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目的探讨动态监测血清孕酮(P)及人绒毛膜促性腺激素(β-hCG)对早期异常宫内妊娠的预后进行判定的价值。方法选取2012年1月至2012年12月在首都医科大学附属北京天坛医院妇产科门诊诊治的有阴道出血的早期异常宫内妊娠患者,自就诊之日起动态监测血清P及β-hCG,计算P及β-hCG的变化率,并随访其妊娠结局。结果共有121例患者纳入本研究,按照其妊娠结局的不同分为:先兆流产继续妊娠组(43例)、稽留流产组(37例)、难免流产组(41例)。难免流产组第二次检测的β–hCG及P值均低于第一次检测的结果 (P<0.001);另外两组第二次检测的β–hCG均高于第一次检测的结果 (分别为P=0.006及P<0.001),而P的两次检测结果之间比较差异无统计学意义(分别为P=0.947及P=0.05)。β-hCG的变化率以先兆流产继续妊娠组为最大(与另外两组比较,均为P<0.01),稽留流产组最小(与另外两组比较,均为P<0.01)。P的变化率以难免流产组为最大(与另外两组比较,均为P<0.01),而另外两组P的变化率比较差异无统计学意义(P=0.276)。结论动态监测血清P及β–hCG可以简单、快速的诊断难免流产,而动态监测血清P及β-hCG的变化趋势及变化幅度,可以为临床上鉴别稽留流产及先兆流产继续妊娠的患者提供依据。
Objective To investigate the value of dynamic monitoring serum progesterone (P) and human chorionic gonadotropin (β-hCG) in determining the prognosis of early abnormal intrauterine pregnancy. Methods From January 2012 to December 2012, patients with early abnormal intrauterine pregnancy with vaginal bleeding who were diagnosed as obstetrics and gynecology at the Beijing Tiantan Hospital, Capital Medical University were enrolled in this study. Serum P and β-hCG levels were monitored dynamically from the date of treatment, Calculate the rate of change of P and β-hCG, and follow-up of its pregnancy outcome. Results A total of 121 patients were enrolled in this study. According to their pregnancy outcomes, 43 cases of threatened miscarriage, 37 cases of missed abortion group and 41 cases of unavoidable abortion group were included in this study. The β-hCG and P values of the second test in the abortion group were both lower than those of the first test (P <0.001). The β-hCG values of the second test in both groups were higher than those of the first test ( Respectively, P = 0.006 and P <0.001, respectively). There was no significant difference between the two test results of P (P = 0.947 and P = 0.05 respectively). The rate of change of β-hCG was the largest among the pregnant women who underwent threatened abortion (P <0.01 compared with the other two groups) and the smallest among the missed abortion groups (all P <0.01 compared with the other two groups). The rate of change of P was the largest in the unavoidable abortion group (both P <0.01 compared with the other two groups), while there was no significant difference in the change rate of P in the other two groups (P = 0.276). Conclusions Dynamic monitoring of serum P and β-hCG can be a simple and rapid diagnosis of inevitable abortion. The dynamic changes of serum P and β-hCG and the range of change can provide a basis for the clinical identification of patients with missed abortion and threatened abortion .