血β-HCG、孕酮、雌二醇和B超检查预测宫内妊娠早期阴道流血结局

发布时间：2018-09-12 14:29

【摘要】：【目的】探讨宫内妊娠早孕期阴道流血的结局预测。【方法】选择2009年10月至2013年2月因阴道流血在我院就医、初诊为先兆流产的孕妇153例,分为流产组66例和继续妊娠组87例,同时选取正常早孕妇女94例作为对照组。就诊当日放射免疫法检测血β-HCG、孕酮和雌二醇,并行腹部B超检查;48 h后复查β-HCG,必要时复查B超确定胚胎停育或出现胎心搏动,妊娠11~13周产科B超检查确定继续妊娠,随访至妊娠28~30周。【结果】流产组2次血β-HCG水平(27.68±25.02、52.61±48.69)U/m L,均明显低于继续妊娠组(38.95±28.95、78.20±57.69)U/m L和正常对照组(40.72±30.11、81.61±60.91)U/m L,P0.05。但3组间β-HCG数值及其48 h后变化幅度均有较大范围重叠;流产组血清孕酮水平(11.02±4.57)ng/m L,显著低于继续妊娠组(24.65±7.71)ng/m L,和正常对照组(25.43±8.12)ng/m L,P0.01;流产组血清雌二醇水平(146.71±55.50)pg/m L,也明显低于继续妊娠组(402.53±170.79)pg/m L,和正常对照组(425.17±130.05)pg/m L,P0.01;腹部B超检查示流产组仅21.21%(14/66)出现胚芽。【结论】宫内妊娠早孕期阴道流血需动态监测,结局预测需要多方面综合评估:血β-HCG监测不能准确评定胚胎,单次血清孕酮或雌二醇水平检测对妊娠结局有预测价值;B超检查确定早期妊娠结局,对于孕7~8周B超检到胎心搏动的高危孕妇,仍需继续随诊。
[Abstract]:[objective] to study the outcome prediction of vaginal bleeding during early intrauterine pregnancy. [methods] 153 pregnant women who were hospitalized in our hospital from October 2009 to February 2013 were diagnosed as threatened abortion. It was divided into abortion group (66 cases) and continuous pregnancy group (87 cases). 94 normal early pregnant women were selected as control group. Serum 尾 -HCG, progesterone and estradiol were detected by radioimmunoassay on the same day. 尾 -HCG was examined 48 hours after abdominal B-ultrasound examination. If necessary, B-ultrasound confirmed the termination of embryo or the occurrence of fetal heart pulsation, and the B ultrasound examination at 1113 weeks of pregnancy confirmed the continuation of pregnancy. [results] the serum 尾 -HCG level in the abortion group was (27.68 卤25.02 卤52.61 卤48.69) U / mL, which was significantly lower than that in the continuous pregnancy group (38.95 卤28.95 卤78.20 卤57.69) UMP / L and the normal control group (40.72 卤30.1181.61 卤60.91) UP / mL. However, the 尾 -HCG value and the variation range of 尾 -HCG were overlapped in a large range after 48 h. The serum progesterone levels in the abortion group (11.02 卤4.57) ng/m / L were significantly lower than those in the continuous pregnancy group (24.65 卤7.71) ng/m / L and in the normal control group (25.43 卤8.12) ng/m / L P0.01.The serum estradiol level in the abortion group (146.71 卤55.50) pg/m / L was also significantly lower than that in the continuous pregnancy group (402.53 卤170.79) pg/m / L and in the normal control group (425.17 卤130.05) pg/m / L P 0.01, respectively. Only 21.21% (14 / 66) germs appeared in the labor group. [conclusion] the vaginal bleeding during early intrauterine pregnancy should be monitored dynamically. Multiple comprehensive evaluation is needed for outcome prediction: serum 尾 -HCG monitoring can not accurately evaluate embryo, single serum progesterone or estradiol level can predict pregnancy outcome, B-ultrasound can determine early pregnancy outcome. For 7 ~ 8 weeks high-risk pregnant women with fetal heart beat detected by B-ultrasound, we should continue to follow-up.
【作者单位】：广东省人民医院//广东省医学科学院生殖医学科;广东省人民医院//广东省医学科学院超声科;广东省人民医院//广东省医学科学院产科;
【基金】：广东省科技计划项目(2012B031800406) 广东省卫生厅科研项目(A2011028)
【分类号】：R714.21

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