雌激素水平与早孕期妊娠结局的关系及预测价值

目的 探讨孕妇在孕早期每周的雌二醇（E2）、β人促绒毛膜促性腺激素（β-hCG）、孕酮（P）水平与妊娠结局的关系。方法 回顾性分析2016年1月至2021年6月于湖北妇幼保健院进行妊娠监测妇女的491例临床资料,根据妊娠结局将孕妇分为继续妊娠组（396例）及流产组（95例）,比较两组孕妇每周的β-hCG、P、E2水平来评估其对妊娠结局的影响,应用受试者操作特征（ROC）曲线评价预测结局效果。结果 第4周继续妊娠组E2水平显著高于流产组,第5～9周继续妊娠组β-hCG、P、E2水平显著高于流产组,均有统计学意义（P<0.05）。β-hCG、P、E2均是预测妊娠结局的良好指标,联合预测价值>E2>β-hCG>P。结论 β-hCG、E2、P水平的维持与早期妊娠的结局有一定的相关性,三项激素水平过低可能导致不良妊娠结局。在胎盘完全形成之前,对早孕期孕妇（尤其是有复发流产病史的孕妇）血清β-hCG、E2、P值进行动态监测,结合其每周最佳界值综合分析,对于临床诊断及临床干预有重要意义。对于监测雌孕激素低的孕妇补充雌孕激素可能有利于胚胎发育。     

孕妇血清ADAM12-S水平与妊娠结局的相关性研究

目的探讨妊娠早期孕妇血清解整合素-金属蛋白质酶12（ADAM12-S）水平变化与唐氏综合征等妊娠结局的关系。方法应用时间分辨荧光免疫分析法检测早孕期（8-11周）孕妇血清中ADAM12-S水平,并分析ADAM12-S水平变化与唐氏综合征等妊娠结局的关系。结果正常单胎血清ADAM12-S水平随孕周增加而逐渐上升的趋势,且呈线性相关（r=0.993,P〈0.01）。唐氏综合征等非整倍体染色体异常的ADAM12-S水平的明显低于正常单胎孕妇,差异有统计学意义（P〈0.05）.结论早孕期孕妇血清中ADAM12-S水平随孕周增加而上升,可用于非整倍体常染色体异常的筛查,预测胎停育、异位妊娠等早期妊娠丢失,可作为产前筛查指标。     

妊娠4～9周孕妇血清hCG、E2水平与先兆流产的相关性分析

目的分析妊娠4～9周孕妇血清人绒毛膜促性腺素(hCG)、雌二醇(E_2)水平与先兆流产的相关性。方法回顾性分析我院2015年6月至2017年6月收治妊娠4～9周先兆流产孕妇和正常孕妇临床资料,根据临床资料将146例先兆流产孕妇设为研究组,进一步分成妊娠失败组(n=42)和妊娠成功组(n=104),154例正常孕妇为对照组。比较所有孕妇不同孕周hCG、E_2和孕酮(P)水平变化,同时分析hCG、E_2和P三者串联或并联诊断先兆流产孕妇妊娠结局确诊率。结果三组孕妇血清中hCG和E_2水平均随着孕周增加而逐渐上升,妊娠失败组和妊娠成功组孕妇妊娠4～9周血清hCG和E_2水平均显著低于对照组,三组之间差异具有统计学意义(P <0.05);妊娠失败组,妊娠成功组和对照组孕妇妊娠4～9周血清P水平依次降低,且三组之间差异具有统计学意义(P <0.05);三者联合诊断时,串联诊断时其特异性较高(94. 32%),并联诊断时灵敏度较好(96.53%)。结论妊娠4-9周先兆流产孕妇体内血清hCG、E_2等激素水平下降,其对随后孕妇保胎治疗和妊娠结局预测具有指导意义,值得重点关注。     

