目的:研究早期妊娠去氢孕酮管理对妊娠结局的影响及其Th1和Th2细胞因子水平的关系.方法:随机性纳入366例习惯性流产女性并分为去氢孕酮组(实验组)和安慰剂组(对照组)和168例无流产史的健康女性;统计分析研究对象的妊娠结局,以及初始纳入时、妊娠终止时或妊娠20周时血清中Th1(IFN-y和TNF-α)和Th2((IL-4和IL-10)细胞因子水平.结果:实验组流产女性比例显著性低于对照组女性(7.2％ vs.17.7％,P=0.024);实验组分娩时平均妊娠周期显著性高于对照组(38.1 ±2.8vs.37.1±2.4,P＜0.001);实验组和对照组流产女性血清中IFN-γ水平的变化量与健康组相比差异性显著(P＜0.05);不良妊娠结局早产、低出生体重和小于胎龄儿仅在初始纳入时(妊娠4～8周)的血清中细胞因子水平与妊娠结局正常相比,差异性显著.结论:对于习惯性流产女性早期去氢孕酮管理有助于改善妊娠结局,可以降低流产比率和改善分娩时孕周及新生儿体重,但是上述妊娠结局的调整与Th1和Th2细胞因子生成无关.%Objectives:To study the effect of oral dydrogesterone in early pregnancy on pregnancy outcome and its correlation with Th1 and Th2 cytokine levels.Methods:366 patients with recurrent abortion were included and randomly divided into experimental group and control group Another 168 healthy female without abortion history were also included.The pregnancy outcomes were statistically analyzed.The Th1 (IFN-γ and IFN-oα) and Th2 (IL-4 and IL-10) cytokines levels in serum were also detected at recruitment (4 8 weeks of gestation) and at abortion or 20 weeks of gestation.Results:The occurrence of abortions in experimental group was significantly high-er than that in the control groups (7.2％ vs 17.7％,P =0.024).The mean gestational age at delivery increased significantly in the experimental group compared with that in the control group (38.1 ± 2.8 vs 37.1 ± 2.4,P ＜ 0.001).The percentage change in the serum level of IFN-y was found to be significantly higher in the experimental group and control groups compared with that in the healthy pregnant controls (P ＜ 0.05).The serum cytokine levels for adverse pregnancy outcomes such as preterm delivery,low-birth weight babies and small-for-date babies showed a statistically significant difference only at the time of recruitment (4-8 weeks).Conclusion:The use of dydrogesterone in women with recurrent abortions can improve the pregnancy outcome,such as a reduction in abortions and improved gestational age and baby weight at delivery.But these outcomes are not modulated by Thl and Th2 cytokine production.
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