| 马小磊,冯 迟,李轶凡,刘 正,冯 欣.地屈孕酮治疗早期先兆流产效果的影响因素及妊娠结局随访研究[J].,2021,(24):4672-4675 |
| 地屈孕酮治疗早期先兆流产效果的影响因素及妊娠结局随访研究 |
| Follow up Study on Influencing Factors and Pregnancy Outcomes of Early Threatened Abortion Treated with Dydrogesterone |
| 投稿时间：2021-04-05 修订日期：2021-04-28 |
| DOI：10.13241/j.cnki.pmb.2021.24.014 |
| 中文关键词: 地屈孕酮 先兆流产 疗效 影响因素 产妇结局 新生儿结局 |
| 英文关键词: Dydrogesterone Threatened abortion Curative effect Influencing factors Maternal outcomes Neonatal outcome |
| 基金项目:北京市2021年度"扬帆"计划重点医学专业项目（ZYLX202119）；首都医科大学附属北京妇产医院中青年学科骨干培养专项（FCYY201808） |
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| 中文摘要: |
| 摘要 目的：探讨地屈孕酮治疗早期先兆流产效果的影响因素，并随访继续妊娠患者的妊娠结局。方法：于2017年1月至2019年1月期间选取我院收治的300例早期先兆流产患者，均给予地屈孕酮首次剂量40 mg/次口服，之后改为30 mg/次，2次/d。按照治疗是否有效分为有效组和无效组，收集两组基本临床资料，采用多因素Logistic回归分析地屈孕酮治疗早期先兆流产效果的影响因素，并随访妊娠结局。结果：300例患者治疗有效245例(81.67%)，治疗无效55例(18.33%)；单因素分析显示：与无效组比较，有效组的年龄、孕次、流产次数、产次、抗子宫内膜抗体(EMAb)阳性率较小，血清β-人绒毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)水平较高，差异有统计学意义(P＜0.05)，多因素Logistic回归分析显示：年龄（较大）、孕次（较多）、产次（较多）、流产次数（较多）、EMAb阳性是影响地屈孕酮治疗效果的危险因素(P＜0.05)，血清β-HCG（较高）、P（较高）、E2（较高）是影响地屈孕酮治疗效果的保护因素(P＜0.05)。随访结果显示：继续妊娠的245例患者平均分娩孕周(39.43±1.06)周，产妇结局：出现产后出血6例，产后胎盘粘连17例；新生儿结局：Apgar评分为(9.43±0.20)分，出现早产2例，畸形1例，永存右脐静脉1例。结论：年龄、孕产次数、流产次数、EMAb阳性、血清β-HCG、P、E2是地屈孕酮治疗早期先兆流产效果的影响因素，地屈孕酮治疗早期先兆流产是否会增加产妇及新生儿不良结局的发生风险仍需进一步研究。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the influencing factors of the effect of dydrogesterone in the treatment of early threatened abortion, and follow up the pregnancy outcome of patients with continued pregnancy. Methods: 300 patients with early threatened abortion who were admitted to our hospital from January 2017 to January 2019 were selected. All patients were given the first dose of dydrogesterone 40 mg/time orally, then changed to 30 mg/time, twice a day. They were divided into effective group and ineffective group according to whether the treatment was effective or not, basic clinical dataes of the two groups were collected. Multivariate Logistic regression was used to analyze the influencing factors of the effect of dydrogesterone on early threatened abortion, and the pregnancy outcome was followed up. Results: Among the 300 patients, 245 cases (81.67%) were effective, and 55 cases (18.33%) were ineffective. Univariate analysis showed that compared with the ineffective group, the age, gestational times, abortion times, birth times and anti-endometrial antibody(EMAb) positive rate in the effective group were lower, and the serum levels of β-human chorionic gonadotropin (β-HCG), progesterone (P) and estradiol (E2) were higher, and the differences were statistically significant (P＜0.05). Multivariate Logistic regression analysis showed that: Age (older), gestational times (more), birth times (more), abortion times (more) and EMAb positive were the risk factors affecting the effect of dydrogesterone treatment (P＜0.05). Serum β-HCG (higher), P (higher) and E2 (higher) were the protective factors affecting the effect of dydrogesterone treatment(P＜0.05). Follow-up results showed that the average gestational age of the 245 patients with continued pregnancy was(39.43±1.06) weeks. The maternal outcomes were as follows: 6 cases had postpartum hemorrhage, and 17 cases had postpartum placental adhesion. Neonatal outcome: Apgar score was(9.43±0.20) score, preterm delivery occurred in 2 cases, malformation occurred in 1 case, and right umbilical vein was permanent in 1 case. Conclusion: Age, pregnancies times, abortion times, EMAB positive, serum β-HCG, P and E2 are the influencing factors for the efficacy of dydrogesterone in the treatment of early threatened abortion, whether the treatment of Early Threatened Abortion with didroxyprogesterone can increase the risk of adverse maternal and neonatal outcomes remains to be further studied. |
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