先兆流产患者不同给药方式黄体支持的疗效分析  

Effectiveness of different progestagen therapy in threatened abortion

作　　者：黄坚[1] 陈美英[1] 邓月月[1] 王珏[2] 石一复[3] 

机构地区：[1]杭州市第一人民医院妇产科,浙江杭州310006 [2]南京医科大学,江苏南京210029 [3]浙江大学医学院附属妇产科医院,浙江杭州310006

出　　处：《生殖医学杂志》2009年第6期524-526,共3页Journal of Reproductive Medicine

摘　　要：目的比较黄体支持的不同用药方式对先兆流产治疗的疗效。方法对93例妊娠早期先兆流产患者随机分组,肌注组38例肌注黄体酮(P)针剂,口服组55例口服P胶囊,并选择同期未使用任何药物的健康早孕妇女31例作为对照组,观察肌注组和口服组的保胎成功率;测定治疗前后血清P,雌二醇(E_2)和人绒毛膜促性腺激素(hCG)的变化,并与对照组进行比较。结果(1)93例患者中共78例保胎成功,肌注组保胎成功率87%,口服组82%,两组比较无显著差异(P>0.05)。(2)78例保胎成功患者初次治疗一周前后血清P、E_2、hCG的日增长率的结果,P的日增长率口服组显著高于对照组和肌注组,肌注组显著高于对照组(P<0.05);E_2和hCG的日增长率组间两两比较均无显著差异(P>0.05)。(3)治疗1周后继续用药患者平均每隔1周测定P、E_2、hCG的变化,两组患者三项指标日增长率比较均无显著差异(P均>0.05)。结论口服和肌注P对治疗先兆流产均有良好疗效。口服比肌注血清P值增长快,但相对生物利用度低,因此不能仅凭血清P浓度来判断药物治疗效果,结合E_2、hCG以及B超监测等进行综合判断,可更客观全面地评价妊娠状态和药物疗效。Objective： To compare the effect of progestagen therapy by different ways in threatened abortion. Methods： 93 cases of early threatened abortion were randomized and divided into intramuscular injection group（n=38） and per os group（n= 55）. Control group was composed of 31 healthy early pregnant women who did not take any drug over the same period. Anti-abortive effects of the two groups were observed. The changes of serum progesterone（P）, estradiol（E2） and hCG pre- and post-treatment of the two groups were measured and compared with the control group. Results： （1） Pregnancy was successfully been maintained in 78 women of the 93 cases. The effective rate was 87 % and 82 % in intramuscular injection group and per os group, respectively. There was no notable difference between the two groups （P〉0.05）. （2） In the 78 successful cases, the comparison of P, E2 and hCG pre- and post-treatment within the first week shows： Daily growth rate （DGR） of P in the per os group was significantly higher than the other two groups. The DGR of P in intramuscular injection group was higher than control group （P〈0.05）. There was little statistical difference among the three groups when it came to E2 and hCG （P〉0.05）. （3）After measuring the growth rate of P, E2 and HCG of the patients who kept on treatment weekly, we found that long-term DGR of all the three hormones were similar between the two groups （P〉0.05）. Conclusions： Progesterone per os or intramuscular injection both has good effect on threatened abortion. Concentration of serum P increased more quickly when progesterone was taken orally, however it has lower relative bioavailability. Therefore, it is impropriety to estimate the effects only by the level of P. Combining with E2, hCG and B ultrasound is also needed in the evaluation.

关 键 词：治疗效果 流产 先兆 绒毛膜促性腺激素 药物 酮类 肌肉注射 生物利用度 

分 类 号：S858.287.2[农业科学—临床兽医学] S941.62[农业科学—兽医学]