先兆流产患者血清HCG,孕酮,CA125水平的检测

目的探讨血清癌抗原125（CAl25）、人绒毛膜促性腺激素（HCG）和孕酮联合监测对先兆流产的预测价值。方法选择115例孕龄5～8周的单胎孕妇,根据妊娠结局将其分为3组：正常妊娠组30例,先兆流产组55例,难免流产组30例。测定3组血清CAl25、孕酮及HCG水平。结果与结论先兆流产继续妊娠组和难免流产组孕妇血清CAl25明显高于正常妊娠组。     

既往流产史妇女早孕期TEG水平分析

目的 探讨既往流产史妇女孕早期血栓弹力图指标水平特点。方法 选择就诊于兰州大学第二医院既往流产史妇女351例。根据既往流产次数、是否就诊1周内发生胚胎停育、妊娠结局进行分组分析。测定所有患者早孕期血清R、K、Angle、MA、LY30、EPL、CL指标水平。使用单因素方差分析、独立样本t检验比较各组间孕早期血栓弹力图水平差异。结果 在既往流产≥3次组中，R值（5.78±1.55）、CL值（0.66±2.11）与既往流产1次组相比存在显著差异（P<0.05）;MA为与其他两组相比均存在统计学差异，但并未随着既往流产次数增加呈正相关趋势。就诊1周内胚胎停育组与正常妊娠组相比，R值（4.84±1.26）、K值（1.73±0.56）降低，Angle(65.55±6.95)、CL(1.24±1.81)升高，差异具有统计学意义（P<0.05）。根据妊娠结局分组分析，两组间各指标均差异无统计学意义。结论对既往流产史妇女应行TEG监测评估母体凝血功能，尤其是R、MA、CL值的动态变化，提示早期胚胎停育可能，但孕早期凝血改变无法预测本次妊娠结局。     

rhuIL-2对妊娠中期小鼠外周血清雌激素和孕激素水平的影响

目的探讨不同浓度重组人白介素-2（rhuIL-2）对妊娠中期小鼠外周血清雌激素（E2）、孕激素（P）水平及P/E2比值的影响。方法 BALB/c孕鼠随机分入4组,妊娠第7、8、9天行腹腔药物注射（空白对照组予灭菌水0.2ml,低、中、高剂量组分别予rhuIL-2500U、1KU、2KU）,第12天取血,ELISA法测定血清E2、P浓度,计算P/E2比值,并评价妊娠结局。结果与空白组相比,处理组血清E2、P浓度明显降低（P〈0.05）,不良妊娠结局事件增加（P〈0.05）,P/E2比值未观察到明显异常（P〉0.05）。结论伴随着外周血清E2、P水平的下降,呈不同程度升高的妊娠中期小鼠血清IL-2水平,导致了病理性妊娠结局事件增加,由此推测：妊娠中期小鼠血清IL-2水平增高可能通过干扰血清E2、P水平进而影响正常妊娠。     

淋巴细胞的KIR2DL4基因表达在反复性胚胎停育主动免疫治疗前后的研究

目的检测复发性胚胎停育患者淋巴细胞主动免疫前后KIR2D1,4基因的表达的变化,探讨反复性胚胎停育免疫学原因。方法选择2011年6月至2012年6月就诊的2次以上早孕胚胎停育的患者,根据以往有无人工流产和／或者分娩史分为无妊娠史（无人工流产及分娩史）组30例;有妊娠史（有人工流产史及分娩史）组55例;对照组为正常无妊娠史的未孕妇女30例。对研究者进行淋巴细胞主动免疫治疗4个周期后,采用荧光实时定量PCR技术检测治疗前后患者的淋巴细胞的KIR2DL4基因的表达。随访研究者妊娠结局。结果（1）两组胚胎停育组治疗前ⅪR2DL4基因表达无妊娠史组为（43．55±12．71×103／m1）、有妊娠史组为（21．48±9．43×103／m1）,分别与对照组（55．35±12．68×103／m1）比较,差异有统计学意义（P〈0．05）;两组胚胎停育组经淋巴细胞主动免疫治疗后KIR2DL4基因的表达分别为（56．76±10．90×103／ml、67．89±11．39×103／m1）与对照组治疗后（70．84±13．47×103／m1）比较,差异无统计学意义（P〉0．05）。两组胚胎停育组免疫治疗前后比较KIR2DL4基因比较差异有统计学意义（P〈0．05）。（2）免疫治疗前有妊娠史胚胎停育组l（IR2DL4基因的表达（21．48±9．43×103／m1）,与无妊娠史胚胎停育组KIR2DL4基因表达（43．55±12．71×103／m1）比较,差异有统计学意义（P〈0．05）,主动免疫治疗后差异无统计学意义（P〉0．05）。（3）随访结果：两组胚胎停育组免疫治疗结束后,每组妊娠患者中,胚胎停育率分别为21．74％,18．75％;对照组胚胎停育率为20％。胚胎停育率比较差异无统计学意义（P〉0．05）。结论淋巴细胞KIR2DL4基因的表达数量异常与反复性胚胎停育有关。     

