首次发生自然流产的高龄妇女病因筛查及治疗效果评价

Etiological screening of first spontaneous abortion in women over 35 years of age and therapy evaluation

目的研究首次发生自然流产的≥35周岁妇女的病因筛查及治疗效果。方法 172名在近3个月内首次发生自然流产的≥35周岁患者,经知情同意将其中要求根据复发性流产检查指南进行病因筛查的82名患者作为干预组,进行病因筛查并根据筛查结果进行治疗,另90名不愿行病因筛查的患者作为对照组,随访两组1年之内的受孕结局。结果干预组中,筛查阳性率为60.98%,被筛查出2种及以上病因的占20.73%,其中＂可疑血栓前状态＂的筛查阳性率最高,为45.12%;其次为＂卵巢功能减退＂（15.85%）及免疫原因（10.98%）。干预组1年内自然受孕率为37.50%,显著高于对照组的21.18%（χ^2=5.323,P=0.021）,且再次妊娠后孕早期流产率（26.67%）显著低于对照组（72.22%）,χ^2=9.487,P=0.002。结论对首次发生自然流产的高龄妇女实施病因筛查和治疗有利于改善再次受孕不良结局。

Objective To study the etiological screening of spontaneous abortion for the first time in women over 35 years of age and therapeutic effect. Methods Totally 172 women over 35 years of age who had only spontaneous abortion in the past 3 months were selected as subjects. Among them,82 subjects who actively requesting etiological screening were included into intervention group and therapy were given aiming at etiology,whereas the other 90 women who refused etiological screening were recruited into control group. The conception outcomes within 1 year of all subjects in two groups were followed up. Results In the intervention group,the positive rate of screening was60. 98% and 20. 73% of the women were detected to have no less than 2 types of etiology. The screening positive rate of suspected prethrombotic state was highest（ 45. 12%）,followed by positive rate of ovarian dysfunction and immune abnormalities（ 15. 85%,10. 98%）. In the intervention group the nature conception rate within 1 year was 37. 50%,which was significantly higher than that in the control group（ 21. 18%,χ^2= 5. 323,P = 0. 021）. But spontaneous abortion rate in early pregnancy in intervention group was notably lower than that in the control group（ 26. 67% vs 72. 22%,χ^2= 9. 487,P = 0. 002）. Conclusion Administering comprehensive etiological screening and targeted therapy on women over 35 years of age having spontaneous abortion for the first time is beneficial to improving conception outcomes.