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目的 探讨生殖激素雌二醇 (E2 ) ,孕酮 (P)与药物流产结局的相关性。方法 选择停经≤ 4 9d已确诊早孕 ,要求用药物 (米非司酮配伍米索前列醇 )流产的妇女 138例 ,其中完全流产 86例 ,不完全流产5 2例。于孕囊排出后 7,14 ,2 1d随诊时分别抽肘静脉血 ,以磁性颗粒酶联免疫法测定E2 、P水平。对出血超过 2周者进行刮宫送病理检查。结果 药物流产后 7d时完全流产组与不完全流产组E2 水平迅速下降到卵泡期水平 ,两组无差异 ,而不完全流产组P水平明显高于完全流产组 (P <0 .0 5 )。药物流产后 14d与 2 1d时 ,不完全流产组E2 水平明显低于完全流产组 (P <0 .0 5 ) ,而两组P水平却无明显差异。完全流产组药物流产后 14d较 7d时E2 明显上升 (P <0 .0 5 ) ,不完全流产组E2 无明显升高 ;完全流产组 7d时 ,P处于卵泡期水平 ,不完全流产组P则高于卵泡期水平。不完全流产组刮宫均有蜕膜或绒毛残留 ;完全流产组有 16例为功能性子宫出血。结论 米非司酮药物流产致雌激素水平低下 ,可能是不完全流产及药物流产后出血的原因之一 ,药物流产后 7d时孕激素高于卵泡期水平 ,可作为预测不完全流产的指标 ,药物流产后出血超过 2周的主要原因是不完全流产 ,但药物流产后发生的功能性子宫出血应引起重视。
Objective To investigate the correlation between reproductive hormone estradiol (E2), progesterone (P) and medical abortion outcome. Methods 138 women with abortion ≤ 49 days who had been diagnosed with early pregnancy and requiring abortion with mifepristone and misoprostol were enrolled. 86 cases were completely aborted and 52 cases were incomplete abortion. The elbow venous blood was drawn 7,14 and 21 days after the discharge of gestational sac respectively, and E2 and P levels were measured by magnetic particle enzyme-linked immunosorbent assay. Hemorrhage for more than 2 weeks curettage sent pathological examination. Results The level of E2 in complete abortion group and incomplete abortion group decreased rapidly to follicular phase level at 7 days after abortion. There was no difference between the two groups, but the level of P in incomplete abortion group was significantly higher than that in complete abortion group (P <0.05). At14d and21d after medical abortion, E2 level in incomplete abortion group was significantly lower than that in complete abortion group (P <0.05), but there was no significant difference in P level between the two groups. In the complete abortion group, the E2 of the abortion group increased significantly (P <0.05) on the 14th day after abortion compared with that on the 7th day, E2 was not significantly increased in the incomplete abortion group, P was on the follicular phase at 7d, Higher than follicular phase level. Incomplete abortion group have decidual decidualization or villus residue; complete abortion group, 16 cases of functional uterine bleeding. Conclusion The low level of estrogen induced by mifepristone may be one of the causes of incomplete abortion and bleeding after medical abortion. The progestin is higher than that of follicular phase at 7 days after abortion, which can be used as an index to predict incomplete abortion. Medical abortion after bleeding for more than two weeks the main reason is incomplete abortion, but the dysfunctional uterine bleeding after medical abortion should be taken seriously.