孕妇血清妊娠相关蛋白A检测及意义

目的 :探讨妊娠相关蛋白A(PAPP -A)作为血清标记物在孕早期产前筛查中应用的价值。方法 :用酶联免疫吸附法 (ELISA)测定孕 9～ 1 3周孕妇血清中PAPP -A浓度。结果 :共检测 2 70 1例 9～ 1 3周单胎妊娠孕妇 ,筛查出PAPP -A低值的高危孕妇 1 6 0例 ,确诊染色体异常 (2 1三体 ) 2例 ,高危组不良妊娠结局 8例 ,筛查高危组与筛查正常组不良妊娠结局比较有显著差异 (x2 =4 3 38,p <0 0 1 )。结论 :PAPP -A可作为孕早期染色体异常 (2 1三体 )筛查的一个指标 ,对于PAPP -A低值的孕妇提示有不良妊娠结局的可能     

不孕女性孕前体质量指数对妊娠结局的影响

目的 本研究旨在阐明不孕女性孕前体质量指数（BMI）对首次进行IVF/ICSI新鲜周期妊娠结局的影响。方法 回顾性分析2010—2018年期间首次接受IVF-ET/ICSI新鲜胚胎移植的7656例不孕症患者的临床资料，比较不同孕前体质量指数组的妊娠结局。结果 体质量过低患者比体质量正常患者发生原发不孕症的比例更高（P<0.001），可获得优质胚胎的周期数显著低于正常体质量组（P<0.05）；超重及肥胖患者不孕年限更长且排卵障碍者占比更高（P<0.01）；各组的胚胎着床率、临床妊娠率、活产率及早产率无显著性差异（P>0.05）；与正常组相比，超重组与肥胖组流产率显著升高（P<0.05），尤其是晚期流产率显著升高（P<0.05）。BMI升高与流产、早产、剖宫产及妊娠并发症（妊娠糖尿病、妊娠高血压）呈正相关。Logistic回归分析表明，孕前BMI升高与流产风险增加相关（aOR·1.921,95%CI:1.158～3.186,P=0.011）。结论 孕前BMI升高与女性生育潜力降低、流产风险增加及妊娠并发症发生率升高有关。     

体质量指数对整倍体胚胎移植患者妊娠结局的影响

目的 探讨女性BMI对行胚胎PGT-A技术筛选出的整倍体胚胎移植后妊娠结局的影响。方法 本研究回顾性分析了自2019年1月至2021年8月在同济大学附属第一妇婴保健院行PGT-A筛选并获得整倍体胚胎的冻融胚胎移植周期的患者病史资料,共计366个周期,根据胚胎移植时女方BMI(kg/m2)分为3组：超重组（≥24,n=90）、正常组（18.5～23.9,n=249）和偏瘦组（<18.5,n=29）。比较分析各组间妊娠结局的差异。结果 3组患者间基本情况均差异无统计学意义（P>0.05）。3组患者间的妊娠结局,包括胚胎的着床率、生化及临床妊娠率、胎儿流产率和最终的活产率均差异无统计学意义（P>0.05）。结论 不同BMI患者移植整倍体胚胎的妊娠结局没有显著差异。     

