臨床婦人科産科70巻1号

2016年01月発行

合併増大号　今月の臨床 難治性の周産期common diseaseへの挑戦 反復後期流・早産の治療

絨毛膜羊膜炎に対する薬物療法の有効性と限界について

著者： 小谷友美¹

所属機関： ¹名古屋大学産婦人科

ページ範囲：P.36 - P.41

●抗菌薬投与は母児の予後を改善する．

●現時点での薬物療法の効果には限界があり，娩出時期を逸しないよう注意する．

●児の脳保護薬が期待されている．

参考文献

1） Romero R, et al : Preterm labor : one syndrome, many causes. Science 345 : 760─765, 2014

2） Chapman E, et al : Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev （12） : CD010976, 2014

3） Saccone G, et al : Antibiotic prophylaxis for term or near-term premature rupture of membranes : metaanalysis of randomized trials. Am J Obstet Gynecol 212 : 627. e621─629, 2015

4） Flenady V, et al : Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev （12） : CD000246, 2013

5） Shiozaki A, et al : Intestinal microbiota is different in women with preterm birth : results from terminal restriction fragment length polymorphism analysis. PLoS One 9 : e111374, 2014

6） Bauer AJ, et al : Pravastatin attenuates hypertension, oxidative stress, and angiogenic imbalance in rat model of placental ischemia-induced hypertension. Hypertension 61 : 1103─1110, 2013

7） Redelinghuys MJ, et al : Antimicrobial susceptibility patterns of Ureaplasma species and Mycoplasma hominis in pregnant women. BMC Infect Dis 14 : 171, 2014

8） Nair V, et al : Azithromycin and other macrolides for prevention of bronchopulmonary dysplasia : a systematic review and meta-analysis. Neonatology 106 : 337─347, 2014

9） Ueno T, et al : Eukaryote-made thermostable DNA polymerase enables rapid PCR-based detection of mycoplasma, ureaplasma and other bacteria in the amniotic fluid of preterm labor cases. PLoS One 10 : e0129032, 2015

10） Sotiriadis A, et al : Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm : a systematic review and meta-analysis. Obstet Gynecol 125 : 1385─1396, 2015

11） Been JV, et al : Antenatal steroids and neonatal outcome after chorioamnionitis : a meta-analysis. BJOG 118 : 113─122, 2011

12） Vogel JP, et al : New WHO recommendations to improve the outcomes of preterm birth. Lancet Glob Health 3 : e589─590, 2015

13） Kamyar M, et al : Magnesium sulfate, chorioamnionitis, and neurodevelopment after preterm birth. BJOG, 2015［Epub ahead of print］

14） Combs CA, et al : 17-hydroxyprogesterone caproate for preterm rupture of the membranes : a multicenter, randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 213 : 364. e1─364. e12, 2015

15） Guzeloglu-Kayisli O, et al : Mechanisms of chorioamnionitis-associated preterm birth : interleukin-1beta inhibits progesterone receptor expression in decidual cells. J Pathol, 2015［Epub ahead of print］

16） Furcron AE, et al : Vaginal progesterone, but not 17alpha-hydroxyprogesterone caproate, has anti-inflammatory effects at the murine maternal-fetal interface. Am J Obstet Gynecol, 2015［Epub ahead of print］

17） De Nicola AF, et al : Progesterone protective effects in neurodegeneration and neuroinflammation. J Neuroendocrinol 25 : 1095─1103, 2013

18） Gao F, et al : Magnesium sulfate provides neuroprotection in lipopolysaccharide-activated primary microglia by inhibiting NF-kappaB pathway. J Surg Res 184 : 944─950, 2013

19） Lamhot VB, et al : Magnesium sulfate prevents maternal inflammation-induced impairment of learning ability and memory in rat offspring. Am J Obstet Gynecol, 2015［Epub ahead of print］

20） Leuchter RH, et al : Association between early administration of high-dose erythropoietin in preterm infants and brain MRI abnormality at term-equivalent age. JAMA 312 : 817─824, 2014

21） Robertson NJ, et al : Melatonin augments hypothermic neuroprotection in a perinatal asphyxia model. Brain 136 : 90─105, 2013

22） Gitto E, et al : Correlation among cytokines, bronchopulmonary dysplasia and modality of ventilation in preterm newborns : improvement with melatonin treatment. J Pineal Res 39 : 287─293, 2005

23） Chang EY, et al : N-acetylcysteine prevents preterm birth by attenuating the LPS-induced expression of contractile associated proteins in an animal model. J Matern Fetal Neonatal Med 25 : 2395─2400, 2012

24） Beloosesky R, et al : Maternal N-acetyl-cysteine（NAC） protects the rat fetal brain from inflammatory cytokine responses to lipopolysaccharide（LPS）. J Matern Fetal Neonatal Med 25 : 1324─1328, 2012

25） Gilgun-Sherki Y, et al : Antioxidant therapy in acute central nervous system injury : current state. Pharmacol Rev 54 : 271─284, 2002

26） Ohta S : Molecular hydrogen as a novel antioxidant : overview of the advantages of hydrogen for medical applications. Methods Enzymol 555 : 289─317, 2015

27） Hattori Y, et al : Maternal molecular hydrogen treatment attenuates lipopolysaccharide-induced rat fetal lung injury. Free Radic Res 49 : 1026─1037, 2015

28） Mano Y, et al : Maternal molecular hydrogen administration ameliorates rat fetal hippocampal damage caused by in utero ischemia-reperfusion. Free Radic Biol Med 69 : 324─330, 2014