复发性自然流产夫妇的病因分析  

Etiology analysis on recurrent spontaneous abortion

作　　者：符梅[1,2] 徐克惠[1] 

机构地区：[1]四川大学华西第二医院生殖内分泌科,成都610041 [2]成都中医药大学第二临床医学院,611137

出　　处：《中华妇幼临床医学杂志（电子版）》2016年第4期395-400,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家重点基础研究发展计划:973计划子课题(2012CB944903)~~

摘　　要：目的探讨复发性自然流产(RSA)的相关病因。方法选择2014年12月至2015年11月于四川大学华西第二医院生殖内分泌科和遗传优生科就诊的212对(424例)RSA夫妇的临床病历资料为研究对象。根据女方RSA发生次数,将这212对RSA夫妇分为2次RSA组(157对,314例)与≥3次RSA组(55对,110例)。收集212对RSA夫妇的年龄,女方月经史,生育史,流产情况(流产次数、时间及清宫次数),以及双方家族史等基本资料。对RSA夫妇双方进行外周血染色体核型分析,女方子宫超声检查、内分泌功能检查、免疫系统功能检查及女方弓形体病,风疹、巨细胞、单纯疱疹病毒(TORCH)血清学定量检测,以及男方精液常规检查等,筛查RSA病因。两组RSA夫妇的年龄等基本临床资料比较,差异无统计学差异(P>0.05)。本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准。结果1本研究212对(424例)RSA夫妇中,共计检出染色体异常者为37例,检出异常率为8.7%(37/424),其中女方染色体异常者为27例,男方异常者为10例。女方子宫解剖结构异常者为23例(10.8%,23/212),内分泌功能异常者为60例(28.2%,60/212),生殖道感染者为16例(7.5%,16/212),免疫系统功能异常者为44例(20.7%,44/212)。男方精液数量或质量异常者为20例(9.4%,20/212)。本研究212对RSA夫妇中,76对(35.8%,76/212)上述因素均未见异常。部分RSA夫妇同时合并上述多种因素异常。2两组RSA夫妇染色体异常检出率比较,差异无统计学意义(χ2=1.470,P=0.225),但≥3次RSA组夫妇染色体易位核型检出率(7.3%,8/110)显著高于2次RSA组(1.6%,5/314),二者比较,差异有统计学意义(χ2=7.036,P=0.008)。≥3次RSA组女方子宫解剖结构异常检出率(18.2%,10/55)亦显著高于2次RSA组(8.3%,13/157),二者比较,差异有统计学意义(χ2=4.129,P=0.042)。≥3次RSA组不明原因RSA夫妇所占比例(21.8%,12/55)显著低于2次RSA组(Objective To explore related etiology of recurrent spontaneous abortion（RSA）.Methods From December 2014 to November 2015,clinical data of 212couples（424cases）of RSA who were outpatients in Department of Reproductive Endocrinology and Department of Heredity and Aristogenesis of West China Second University Hospital,Sichuan University were selected as research subjects.All the 212 couples of RSA were divided into two times RSA group（157couples,314cases）and ≥three times RSA group（55couples,110cases）according to the frequencies of RSA patients.The general clinical information of 212 couples with RSA were collected,such as age,the women′s menstrual history,childbearing history,natural abortion cases（natural abortion times,time and number of uterine curettage）,and family history of RSA couples.The etiology screening methods in this research were taken by peripheral blood karyotype analysis of RSA couples,uterus ultrasound examination of females,endocrine function examination of females,the quantitative detection in serology of toxoplasma,rubella virus,cytomegalovirus,herpes simplex virus（TORCH）of females,immune system function examination of females and the semen routine inspection of males.There were no statistical differences of the basic information between two groups,such as age and so on（P〈0.05）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital,Sichuan University.Results 1 Among 212couples（424cases）of RSA,37 cases were detected as abnormal chromosome,the detection rate of abnormal chromosome was 8.7%（37/424）,including 27 cases of females and 10 cases of males.Twenty-three cases（10.8%,23/212）of females were detected as anatomical cacogenesis of uterus.Sixty cases（28.2%,60/212）of females were detected as endocrine dysfunction.Sixteen cases（7.5%,16/212）of females were detected as reproductive tract infections.Forty-four cases（20.7%,44/212）of females were detected as immune syste

关 键 词：流产 习惯性 病因 染色体障碍 免疫 不明原因 

分 类 号：R714.21[医药卫生—妇产科学]