High NK cell activity in early pregnancy correlates with subsequent abortion with normal chromosomes in women with recurrent abortion

PROBLEM: The aim of this study was to assess the role of natural killer (NK) cells in pregnant women with a history of recurrent spontaneous abortion (RSA). METHOD OF STUDY: Consecutive 66 pregnant women with a history of RSA were prospectively assessed for peripheral NK cell activity, percentage of the NK cell subsets, and subsequent pregnancy outcome. RESULTS: NK cell activity in women with subsequent live birth (group I) at 4-5 gestational weeks (GW) (mean +/- SD, 32.5 +/- 12.31%) significantly decreased at 6-7 GW (28.1 +/- 12.1%) and at 8 9 GW (28.0 +/- 11.8%). NK cell activity in women with subsequent abortion with normal chromosomes (group II) at 6 7 GW (41.2 +/- 19.0%) was significantly higher than that in group I women, while NK cell activity at 6-7 GW in women with subsequent abortion with abnormal chromosomes (group III) was the same as the level in group I women. CONCLUSIONS: High NK cell activity at 6-7 GW correlates with subsequent abortion with normal chromosomes.     

A prospective study of the incidence, time of appearance and significance of anti-paternal lymphocytotoxic antibodies in human pregnancy

The incidence and natural history of serum anti-paternal cytotoxic antibody (APCA) in normal pregnancy and spontaneous abortion was investigated prospectively in 306 women (64 primigravidae and 242 multigravidae), in order to establish whether serum APCA is a useful screening test in the diagnosis, treatment and prognosis for patients with recurrent pregnancy loss. Pre-pregnancy, serial pregnancy and post delivery serum samples were tested against partner's lymphocytes, using a microdroplet lymphocytotoxicity assay. The incidence of serum APCA in the 256 pregnancies successfully completed was 32%, compared with 10% amongst the 50 pregnancies ending in spontaneous abortion. The lower incidence of positive APCA tests in unsuccessful pregnancies was explained by our finding that positive APCA tests are related to the gestational age of the pregnancy and are rarely demonstrable before 28 weeks gestation. Since APCA usually disappears between pregnancies, its usefulness as a diagnostic test for immunotherapy against recurrent abortion should be questioned.     

Early pregnancy termination with vaginal misoprostol before and after 42 days gestation

BACKGROUND: Misoprostol is a prostaglandin E(1) analogue that has been used for medical abortion. We conducted this prospective study to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <42 days and in women at a gestational age of 42-56 days. METHODS: A total of 160 women seeking medical termination of a pregnancy of <56 days were enrolled in the study. Medical termination was performed using 800 micro g of vaginal misoprostol, repeated every 24 h for a maximum of three doses. RESULTS: The overall complete abortion rate was 91.3%. In group A (gestation <42 days) complete abortion occurred in 96.3% of women, whereas in group B (gestation = 42-56 days) complete abortion occurred in 86.3% of women (P < 0.025). The two groups did not differ significantly with respect to side-effects (incidence of pain, bleeding, nausea, diarrhoea, fever and headache). Women who had aborted successfully were significantly more satisfied with the method compared with women who did not (P < 0.001). CONCLUSIONS: The vaginal misoprostol-alone regimen is highly effective for women seeking medical abortion of pregnancies of 相似文献   

Elevated expression of activation molecules by decidual lymphocytes in women suffering spontaneous early pregnancy loss.

