구 취약성 시험을 수행하였다. 또한 원심분리하여 얻어진 혈장에서 생화학적 성상 등을 조사한 결과 다음과 같은 성적을 얻었다. 1. 적혈구수 및 hematocrit치는 captafol 투여량에 비례적으로 유의한(p<0.05) 감소를 나타내었다. 2. 적혈구막 취약성 실험에서 $1{\times}10^{-3}M$ 및 $1{\times}10^{-2}M$ 농도에서 대조군에 비하여 유의한(p<0.01) 증가를 나타내었다. 3. 혈장내 potassium이온의 농도는 captafol의 투여량에 비례적으로 증가하였다. 4. Total bilirubin 및 creatine kinase가 대조군에 비하여 각각 증가 및 감소하였다. The effect of captafol on the hematological value, erythrocyte membrane and plasma biochemical value was investigated using blood of SPF Sprague-Dawley male rats in vitro. For the anticoagulations, we used 0.5mg of heparin per $10m{\ell}$ of blood from vena cava. Three con-centrations($0.1{\times}10^{-4}M$, $1{\times}10^{-3}M$ and $1{\times}10^{-2}M$) captafol in ethanol were added to the each $2.5m{\ell}$ blood so that the linal concentration of ethanol was 1%. The blood contained with each concentration of captafol was incubated at $37^{\circ}C$ C for 2 hours under 5% $CO_2$ gas The whole blood and plasma were examined for hematological vaJues, erythrocyte membrane damage and biochemical values, respectively. The results obtained were summarized as follows ; 1. The number of RBC in $1{\times}10^{-2}M$ group and the concentration of MCHC in $1{\times}10^{-3}M$ group were significantly (p<0.05) decreased and increased from that of control values, respectively. The percentage of Hct was significantly (p<0.05) decreased with dose-response. 2. Erythrocyte fragility rate of $1{\times}10^{-3}M$ and $1{\times}10^{-2}M$ group were significantly (p<0.01) increased from that control with dose response. 3. Potassium ion level of $1{\times}10^{-2}M$ was significantly (p<0.05) increased from that of control. 4. The concentration of total bilirubin in the $1{\times}10^{-3}M$ and $1{\times}10^{-2}M$ groups were significantly increased from that of control. The enzyme level of creatine kinase in $1{\times}10^{-2}M$ group was significanlty (p<0.05) decreased from control value.

불임 환자에서 난관수종의 수술적 치료가 임신의 예후에 미치는 영향

박찬우 ( Chan Woo Park ),양광문 ( Kwang Moon Yang ),차선화 ( Sun Hwa Cha ),황유임 ( Yu Im Hwang ),구화선 ( Hwa Seon Koo ),배주연 ( Ju Youn Bae ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.12

Objective The aim of this study is to evaluate the efficacy of surgical treatment in patients with hydrosalpinx on the success of the pregnancy. Methods We retrospectively analyzed the medical records of 65 patients who were diagnosed to hydrosalpinx by hysterosalpingogram. Among 65 patients who diagnosed to hydrosalpinx, 38 patients were received surgical treatment (surgical treatment group). Otherwise, 27 patients didn`t received any surgical treatment and classified as no treatment group. After then, surgical treatment group was subgrouped into two groups according to their method of surgery such as salpingoneostomy group (n = 29) and salpingectomy group (n = 9). Then we analyzed several factors related to pregnancy of each group. Results There were no statistically significant differences in age, duration of infertility, fertility history and causes of infertility between groups. The in vitro fertilization (IVF) success rate in salpingectomy group (77.8%) was significantly higher than that of no treatment group (34.8%) ( P=0.035). Conclusion In infertile patients with hydrosalpinx, surgical treatment of hydrosalpinx seems to have beneficial effects to increase the success rate of pregnancy through IVF.