正常妊娠与自然流产患者妊娠初期血清孕酮水平变化与黄体支持疗效的比较

摘要

目的 观察正常妊娠与自然流产患者在妊娠初期排卵后不同时间孕酮与血清人绒毛膜促性腺激素(HCG)水平变化情况及黄体支持对孕酮水平的影响.方法 回顾性分析近年来收治的120例妊娠患者的临床资料,其中65例患者正常妊娠直至分娩视为妊娠组,55例患者未至分娩、中途自然流产视为流产组.根据患者意愿自由选择是否采用黄体支持疗法,对于自愿应用黄体支持疗法者于排卵日后给予微粉化黄体酮200mg口服,1次/d或给予HCG 2000 U/次,1次/3 d.比较两组患者妊娠初期排卵后不同时间孕酮与HCG水平变化情况,观察黄体支持疗法对孕酮水平的影响.结果 两组患者排卵后随时间延长血清HCG水平均明显增长,妊娠组孕酮水平变化不明显,但流产组孕酮水平逐渐下降,且组间比较妊娠组HCG、孕酮水平均明显高于同期流产组患者(P<0.05);妊娠组患者排卵后不同时期孕酮水平比较均无显著差异(P>0.05),流产组患者随着排卵时间延长孕酮水平逐渐下降,排卵28 d时水平最低,且流产组黄体支持者同期孕酮水平明显高于无黄体支持者,差异有统计学意义(P<0.05).结论 自然流产患者血清孕酮水平明显低于正常妊娠者,且随排卵后时间延长逐渐下降.黄体支持疗法对不良发育胚胎意义不大,孕酮水平不能作为指导黄体支持治疗的应用指征.%Objective To evaluate the changes in serum levels of progesterone and human chorionic gonadotropin(HCG)in women with normal pregnancy and patients with abortion in early pregnancy at different periods after ovulation and the impact on changes in progesterone levels with luteal support.Methods The clinical data of 120 patients with pregnancy admitted to department of gynecology and obstetrics in recent years were retrospectively analyzed.Among them,65 cases with normal pregnancy until childbirth were listed in pregnancy group,and 55 patients with midway abortion were listed in abortion group.According to the choice of patients whether to adopt the luteal support therapy,the voluntary appli-cation of luteal support therapy was orally given after ovulation with micronized progesterone 200 mg,1 time/d or giving HCG 2000 u/time,1time for 3 d.The changes in levels of progesterone and HCG in patients of these two groups at different periods after ovulation were compared,and the effect of luteal support therapy on levels of progesterone had been observed.Results Patients in these two groups after ovulation,their serum lev-els of HCG were significantly increased with the extention of time.The changes in levels of progesterone in pregnancy group were not obvious,but levels of progesterone in patients of abortion group were gradually decreased.The comparison among groups,serum levels of HCG and progesterone in patients of pregnancy group were significantly higher than those of patients in abortion group at the same period(P <0.05).The difference in levels of progesterone in patients of pregnancy group after ovulation in different periods is not significant(P >0.05).The levels of progesterone in patients with prolonged abortion group after ovulation were gradually declined,the lowest levels were at 28 d of ovulation,and at the same peri-od,the levels of progesterone in patietns of abortion group with support of corpus luteum were obviously higher than those of patietns without corpus luteum support(P <0.05),and the difference was statistically significant.Conclusion Luteal support therapy has little effect on the develop-ment of defective embryos,and the level of progesterone can not be used as guidance for the treatment with luteal support.