일반연제 발표 : 논문 ; 산과학 : 태아장애 예측에 있어서 비수축검사, 수축검사 및 혈청 Estriol치의 비교

궁미경,김미영,양미혜,안정자,김종일,강신명 대한산부인과학회 1984 대한산부인과학회 학술대회 Vol.54 No.-

인체의 난관수종액이 생쥐의 배아발달에 미치는 영향: II. 포배기내의 세포 수에 미치는 영향

궁미경,전진현,송상진,송지홍,홍수정,유근재,손일표,김정욱,강인수,Koong, Mi-Kyoung,Jun, Jin-Hyun,Song, Sang-Jin,Song, Ji-Hong,Hong, Soo-Jeong,Yoon, Keun-Jae,Song, Il-Pyo,Kim, Jeong-Wook,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2

In our previous study, we observed that hydrosalpingeal fluid (HSF) adversely effect mouswe embryo development and hatching. The aim of this study was to evaluate the effect of HSF as assessed by the blastocyst development rate (BDR) and by cell counting in vitro. HSF was collected from ninie patients undergoing salpingoneostomy to correct hydrosalpinx. Two-cell embryos were obtained from superovulated ICR mice. T6 medium and $T6{\pm}0.4%$ bovine serum albumin were used as control media. T6 medium containing 10% or 50% HSF and 100% HSF from each patient were used as test media. Nine to 15 embryos were cultured in micro drops prepared from each of these media. To assess the total cell number within each blastocyst, the blastocysts were fixed and stained with Hoechst 33342 to facilitate cell counting. The mean BDR in two control media were 88.89% and 85.40%. The mean BDR in media containing 10%, 50%, 100% HSF were 85.87%, 89.58% and $75.57%^*$, respectively ($^*$: p<0.05). The overall mean cell count $({\pm}SEM)$ in control media were $87.6{\pm}9.65\;and\;90.12{\pm}11.38$. The BDR was affected adversely only by 100% HSF and not in media containing 10% or 50% HSF. Mean cell counts were decreased significantly only in blastocysts cultured 100% HSF ($63.8{\pm}13.66$; p<0.01) but not in blastocysts cultured in 10% or 50% HSF ($91.3{\pm}12.44\;and\;82.9{\pm}18.27$, respectively). Thus, it is concluded that HSF has no embyotoxic effect but has a mildly negatively effect on embryonic growth and development.

복강경시술을 이용한 난관복원술(Laparoscopic microsurgical tubal reanastomosis)의 임신성적 보고

궁미경,연혜정,이종표,유근재,이기훈,송지홍,강인수,이인국,박인서 대한산부인과학회 1997 대한산부인과학회 학술대회 Vol.80 No.-

인간의 난관수종액이 생쥐배아발달에 미치는 영향

궁미경,전진현 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Recent studies reported that patients with hydrosalpinx have reduced pregnancy rates following in vitro fertilization and embryo transfer(IVF-ET). Hydrosalpingeal fluid(HSF) in the fallopian tube(s) can leak into the uterine cavity, and it may change the intrauterine microenvironment, and affect embryo development or implantation adversely. The objective of this study is to determine if HSF affects development or implantation adversely. The objective of this study is to determine if HSF affects development, hatching or implantation of mouse embryo in vitro. HSF was collected from 10 patients with hydrosalpinges undergoing salpingoneostomy. Collected fluid was centrifuged and supernatant was stored frozen at -20 C. For co-culture, human endometrial cells were obtained by endometrial biopsy and were cultured using Ham`s F-10 medium. Two-cell mouse embryos(ICR-strain) were cultured for 6 days in T6 medium containing 0, 10, 20, 50 % of HSF with or without human endometrial cells. Statistical analysis was done by chi-square test. The ratios of developing mouse embryo in 0, 10, 20 50 % of HSF in media(n=80 in each group) were 70, 75, 70, 59 % to blastocyst, 70,65, 60, 46 % to hatching, and 50, 44, 48, 36 % to outgrowth, respectively. This mean ratios showed decreasing tendency according to increasing HSF concentration( :p$lt;0.05). A similar tendency was observed in cluture with endometrial cell. The ratios of developing mouse embryo co-cultured with endometrial cells(n=40 in each group)were 82, 75, 65, 57 % to blastocyst, 78, 68, 63, 60 % to gatching, and 64, 55, 58, 58 % to implantation, respectively (:p$lt;0.05). These data suggest that HSF adversely affect mouse embryo development and hatching rather than outgrowing or implantation in vitro. Thus, the hydrosalpinx-associated reduction in pregnancy rates among IVF-ET patients may be related, at least in part, to the deleterous effects of HSF on embryo development. In this study, the final medium concentrations were varying also by adding HSF, however, this dilution effect is considerd to be anlogous to in vivo condition when HSF influxes into the uterine fluid.

