目的 探討免疫球蛋白聯(lián)合黃體酮和人絨毛膜促性腺激素治療抗心磷脂抗體陽性復(fù)發(fā)性流產(chǎn)的臨床療效。方法 選取2013年8月—2018年5月在東莞市第三人民醫(yī)院診治的ACA陽性復(fù)發(fā)性流產(chǎn)患者72例作為研究對(duì)象，根據(jù)治療方法將患者分為對(duì)照組和觀察組，每組各36例。對(duì)照組患者給予傳統(tǒng)方法治療，從確診為早孕開始治療，肌注黃體酮注射液，20 mg，1次/d。隔日1次肌注注射用絨促性素，2 000 U，直至孕12周。觀察組患者在對(duì)照組治療的基礎(chǔ)上給予免疫球蛋白治療，妊娠前卵泡期給予靜注人免疫球蛋白2 mL，妊娠后立即再用1次，隔日1次肌注注射用絨促性素2 000 U，以后每隔4周1次，直至孕12周停藥。比較兩組患者的黃體生成激素（LH）、睪酮（T）、抗繆勒管激素（AMH）與腫瘤壞死因子相關(guān)蛋白12（CTRP12）水平、妊娠情況。結(jié)果 兩組治療后的血清LH與T水平都顯著低于治療前，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，觀察組性激素水平顯著低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者血清AMH水平顯著低于治療前，CTRP12水平顯著高于治療前，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，觀察組血清AMH和CTRP12水平顯著優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，觀察組的妊娠成功率為86.1%，顯著高于對(duì)照組的47.2%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 免疫球蛋白治療ACA陽性復(fù)發(fā)性流產(chǎn)能改善機(jī)體的性激素分泌平衡，提高患者生育功能與妊娠成功率，且安全性好。

Objective To investigate the clinical efficacy of immunoglobulin combined with progesterone and human chorionic gonadotrophin in treatment of ACA-positive recurrent spontaneous abortion. Methods Patients (72 cases) with ACA-positive recurrent spontaneous abortion in Third People's Hospital of Dongguan from August 2013 to May 2018 were divided into control and observation group, each group had 36 cases. Patients in the control group were treated with traditional methods, starting from the diagnosis of early pregnancy, and injected with Progesterone Injection, 20 mg, once daily. Intramuscular injection of Chorionic Gonadotrophin for Injection 2 000 U every other day up to 12 weeks of gestation. Patients in the observation group were given immunoglobulin treatment on the basis of control group, before pregnancy, 2 mL of Human Immunoglobulin (pH4) for Intravenous Injection was given intravenously in the follicular phase, and then it was used once immediately after pregnancy. Every other day, 2000 U of Chorionic Gonadotrophin for Injection was injected intramuscularly, and then it was stopped every 4 weeks until the 12th week of pregnancy. After treatment, the levels of LH, T, AMH, CTRP12, and pregnancy result in two groups were compared. Results After treatment, the serum levels of LH and T in two groups were significantly decreased, the difference in the same group was statistically significant (P<0.05). After treatment, sex hormone levels in the observation group were significantly lower than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, the serum levels of AMH in two groups was significantly decreased, but CTRP12 was significantly increased, the difference in the same group was statistically significant (P<0.05). After treatment, AMH and CTRP12 levels in the observation group were significantly better than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, the pregnancy success rate in the observation group was 86.1%, which was significantly higher than 47.2% in the control group, the difference between two groups was statistically significant (P<0.05). Conclusion Immunoglobulin in treatment of patients with ACA-positive recurrent spontaneous abortion can improve the balance of sexual hormone secretion, improve the fertility and pregnancy success rate of patients, which has a good safety.

R984

東莞市社會(huì)科技發(fā)展（重點(diǎn)）項(xiàng)目（201750715024450）；廣東省科技計(jì)劃項(xiàng)目（2012B032000015）