Winkler M, Heyl W, Reister F, Rath W
Frauenklinik für Gynäkologie und Geburtshilfe der Rheinisch-Westfälischen Technischen Hochschule (RWTH), Aachen.
Geburtshilfe Frauenheilkd. 1996 Jun;56(6):317-21. doi: 10.1055/s-2007-1023237.
Silent intrauterine infection is a frequent cause of preterm labour. Maternal C-reactive protein (CRP) and leukocyte count are important predictors of such infections. Treatment with corticosteroids is known to elevate leukocyte count and in this manner can possibly interfere with its accuracy as a predictor of infection. Therefore, we investigated the impact of antenatal administration of 16-methylene-prednisolone (Decortilen solubile) on the maternal serum level of CRP and leukocyte count. Furthermore, we determined the haptoglobin, the platelet count as well as the percentage of stab cells and lymphocytes.
20 patients with preterm labour between 25 + 6 and 34 + 2 weeks of gestation were enrolled in a prospective study. Premature rupture of the membranes, uterine bleeding, infection and treatment with antibiotics were criteria for exclusion. Three doses (60 mg) of Decortilen solubile were given intravenously 24 h apart. Blood samples were obtained before, twice a day (8.00 a.m. and p.m.) during treatment and until the day 4 after termination of corticosteroid treatment. For statistical analysis the Wilcoxon rank sum test was used.
Before corticosteroid treatment the medians (range) were: CRP: 5.2 ( < 5.0-28.0) mg/l, haptoglobin: 1.4 (0.7-2.0) g/l, leukocytes: 10.5 (5.2-16.0) G/l, platelets: 246 (128-424) G/l, stabs: 9.5 (3.0-14.0)% and lymphocytes: 28.5 (16.0-50.0)%. During the after termination of corticosteroid administration no significant changes in the CRP and haptoglobin levels were seen. The leukocyte count was unchanged during treatment and decreased on day 1-2 after termination of treatment. The platelet count remained unchanged during corticosteroid treatment and increased significantly thereafter. The stab cell percentage increased slightly from day 1-2 to day 3-4 after termination of treatment. The lymphocyte percentage increased during treatment and decreased significantly from day 1-2 to day 3-4 after treatment.
Decortilen solubile treatment is not associated with an increase in maternal CRP-level and leukocyte count. We emphasise that the accuracy especially of the CRP for early prediction of silent infection in preterm labour does not seem to be impaired by this corticosteroid in a dosage usually administered for prevention of respiratory distress syndrome.
无症状宫内感染是早产的常见原因。母体C反应蛋白（CRP）和白细胞计数是此类感染的重要预测指标。已知使用皮质类固醇治疗会使白细胞计数升高，从而可能干扰其作为感染预测指标的准确性。因此，我们研究了产前给予16-亚甲基泼尼松龙（可溶性去炎松）对母体血清CRP水平和白细胞计数的影响。此外，我们还测定了触珠蛋白、血小板计数以及杆状核细胞和淋巴细胞的百分比。
20例妊娠25 + 6至34 + 2周的早产患者纳入一项前瞻性研究。胎膜早破、子宫出血、感染和使用抗生素治疗均为排除标准。每隔24小时静脉注射3剂（60毫克）可溶性去炎松。在治疗前、治疗期间每天两次（上午8点和下午）以及皮质类固醇治疗结束后第4天采集血样。统计分析采用Wilcoxon秩和检验。
在皮质类固醇治疗前，中位数（范围）为：CRP：5.2（<5.0 - 28.0）毫克/升，触珠蛋白：1.4（0.7 - 2.0）克/升，白细胞：10.5（5.2 - 16.0）×10⁹/升，血小板：246（128 - 424）×10⁹/升，杆状核细胞：9.5（3.0 - 14.0）%，淋巴细胞：28.5（16.0 - 50.0）%。在皮质类固醇给药结束后，CRP和触珠蛋白水平未见明显变化。白细胞计数在治疗期间未改变，在治疗结束后第1 - 2天下降。血小板计数在皮质类固醇治疗期间保持不变，此后显著增加。杆状核细胞百分比在治疗结束后第1 - 2天至第3 - 4天略有增加。淋巴细胞百分比在治疗期间增加，在治疗后第1 - 2天至第3 - 4天显著下降。
可溶性去炎松治疗与母体CRP水平和白细胞计数升高无关。我们强调，对于早产中无症状感染的早期预测，尤其是CRP的准确性，似乎不会因通常用于预防呼吸窘迫综合征的这种皮质类固醇剂量而受到损害。
