探讨孕激素诱导的封闭因子与早期先兆流产结局的关系

Relationship between progesterone-induced blocking factor and outcome of threatened abortion

目的通过动态测定地屈孕酮（达芙通）治疗前后的早期先兆流产患者血清及尿液中孕激素诱导的封闭因子（PIBF）的表达水平,探讨PIBF与早期先兆流产结局的关系及临床意义。方法观察80例2013年7月至12月在苏州大学附属第一医院就诊的孕5～12周的妇女。正常妊娠组40例;早期先兆流产组40例。先兆流产组中32例为妊娠继续组,即经过口服达芙通保胎成功;妊娠失败组8例,即经过口服达芙通后最终难免流产。采用酶联免疫吸附法（ELISA）测定血清及尿液中PIBF水平。结果 （1）正常妊娠组和妊娠继续组血清及尿液PIBF浓度随孕周增长逐渐升高。（2）治疗前,先兆流产组血清及尿液PIBF浓度明显低于正常妊娠组,差异有统计学意义（P〈0.05）。（3）妊娠继续组达芙通治疗后血清及尿液PIBF浓度达到正常妊娠组水平,差异无统计学意义（P〉0.05）。（4）妊娠失败组血清及尿液PIBF浓度明显低于正常妊娠组和妊娠继续组,差异有统计学意义（P〈0.05）。（5）根据ROC曲线,早期先兆流产患者,血清PIBF〉197.45ng/ml、尿液PIBF〉16.50ng/ml时可以作为保胎成功的预测指标。结论达芙通用于早期先兆流产患者,可以提高患者血清及尿液中PIBF水平,并发挥保胎作用。妊娠早期低浓度血清及尿液PIBF水平有助干预测先兆流产孕妇不良妊娠结局。

Objective： To explore the relationship between progesterone-induced blocking factor（PIBF） and the outcome of early threatened abortion by dynamically measuring serum and urine PIBF levels before and after dydrogesterone（Duphaston）treatment in early threatened abortion patients. Methods： Eighty pregnant women between 5 and 12 weeks participated in this study in the Department of Gynecology of the First Affiliated Hospital of Soochow University from July 2013 to December 2013. Among them, 40 patients were normal pregnancy（ normal pregnancy group）and 40 patients with early threatened abortion（early threatened abortion group）. After administration of Duphaston, 32 patients（continued pregnancy group）maintained pregnancy and the other 8 patients（abortion group）lost pregnancy among 40 patients of early threatened abortions. The serum and urine PIBF levels were measured by using enzyme linked immunosorbent assay（ELISA）. Results： The serum and urinary PIBF levels were increased along with the gestational weeks in normal pregnancy group and continued pregnancy group. The serum and urinary PIBF levels before treatment were significantly lower in early threatened abortion group than the normal pregnancy group（P〈0.05）. After treatment, the difference between continued pregnancy group and normal pregnancy group was not statistically significant （P 〉 0.05）. The serum and urinary P1BF levels in the abortion group were significantly lower than those in the normal pregnancy group and continued pregnancy group（P〈0.05）. According to ROC curve,the serum PIBF levels over 197.45 ng/ml and the urine PIBF levels over 16.50 ng/ml may be considered as predictor of successful pregnancy maintenance for patients with early threatened abortion. Conclusions： Dydrogesterone treatment increases the PIBF levels in serum and urine of early threatened abortion patients. In early threatened abortion patients,low levels of serum and urine PIBF are associated with adverse pregnancy outcomes.