黄体酮联合地屈孕酮对高龄先兆流产者的保胎效果与作用机制

The Protective Effect and Mechanism of Progesterone Combined with Dydrogesterone on Threatened Miscarriage in Elderly Patients

目的探讨黄体酮联合地屈孕酮对高龄先兆流产者的保胎效果与作用机制。方法纳入郸城县妇幼保健院于2020年1月至2022年10月诊治的100例高龄先兆流产患者,按信封法分两组。对照组50例给予地屈孕酮治疗,联合组50例在地屈孕酮的基础上给予黄体酮治疗,连续治疗2周。比较两组治疗前、治疗1周及2周后性激素指标[孕酮(P)、雌二醇(E_(2))、人绒毛膜促性腺激素(HCG)]、孕激素诱导阻断因子(PIBF)水平,并比较两组症状缓解情况、保胎效果、新生儿结局及不良反应。结果联合组治疗1周及2周后的P、E_(2)及HCG水平高于对照组,差异有统计学意义(P<0.05)。联合组治疗1周及2周后的PIBF水平高于对照组,差异有统计学意义(P<0.05)。联合组各类症状缓解时间短于对照组,差异有统计学意义(P<0.05)。联合组保胎成功率、Apgar评分及新生儿体重高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较(10.00%VS 12.00%),差异无统计学意义(P>0.05)。结论对高龄先兆流产患者应用黄体酮、地屈孕酮联合方案治疗可有效调节机体性激素水平,缓解临床症状,改善保胎效果及新生儿结局,且不会对临床安全性造成明显影响。

Objective To explore the protective effect and mechanism of progesterone combined with dydrogesterone on threatened miscarriage in elderly patients.Methods A total of 100 elderly patients with threatened miscarriage who were diagnosed and treated in our hospital from January 2020 to October 2022 were divided into two groups according to the envelope method.Among them,50 cases in the control group were treated with dydrogesterone,while 50 cases in the combination group were treated with progesterone on the basis of dydrogesterone for 2 consecutive weeks.The levels of sex hormone indicators(progesterone(P),estradiol(E_(2)),human chorionic gonadotropin(HCG),and progesterone induced blockade factor(PIBF)between the two groups before treatment,1 week,and 2 weeks after treatment were compared,and the symptom relief,fetal protection effect,neonatal outcomes,and adverse reactions also compared between the two groups.Results The levels of P,E_(2),and HCG in the combination group after 1 and 2 weeks of treatment were higher than those in the control group,with significant differences(P<0.05).The PIBF levels in the combination group after 1 and 2 weeks of treatment were higher than those in the control group,with significant differences(P<0.05).Compared to the control group,the relief time of various symptoms in the combination group was shorter,and the difference was significant(P<0.05).Compared to the control group,the success rate of fetal protection,Apgar score,and neonatal weight in the combination group were higher,with significant differences(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(10.00%vs 12.00%)(P>0.05).Conclusion The combination therapy of progesterone and dydrogesterone can effectively regulate the body’s sex hormone levels,alleviate clinical symptoms,improve the effectiveness of fetal protection and neonatal outcomes for elderly threatened miscarriage patients,and will not have a significant impact on clinical safety.