임신성 고혈압의 예측을 위한 융모성 성선 자극호르몬의 유용성

변상운(Sang Woon Byun),김성한(Seong Han Kim),주재영(jae Young Joo),박정실(Jung sil Park),한광수(Kwang Soo Han),배국환(Koock Howan Bae) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 임신 제 2분기에 다중혈청지표검사의 일부로 실시한 융모성 성선 자극호르몬의 임신성 고혈압을 조기 예측하는 지표로서의 임상적 유용성을 고찰해보고, 경증과 중증 임신성 고혈압에서 이 호르몬의 차이를 비교해 보고자 한다.연구방법 : 1998년 1월부터 1999년 12월까지 부산 메리놀 병원 산부인과에서 다중혈청지표검사를 하고 분만한 580 명 중 고혈압이 발생한 33 명을 임신성 고혈압군으로, 고혈압이 발생하지 않았던 547 명을 대조군으로, 다시 임신성 고혈압이 발생한 33 명은 경증 22 명, 중증 11 명으로 나누어 각각에서의 융모성 성선 자극호르몬의 측정치를 비교해 보았다.결과 : 융모성 성선 자극호르몬은 임신성 고혈압 산모에서 1.53 ± 0.39 MoM으로 대조군의 0.97 ± 0.44 MoM에 비해 유의하게 높았으며, 경증과 중증 임신성 고혈압에서는 1.51 ± 0.41 MoM, 1.57 ± 0.38 MoM으로 유의한 차이가 없었다. 임신성 고혈압 예측을 위한 차단치를 1.9 MoM으로 잡았을 때 민감도는 33.6 %, 특이도는 95.2 %, 양성 예측도 26.7 %로 나타났다.결론 : 임신 제 2분기에 실시한 다중혈청지표검사의 일부로서의 융모성 성선 자극호르몬은 임신성 고혈압이 발생할 산모에서 유의하게 증가되었지만, 조기 진단법으로 사용하기에는 아직 많은 제한점이 있다고 분석되었다. Objective : This study was designed to evaluate whether maternal serum human chorionic gonadotropin (HCG) levels measured during second trimester could be used as a screening test for pregnancy - induced hypertension, and to compare the levels of this hormone in mild and severe pregnancy - induced hypertension.Methods : Between January 1998 and December 1999, we examined 580 women undergoing second trimester triple marker screening test who delivered at our hospital. Pregnancy induced - hypertension group (n=33) was classified as mild (n=22) or severe (n=11) subgroups.Results : Maternal serum human chorionic gonadotropin levels were significantly higher in the pregnancy induced - hypertension group than in the control group, but no significant differences of the levels of this hormone were observed in the mild and severe pregnancy induced - hypertension subgroups. In the pregnancy induced - hypertension group, with the use of 1.9 multiples of the median as a cutoff value, the sensitivity was 33.6 %, specificity was 95.2 %, and positive predictive value was 26.7 %.Conclusion : High maternal serum human chorionic gonadotropin levels at second trimester were related to a risk for pregnancy induced - hypertension, but the clinical utility of elevated second trimester HCG as a screening test for pregnancy induced hypertension is limited.

임신성 고혈압의 예측지표로서 임신중기에 증가된 융모성 성선 자극호르몬의 임상적 유용성

김현수(Hyun Soo Kim),오민정(Min Jeong Oh),김해중(Hai Joong Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

N/A Objective: This study was designed to evaluate whether maternal serum human chorionic gonadotropin(hCG) level measured during second trimester could be used as a predictor of pregnancy-induced hypertension. Methods: Between March 1996 and November l997, 505 pregnant women undergoing second trimester(14-22 weeks of amenorrhea) triple marker screening for neural tube defect and Down syndrome who delivered at our institution were reviewed. All samples were assayed in the same laboratory and medical records were reviewed about medical and obstetrical history. Results: Maternal serum human chorionic gonadotropin level(multiples of the median, MoM) was significantly higher in the pregnancy-induced hypertension group than in the control group. With the use of 2. l multiples of the median as a cutoff value, the sensitivity of human chorionic gonadotropin as a screening marker for development of pregnancy-induced hypertension was 38.7%, the specificity was 95.9%, positive predictive value was 38.7% and negative predictive value was 95.9%. Conlusion: We suggest that second trimester maternal serum human chorionic gonadotropin levels can be used clinically as an early predictive marker for pregnancy-induced hypertension.

