炎症から見た早産の予知・予防戦略(<特集>第57回学術講演会シンポジウム : 早産の予防)

NDLデジタルコレクション 参考文献14件

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  • Prognostic and Preventive Strategies for Preterm Delivery from an Inflammatory Standpoint

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In these past 10 years, bacterial vaginosis, cervical shortening and cervicitis were reported to be useful prognostic markers for premature delivery. And many clinical studies have done to evaluate whether premature labor was prevented or not by treatment for patients with bacterial vaginosis or cervical shortening. However, unfortunately we cannot find any randomized controlled trial that prevent preterm delivery. In this study, we measured cervical length and IL-8 concentrations in cervical mucus at weeks 20 to 28 of gestation, and investigated whether treatment for cervical shortening or IL-8 elevations decreased premature birth and pPROM. The values of cervical mucus IL-8 were measured by ELISA method. Successful treatment for women with IL-8 elevations in cervical mucus decreased rates of premature birth or pPROM. However, we did not find a decrease in premature births or pPROM attributable to treatment for cervical shortening. Next, we evaluated effectiveness of cerclage for short cervix in the mid trimester, from inflammatory point of view. Among patients with a short cervix, preterm delivery was more likely when cervical mucus IL-8 was elevated. When cervical mucus IL-8 was high, preterm delivery was more likely with than without cerclage. With cervicitis, cerclage for cervical shortening may be harmful. We investigated the relationship between vaginal pathogens and values of IL-8 in cervical mucus. Absence of vaginal Lactobacilli species and presence of anaerobic pathogens were associated with increased cervical IL-8 and increased risk of premature delivery. Bacterial vaginosis, which was known to be a risk factor of premature labor, have been considered as status with decrease of the Lactobacilli species and increase of G. vaginalis and Bacteroides, without inflammation. In this study, however, it became clear that absence of Lactobacillus genus with inflammation such as elevated cytokine concentrations in cervical mucus or increased granulocyte counts in cervical secretion raise a risk for premature labor. General obstetric hospitals presumably would be unable to screen all pregnant women for IL-8 elevations. A more simple and cost-effective method that correlates well with cervical mucus IL-8 is needed. We evaluated correlation between granulocyte counts and the value of IL-8 in cervical mucus, and ability for predicting preterm delivery. Granulocyte counts were calculated by microscopically. The measurement of cervical mucus granulocyte counts in the mid-trimester is cheap and simple method for screening cervicitis.

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