LH峰日子宫内膜形态及孕早期血清P／E2比值对妊娠结局的预测

The value of endometrial form on the day of luteinizing hormone （LH） surge and blood progestogen/estradiol2 （P/E：） ratio in the early pregnancy in forecasting the gestation outcome

目的：探讨LH峰日子宫内膜形态、孕早期血清激素值对妊娠结局预测的临床意义。方法：回顾性分析在本中心监测排卵受孕的患者资料，测定其LH峰日子宫内膜类型及厚度，并于出现LH峰日后2～3周测定血清雌孕激素数值，计算P／E2追踪妊娠结局，按妊娠是否超过12周分为继续妊娠组及不良妊娠组。结果：215例中子宫内膜厚度8-12mm组，临床妊娠率为92．25％；厚度〈8mm组，临床妊娠率为17．78％；厚度〉12mm组，临床妊娠率为31．71％。前者与后两者相比存在显著性差异（P〈0．05），明显高于后两者；子宫内膜类型A型组临床妊娠率为79．41％，B型组临床妊娠率为63．95％，C型组临床妊娠率为14-81％，A型组与B型组相比较，无显著型差异存在（P〉0．05），A型组与C型组相比较，存在显著性差异（P〈0．05），B型组与C型组相比较，存在显著性差异（P〈0．05）；P／E2比值为130-150组的临床妊娠率为89181％，与〈130组及〉150组相比，均有显著性差异（P〈0．05），且明显高于二者：32135％及43．84％。将孕早期孕激素水平P≥23ng/ml（均值减去一个标准差）定为诊断阈值时，灵敏度为93．57％，特异度为74．67％。结论：选择合适的子宫内膜类型及厚度有利于受精卵的着床，可明显提高妊娠成功率；早期测定血清激素值，尤其是P／E2比值可以评价官腔内环境，预测妊娠结局，对先兆流产的临床治疗也有很好的指导价值。

Objective：To study the clinical significance of endometrial shape on the day of LH surge and blood P/E2 ratio in the early pregnancy in predicting the gestation outcome. Methods ：All the information of 215 patients whose ovulation and conception monitored in our centre were collected and studied respectively. The type and thickness of endometrium on the day of LH surge were measured and then the blood Estradio12 and progestogen were tested 2-3weeks later. The outcome of pregnancy was followed up. The pregnancy was divided into continue cyesis and dys-cyesis according to the pregnant time exceeding 16 weeks or not. Results：Among the 215 cases, those with endometrial thickness 8-12mm had 92.25% clinical pregnancy rate, those with endometrial thickness less than 8mm had 17.78% and those with thickness more than 12mm had 31.71%. There was a significant difference between the former one and the later two （P〈0.005）. The patients with type A endometrial changes had 79.41% clinical pregnancy, type B 63.95% and type C 14.81%. There was significant difference between type A and type C （P〈0.05）, but no significance between type A and type B （P〉0.05）. The clinical pregnancy rate in cases with P/E2 ratio between 130 and 150 was 89.81% but in eases with P/E2 ratio 〈130 was 32.35% and P/E2 ratio 〉 150 was 43.84%. And it reached statistical significance （P〈0.005） comparing the former one with the later two. If the progestogen level ≥23ng/ml is used as a threshold value to predict the pregnancy outcome, the sensibility is 93.57% and the specificity is 74.67%. Conclusion ：The detection of P/E2 ratio in early pregnancy could be useful in predicting the pregnancy outcome.