이상태아 예측을 위한 비수축검사, 수축검사 및 혈청 Total estriol치에 관한 연구

궁미경,김종일,우복희,강신명 대한산부인과학회 1986 대한산부인과학회 학술대회 Vol.58 No.-

난관수종 (Hydrosalpinx) 과 그의 수술적 교정이 체외수정시술시 임신율 및 착상율에 미치는 영향

궁미경,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

The aim of this study is to determine whether or not hydrosalpinx affects pregnancy rate and implantation rate adversely in human IVF-ET program. 110 infertile couples with tubal factor undertaken IVF-ET treatment from May 1995 through April 1996 were included. Patients with tubal factor combined with other factors were excluded from this study. The hydrosalpinx group included 35 patients who had unilateral or bilateral hydrosapinx. Fifty four patients with proximal tubal occlusion without hydrosalpinx served as a control. The corrected hydrosalpinx group included 21 patients hydrosalpinx served as a control The corrected hydrosalpinx group included 21 patients who had undertaken either salpingectomy(n=5) or salpingoneostomy(n=16) before IVF-ET cycle. Controlled ovarian hyperstimulation was performed using GnRH agonist/human menopausal gonadotropin or follicular stimulation hormone(FSG). Thirty four hours after intramuscular injection of 10,000 IU human chorionic gonadotropin(hCG), trasvaginal sonography-guided oocyte retrieval was done, The cleaved embryos were transferred to the uterus on day two or three after fertilization. There was no significant difference in age(mean +or- SEM; 32.9 +or- 0.4, 32.7 +or- 0.6, 31.4 +or- 0.6), basal FSH level(7.1 +or- 0.3, 7.2 +or0 0.3, 7.0 +or- 0.4 mIU/ml) and estradiol on the day of hCG injection(2674 +or- 219, 3239 +or- 304, 3376 +or- 360 pg/ml) among the control, hydrosalpinix and corrected hydrosalpinx group, respectively(p$gt;0.05). The number of trasferred embryos(5.1 +or- 0.3, 5.6 +or- 0.3 and 5.4 +or- 0.6) were similar between the groups. The clinical pregnancy rate of 8.3% in hydrosalpingeal group was significantly lower than 25.4% of control group (p=0.057). However, in corrected hydrosalpinx group, pregnancy rate of 27.3% compared well with the control group. The implantation rate showed a similar pattern with pregnancy rate, i.e., hydrosalpingeal group had the lowest implantation rate of 2.0%, which was significantly lower than 11.6% of control group. In the corrected hydrosalpinx group, implantation rate(9.3%) recovered as that of the control group. The ectopic pregnancy rate(11.1%) of the hydrosalpingeal group was higher than that of the control group(1.7%) and was intermediate(4.5%) in corrected hydrosalpinx group(p$gt;0.05). In conclusion, these data show that hydrosalpinx affects the pregnancy rate adversely in IVF-ET cycyle. Thus, it is suggested that surgical correction of the hydrosalpinx before the initiation of IVF-ET cycle may be beneficial in increasing the pregnancy rate as well as decreasing the ectopic pregnancy.

포스타 : 불임 및 생식내분비학 ; 양막을 이용한 자궁내막증 모델에서 탈락된 자궁내막의 유착부위에 대한 전자현미경적 연구

궁미경,전진현,홍수정,강인수 대한산부인과학회 1999 대한산부인과학회 학술대회 Vol.84 No.-

생리혈내 탈락된 자궁내막세포의 유착력에 관한 연구: 자궁내막증의 병인 연구를 위한 실험 모델

궁미경(Mi Kyoung Koong),전진현(Jin Hyun Jun),김은수(Eun Soo Kim),고경남(Kyoung Nam Ko),홍수정(Soo Jeong Hong),송지홍(Ji Hong Song),유근재(Keun Jai Yoo),강인수(Inn Soo Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.12