임신성 고혈압의 한약 치료에 대한 무작위 대조군 연구의 문헌고찰

황수인,윤영진,박장경,Hwang, Su-In,Yoon, Young-Jin,Park, Jang-Kyung 대한한방부인과학회 2020 大韓韓方婦人科學會誌 Vol.33 No.3

Objectives: The purpose of this study is to confirm the effectiveness and safety of herbal medicine treatment for treating pregnancy-induced hypertension. Methods: We searched for randomized controlled trials of pregnancy-induced hypertension treated with herbal medicine, through nine databases. Interventions and results of the selected clinical studies were analyzed. Results: Eleven randomized controlled trials were finally included according to the inclusion and exclusion criteria. Treatment group was treated with herbal medicine alone in two studies, and with herbal medicine and western medicine in nine studies. Control group was treated with western medicine. Taxilli Ramulus (桑寄生) (54.5%) was the most frequently used herb in herbal medicine treatment. In all of eleven studies, treatment group was more effective for pregnancy-induced hypertension than the control group. Conclusions: This study suggested that herbal medicine treatment alone or combined with western medicine treatment could be helpful in improving the therapeutic effect on pregnancy-induced hypertension and reducing side effects as well. However, in order to obtain stronger evidence of herbal medicine treatment for pregnancy-induced hypertension, more high-quality and well-designed randomized controlled trials should be conducted.

태반조기박리가 동반된 임신성 고혈압 임산부와 정상혈압 임산부에서의 주산기 예후에 대한 비교 분석

박지용(Ji Yong Park),정진훈(Jin Hoon Chung),조용균(Yong Kyoon Cho),최훈(Hoon Choi),김복린(Bok Rin Kim),이홍균(Hong Kyoon Lee),유태환(Tae Hwan Yoo),고수진(Soo Jin Ko),박교훈(Gyo Hoon Park),서정식(Jeong Sik Seo) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A Objective: The objective of this study was to compare perinatal outcomes of pregnancy-induced hypertensive and normotensive women experiencing abruptio placentae, Our hypothesis is that pregnancy-induced hypertensive women have a less favorable perinatal outcome than do normotensive women. Methods: Women with the diagnosis of abruptio placentae delivered between August 1,1989 and December 1,1996, composed the study group (n-92) in this case-control study. The women with abruptio placentae were divided according to their hypertensive (n 37) or normotensive (n 55) status. Maternal and neonatal medical records were reviewed and abstracted for demographic variables, antepartum complications, delivery route, abruptio placentae grade, neonatal gender, birth weight, Apgar score and perinatal mortality. We compared these perinatal outcome variables between the pregnancy-induced hypertensive and normotensive pregnant women. Results: The incidence of abruptio placentae was 0.35%. The two groups of woman wne similar with regard to age and parity. Abruptio placentae grades 2 occurred more often in hypertensive women (P=0.0053). Pregnancy-inducedhypertensive women were similar to normotensive women with regard to antenatal complications. The mean gestational age of delivery, delivery route, neonatal weight and sex were similar between two groups of women. Neonates from pregnancy-induced hypertensive women were no more likely to have low 1 and 5-minute Apgar score or to die than those from normotensive women. Statistical analysis was performed with two-tailed independent t-test and Kruskal-Wallis analysis. Conclusion: Although pregnancy-induced hypertensive women experiencing abruptio placentae are more likely to have grade 2 abruptio placentae with fetal distress, the overall perinatal outcome was not significantly different from that of normotensive women experiencing abruptio placentae.

