结合腹部彩超以及实验室数据对先兆流产预后的初步判断及临床意义

Clinical Significance of Combined Abdominal Ultrasound and Laboratory Test on the Preliminary Diagnosis of Threatened Abortion

目的通过测定早孕5~12周孕妇的血清雌二醇（E2）、孕酮（Pro）水平,并且根据E2/P的比值结合腹部彩超孕囊、卵黄囊及胚芽的有无来初步判断先兆流产的预后,探讨E2、Pro及E2/P比值在早孕先兆流产预后诊断中的临床意义。方法将85例早孕5~12周有先兆流产症状的患者分为先兆流产妊娠持续组和先兆流产妊娠失败组,同时和50例相同孕周的正常妊娠组进行对比分析,采用电化学发光法分别测定血清E2、Pro并计算E2/P比值。并在同一时间使用美国Voluson-E8型号超声仪,行腹部彩超检查。结果 （1）先兆流产妊娠持续组的血清E2的测定值低于正常妊娠组,同时E2/P的比值也低于正常妊娠组,差异具有统计学意义（P〈0.05）。血清Pro的测定值差异没有统计学意义（P〉0.05）,同时结合彩超,正常妊娠组均可见孕囊、卵黄囊和胚芽,而先兆流产妊娠持续组有88.3%可见孕囊,76.7%可见卵黄囊,50%可见胚芽。（2）先兆流产妊娠失败组的血清E2、Pro的测定值明显低于正常妊娠组,同时E2/P的比值也明显低于正常妊娠组,血清E2、Pro和E2/P比值与正常妊娠组相比差异有统计学意义（P〈0.05）。彩超下均未见孕囊、卵黄囊和胚芽。（3）先兆流产妊娠持续组的血清E2测定值明显高于先兆流产妊娠失败组,血清Pro的测定值以及E2/P比值也是高于妊娠失败组,两组之间相比较差异有统计学意义（P〈0.05）。结论在先兆流产预后的实验室初步诊断试验中,以血清E2和Pro的测定为重要,尤其以血清E2的测定值为关键,同时根据E2/P的比值可以判断先兆流产妊娠的去留,如果能结合彩超下所见孕囊、卵黄囊及胚芽的有无可以为临床初步判定是否具有保胎价值提供可靠的依据。

Objective To explore the clinical significance of combined detection of serum levels of estradiol（ E2）,progesterone（ Pro） and E2/ p ratio and abdominal ultrasound on the diagnosis of early pregnant threatened abortion. Methods 85 cases of early pregnancy（ 5 to 12 weeks） which showed the threatened abortion symptom were divided into threatened abortion pregnancy group and threatened abortion pregnant failure group. 50 normal pregnancy cases with same pregnant weeks were selected as control group. The serum levels of E2 and Pro were determined by electrochemluminescence immunoassay. The patients were also carried abdominal ultrasound examination. Results The serum E2 levels and the ratio of E2/ P in threatened abortion pregnancy group were significantly lower than the normal pregnancy group（ P 〈 0. 05）,but there was no statistically difference on the serum progesterone levels between two groups（ P 〉 0. 05）. Combined with color Doppler Ultrasound,the normal pregnancy group showed the gestational sac,yolk sac and embryo. However,there is 88. 3% visible gestational sac,76. 7% visible yolk sac,and 50% visible germ in threatened abortion pregnancy group. Moreover,the serum levels of E2,Pro and the ratio of E2/ P in threatened abortion pregnant failure group were lower than that of in the normal pregnancy group（ P 〈 0. 05）. The serum levels of E2,Pro and the ratio of E2/ P in threatened abortion pregnancy group were obviously higher than that of threatened abortion pregnant failure group（ P 〈 0. 05）. Conclusion Combined detection of serum levels of estradiol,progesterone and E2/ p ratio and abdominal ultrasound have an important clinical significance on the diagnosis of early pregnant threatened abortion.