地屈孕酮联合环孢素A治疗原因不明复发性流产的效果观察

Effect of Dydrogesterone Combined with CsA in the Treatment of Unexplained Recurrent Abortion

目的:探讨地屈孕酮联合环孢素A治疗原因不明复发性流产的临床效果。方法:选取2015年5月~2018年6月我院诊治的原因不明复发性流产患者81例,根据患者入院先后顺序分为两组,对照组40例给予地屈孕酮进行治疗,观察组41例在对照组的基础上给予环孢素A治疗。比较两组患者的妊娠成功率和妊娠结局,两组患者孕8周和孕10周的血清绒毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)水平以及两组患者孕前T、B和NK淋巴细胞水平。结果:观察组患者的妊娠成功率为87.8%,显著高于对照组(67.5%,P<0.05),但两组患者妊娠成功后的早产、分娩孕周相比无统计学差异(P>0.05)。观察组患者孕8周和孕10周的血清β-HCG和E2水平均显著高于对照组(P>0.05),而两组血清P水平比较差异无统计学意义(P>0.05)。观察组患者孕前CD4^+、CD4^+/CD8^+和NK细胞水平均显著低于对照组,CD8^+水平显著高于对照组(P>0.05),但两组CD3^+和B细胞水平比较差异无统计学意义(P>0.05)。结论:地屈孕酮联合环孢素A可显著提高原因不明复发性流产患者孕早期血清β-HCG和E2水平,抑制患者的免疫功能,提高妊娠成功率,且不影响妊娠结局。

Objective: To explore the clinical effect of dydrogesterone combined with CsA in the treatment of unexplained recurrent abortion. Methods: 81 cases of unexplained recurrent abortion diagnosed and treated in our hospital from May 2015 to June 2018 were selected, which were divided into two groups according to the sequence of admission. 40 cases of the control group were treated with dydrogesterone, while 41 cases of the observation group were treated with CsA on the basis of the control group. The pregnancy success rate and pregnancy outcome of the two groups were compared, and the levels of serum β-HCG, P and E2 were compared between the two groups at 8 and 10 weeks of gestation, and T, B and NK lymphocyte before pregnancy were compared between the two groups. Results: The success rate of pregnancy in the observation group was 87.8%, which was significantly higher than that of the control group(67.5%, P<0.05). But there was no significant difference in the preterm birth or gestational week between the two groups after successful pregnancy(P>0.05). At 8 weeks and 10 weeks of gestation, the levels of serum β-HCG and E2 in the observation group was significantly higher than that in the control group(P>0.05). While there was no significant difference in serum P level between the two groups(P>0.05). The levels of CD4^+, CD4^+/CD8^+and NK cells pre-pregnancy in the observation group were significantly lower than those in the control group, and the levels of CD8^+were significantly higher than those in the control group(P>0.05). But there was no statistical difference between the two groups about CD3^+and B cell level(P>0.05). Conclusion: Dydrogesterone combined with CsA can improve the level of serum β-HCG and E2 in early pregnancy of patients with unexplained recurrent abortion, inhibit the immune function of patients in active state, and thus improve the success rate of pregnancy without affecting the pregnancy outcome, which is worthy of clinical reference.