静脉注射免疫球蛋白联合地屈孕酮治疗绒毛膜下血肿合并先兆流产的疗效观察  

Intravenous immunoglobulin combined with dydrogesterone in the treatment of subchorionic haematoma combined with threatened obortion

作　　者：吴莎 王成 夏曦 WU Sha;WANG Cheng;XIA Xi(Shenzhen Bao'an Clinical Medical College,Guangdong Medical University,Shenzhen Guangdong 518000,China;Department of Obstetrics,Shenzhen Bao'an People's Hospital,Shenzhen Guangdong 518101,China;Medical Laboratory,Shenzhen Luohu Hospital Group,Shenzhen Guangdong 518000,China;Reproductive Medicine Center,Guangdong Medical University,The First Clinical Medical College,Shenzhen Guangdong 518100,China)

机构地区：[1]广东医科大学深圳宝安临床医学院,广东深圳518000 [2]深圳市宝安区人民医院产科,广东深圳518101 [3]深圳市罗湖医院集团医学检验实验室,广东深圳518000 [4]广东医科大学第一临床医学院生殖医学中心,广东深圳518100

出　　处：《临床和实验医学杂志》2025年第6期621-625,共5页Journal of Clinical and Experimental Medicine

基　　金：广东省科技计划项目(编号:2021G00283)。

摘　　要：目的探讨静脉注射免疫球蛋白(IVIg)联合地屈孕酮治疗对绒毛膜下血肿(SCH)伴先兆流产患者的临床价值。方法前瞻性选取2021年1月至2023年10月深圳市宝安区人民医院收治的160例SCH伴先兆流产患者,按照随机数字表法将其分为两组:对照组和观察组,每组各80例。两组均给予维生素E胶丸治疗,在此基础上,对照组给予地屈孕酮治疗,观察组在对照组基础上给予IVIG治疗。治疗2周后,评估两组阴道止血时间、住院时间,比较两组治疗前、治疗2周后的SCH面积、SCH面积/孕囊面积、Th1/Th2细胞因子[肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素(IL)-4、IL-10]水平及妊娠相关激素[β-人绒毛膜促性腺激素(β-hCG)、孕酮、雌二醇]水平变化,记录并比较两组妊娠结局及妊娠并发症发生情况。结果观察组阴道止血时间、住院时间分别为(3.56±1.04)、(8.25±2.17)d,均短于对照组[(4.32±1.17)、(10.02±3.21)d],差异均有统计学意义(P<0.05)。治疗2周后,两组SCH面积、SCH面积/孕囊面积均较治疗前下降,且观察组SCH面积、SCH面积/孕囊面积分别为(0.33±0.11)cm 2、(5.06±0.87)%,均低于对照组[(0.97±0.18)cm 2、(8.97±1.44)%],差异均有统计学意义(P<0.05)。治疗2周后,两组TNF-α、IFN-γ水平均较治疗前下降,IL-4、IL-10水平均较治疗前升高,且观察组TNF-α、IFN-γ水平分别为(4.15±0.86)、(16.23±2.14)pg/mL,均低于对照组[(4.97±1.03)、(18.17±2.95)pg/mL],IL-4、IL-10水平分别为(1.87±0.34)、(3.95±0.52)pg/mL,均高于对照组[(1.52±0.31)、(3.04±0.48)pg/mL],差异均有统计学意义(P<0.05)。治疗2周后,两组β-hCG、孕酮、雌二醇水平均较治疗前升高,且观察组β-hCG、孕酮、雌二醇水平分别为(177.57±78.96)U/mL、(34.87±7.82)ng/mL、(20.18±1.45)ng/mL,均高于对照组[(128.92±67.46)U/mL、(28.45±7.63)ng/mL、(16.87±1.25)ng/mL],差异均有统计学意义(P<0.05)。观察组流产、产后出血及胎盘粘连Objective To observe the efficacy of intravenous immunoglobulin(IVIG)combined with dydrogesterone in the treatment of subchorionic haematoma(SCH)combined with threatened obortion.Methods A total of 160 patients with SCH combined with threatened abortion admitted to Shenzhen Bao'an People's Hospital from January 2021 to October 2023 were prospectively selected and divided into two groups according to the random number table method:the control group and the observation group,with 80 cases in each group.Both groups were treated with vitamin E capsules,on this basis,the control group was treated with dydrogesterone,and the observation group was treated with IVIG on the basis of the control group.The vaginal hemostasis time and hospitalization time of the two groups were evaluated 2 weeks after treatment.The changes of SCH area,SCH area/gestational sac area,the levels of Th1/Th2 cytokines[tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin(IL)-4,IL-10]and pregnancy-related hormones[β-human chorionic gonadotropin(β-hCG),progesterone,estradiol]before and 2 weeks after treatment were evaluated.The pregnancy outcome and pregnancy complications were recorded and compared between the two groups.Results The vaginal hemostasis time and hospitalization time in the observation group were(3.56±1.04)and(8.25±2.17)d,respectively,which were shorter than those in the control group[(4.32±1.17)and(10.02±3.21)d],and the differences were statistically significant(P<0.05).After 2 weeks of treatment,the SCH area and SCH area/gestational sac area of the two groups were lower than those before treatment,and the SCH area and SCH area/gestational sac area of the observation group were(0.33±0.11)cm 2 and(5.06±0.87)%,respectively,which were lower than those of the control group[(0.97±0.18)cm 2 and(8.97±1.44)%],the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of TNF-α and IFN-γin the two groups were lower than those before treatment,and the levels of IL-4 and IL-10 were highe

关 键 词：免疫球蛋白类 静脉内 地屈孕酮 先兆流产 妊娠结局 绒毛膜下血肿 

分 类 号：R714.21[医药卫生—妇产科学]