목적: 자궁내막증의 원인은 아직도 잘 밝혀지지 않았으나, 역류된 자궁내막세포 및 조직이 복강 내로 전이, 착상되어 형성된다는 가설이 지배적이다. 그러나, 실제적으로 복강 내에서 어떤 과정에 의해 자궁내막세포 및 조직이 복막에 유착되고 침윤되어 병변이 발생되는 가에 관하여서는 알려지지 않았다. 따라서 본 연구에서는 양막을 이용하여 생리혈에 존재하는 탈락된 자궁내막조직이 상피층에 유착될 수 있는 가를 알아보고자 하였다. 연구방법: 정상적인 생리주기를 갖는 20명의 여성으로부터 생리주기 제2일이나 제3일에 자궁으로부터 Wallace catheter를 통해 흘러나오는 생리혈을 채취하였다. 양막은 합병증이 없는 만삭분만시의 태반으로부터 채취, 분리하여 사용하였다. 채취된 생리혈은 Ham's F-10 배양액으로 2회 세척한 후 준비된 양막조각 위에서 배양액과 함께 5일간 배양하였다. 그 후 양막에 자궁내막조직이 유착된 부위를 해부현미경 하에서 관찰하였고, 유착부위가 관찰되면 이를 고정하여 조직절편으로 만들어 염색, 관찰하였다. 결과: 생리혈에 존재하는 자궁내막조직의 유착부위는 양막의 세포외 기질층 뿐 아니라 상피층 모두에서 관찰되었다. 유착부위의 크기는 매우 다양하여 현미경적 크기부터 육안 확인 가능한 크기까지 관찰되었다. 결론: 생리혈에 존재하는 자궁내막조직은 이미 탈락되었음에도 불구하고 유착력을 가지고 있으며, 이러한 유착력은 자궁내막증을 일으키는 데 관여할 것으로 사료된다. Objectives: The purpose of this study was to determine whether or not the shed endometrial tissues in menstrual fluid (MF) have adhesive potentials, using human amniotic membrane (AM). Methods: The MF from 20 patients with regular menstruation was collected with Wallace catheter by aspiration from the uterine cavity on the second or third day of the menstrual period. The AM was obtained from the placenta of term delivery without any complication. The MF was washed and diluted fivefold with Hams F-10 medium supplemented with 10% fetal bovine serum. The cell suspension was placed on either epithelial layer (EP) or extracellular matrix layer (ECM) of the AM. After 5 days of culture, the adhesion sites were observed under a stereomicroscope. For histological observation, each cultured AM was prepared for the serial paraffin section. Results: The adhesion sites of endometrial tissues in MF were found both ECM (20/20) and EP (11/20) of the AM. The size of adhesion sites in each AM were highly variable from microscopic to macroscopic size. Conclusion: We found that the shed endometrial tissues in MF have adhesive potential to epithelial layer in addition to extracellular matrix layer of amniotic membrane. This adhesive potential may be related to pathogenesis of endometriosis. We suggest that this culture system can be useful as an in-vitro model for endometriosis.

비수축 및 수축검사와 혈청 Estriol검사에 의한 고위험임시기의 태아예후예측

궁미경(MK Koong),김미영(MY Kim),양미혜(MH Yang),안정자(JJ Ahn),김정일(CI Kim),강신명(SM Kang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.9

위험도가 높은 인신에 있어서 태아의 예후를 판정하기위해 비수축 및 수축검사 (nonstress-con-traction stress test)와 혈청 estriol치를 검사를 실시하여 분석한 결과 다음과같은 결론을 얻었다 1 비수축검사(nonstress test)결과 무반응형(nonreactive)으로 나타났을 경우에는 44%, 즉 반수정도에서 현성태아장애(overt fetal distress)를 예측할 수 있었으며, 이와반면에 반응형(reactive)으로 나타났을 경우에는 93 3% 즉 대부분이 건강한 태아를 예측할 수 있었다 2 비수축검사에서 무반응형으로 나타난 예에 대하여 제2단계 검사인 수축검사(contraction stress test)를 실시한 결과, 혼합심박하강형(mixed deceleration)으로 나타난 군에서는 50%가, 만기하강형(late deceleration)으로 나타난 군에서는 100%에서 현성태아장애를 예측할 수 있었다 요컨대, 비수축검사와 수축검사를 병용함으로써 태아장애의 예측도를 현저하게 높일 수 있었다 (80%) 3 진통을 수반하지 않은 만삭임신에서 11ng/ml이하로 혈청 estriol치를 나타냈을 경우에는 대부분이 태아장애를 예측할 수 있었으나, 11ng/ml이상으로 높게 나타낸 군에서도 27%가 위음성(false negative) 즉 태아장애를 나타냈으므로 태아장애예측에 대한 신빙성이 적었다 또한, 일단 진통이 시작되면 혈청estriol치는 진통전에 비해 29∼65%가 감소되었다 5 연장임신시 태아예후를 예측하는 데 수축검사(contraction stress test)가 대단히 예민한 것으로 나타났으며 특히 과숙아인 경우에 혼합심박하강형(mixed deceleration)을 보였다 이때, 혈청 estriol치는 과숙아판정에 도움이 되지않았다 6 중증자간전증(severe preeclampsia)시의 태아예후 예측에서도 역시 수축검사(contraction stress test)가 대단히 실용적이였으며, 이때 혈청 estriol치에 의한 예측율도 비교적 높았다 The precise prenatal assessment of fetal wellbeing is still unsolved problem in modern obstetric practice, especially in high risk pregnancy The data presented are based on 40 cases of high risk pregnancy, including preeclampsia, prolonged labor, maternal medical illness associated with pregnancy and others In this study, we will discuss 16 cases of CST(contraction stress test), 24 cases of NST(nonstress test) followed by CST, and 40 cases of serum estriol test for prediction of fetal distress prenatally The results obtained were as follows: 1 When nonreactive pattern appeared in nonstress test, these may able to predict overt fetal distress 44% or nearly one half of the cases 2 When CST is added to the cases with nonreactive type in intial NST, the prediction rate of fetal distress was significantly high (80%); it was accounted for 50% by mixed deceleration and 100% by late deceleration 3 The applicability of the serum estriol level measured before labor was considered to be less practical, because of high false negative rate (27%) in serum estriol level higher than 11ng/ml 4 In the prediction of fetal distress among postdatism, CST was very valuable, and all the postmaturity showed mixed deceleration pattern The serum estriol level appeared to be a less useful parameter 5 In the prediction of fetal distress resulted from severe preeclampsia, CST was also considered to be very useful as well as serum estriol analysis