The purpose of this study was to investigate, quantify and compare the expression of activation markers by decidual leukocytes in sporadic spontaneous early pregnancy loss and apparently normal first trimester human pregnancy. Decidua was obtained from 18 therapeutic abortions and 20 sporadic spontaneous abortions at 8-12 weeks gestational age. Cryostat sections were labelled by the avidin-biotin complex-peroxidase method using monoclonal antibodies specific for CD45, CD56, CD3, human leukocyte antigen (HLA) DR, CD69, CD25 and very late antigen (VLA)1. Positive cells were quantified and the results were analysed using the Mann-Whitney statistical test. Significantly increased numbers of CD69-positive and CD25-positive cells were detected in spontaneous abortion decidua, when compared with therapeutic abortion decidua. Approximately 50% of women experiencing spontaneous miscarriage also contained significantly elevated numbers of HLA DR-positive cells within decidua. Double immunohistochemical labelling studies demonstrated that the CD25-positive and CD69-positive cells in spontaneous abortion decidua were CD3-positive T cells rather than CD56-positive granulated lymphocytes. Immunological dysfunction within endometrium may account for a proportion of sporadic spontaneous abortions.     

血清CA-125水平与妊娠先兆流产预后的关联分析

目的探讨早期正常妊娠及先兆流产孕妇血清糖类抗原125（CA-125）水平的变化,讨论其对妊娠预后的预测价值。方法对97例单胎早孕孕妇的临床资料进行回顾性分析。孕妇均为正常妊娠,无先兆流产病史。其中,正常妊娠32例,先兆流产继续妊娠38例,先兆流产妊娠失败27例。动态监测CA-125水平,比较分析监测指标的意义。结果先兆流产妊娠失败组孕妇的CA-125水平显著高于正常妊娠组和先兆流产继续妊娠组（P〈0．05）。结论血清CA-125的水平检测对妊娠的预后判断有较高的临床应用价值。     

正常妊娠及妊娠期糖尿病患者血脂代谢特点

目的观察妊娠期糖尿病（gestational diabetes mellitus,GDM）孕妇和正常妊娠孕妇不同孕期的血脂代谢特点,探讨妊娠早中期血脂变化与GDM的关系。方法选择在我院门诊就诊的正常健康孕妇（A组）及GDM孕妇（B组）,两组分别于孕14-19周、28-34周抽取空腹静脉血测定血浆总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、载脂蛋白AI（APOAI）、载脂蛋白B（APOB）、脂蛋白A（LPA）。结果 （1）正常妊娠组与GDM组孕妇随着孕周的增加,TC、TG、APOB、LDL值显著升高（P〈0.01）,APOAI值明显升高（P〈0.05）,正常妊娠组中LPA值随孕周增加明显升高（P〈0.05）;（2）GDM组孕妇在孕14-19周及孕28-34周,TG值较同孕周的正常妊娠组显著升高（P〈0.01）,APOB值在GDM组孕14-19周时明显高于同期正常妊娠组（P〈0.01）;（3）TC、LDL、HDL、APOAI、LPA在两组不同孕周间比较均无显著性差异（P〉0.05）,HDL值随两组孕周增加升高不明显（P〉0.05）。结论GDM孕妇在不同孕周的甘油三酯水平均高于正常妊娠孕妇;GDM孕妇在孕早中期较正常妊娠孕妇存在更早期、更明显的脂代谢紊乱。在孕早中期监测血糖、血脂水平,及时制定合理的饮食计划,可减少GDM的发生和尽早防治其可能带来的母婴危害。     

Maternal serum levels of pro-inflammatory cytokines in missed and threatened abortion

PROBLEM: A study of association between pro-inflammatory cytokines, and missed and threatened abortions with good outcome has been performed. METHOD OF STUDY: The presence of pro-inflammatory cytokines, namely interleukin (IL)-8 and IL-12 and the soluble interleukin-2 receptor (SIL-2R) was investigated in maternal serum of 12 patients with threatened abortion twice (at admission and discharge), 14 patients with missed abortion, 14 women with healthy first-trimester pregnancy, and 14 normal non-pregnant women, using specific enzyme-linked immunosorbent assays. RESULTS: SIL-2R and, in particular, IL-12 was detected with significantly higher levels in missed abortion group compared with all other groups. IL-8 was detected with no significant difference among all the groups studied. CONCLUSIONS: In spite of caution due to the small sizes of the subject samples, these results support a role of the immune system in the first trimester pregnancy and hypothesize that missed abortion may be associated with an enhanced Th1 reactivity, whereas threatened abortion with good outcome resembles the normal pregnancy with a non-enhanced Th1 reactivity.     

