早期先兆流产妇女血浆β-内啡肽的研究

Plasma β-endorphin levels in early threatened abortion

为了解有自然流产史早期先兆流产妇女外周血浆β内啡肽（βＥＰ）、促性腺激素释放激素（ＧｎＲＨ）、人绒毛膜促性腺激素（ｈＣＧ）和孕酮（Ｐ４）的变化。随机选择孕７～８周的有反复自然流产史的先兆流产妇女２０例，于治疗前及后（孕１０～１２周）测血浆βＥＰ、ＧｎＲＨ、ｈＣＧ和Ｐ４水平（ＲＩＡ法）。随机选择正常早孕妇女２０名，分别于孕７～８和１０～１２周进行上述４项测定，收集孕１０～１２周不全流产妇女外周血同样进行以上测定，后两组作为对照。结果：（１）正常早孕妇女孕１０～１２周血浆βＥＰ、ＧｎＲＨ、ｈＣＧ和Ｐ４水平比孕７～８周时值明显上升（Ｐ＜０．０１）。（２）孕７～８周时，先兆流产妇女血浆βＥＰ值明显高于正常相应孕周水平（Ｐ＜０．０１），ＧｎＲＨ、ｈＣＧ和Ｐ４则明显低于正常早孕组（Ｐ＜０．０１）。经过给予心理支持、中药综合治疗后，先兆流产症状消失，１６例足月分娩，其孕１０～１２周时的４项水平与相应孕周间无显著差异（Ｐ＞０．０５）。（３）不全流产组除血βＥＰ值明显高于正常早孕组水平（Ｐ＜０．０１）外，其他则明显低于正常妊娠早孕组水平（Ｐ＜０．０１）。认为βＥＰ在自然流产的发生中可能起着重要作用。

Objective: To observe plasma βendorphin (βEP) and gonadotrophin releasing hormone (GnRH), human chorionic gonadotrophin (hCG), progesterone (P4) levels in women of early threatened abortion and with a history of recurrent spontaneous abortions (RSA).Methods: Twenty patients of threatened abortion in 7～8 weeks of gestation were recruited, all of them had a history of 3 or more recurrent unexplained abortions. They were treated with psychological consultation accompanied by traditional Chinese herbs. Blood samples were taken to measure βEP,GnRH, hCG and P4 levels by RIA. The treatments were continued till 10～12 weeks, blood were taken again to compare the changes of these peptides/hormones. Twenty normal pregnant women in 7～8 and 10～12 weeks and 20 incomplete abortion patients in 10～12 weeks composed of two control groups.Results: (1)In normal pregnant women,plasma βEP,GnRH,hCG and P4 levels of 10～12 weeks were significantly higher than that in 7￣8 weeks (P<0.01). (2) In threatened abortive patients with RSA, plasma βEP levels of 7￣8 weeks were significantly higher than that in normal pregnant women (P<0.01),on the contrary, plasma GnRH,hCG and P4 levels in these patients were significantly lower than that in normal cases (P<0.01). After treatment, 16 of the 20 patients succeeded in maintaining their pregnancies, the levels of four plasma contents during 10～12 weeks were similar to those in normal cases (P>0.05). (3) Plasma βEP levels in patients with incomplete abortions of 10￣12 weeks were dramatically higher and GnRH,hCG and P4 lower than that in normal cases (P<0.01)Conclusion: βEP might play an important role in the pathophysiology of spontaneous abortion.