이상태아예측을 위한 비수축검사, 수축검사 및 혈청 Total Estriol치에 관한 연구

궁미경(MK Koong),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.10

고위험임부 30예를 대상으로 비수축검사(nonstress test), 수축검사(contraction stress test) 및 모체의 혈청 total estriol검사에 의해 이상태아의 예후에 대한 판정의 신빙도는 다음과 같았다. 1. 비수축검사시에 나타나는 비반응형(nonreactive)이나, 수축검사시에 나타나는 심박변이(variavbility)가 결여된 음성형(negative) 또는 양성형(positive)으로 나타날 때는 이상태아에 대한 예측율이 각각 82%, 86% 및 100%로 모두 신빙성이 높았다. 2. 모체의 진통전 혈청 total estriol치가 160ng/ml미만으로 나타난 예에서는 이상태아 예측율이 비교적 높았으나(88%), 그 반면 160ng/ml 또는 그 이상으로 나타난 예에서는 위음성율이 42%로 높았다. 따라서, 이때는 비수축검사의 병용이 반드시 필요하며 이상태아의 예측에 대한 신빙도를 보완할 수 있었다(83%). 3. 임신성 고혈압을 동반한 임부에 있어서는 진통전 혈청 total estriol평균치가 정상임부의 평균치에 비하여 현저하게 낮았다(p<0.05). 특히 자궁내 성장지연을 동반한 임신성 고혈압임부에 있어서 그 평균치(152.5ng/ml)는 동반치 않은 단순 임신성 고혈압임부의 평균치(236.4ng/ml)에 비해 더 낮은 경향이 있었다. Level for the Prediction of Abnormal Fetal Outcome The precise evaluation of abnormal fetal outcome is still unresolved problem. In this paper, 30 cases of high risk term pregnancies including pregnancy induced hypertension with or without intrauterine growth retardation(12 cases), diabetes mellitus(2 cases) and others were studied. The abnormal fetal outcome was evaluated by means of nonstress test, contraction stress test and simultaneous measurement of maternal serum total estriol. The results obtained were as follows: 1. In the prediction of the abnormal fetal outcome among high risk term pregnancies, the nonreactive pattern of nonstress test, the negative pattern associated with no variability or positive pattern of contraction stress test all appeared to be highly reliable indicators. 2. The high risk pregnancies revealing serum total estriol concentration less than 160ng/ml before labor showed fairly high predictability of abnormal fetal outcome(88%). However, when the value of serum total estriol concentration was 160ng/ml or above, the false negative rate was very high(42%) and therefore, in such cases, we believe the additional nonstress test to be needed for the better prediction of the abnormal fetal outcome(83%). 3. The mean serum to total estriol concentration before labor in pregnancies complicated by hypertensive disorders was significantly lower compared with that of normal pregnancies(P<0.05). Especially, the mean value in pregnancy induced hypertension associated with intrauterine growth retardation(152.5ng/ml±) tended to be lower in comparison with that of without intrauterine growth retardation(236.4ng/ml±36.2).