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대한생식의학회지 제32권 제3호 2010년
습관성 유산 환자에서 저용량 면역글로불린 치료와 말초혈액 내 Natural Killer (NK) 세포의 임계치에 관한 연구
성균관대학교 의과대학, 삼성제일병원 산부인과 불임 및 생식내분비
차선화, ,차선화,김해숙,김혜옥,송인옥,유근재,궁미경,강인수,양광문
The Preconceptional Level of Peripheral Natural Killer Cells which was Expected to Bring Successful Treatment Outcome using Low-dose Intravenous Gamma Immunoglobulin (IVIg) Infusion in Patients with Recurrent Spontaneous Abortion
Sun Hwa Cha, Hae Suk Kim, Hye Ok Kim, In Ok Song, Keun Jai Yoo, Mi Kyung Koong, Inn Soo Kang, Kwang Moon Yang
Department of Obstetrics and Gynecology, Samsung Cheil Hospital & Women's Healthcare Center Sungkyunkwan University School of Medicine, Seoul, Korea
.
Objectives: We aimed to investigate the clinical effect of low-dose intravenous immunoglobulin treatment in unexplained recurrent spontaneous aborters (RSA) with elevated peripheral CD56+ natural killer (NK) cell levels and to determine the pre-conceptional NK cell percentage predictive of subsequent successful pregnancy outcome.
Materials and Methods: Sixty four cases of unexplained recurrent miscarriage with elevated peripheral NK cells (>15%) were received low dose IVIg infusion at the dosage of 400 mg/Kg/month after confirmation of gestational sac and continued until 20 weeks. The patients were divided into two groups according to the pregnancy outcome: Group I was success of treatment defined as live birth at or after 25 gestational weeks and Group II was failure of treatment. The preconceptional levels of the peripheral blood NK cells were compared between two groups.
Results: Fifty-three pregnancies resulted in live births after 25 weeks and 11 resulted in abortion (Overall success rate of IVIG treatment was 82.8%). Preconceptional CD56+ NK cell percentage in group II (27.4±1.9%) was higher than those in group I (22.3±0.8%). By using ROC curve, optimal discrimination between success and failure of treatment was achieved with ≤27% of preconceptional
NK cell percentage.
Conclusion: In RSA patients with elevated NK cells, we suggest that preconceptional peripheral blood CD56+ NK cell level could be a useful marker for predicting successful treatment outcome of low-dose IVIg infusion.
키워드 : Recurrent spontaneous abortion, Natural killer cell, Intravenous immunoglobulin
교신저자 : ykm2955@yahoo.co.kr
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