정상 임신과 자궁내 발육제한 , 임신성 고혈압 환자의 태반에서 고사와 bcl - 2 발현에 관한 연구

최상준(Sang Joon Choi),문현주(Hyun Ju Moon),박성훈(Sung Hun Park),이경(kyung Lee),안태규(Tae Gyu Ahn),송창훈(Chang Hoon Song),한세준(Sae Jun Han),정혁(Hyuk Jung),임성철(Sung Chul Lim),박창수(Chang Soo Park) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 본 연구는 정상 임신에서 태반 성장 과정에 일어나는 고사와 자궁내 발육지연 및 임신성 고혈압이 있는 임신 태반에서 나타나는 고사의 차이를 비교하고, bcl-2 발현 관계를 비교하여 자궁내 발육지연의 태반변화를 알고자 시행하였다. 연구 대상 및 방법 : 연구 대상은 임신 제1 삼분기(8주-14주) 15예, 제 2삼분기(24주-28주) 13예, 만삭임신(37주-41주) 30예의 태반과 자궁내 발육지연(34주-41주) 10예, 임신성 고혈압 임신(28주-39주) 8예의 태반을 이용하였고, 헤마톡실린 에오신 염색, TUNEL 염색, 면역 조직 화학 염색을 하여 고사 세포와 bcl-2 발현 여부를 관찰하여 다음과 같은 결론을 얻었다. 결과 : 1. 고사 세포는 임신 제1 삼분기에 1.84±1.24, 제2 삼분기에 1.13±0.97, 만삭임신에 2.11±1.52를 보여 만삭임신에서 의의있게 증가하였다(p<0.05, Kruskal Wallis u test). 2. 고사 세포는 자궁내 발육지연 임신 태반에서 3.30±1.07, 임신성 고혈압 산모의 태반에서 3.11±1.25로 자궁내 발육지연 임신 태반에서 만삭임신에 비해 증가하였다(p<0.05, Mann-Whitney u test). 3. bcl-2는 태반 세포 고사가 가장 적은 임신 2삼분기 때 발현이 높았다(p<0.05, Kruskal Wallis u test). 결론 : 본 연구를 통해 고사는 인간의 태반조직내에서 일어나는 정상 생리 작용이며 태반의 성장이 가장 왕성한 시기, 만삭임신에 제일 많이 일어난다는 것을 알게 되었다. Objective : Placenta is organ which is growing from early pregnancy and which is senescent in late pregnancy. During senescent process, apoptosis has been correlated with gestational weeks and birth weight. Methods : Formalin fixed paraffin embedded tissues from 30 term pregnancy normal placental samples, 13 second trimester placental samples, 15 first trimester placental samples, 10 placental samples of intrauterine growth restriction and 8 placental samples of pregnancy induced hypertension. Light microscopy, electron microscopy, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate marker nick end-labeling staining were used to identify apoptosis. Immunohistochemical stain was performed by microprobe system(Fisher Co) Results : Apoptosis has been demonstrating within placental tissue. Quantification of apoptosis(medians) was as follows; first trimester (n=15)1.84±1.24, second trimester(n=13)1.13±0.97, term pregnancy(n=30)2.11±1.52, intrauterine growth restriction(n=10)3.30±1.07, PIH(n=8) 3.11±1.25. Incidence of apoptosis was significantly higher in placental samples from term pregnancy than second trimester (p<0.05, Kruskal Wallis u test) and also higher in placental samples of intrauterine growth restriction than term pregnancy (p<0.05, Mann-Whitney u test). bcl-2 expression was maximal during the second trimester (p<0.05,Kruskal Wallis u test) and no statistic significance between term pregnancy and intrauterine growth restriction and between term pregnancy and PIH. Conclusion : These data suggest that programmed cell death(Apoptosis) is a naturally occurring physiologic process in the human placenta and that the period of maximal placental growth, second trimester is associated with an increased expression of cell survival factors.

