血清HCG、P、E2水平与早期先兆流产中医证型的关系研究

Relationship between Serum HCG,P,E2 and TCM Syndrome Types of Early Threatened Abortion

目的探讨血清绒毛膜促性腺激素(Serum chorionic gonadotropin,HCG)、孕酮(Progesterone,P)、雌激素(Estradiol,E_(2))水平与早期先兆流产中医证型的关系研究。方法选择118例诊断为早期先兆流产的患者作为研究对象,所有患者均行中医辨证分型,且于治疗前、治疗后每1周采用化学发光免疫法检测血HCG、P、E_(2)水平,时间持续至12周。比较不同中医证型患者临床差异及血HCG、P、E_(2)差异。结果肾虚证患者56例(47.46%),血热证32例(27.12%)、血瘀证18例(15.25%),气血虚弱证12例(10.17%);有78例患者既往有流产史,占66.10%;有91例患者最终继续妊娠,占77.12%;初产妇63例,占53.39%。肾虚证患者35-41岁比例高于其他证型患者(P<0.05),血热证的无流产患者比例高于其他证型患者(P<0.05),肾虚证的流产次数≥3次患者比例高于其他证型患者(P<0.05),血瘀证终止妊娠患者比例高于其他证型患者(P<0.05)。继续妊娠患者孕5~12周血HCG、P、E_(2)值均随孕周的增加而上升(P<0.05)。终止妊娠患者孕5-12周血HCG、P、E_(2)值与前1周相比差异无统计学意义(P<0.05)。继续妊娠患者血HCG、P、E_(2)值第7周开始均高于相应孕周终止妊娠患者(P<0.05)。继续妊娠及终止妊娠患者不同证型相同孕周患者血HCG、P水平比较差异均无统计学意义(P>0.05);继续妊娠的血瘀证患者孕第7周开始血E_(2)水平低于继续妊娠的其他证型患者(P<0.05)。结论早期先兆流产的常见中医证型发生频率依次为:肾虚证>血热证>气血两虚证>血瘀证,中医证型同年龄、流产情况及妊娠结局之间存在一定相关性。血瘀型早期先兆流产的发生与E_(2)降低关系更为密切。

Objective To investigate the relationship between serum levels of chorionic gonadotropin(HCG),progesterone(P)and estrogen(E_(2))and TCM syndrome types of early threatened abortion.Methods One hundred and eighteen patients diagnosed as early threatened abortion were selected as the research subjects.All the patients received TCM syndrome differentiation,and the levels of HCG,P and E_(2)in blood were detected by chemiluminescent immunoassay before treatment and every one week after treatment,which lasted until 12 weeks.The clinical effects and levels of HCG,P and E_(2)among patients with different TCM syndromes were compared.Results 56 cases(47.46%)were kidney deficiency syndrome,32 cases(27.12%)were blood heat syndrome,18 cases(15.25%)were blood stasis syndrome and 12 cases(10.17%)were Qi and blood deficiency syndrome.78 patients(66.10%)had a history of abortion and 91 patients(77.12%)finally continued pregnancy.There were 63 primiparous parturients(53.39%).The proportion of patients with kidney deficiency syndrome aged 35~41 years old was higher than that of those with other syndrome types(P<0.05).The proportion of blood heat syndrome patients without abortion was higher than that of those with other syndrome types(P<0.05).The proportion of kidney deficiency syndrome patients with the number of abortions≥3 was higher than that of those with other syndrome types(P<0.05),and the proportion of blood stasis syndrome patients with pregnancy termination was higher than that of those with other syndrome types(P<0.05).The levels of HCG,P and E_(2)in blood of patients with continued pregnancy for 5~12 weeks increased with the increase of gestational weeks(P<0.05).There was no difference in the levels of HCG,P or E_(2)between the patients with terminated pregnancy for 5~12 weeks and those in the previous week(P<0.05).The levels of HCG,P and E_(2)of patients with continued pregnancy were higher than those of patients with terminated pregnancy in the corresponding pregnancy week(P<0.05).There was no difference in serum HCG or P between patients with different syndromes and the same gestational week who continued pregnancy and those who terminated pregnancy(P>0.05).The blood E_(2)level of the patients with blood stasis syndrome who continued pregnancy was lower than that of the patients with other syndromes who continued pregnancy at the beginning of the 7th week of pregnancy(P<0.05).Conclusion The frequency of common TCM syndrome types of early threatened abortion is:kidney deficiency syndrome>blood heat syndrome>deficiency of both Qi and blood syndrome>blood stasis syndrome.There is a certain correlation between TCM syndrome types and age,abortion and pregnancy outcome.The occurrence of blood stasis type of early threatened abortion is more closely related to the decrease of E_(2).