高龄早期复发性流产患者流产原因分析

Etiology of Early Recurrent Spontaneous Abortion in Women with Advanced Maternal Age

【目的】探讨高龄早期复发性流产患者的流产原因。【方法】回顾性分析2008年1月至2012年10月,在我院诊治的高龄早期复发性流产患者的病历资料,对已行系统病因学检查,并且流产后成功行绒毛染色体分析的82例患者的病因分布进行分析。并比较了高龄早期复发性流产与高龄偶发性早期流产的绒毛染色体异常发生率,原发性流产与继发性流产的病因分布,不同流产次数的复发性流产患者的病因分布。【结果】高龄偶发性流产的绒毛染色体异常发生率(85.1%)高于复发性流产的染色体异常发生率(67.1%),(P<0.05)。胚胎染色体异常是高龄复发性流产最主要的流产原因(67.1%),其次是内分泌因素(24.4%,包括亚临床甲状腺功能减退、PCOS、DM、高PRL)、子宫异常(19.5%,主要为子宫纵隔和宫腔粘连)、APA阳性(12.2%)、夫妇染色体异常(3.7%)、感染(2.4%),真正不明原因的复发性流产占15.9%。原发性与继发性流产的病因分布无明显差异。不同流产次数的复发性流产患者的病因分布无明显差异。【结论】胚胎染色体异常是高龄早期复发性流产的最主要原因,对复发性流产患者不仅要行传统的流产病因学检查,还应对流产胚胎组织进行染色体检查,以进一步明确流产原因,及时给予合理的诊治。

[Objective ] To investigate the etiology of early recurrent spontaneous abortion （RSA） in patients with advanced maternal age. [Methods] From January 2008 to October 2012, the data of 82 early RSA patients with advanced maternal age who underwent both conventional examination for RSA and karyotype analysis on products of conception were retrospectively analyzed. The rate of abnormal embryonic karyotype in patients with RSA was compared to that with sporadic spontaneous abortion （SSA）. The distribution of causes in primary and secondary RSA was also compared. The distribution of causes of RSA among woman with different number of prior spontaneous abortion were compared. [ Results ] The rate of abnormal embryonic karyotype in patients with SSA was higher than that of patients with RSA （85.1% vs 67.1%）. Embryonic karyotype anomaly was the most frequent （67.1%） causes of RSA. The prevalence of endocrinologic factor, uterine anomaly, APA positive, parental chromosomal abnormality and infection were 24.4%, 19.5%, 12.2%, 3.7%, and 2.4%, respectively. The prevalence of RSA of truly unexplained causes was 15.9%. The distribution of causes of early RSA in primary and secondary RSA had no difference. The distribution of causes did not differ among patients with different spontaneous abortion numbers. [ Conclusions ] Abnormal embryonic karyotype was the most common cause of RSA in patients with advanced maternal age. Embryonic karyotype analysis should be added to the list of evaluation items in women with RSA.