임신성고혈압에서 Caspase-related M30 CytoDeath 발현을 이용한 영양막세포고사 연구

김호진,박혜숙,김영주,박보현,이화영 대한해부학회 2004 Anatomy & Cell Biology Vol.37 No.1

Pregnancy-induced hypertension (PIH) is a multi-system disorder unique to human pregnancy. Although theetiology of PIH is still unknown, there is a large evidence suggesting that abnormal trophoblast invasion is occurring inearly pregnancy and that this may contribute to relative placental hypoxia and oxidative stress that may furtherexacerbate placental pathology. This study was undertaken to determine placental Cu/Zn superoxide dismutase (SOD)and Mn SOD activities and evaluate the use of M30 CytoDeath antibody to assess trophoblasts apoptotic activity innormal and PIH pregnancies. We also compared apoptotic rates as detected by M30 and TdT-mediated dUTP nickendlabelling (TUNEL). Placental expression of Cu/Zn SOD and Mn SOD were reduced in PIH as compared to normalpregnancies. M30 immunoreactivity occurred predominantly in the syncytiotrophoblasts, and a significantly highernumber of M30 positive cells in the preeclamptic placentas were found when compared with normal placentas. Thenumber of M30 positive cells correlated with another apoptotic index previously detected by TUNEL method. ─임신성고혈압에서 Caspase-related M30 CytoDeath 발현을이용한 영양막세포고사 연구김호진1, 박혜숙2, 김영주3, 4, 박보현2, 이화영1, 4*이화여자대학교 의과대학 1해부학교실, 2예방의학교실, 3산부인과학교실4이화여자대학교 의과학연구소임신성고혈압은 모체와 주산기의 사망률 및 이환률을 높이는 주요 원인이며 이의 발병에 관한 명확한 병리기전은 밝혀져있지 않으나, 태반형성 시 비정상적인 영양막 침윤으로 인한 나선동맥의 불충분한 생리학적 변화와 이로 인한 태반허혈 및산화손상이 모체의 혈관내피세포 기능변화를 유발하고, 태반의 구조적 변화를 악화시키는 것으로 알려져 있다. 본 연구는 임신성고혈압의 태반내 항산화상태와 영양막의 세포고사를 조사하고자, 정상 임산부와 임신성고혈압 환자의 출산 시 분리된태반을 대상으로 태반 내 Cu/Zn superoxide dismutase (SOD) 및 Mn SOD의 함량을 측정하였다. 또한 영양막 세포고사 연구를위하여 근래에 개발된 M30 CytoDeath 발현과 기존의 TdT-mediated dUTP nickend labelling (TUNEL)을 병행하여 관찰하고이를 통계적으로 분석, 비교하였다. 태반에 함유된 Cu/ Zn SOD와 Mn SOD 활성은 정상임신에 비하여 임신성고혈압에서 의미있게 감소되었으며, 세포고사를 표지하는 M30발현을 통하여 임신성고혈압의 융합영양막에서 그 반응성과 발현세포의 숫적증가가 관찰되었다.찾아보기 낱말 : 임신성고혈압, 영양막, 산화손상, 세포고사, SOD, M30Ho Jin Kim, Hyesook Park, Young Ju Kim, Bohyun Park, Hwayoung Lee 59

Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy

원현선,김도이,양문석,이성자,신현호,박정배 대한심장학회 2011 Korean Circulation Journal Vol.41 No.1

Background and Objectives: The aim of this study was to identify the association of pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) with the development of venous thromboembolism (VTE). Subjects and Methods: This was a retrospective study of 57,009 pregnancies during 2002-2008 at Cheil General Hospital, Kwandong University. The diagnosis of VTE {deep vein thrombosis or pulmonary embolism (PE)} was based on clot visualization via ultrasound or computed tomography. Results: In total, 27 cases (PE, 20 cases) were detected. The incidence of VTE was 0.47 per 1,000 pregnancies. To determine risk factors associated with pregnancy-induced VTE, univariate analysis using a chi-square test was performed. Cesarean (C)-section, multiple pregnancy, PIH, placenta previa, and assisted reproduction technique (ART) were statistically significant compared to the controls (all, p=0.000). However, age, premature rupture of membrane, and GDM were not statistically related to VTE. Logistic regression analysis was used to calculate the odds ratios for the risk factors. Placenta previa showed a 12.6-fold higher risk, while PIH had a 9.8-fold higher risk for the occurrence of VTE. C-section and ART procedures increased the risk of VTE by 4.2 times compared to that of the controls. Conclusion: Placenta previa and PIH were significant risk factors for VTE, whereas the known traditional risk factors of increased age and GDM were not found to be associated with VTE.

Increased Apoptotic Activity of Human Trophoblasts in Pregnancy-Induced Hypertension: Assessment by the Caspase-related M30 CytoDeath Antibody

김호진(Ho Jin Kim),박혜숙(Hyesook Park),김영주(Young Ju Kim),박보현(Bohyun Park),이화영(Hwayoung Lee) 대한해부학회 2004 Anatomy & Cell Biology Vol.37 No.1

