임신성 고혈압 환자에서 적혈구교체의 지표로서 일산화탄소 혈색소와 혈청 철의 임상적 의의

Increased Carboxyhemoglobin and Serum Iron Concentration as an Indicator of increased Red Cell Turnover in Preeclampsia

1992년 10월 1일부터 1993년 3월 31월까지 영남대학교 의과대학 부속병원 산부인과에 입원하여 만삭분만한 정상산모 35명을 대조군으로, 경증 자간전증 환자 23명을 대상군으로 일산화탄소혈색소와 혈청 철의 농도를 측정하여 다음과 같은 결과를 얻었다. 혈청철의 농도는 임신성 고혈압 환자군에서 $86.5{\pm}6.1{\mu}g/dl$, 정상 산모군에서 $53.2{\pm}6.1{\mu}g/dl$로 임신성 고혈압 환자군에서 유의성 있게 증가하였고, 일산화탄소혈색소 농도도 각 군에서 분만 전 $0.61{\pm}0.21{\mu}g/dl$, $2.55{\pm}0.4{\mu}g/dl$, 분만후 $0.53{\pm}0.2{\mu}g/dl$, $1.21{\pm}0.4{\mu}g/dl$로 임신성 고혈압 환자군에서 높게 나타났다. 간세포 손상의 근거로서 SGOT, SGOP 및 적혈구 파괴의 근거로서 혈색소치와 혈액농축의 근거로소 적혈구용적치는 각각 양 군에서 의의있는 차이가 없었다. 이상의 결과로 미루어 보아 경증 자간전증 환자군에서 정상 산모군에 비하여 혈청 철과 일산화탄소혈색소가 훨씬 증가하였음을 관찰 할 수 있었다.

Pregnancy induced hypertension is multifaceted syndrome with variable involvement of several key organ systems, so sensitive and specific laboratory tests for predicting severity and prognosis, and early diagnosis of this disease are required. Because heme catabolism results in equimolar production of carboxyhemoglobin, iron and bilirubin, a concomittant rise of these parameters would provide confirmation of increased heme catabolism. Microangiopathic hemolytic anemia may occurs in severe preeclampsia, but it is not known whether increased red cell turnover occurs with mild preeclampsia as complication. The purpose of this study was to confirm that increased heme catabolism also occurs in patients with mild preeclampsia. The analysis of data was done on 23 cases with mild preeclampsia and 35 normal pregnant women, who were admitted to Yeungnam University Hospital from October 1992 to March 1993. The results were as follows. 1. The mean antepartum serum iron concentration was significantly higher in the group with mild preeclampsia($86.5{\pm}6.1{\mu}g/dl$) than in the controls($53.2{\pm}5.3{\mu}g/dl$). 2. The mean antepartum and postpartum carboxyhemoglobin concentrations were significantly higher in the group with mild preeclampsia(antepartum : $2.55{\pm}0.42{\mu}g/dl$, postpartum : $1.21{\pm}0.4{\mu}g/dl$) than the controls(antepartum : $0.61{\pm}0.2{\mu}g/dl$, postpartum $0.53{\pm}0.2{\mu}g/dl$) 3. During postpartum, carboxyhemoglobin concentration in preeclampsia reduced significantly from antepartum level, but, there was no difference between antepartum and postpartum carboxyhemoglobin concentrations among controls. 4. Bilirubin concentrations were similar in both groups.