臨床婦人科産科72巻3号

2018年04月発行

今月の臨床 ここが知りたい！　早産の予知・予防の最前線 早産の予知

Q. 早産予知に有用な子宮頸部生化学マーカーは？

著者： 大口昭英¹

所属機関： ¹自治医科大学産科婦人科学講座

ページ範囲：P.308 - P.312

〈Answer〉

現在保険適用がある腟内癌胎児性フィブロネクチン定性法は，その後の妊娠34週未満の早産について軽度から中等度の予知能があります．しかし，初妊婦に対してはその有用性は低く，また，その後の早産予防に有用とはいえません．近年，腟・頸部のalbumin/vitamin D binding protein（VDBP）比，あるいはplacental alpha microglobulin-1（PAMG-1）が癌胎児性フィブロネクチンよりも陽性的中率が高いと報告されており，今後のエビデンス集積が望まれます．

参考文献

1）平成28年（2016）人口動態統計（確定数）の概況　http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei16/index.html（2017年11月12日アクセス）

2）Honest H, et al : Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth : systematic review. BMJ 325 : 301, 2002

3）Schaaf JM, et al : Development of a prognostic model for predicting spontaneous singleton preterm birth. Eur J Obstet Gynecol Reprod Biol 64 : 150─155, 2012

4）Esplin MS, et al : Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women. JAMA 317 : 1047─1056, 2017

5）Berghella V, et al : Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor : a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 215 : 431─438, 2016

6）Nakai A, et al : Increased level of granulocyte elastase in cervical secretion is an independent predictive factor for preterm delivery. Gynecol Obstet Invest 60 : 87─91, 2005

7）Sunagawa S, et al : Comparison of biochemical markers and cervical length for predicting preterm delivery. J Obstet Gynaecol Res 34 : 812─819, 2008

8）Tanaka K, et al : Prediction of spontaneous preterm delivery in asymptomatic twin pregnancies using cervical length and granulocyte elastase. Taiwan J Obstet Gynecol 56 : 188─191, 2017

9）Conde-Agudelo A, et al : Novel biomarkers for the prediction of the spontaneous preterm birth phenotype : a systematic review and meta-analysis. BJOG 118 : 1042─1054, 2011

10）Conde-Agudelo A, et al : Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth : a systematic review and metaanalysis. Am J Obstet Gynecol 214 : 57─73, 2016

11）Liong S, et al : New biomarkers for the prediction of spontaneous preterm labour in symptomatic pregnant women : a comparison with fetal fibronectin. BJOG 122 : 370─379, 2015

12）Wing DA, et al : Placental alpha microglobulin-1 compared with fetal fibronectin to predict preterm delivery in symptomatic women. Obstet Gynecol 130 : 1183─1191, 2017

13）Melchor JC, et al : Retrospective cohort study of PAMG-1 and fetal fibronectin test performance in assessing spontaneous preterm birth risk in symptomatic women attending an emergency obstetrical unit. Ultrasound Obstet Gynecol, 2017. doi:10.1002/uog.18892

14）Yoneda N, et al : Polymicrobial amniotic fluid infection with mycoplasma/ureaplasma and other bacteria induces severe intra-amniotic inflammation associated with poor perinatal prognosis in preterm labor. Am J Reprod Immunol 75 : 112─125, 2016