임신성고혈압은 모체와 주산기의 사망률 및 이환률을 높이는 주요 원인이며 이의 발병에 관한 명확한 병리기전은 밝혀져 있지 않으나, 태반형성 시 비정상적인 영양막 침윤으로 인한 나선동맥의 불충분한 생리학적 변화와 이로 인한 태반허혈 및 산화손상이 모체의 혈관내피세포 기능변화를 유발하고, 태반의 구조적 변화를 악화시키는 것으로 알려져 있다. 본 연구는 임신성고혈압의 태반내 항산화상태와 영양막의 세포고사를 조사하고자, 정상 임산부와 임신성고혈압 환자의 출산 시 분리된 태반을 대상으로 태반 내 Cu/Zn superoxide dismutase (SOD) 및 Mn SOD의 함량을 측정하였다. 또한 영양막 세포고사 연구를 위하여 근래에 개발된 M30 CytoDeath 발현과 기존의 TdT-mediated dUTP nickend labelling (TUNEL)을 병행하여 관찰하고 이를 통계적으로 분석, 비교하였다. 태반에 함유된 Cu/ Zn SOD와 Mn SOD 활성은 정상임신에 비하여 임신성고혈압에서 의미있게 감소되었으며, 세포고사를 표지하는 M30발현을 통하여 임신성고혈압의 융합영양막에서 그 반응성과 발현세포의 숫적증가가 관찰되었다. Pregnancy-induced hypertension (PIH) is a multi-system disorder unique to human pregnancy. Although the etiology of PIH is still unknown, there is a large evidence suggesting that abnormal trophoblast invasion is occurring in early pregnancy and that this may contribute to relative placental hypoxia and oxidative stress that may further exacerbate placental pathology. This study was undertaken to determine placental Cu/Zn superoxide dismutase (SOD) and Mn SOD activities and evaluate the use of M30 CytoDeath antibody to assess trophoblasts apoptotic activity in normal and PIH pregnancies. We also compared apoptotic rates as detected by M30 and TdT-mediated dUTP nickend labelling (TUNEL). Placental expression of Cu/Zn SOD and Mn SOD were reduced in PIH as compared to normal pregnancies. M30 immunoreactivity occurred predominantly in the syncytiotrophoblasts, and a significantly higher number of M30 positive cells in the preeclamptic placentas were found when compared with normal placentas. The number of M30 positive cells correlated with another apoptotic index previously detected by TUNEL method.

Zonulin as marker of pregnancy induced hypertension: a case control study

Bawah Ahmed Tijani,Tornyi Henry,Seini Mohammed Mustapha,Ngambire Lincoln Toamsoma,Yeboah Francis Agyemang 대한고혈압학회 2020 Clinical Hypertension Vol.26 No.3

Background: Zonulin has been implicated in many metabolic disorders including hypertension and obesity. However, there is insufficient information about the involvement of zonulin in pregnancy induced hypertension (PIH) which comprises preeclampsia (PE) and gestational hypertension (GH). This study was therefore aimed at finding the level of this biochemical marker of regulation of tight junctions among women with PIH. Methods: A total of 88 women with PIH and 60 age and body mass index (BMI) matched healthy pregnant women controls were enrolled. Blood pressure at 11–13 weeks and after 20 weeks of gestation, body mass index (BMI) in addition to serum Zonulin levels and lipid profile were compared between the groups. Student’s t-test was used for comparisons of the mean between the two groups. Correlation analyses were performed using Pearson’s correlation and binary logistic regression was used to evaluate the factors associated with PIH. Results: Zonulin level was significantly higher in the participants with PIH as compared to the normal pregnant controls 56.81 ± 7.72 ng/ml vs 40.4 ± 8.60 ng/ml p < 0.0001 and had strong positive correlation with PIH (OR = 1.805; CI1.139–1.275; p < 0.0001). However, the association between first trimester lipids and PIH was weak. Conclusion: The results showed a strong positive correlation between zonulin and PIH, thus changes in intestinal permeability occur in early stages of pregnancy and may be involved in the pathogenesis of PIH.

Folic acid alone or multivitamin containing folic acid intake during pregnancy and the risk of gestational hypertension and preeclampsia through meta-analyses

( Sang Min Shim ),( Yeo Ul Yun ),( Yun Sook Kim ) 대한산부인과학회 2016 Obstetrics & Gynecology Science Vol.59 No.2

Objective The objective of this study was to assess the effect of folic acid and multivitamin use during pregnancy on the risk of developing of hypertensive disorder of pregnancy. Methods Two reviewers independently determined all prospective cohort study, retrospective cohort study, large population based cohort study, retrospective secondary analysis, and double blinded, placebo-controlled, randomized clinical trial published using PubMed Medline database, KERIS (Korea Education and Research Information Service), Scopus, and the Cochrane Central Register of controlled trials comparing before conception throughout pregnancy intake oral multivitamin containing folic acid or folic acid alone. Meta-analyses were estimated with odds ratios and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. Results Data from six effect sizes from six studies involving 201,661 patients were enrolled. These meta-analyses showed multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence (odds ratio, 0.91; 95% CI, 0.81 to 1.03) than the placebo. And the difference of effective sizes of preeclampsia and gestational hypertension according to two dependent variables, multivitamin and folic acid were not significant, respectively (point estimate, 0.66; 95% CI, 0.46 to 0.96). Conclusion These meta-analyses demonstrate multivitamin containing folic acid or folic acid alone was not significantly effective in reducing gestational hypertension or preeclampsia incidence.