糖皮质激素联合地屈孕酮对不明原因复发性流产患者IL-11R、GM-CSF的影响

Effects of glucocorticoid combined with dydrogesterone for treating patients with unexplained recurrent abortion on the levels of their interleukin-11R and granulocyte-macrophage colony stimulating factor

目的:探讨糖皮质激素联合地屈孕酮对不明原因复发性流产患者白细胞介素-11R(IL-11R)、粒-巨噬细胞集落刺激因子(GM-CSF)的影响。方法:选择2017年3月-2019年3月在本院接受治疗的107例不明原因复发性流产患者,随机数表法分为联合组(54例)和单药组(53例)。单药组给予地屈孕酮治疗,联合组给予糖皮质激素联合地屈孕酮治疗。比较两组临床疗效、血清IL-11R、GM-CSF、凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、孕酮(P)、雌二醇(E2)、β绒毛膜促性腺激素(β-HCG)变化情况及不良反应。结果:治疗后,联合组总有效率(92.6%)高于单药组(73.6%),两组血清GM-CSF均下降且联合组低于单药组,两组IL-11R均上升且联合组高于单药组(P<0.05);两组血清FIB均下降且联合组低于单药组,两组APTT、TT均上升且联合组高于单药组,两组血清P、E2、β-HCG均上升且联合组高于单药组(均P<0.05)。联合组成功分娩率(85.2%)高于单药组(66.0%),异位妊娠(1.9%)、再次流产率(0)低于单药组(13.2%、11.3%)(P<0.05);两组不良反应发生率(5.6%、9.4%)无差异(P>0.05)。结论:不明原因复发性流产患者应用糖皮质激素联合地屈孕酮治疗效果显著,可有效改善患者血清IL-11R、GM-CSF水平,安全性较好。

Objective:To study the effects of glucocorticoid combined with dydrogesterone for treating patients with unexplained recurrent abortion on the levels of their interleukin-11R(IL-11R)and granulocyte-macrophage colony stimulating factor(GM-CSF).Methods:107 patients with unexplained recurrent abortion were selected and divided into study group and control group by random number table method from March 2017 to March 2019.53 women in the control group were given dydrogesterone only,and 54 women in the study group were given glucocorticoid combined with dydrogesterone.The clinical efficacy,the changes of the levels of serum IL-11R and GM-CSF,the values of activated partial thromboplastin time(APTT)and thrombin time(TT),and the levels of fibrinogen(FIB),progesterone(P),estradiol(E2),andβ-human chorionic gonadotropin(β-HCG),and the rate of adverse reactions of the patients were compared between the two groups.Results:After treatment,the total effective rate of the patients in the study group was 92.6%,which was significant higher than that(73.6%)of the patients in the control group(P<0.05).The level of serum GM-CSF of the patients in both groups had decreased significantly,and which of the patients in the study group was significant lower than that of the patients in the control group.The IL-11R level of the patients in both groups had increased significantly,and which of the patients in the study group was significant higher than that of the patients in the control group(P<0.05).The level of serum FIB of the patients in both groups had decreased significantly,and which of the patients in the study group was significant lower than that of the patients in the control group.The APTT and TTIL-11R values,and the levels of P,E2,andβ-HCG of the patients in both groups had increased significantly,and which of the patients in the study group were significant higher than those of the patients in the control group(all P<0.05).The rate of successful delivery(85.2%)of the patients in the study group was significant higher than that(66.0%)of the patients in the control group.The rate of ectopic pregnancy(1.9%)and the rate of abortion again(0)of the patients in the study group were significant lower than those(13.2%and 11.3%)of the patients in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions(5.6%vs.9.4%)of the patients between the two groups(P>0.05).Conclusion:Glucocorticoid combined with dydrogesterone for treating patients with unexplained recurrent abortion has significant effect,which can effectively improve the serum levels of IL-11R and GM-CSF with better safety.