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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200 mg口服,1次/d或给予HCG2 000 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 observe the changes of human progesterone and serum human chorionic gonadotropin (HCG) levels in normal pregnancy and spontaneous abortion at different stages of pregnancy after ovulation, and the effects of corpus luteum support on progesterone levels. Methods The clinical data of 120 pregnant women admitted in recent years were analyzed retrospectively. Among them, 65 cases were normal pregnancy till childbirth as pregnancy group, 55 cases were not delivered, and spontaneous abortion was regarded as abortion group. According to the patient’s wishes and free choice of luteal support therapy, for voluntary use of corpus luteum support therapy given micronized progesterone 200 mg orally, once / d or give HCG2 000 U / time, 1/3 d. The changes of progesterone and HCG levels in different stages of pregnancy after ovulation were compared between the two groups to observe the effects of luteal supportive therapy on progesterone levels. Results Serum HCG levels of both groups increased significantly with time after ovulation, while the level of progesterone in pregnancy group did not change obviously. However, the levels of progesterone in abortion group decreased gradually. The levels of HCG and progesterone in pregnancy group were significantly higher than those in the same period (P <0.05). There was no significant difference in progesterone levels in different stages of pregnancy after ovulation in pregnancy group (P> 0.05). The level of progesterone decreased gradually in ovulation group and the lowest level in 28 days after ovulation , And the level of progesterone in the luteal supporters in the abortion group was significantly higher than that in the luteal supportive group, the difference was statistically significant (P <0.05). Conclusions The serum progesterone level in patients with spontaneous abortion is significantly lower than that in normal pregnancy and gradually decreases with the prolongation of ovulation time. Luteal support therapy has little effect on poorly developed embryos, and progesterone levels can not be used as indications for the use of luteal support.