自然妊娠早孕期孕酮水平及其检测价值的研究

Serum progesterone assay in the first trimester and its value in spontaneous conception

目的探讨自然妊娠早孕期孕酮水平及其检测价值。方法前瞻性收集2015年7月至2015年12月在本医院产科就诊的妇女,排除辅助生育、双胎多胎妊娠、复发性流产、使用孕激素药物的女性。于孕4~10周采血测定血清孕酮水平,并随访妊娠结局。妊娠超过12周、可见胎心搏动为妊娠成功组,其余为妊娠失败组。结果平均采血孕周为(5.9±1.4)周。妊娠成功组137例,早孕期血清孕酮水平呈正态分布,血清孕酮平均值为(77.3±24.4)nmol/L,第5百分位数为37nmol/L,第95百分位数为126.5nmol/L。孕酮水平与孕周、母亲年龄无关。该组15例先兆流产患者的血清孕酮值与无症状者无显著性差异(P>0.05)。妊娠失败组14例,血清孕酮平均值为(53.6±16.5)nmol/L,显著低于妊娠成功组(P=0.000,F=12.784)。结论早孕期孕酮水平波动范围大,难以通过单一孕酮水平预测妊娠结局。

Objective：To investigate the serum progesterone level in the first trimester and its value in spontaneous conception.Methods：Early pregnant women in outpatient clinic in Peking Union Medical College Hospital were prospectively recruited from July to December 2015.The patients with assisted pregnancy,multiple pregnancies,pregnancy with recurrent miscarriage history,or administration of progesterone medication during pregnancy were excluded.Serum progesterone levels were assayed from 4 to10 gestational weeks.The women who got pregnancy more than 12 weeks of pregnancy and had fetal heart beat were defined as the successful pregnancy group,and the rest women were defined as the failure group.Results：The mean gestational age at progesterone assay was（5.9±1.4）weeks.There were 137 women in the successful pregnancy group.The mean progesterone value was（77.3±24.4） nmol/L,with 5th percentile of 37 nmol/L and 95th percentile of 126.5 nmol/L.The progesterone level was not significantly related to gestational age or maternal age.The progesterone levels in 15 patients with vaginal bleeding were not significantly different with the women without vaginal bleeding.There were 14 women in the failure group.The mean progesterone value was（53.6±16.5） nmol/L,which were significantly lower than those in the successful pregnancy group（P=0.000,F=12.784）.Conclusions：The serum progesterone levels are fluctuated in wide range in the first trimester.It is not reliable to predict pregnancy outcome from this single index.