正常妊娠与自然流产、早早孕丢失周期生殖激素水平的比较

目的:了解异常妊娠周期的生殖内分泌激素的特征。方法:以某纺织厂符合研究条件的轮班作业女工为研究对象,收集每日晨尿直到临床怀孕或满一年,所有尿样用放射免疫法(IRMA)测定绒毛膜促性腺激素(hCG)判断怀孕周期,并结合卵泡刺激素(FSH),雌激素代谢产物E1C与孕激素代谢产物PdG等的测定确定是否排卵及排卵日,从而判断EFL。对已确定排卵日的周期用酶免疫(EIA)法测定排卵日前后各8d尿中PdG、E1C。结果:正常妊娠周期(从排卵到受精卵着床这一段时间)组尿中E1C浓度在卵泡晚期及黄体中期显著低于临床自然流产(SAB)组(P<0.05),与早早孕丢失(EFL)组相比在黄体中期也明显偏低(P<0.05),但在卵泡晚期二者差异无显著性(P>0.05);PdG/E1C在黄体期d4-8的平均值正常组高于SAB组(P<0.05);FSH在排卵日当天正常组大于EFL和SAB组,但无显著性(P>0.05)。结论:临床可见SAB可能与在妊娠周期黄体中期及卵泡晚期PdG/E1C降低、黄体中期E1C升高有关。妊娠周期尿样E1C、PdG测定可用于预测不良的生殖结局。

Comparison of Gestational Period Reproductive Hormone Levels between Women in Groups of Normal Pregnancy, Spantaneous Abortion and Early Fetal Loss

Objective: To compare hormone characteristics during implantation in spontaneous abortion (SAB), early fetal loss (EFL) and normal pregnancy. Methods: Early morning urine samples were collected daily from eligible shift women workers, and hCG, FSH, the urinary steroid metabolites of estrogen and progesterone (PdG, E1C) were measured to determine the day of ovulation and confirm early fetal loss (EFL). Results: Twelve SAB cycles, 18 EFL and 44 normal cycles were analyzed. The mean concentration of midluteal E1C was significantly higher in SAB or EFL cycles than in normal cycles (P<0.05), the mean concentration of late follicular phase E1C was also significantly higher in SAB cycles than in normal cycles (P<0.05). The mean value of luteal PdG/E1C ratios was significantly lower on day 4 to 8 in SAB cycles than in normal cycles (day 0 is the day of peak urinary FSH concentration). Conclusion: It was found that PdG/EIC was lower in midluteal phase and late follicular phase, EIC level was higher in midluteal phase, which may be associated with spontaneous abortion. Urinary PdG, E1C analysis may be useful in predicting abnormal pregnancy outcome.