孕早期自然流产病人内分泌学因素分析及临床干预研究

AN ANALYSIS OF ENDOCRINE FACTORS IN PATIENTS WITH SPONTANEOUS ABORTION IN THE FIRST TRIMESTER AND THE CORRESPONDING CLINICAL INTERVENTION

目的探讨生殖内分泌水平与孕早期自然流产的关系,并探索临床干预方法。方法选择排除夫妇染色体异常、生殖道畸形、感染、免疫因素、环境因素、男方因素等孕早期自然流产病人532例,进行生殖内分泌学检查,在病人再次孕前进行预防性治疗,促使卵泡发育、排卵、加强排卵后功能,孕后根据激素水平给予保胎处理。结果 532例病人确诊为孕激素缺乏者94例,黄体不健者240例,高泌乳素血症者90例,子宫内膜反应不良者37例,仅表现黄体期内膜较薄者35例,各项检查无明显异常者36例。对前4类461例病人再次孕前预防性治疗,促使卵泡发育、加强黄体功能、改善孕卵着床和发育环境条件,孕后适当保胎,妊娠成功率分别为95.74%、94.17%、93.33%、72.97%。后2类71例病人中有40例孕前未经治疗再次妊娠,妊娠成功率62.50%;31例病人确诊后未治疗失访。结论生殖内分泌水平与妊娠结局密切相关,内分泌失调是孕早期自然流产的主要原因,其中黄体功能不足是最常见原因(62.78%);孕前孕后预防性优生治疗能明显提高再次妊娠成功率。

Objective To explorethe relationship between serum levels of reproductive hormiones and spontaneous abortion in the first trimiester,and to find out the corresponding clinical intervention.Methods This study included 532 patients with spontaneous abortion in the first trimester,who(or whose spouse)had no chromosomal abnormalities,genital tractmalformation,infection,or conditions associated with immiune factors,environmental factors,ormale factors.The serum levels of reproductive hormones were measured.Prophylactic treatment was carried out before their next pregnancy to promote follicular development and ovulation and improve corpus luteumi function,and anti-abortion mianagemient was performed according to the hormone level in the gestational period.Results Amiong the 532 patients,94 had progesterone deficiency.240 had luteal phase defect,90 had hyper-prolactinemiia,37 had inadequate endomietrial response,35 only had a thin endomietrium in the luteal phase,and 36 had normal examiination results.For the former fourgroups of patients(461 cases),prophylactie treatment was carried out before their next pregnancy to promote follicular development,enhance corpus luteum function,and improve the environment for zygote implantation and growth,and anti-abortion management was performed during pregnancy;the success rates of their repregnancy were 95.74%,94.17%,93.33%,and 72.97%,respectively.Among the latter two groups of patients(71 cases),40(62.50%)had successful re-pregnancy withou tprophylactic treatment,and 31 were lost to follow-up.Conclusion The pregnancy outcome is closely related to women's reproductive endocrine function.Endocrine disorder is the miajor cause of spontaneous abortion,and luteal phase defect is the most common reason(62.78%).Prophylactic treatment before or after pregnancy can significantly increase the success rate of re-pregnancy.