妊娠早期妇女血清性激素水平及与先兆流产的关系

The relationship between serum hormone level and threatened abortion in early pregnancy

目的探讨血清人绒毛膜促性腺激素(HCG)、孕酮(P)和雌二醇(E2)水平在妊娠早期(4-10周)中的浓度变化;以及先兆流产出血组与正常妊娠组这三种性激素的浓度差异。方法选择在北京妇产医院妇幼保健院就诊妊娠4-10周的妇女279例,B超监测至看到原始心血管搏动后定期产科检查。将其分为两组:正常妊娠组213例和先兆流产出血组66例;再按孕周分为6个亚组(9-10周为一组)。采用化学发光分析法检测孕妇血清中HCG、孕酮、雌二醇水平。结果两组HCG、E2水平与孕周均呈正相关,孕酮水平与孕周无相关性。正常妊娠组与先兆流产出血组HCG:4-7孕周水平无明显差异,但≥8周两组存在明显差异。孕酮:4孕周和大于8孕周水平差异无统计学意义,5至8孕周水平差异有统计学意义;雌二醇:各孕周水平差异有统计学意义。结论先兆流产出血组孕妇各孕周血清HCG、E2水平虽能与孕周成正相关,但r值均低于正常组,同时HCG>8孕周两组有差异,提示先兆流产出血组胚胎活性低于正常组。两组孕酮与雌二醇t-检验结果,提示孕酮、雌二醇水平都是维持早期妊娠的重要因素,先兆流产出血组E2低于正常组显著。妊娠早期进行HCG和孕酮联合雌二醇浓度监测能预测先兆流产病情的危险性,合适的雌孕激素比值是保持良好妊娠结局的重要素。

Objective To explore the level of HCG,P and E2 in early gestation（4-10 w） and the difference of serum level HCG,P and E2 between threatened abortion and pregnancy women.Methods 279 pregnant women,who had conceived from 4 to 10 weeks were previously divided into 2 groups：213 with normal pregnancy and 66 with threatened abortion,and then each group was divided into 6 subgroups based upon gestational age（9-10 weeks for a group）.chemiluminescent immunoassay（CLIA） was used to determine the levels of HCG、P and E2.Results With an increase of age,the levels of serum HCG and E2 in both groups are significantly increased（normal pregnancy：HCG r=0.693,E2 r=0.695;threatened abortion：HCG r=0.631,E2 r=0.56;P0.05）,and the level of progesterone does not have any relationship with the gestational age.The level of HCG 4 to 8 weeks in both groups does not have any remarkable difference（P0.05）,but longer than 8 weeks（P0.05）.So it is the progesterone in women of 4 weeks and longer than 8 weeks（P0.05）,while there was difference in women of 5-8 weeks（P0.05）;There was significant difference of E2 level during different gestational age.Conclusion Though the serum level of HCG、P and E2 is significantly increased with an increase of age in wemen with the threatened abortion,it is lower than the level of wemen with normal pregnancy.Suggesting that the embryo activity in wemen with the threatened abortion is not good as the wemen with normal pregnancy.The two T-check results of P and E2 suggest that serum P and E2 should be the important factor supporting early pregnancy,the level of E2 in wemen with the threatened abortion was lower than the wemen with normal pregnancy.