不良妊娠结局528例病因及相关因素分析

Analysis of etiology and related factors of 528 cases with adverse pregnancy outcome

目的探讨不良妊娠结局的发病原因及相关因素分析。方法对2016年7月—2019年12月来邯郸市中心医院生殖医学科门诊就诊的不良妊娠结局患者528例(观察组)进行生殖道解剖、夫妻外周血染色体核型、TORCH[一组病原体:T为弓形虫,O为其他病毒(梅毒螺旋体病毒、微小病毒19等),R为风疹病毒,C为巨细胞病毒,H为单纯疱疹病毒]、内分泌激素及免疫抗体等的系统检查;同时期来邯郸市中心医院产科门诊就诊的正常孕妇300例(对照组)进行TORCH的检测。结果528例不良妊娠结局患者中,有明确发病原因的238例(45.08%),无明确发病原因的290例(54.92%)。528例不良妊娠结局患者中:生殖道解剖异常的96例(18.18%);328例夫妻外周血染色体核型分析,染色体异常者17例(5.18%);315例患者沙眼衣原体、解脲支原体检测,阳性者65例(20.63%);398例TORCH-IgM抗体(弓形虫-IgM抗体、风疹病毒-IgM抗体、巨细胞病毒-IgM抗体、单纯疱疹病毒-IgM抗体)检测,阳性者20例(5.03%);313例免疫抗体检测,阳性者62例(19.81%);388例内分泌激素检测,诊断为内分泌疾病的患者58例(14.95%);233例夫妻血型及抗体效价检查,阳性者6例(2.58%)。300例正常孕妇中:TORCH-IgM阳性者2例(0.67%),两组感染阳性率相比,差异有统计学意义(P=0.0021)。结论生殖道解剖异常、自身免疫因素、内分泌因素和感染因素是导致不良妊娠结局的主要病因。不良妊娠结局的病因多样,明确发病的原因需进行全面系统检查,为临床的诊断和疗效观察提供可靠的依据。

Objective To investigate the causes and related factors of adverse pregnancy outcomes.Methods A total of 528 patients(observation group)with adverse pregnancy outcomes who visited the Department of Reproduction Medicine of Handan Central Hospital from July 2016 to December 2019 were examined for reproductive tract anatomy,chromosome karyotype of peripheral blood of husband and wife.TORCHS[T is Toxoplasma,O for other viruses(treponema pallidum virus,parvovirus 19,etc.),R is rubella virus,C is cytomegalovirus,H is herpes simplex virus],endocrine hormone and immune antibody system examination;A total of 300 normal pregnant women(control group)who visited the obstetric clinic of Handan Central Hospital during the same period were tested by TORCH.Results Among the 528 patients with adverse pregnancy outcomes,238 cases(45.08%)had clear causes,290 cases(54.92%)had no clear causes.Among the 528 patients with adverse pregnancy outcomes,96(18.18%)had abnormal reproductive tract anatomy.Karyotype analysis of 328 couples showed that 17 cases(5.18%)had abnormal chromosome.Among 315 patients,Chlamydia trachomatis and Ureaplasma urealyticum were detected positively in 65 cases(20.63%).Among 398 cases,20(5.03%)were positive for T.gondii IgM,rubella virus IgM,cytomegalovirus IgM and herpes simplex virus IgM.Among 313 cases,62(19.81%)were positive.388 cases of endocrine hormone detection,58 patients diagnosed as endocrine diseases(14.95%);Blood group and antibody titer test of 233 couples showed positive in 6 cases(2.58%).Among the 300 normal pregnant women,2 cases(0.67%)were positive for TORCH-IgM,and the difference in positive rate between the two groups was statistically significant(P=0.0021).Conclusion Anatomic abnormalities of reproductive tract,autoimmune factors,endocrine factors and infection factors are the main causes of adverse pregnancy outcomes.The causes of adverse pregnancy outcomes are varied,and a comprehensive and systematic examination is needed to clarify the causes of the occurrence,so as to provide reliable basis for clinical diagnosis and curative effect observation.