目的 探讨正常妊娠与自然流产不孕患者排卵后血清人绒毛膜促性腺激素(HCG)和孕酮水平的连续变化,孕酮水平与黄体支持治疗在妊娠初期的关系及其作用.方法 2007年1月至2011年12月在北京朝阳医院妇产科生殖医学中心接受治疗的不孕患者135例,经夫精人工授精受孕宫内单胎妊娠84个周期,自然受孕妊娠66个周期,共150个周期分为两组:顺利妊娠到20周为妊娠组(80个周期),妊娠20周以前流产为流产组(70个周期).比较两组患者的临床资料、基础血清生殖激素水平、超声监测数据和排卵后不同时间血清HCG、孕酮水平.结果 妊娠组平均年龄(30.0±3.9)岁,流产组(30.7±4.9)岁.妊娠组基础雌二醇(E2)水平为(152±66) pmol/L,促卵泡激素(FSH)/促黄体生成素(LH)比值为1.57 ±0.96,流产组基础E2水平为(147±69) pmol/L,FSH/LH比值为1.56±1.08.排卵前两组子宫内膜厚度、优势卵泡数、优势卵泡最大直径、血清激素水平比较差异无统计学意义.妊娠组排卵后14～21 d(128.1 nmol/L)、22 ～27 d(129.3 nmol/L)、28 d后(121.8 nmol/L)孕酮水平稳定,且均高于同时期流产组水平(39.9、35.2、11.7 nmol/L),差异有统计学意义(Z值分别为-4.365、-4.665、-6.687,均P＜0.01).两组使用和不使用黄体支持治疗的血清孕酮水平差异无统计学意义.结论 妊娠初期血清孕酮水平适用于评估胚胎质量,无论是否给予黄体支持治疗,不良发育胚胎的孕酮水平均表现为偏低和/或下降,是否存在临床意义临界值有待探讨,故孕酮水平不能作为指导黄体支持治疗的临床指征.%Objective To investigate serum levels of β-human chorionic gonadotrophin (β-HCG) and progesterone (P) in early pregnant women,and their relation to luteal maintenance therapy for early pregnancy protection.Methods One hundred and thirty five infertility women treated in Department of Gynecology and Obstetrics of Beijing Chaoyang Hospital from January 2007 to December 2011.Total 150pregnancy cycles,including 84 with intrauterine insemination (IUI) and 66 with natural conception,were divided into two groups:normal intrauterine pregnancy group (group A,n =80) and early pregnancy loss group (group B,n =70).Medical history,ultrasonic findings,serum female hormone,P and β-HCG levels at early pregnancy stage were analyzed.Results The age of group A and group B was (30.0 ± 3.9) years and(30.7 ± 4.9) years,respectively (P ＞ 0.05).The follicle-stimulating hormone/luteinizing hormone in group A and group B was 1.57 ±0.96 and 1.56 ± 1.08 ; the estradiol levels in two groups were (152 ±66) pmol/L and (147 ± 69) pmol/L,respectively (both P ＞ 0.05).There were no differences in dominant follicles and endometrial thickness between groups A and B (P ＞ 0.05).Ovulation promotion and luteal support treatments were adopted in both groups:50％ (40/80) of cycles in group A received ovulation promotion,73％ (58/80) of cycles received luteal support,while 44％ (31/70) and 76％ (53/70) received in groups B,respectively.The levels of serum progesterone in group A during 14-21 d,22-27 d and ≥ 28 d after ovulation were higher than those in group B at each time points (P ＜ 0.0l).There were no significant differences in serum progesterone levels between women with luteal support treatment and those without luteal support treatment in both groups (P ＞ 0.05).Conclusion Dynamic monitoring of serum progesterone level in early pregnancy may be used as an auxiliary index for prediction of pregnancy outcome,but it may not be an indicator for luteal maintenance therapy.
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