复发性流产夫妇相关病因分析

Etiological analysis of couples with recurrent abortion

目的探讨复发性流产的夫妇相关病因。方法回顾性分析2017年12月至2018年11月来无锡市妇幼保健院生殖健康科就诊的272对复发性流产夫妇的临床资料作为研究对象,自然流产2次213对,自然流产>2次59对,检查女方妇科超声、阴道分泌物培养、内分泌、自身抗体、外周血免疫功能;男方检查精子活力、精子DNA碎片。结果①272对夫妇,女方内分泌异常145例,占比最高,为53.31%,其次为女方同种免疫紊乱93例和自身免疫功能紊乱74例,分别占34.19%、27.21%,占比最少的为生殖道感染59例(21.69%)、男方精液异常44例(16.18%)、女方生殖系统解剖异常26例(9.56%)、染色体异常22例(8.09%)。②自然流产>2次的女性自身免疫异常和染色体异常发生率大于自然流产2次的女性,然而,男方精液异常自然流产>2次者明显低于自然流产2次者,差异均具有统计学意义(P=0.001,P=0.005,P=0.009)。结论复发性流产发生的主要原因为女性内分泌异常、自身免疫功能异常和细胞免疫紊乱;自然流产>2次患者自然流产与自然流产2次者相比,与自身免疫功能异常和染色体核型异常相关性增加,而与男方精液异常相关性较小。

Objective To investigate the couples'causes of recurrent spontaneous abortion(RSA).Methods The clinical data of 272 RSA couples in Reproductive Health Department of Wuxi Maternal and Child Health Care hospital from December 2017 to November 2018 were retrospectively analyzed as the research objects.According to the frequency of spontaneous abortion,213 couples had spontaneous abortion twice and 59 couples had spontaneous abortion>twice.The women's gynecological ultrasound,vaginal secretion culture,endocrine,autoantibody and peripheral blood cellular immunity were examined.Results①Among those 272 couples,145(53.31%)were female endocrine disorders,followed by 93(34.19%)female homoimmune disorders and 74(27.21%)female autoimmune disorders,59 cases of genital tract infection(21.69%),male semen abnormalities 44(16.18%)and female reproductive system anatomical abnormalities 26(9.56%),chromosome abnormalities 22(8.09%)as the lowest proportion.Some patients had multiple abnormalities at the same time.②The incidence of autoimmune and chromosome abnormalities in women with spontaneous abortion>twice was higher than that in women with spontaneous abortion twice.However,the incidence of spontaneous abortion>twice in men was significantly lower than that in women with spontaneous abortion twice,the difference had statistical significance(P=0.001,P=0.005,P=0.009).Conclusion The main causes of recurrent spontaneous abortion are women endocrine abnormalities,autoimmune dysfunction and cellular immune disorders.Compared with the couples with spontaneous abortion more than twice and the couples with spontaneous abortion twice,Spontaneous abortion has more correlation with autoimmune dysfunction and chromosome karyotype abnormalities,but less correlation with male semen abnormalities.