孕妇血清锌浓度与早期先兆流产关系研究

目的研究孕妇血清锌浓度在孕早期的变化情况,探讨孕妇血清锌浓度与早期先兆流产的关系。方法 2007年6月至2008年6月采用原子光谱吸收法对我院62例早期先兆流产孕妇和66例正常对照孕妇的血清锌浓度进行检测。观察对照组各孕周血锌浓度变化情况,对比对照组和研究组血锌浓度。结果孕妇血清锌浓度在孕早期呈逐渐下降趋势,但其变化不显著(P0.05);研究组孕妇血清锌浓度明显低于对照组(P0.05)。结论孕妇血清锌浓度在正常妊娠维持中起重要作用,血锌浓度低可能会导致早期先兆流产。     

Cytokine production by maternal lymphocytes during normal human pregnancy and in unexplained recurrent spontaneous abortion

It has been proposed that successful pregnancy is a T helper 2-type phenomenon, and that T helper (Th)1-type reactivity is deleterious to pregnancy. The objective of this study was to compare the concentrations of Th1 and Th2 cytokines produced by peripheral blood mononuclear cells from women undergoing unexplained recurrent spontaneous abortion (RSA) with those produced during normal pregnancy at a similar gestational stage. The control group consisted of 24 women with a history of successful pregnancies and the abortion group comprised of 23 women with a history of unexplained RSA. Blood from the control group was obtained at the end of the first trimester as gestational age controls for the abortion group from whom blood was collected at the time of abortion. Phytohaemagglutinin-stimulated peripheral blood cell culture supernatants were analysed for concentrations of cytokines. Significantly higher concentrations of Th2 cytokines were produced by the first trimester normal group than by the RSA group, while significantly higher concentrations of Th1 cytokines were produced by the abortion group as compared to first trimester normal pregnancy, indicating a distinct Th2-bias in normal pregnancy and a Th1-bias in unexplained RSA.     

白血病抑制因子在正常早孕、稽留流产蜕膜绒毛中表达的初步临床研究

目的探讨白血病抑制因子（LIF）在正常早孕、稽留流产蜕膜绒毛组织中的表达,及其与稽留流产发生的关系。方法采用免疫组化技术-链霉菌抗生物素蛋白-过氧化酶连接（SP）法对白血病抑制因子（UF）在2组妇女绒毛蜕膜组织中的表达进行组织学定位和表达强弱度分析。通过病理图像分析仪对图片进行观察,并运用所附分析系统软件测量各组平均光密度值（IOD）。采用放射免疫法检测正常早孕妇女（正常早孕组,20例）、稽留流产患者（稽留流产组,25例）血清人绒毛膜促性腺激素（β—hCG）及孕酮（P）水平。结果（1）孕酮及hCG水平在2组孕妇间的比较：正常早孕组孕妇血清中孕酮、hCG水平分别为（37．5±15．2）ng／mL、（9005,8±2134．9）mIU／L,稽留流产组孕妇分别为（19．1±11．6）ng／mL、（3120．3±1213．2）mIU／L,两组孕妇血清孕酮、hCC水平比较,有显著性（P〈0．01）;（2）LIF平均相对含量在2组孕妇蜕膜、绒毛组织中的比较：正常早孕组孕妇分别为0．38±0．15,0．36±0．11;稽留流产组孕妇分别为0．20±0．17,0．18±0．13。正常早孕组与稽留流产组比较,差异有显著性（P〈0．05）。结论LIF在稽留流产蜕膜绒毛组织中的表达量降低,可能是导致hCG及孕酮分泌下降,最终造成稽留流产的原因之一。