血清雌二醇及孕酮与不同中医证型先兆流产患者预后的关系

作者	单位
楼毅云	首都医科大学宣武医院脑血管病研究室
傅萍	首都医科大学宣武医院脑血管病研究室
刘晓荣	首都医科大学宣武医院脑血管病研究室
姜萍	首都医科大学宣武医院脑血管病研究室
王素霞	首都医科大学宣武医院脑血管病研究室
赵宏利	首都医科大学宣武医院脑血管病研究室
马娴	温州医学院附属慈溪医院
张科群	首都医科大学宣武医院脑血管病研究室
何嘉琳	首都医科大学宣武医院脑血管病研究室

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中文摘要:

目的探讨不同中医证型先兆流产(胎漏、胎动不安)患者血清雌二醇(E2)及孕激素(P)水平与该病预后的关系。方法对598例先兆流产患者,以化学发光酶免疫分析法连续监测先兆流产妊娠第5~13周血清E2、P水平,并按中医辨证分型分为5型(肾虚型151例、脾肾两虚型151例、气血虚弱型36例、血热型235例、跌仆伤胎型25例),分析各证型血清E2及P水平变化。结果 (1)自妊娠第7周起,妊娠继续组血清E2水平高于同组前1周(P<0.05),并且高于同妊娠龄妊娠失败组(P<0.05)。(2)妊娠继续组各妊娠龄血清P水平比较差异无统计学意义(P>0.05);自妊娠第7周起,妊娠继续组血清P水平高于同妊娠龄妊娠失败组(P<0.05)。(3)肾虚型及脾肾两虚型妊娠继续组与妊娠失败组血清E2水平比较与总体妊娠继续组与妊娠失败组血清E2水平比较情况基本符合。结论 (1)初步获得先兆流产妊娠第5-13周各个妊娠龄血清E2及P水平。(2)妊娠第7周为妊娠是否继续的关键,较高E2水平以及E2水平持续稳定的增长预示其良好的妊娠结局。(3)先兆流产(胎漏、胎动不安)以肾虚为主,E2是其肾虚证型的重要物质基础之一。

英文摘要:

Objective To investigate the serum levels of estradiol(E2) and progesterone(P) in patients with the auras of threatened abortion(ATA),i.e.,fetal irritability and vaginal bleeding,and the relation with prognosis.Methods Chinese medicine syndrome of 598 pregnant women with ATA consulted in authors’ hospital were differentiated into 5 types,151 patients of Shen-deficiency type;151 of Pi-Shen deficiency type;36 of qi-blood insufficiency type,235 of blood-heat type,and 25 of traumatic injured type.Their serum levels of E2 and P at the 5th to 13th gestation week were monitored by competitive chemiluminescnet enzyme immunoassay.And the outcome of pregnancy,continued or defeated,was observed.Results(1) From the 7th gestation week on,serum E2 level in women with continued pregnancy(CP) increased continuously,showed a higher value than that at the previous week(P <0.05),and was higher than that in women with defeated pregnancy(DP) of same gestation age(P <0.05).(2) Serum P level was not different in CP women at various gestation age(P >0.05),but from the 7th week on,it was higher in CP women than in DP women of same gestation age(P <0.05).(3) The comparison of serum E2 in CP versus DP of women with Shen-deficiency type or Pi-Shen deficiency type was identical to that in CP versus DP of all women enrolled.Conclusions Serum levels of E2 and P in women with ATA at 5th to 13th gestation weeks were obtained.The 7th week of pregnancy is the critical period of pregnancy development,a comparative high E2 levels and its sustained and steady elevation indicates the goodending of pregnancy with fetal irritability and vaginal bleeding.The Chinese medicine syndrome presented in women with ATA is dominantly the Shen-deficiency type.The variation of serum E2 is one of the important material foundation in pregnancy with fetal irritability and vaginal bleeding of Shen-deficiency type.

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