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임신성고혈압 환자 혈장내 Fibronectin과 Antithrombin Ⅲ의 진단적 가치
홍기연,이희섭 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.3
1990년 11월부터 1991년 9월까지 원광대학교 의과대학 부속병원 산부인과에 입원치료한 환자 119명을 대상으로 turbidimetric immunoassay를 이용하여 fibronectin을 측정하고 radial immunodiffusion 방법으로 Antithrombin Ⅲ를 측정하여 다음과 같은 결과를 얻었다. 1. 임신 만 37주이상의 대상환자 1109명중 정상혈압군이 74예 임신성고혈압군이 45예였으며 환자군간 나이 및 분만력, 제태령에는 유의한 통계학적 차이는 없었다. 2. Fibronectin은 tubidimetric immunoassay, antithrombin Ⅲ는 radial immunodiffusion방법으로 측정하였으며 두 검사 모두 측정평균치가 각각 287.4±77ug/ml 대 424.0±115ug/ml, 23.9±4.2mg/L 대 20.6±2.7mg/L로 정상혈압군과 임신성고혈압군 사이에 통계학적으로 유의한 차이를 보였다(P$lt;0.001). 3. ROC curve 분석에 의하면 임신성고혈압 진단에 fibronectin 측정이 antithrombin Ⅲ 측정보다 나은 검사방법으로 추정됐다. 4. ROC curve 분석에 의하면 fibrnectin의 임신성 고혈압 진단 screening cutoff치로 350ug/ml가 의의있다고 생각되며(양성예견율 67%, 음성예견율 83%) diagnostic cutoff치는 40ug/ml가 의의있다고 추정됐다(양성예견율 92%, 음성예견율 78%). 5. FN과 ATⅢ의 병용검사(FN/ATⅢ비)는 정상 임신군과 임신성고혈압군에서 각각 12.3Ⅲ3.4, 20.4Ⅲ6.1로 통계학적으로 유의한 차이를 보였으며(P$lt;0.001), ROC curve 분석에 의하면 병용검사(FN/ATⅢ 비)가 단독검사보다 진단적 가치를 높일 수 있다고 측정됐다. 6. FN/ANⅢ비의 임신성고혈압 진단 screenign cutoff치는 16.0이 의의 있다고 생각되며(양성예견율 84%, 음성예견율 81%) diagnostic cutoff치는 18.0이 의의 있다고 추정됐다(양성예견율 97%, 음성예견율 77%). This study was undertaken at the department of Obstetrics and Gynecology, School of Medicine, Wonkwang University from November 1, 1990 through September 30, 1991 to evaluate the diagnostic value of plasma Fibronectin (FN) and Antithrombin Ⅲ (ATⅢ) in pregnancy induced hypertension (PIH). FN, a marker for vascular injury, was measured by turbidimetric immunoassay and AT Ⅲ, a marker for thrombolic disease, was measured by radial immunodiffusion method. The results were revealed as follows: 1. Of 119 study subjects who were gestational age greater than completed 37th weeks, 74 subjects were normal blood pressure group and 45 subects were PIH group. The maternal age, parity, and gestational age were statistically not-significant between the normal and PIH group. 2. Mean values of FN and ATⅢ were statistically significant between normal and PIH group, 287.4±77 ug/ml versus 424.0±115 ug/ml and 23.9±4.2 mg/L versus 20.6±77/ug/ml versus 424.0±115ug/ml and 23.9±4.2mg/L versus 20.6±2.7mg/L, respectively (p$lt;0.001). 3. Under the analysis of ROC(Receiver Operating Characteristic) curve, FN was better than ATⅢ in the diagnosis of PIH. 4. Under the analysis of ROC curve, the screening cutoff value of FN was significant at the level of 350ug/ml(positive predictive value 67%, negative predictive value 83%) and the diagnostic cutoff value was significant at the level of 400ug/ml(positive predictive value 92%, negative predictive value 78%). 5. The mean FN/AT Ⅲ ratio was tatistically significant between normal and PIH group, 12.3±3.4 and 20.4±6.1, respectively. Under the analysis of ROC curve, the combination test for FN and ATⅢ(FN/AT ratio)was better than the single test. 6. The screening cutoff value of FN/ATⅢ ratio was significant at the level of 16.0(positive value 84%, negative predictige value 81%) and the diagnostic value was significant at the level of 18.0(positive predictive value 97%, negative predictive value 77%).