作者：吴晓荣，王双双，曹意苒 安康市中心医院生殖医学科，陕西 安康 725000
【摘要】 目的 探讨孕早期先兆流产合并绒毛膜下血肿(SCH)患者血清Th1/Th2细胞因子与孕酮、β-人绒毛膜促性腺激素(β-HCG)水平及妊娠结局的关系。方法 选取2021年1月至2022年1月期间安康市中心医院生殖医学科收治的100例孕早期先兆流产合并SCH患者为研究对象，按照妊娠12周超声检查妊娠结局将其分为治疗后正常妊娠组65例和难免流产组35例，以同期正常孕妇 100例作为对照组。比较三组孕妇的血清Th1型细胞因子[肿瘤坏死因子-α (TNF-α)、白细胞介素(IL)-2]、Th2型细胞因子(IL-4、IL-10)、孕酮、β-HCG水平；采用Pearson相关系数分析上述指标的相关性；采用多元线性回归分析和Spearman相关系数分析血清Th1/Th2细胞因子水平与妊娠结局的相关性；绘制受试者工作特征曲线(ROC)分析上述指标单独及联合检测对孕早期先兆流产合并SCH患者妊娠结局的评估价值。结果 治疗后正常妊娠组、难免流产组孕妇的血清TNF-α、IL-2水平明显高于对照组，血清IL-4、IL-10、孕酮、β-HCG水平明显低于对照组，而治疗后正常妊娠组孕妇的血清TNF-α、IL-2水平明显低于难免流产组，血清 IL-4、IL-10、孕酮、β-HCG水平明显高于难免流产组，差异均有统计学意义(P<0.05)；孕早期先兆流产合并SCH患者血清TNF-α、IL-2水平与孕酮、β-HCG水平及妊娠结局呈负相关(P<0.05)，而血清 IL-4、IL-10水平与孕酮、β-HCG水平及妊娠结局呈正相关(P<0.05)；经多元线性回归分析结果显示，血清TNF-α、IL-2、IL-4、IL-10、孕酮、β-HCG均是影响孕早期先兆流产合并SCH患者妊娠结局的因素(P<0.05)；经ROC分析结果显示，血清TNF-α、IL-2、IL-4、IL-10、孕酮及β-HCG联合检测的曲线下面积(AUC)均大于上述指标单独检测的AUC (P<0.05)。结论 孕早期先兆流产合并SCH患者血清Th1/Th2细胞因子与孕酮、β-HCG水平均呈现异常表达，血清Th1/Th2细胞因子与孕酮、β-HCG水平及妊娠结局之间具有一定相关性，联合检测对患者妊娠结局具有良好评估价值。
【中图分类号】 R714.21 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1290—05
Relationship between serum Th1/Th2 cytokines and progesterone, β-human chorionic gonadotropin levels andpregnancy outcome in patients with early threatened abortion combined with subchorionic hematoma.
WUXiao-rong, WANG Shuang-shuang, CAO Yi-ran. Department of Reproductive Medicine, Ankang Central Hospital, Ankang725000, Shaanxi, CHINA
【Abstract】 Objective To investigate the relationship between serum Th1/Th2 cytokines and progesterone,β-human chorionic gonadotropin (β-HCG) levels and pregnancy outcome in patients with early threatened abortion com-bined with subchorionic hematoma (SCH). Methods One hundred patients with early threatened abortion combinedwith SCH admitted to the Department of Reproductive Medicine, Ankang Central Hospital between January 2021 andJanuary 2022 were selected as the research objects. According to the pregnancy outcome of ultrasound examination at12 weeks of pregnancy, they were divided into normal pregnancy group (n=65) and inevitable abortion group (n=35) af-ter treatment. One hundred normal pregnant women in the same period were taken as control group. Serum Th1 cytokine[tumor necrosis factor-α (TNF-α), interleukin (IL)-2], Th2 cytokine (IL-4, IL-10), progesterone, and β-HCG levelswere compared among the three groups of pregnant women. Pearson correlation coefficient was used to analyze the cor-relation between the above indicators. Multiple linear regression analysis and Spearman correlation coefficient were usedto analyze the correlation between serum Th1/Th2 cytokines levels and pregnancy outcome. The value of the above indi-cators alone and in combination on the assessment of pregnancy outcome in patients with early threatened abortion com-bined with SCH in early pregnancy was analyzed by receiver operating characteristic (ROC) curve. Results After treat-ment, the serum TNF-α and IL-2 levels of pregnant women in the normal pregnancy group and the inevttable abortiongroup were significantly higher than those in the control group, and the serum IL-4, IL-10, progesterone, and β-HCGlevels were significantly lower than those in the control group; the serum TNF-α and IL-2 levels of pregnant women inthe normal pregnancy group after treatment were significantly lower than those in the inevitable abortion group, and theserum IL-4, IL-10, progesterone, and β-HCG levels were significantly higher than those in the inevitable abortiongroup; and the differences were statistically significant (P<0.05). Serum TNF-α and IL-2 levels were negatively correlat-ed with progesterone, β-HCG levels and pregnancy outcome in patients with early threatened abortion combined withSCH (P<0.05), while serum IL-4 and IL-10 levels were positively correlated with progesterone, β-HCG levels and preg-nancy outcome (P<0.05). The results of multiple linear regression analysis showed that serum TNF-α, IL-2, IL-4,IL-10, progesterone, and β-HCG were all factors affecting pregnancy outcome in patients with early threatened abortioncombined with SCH in early pregnancy (P<0.05). The results of ROC analysis showed that the area under the curve(AUC) of combined detection of serum TNF-α, IL-2, IL-4, IL-10, progesterone and β-HCG was greater than that ofsingle detection of the above indicators (P<0.05). Conclusion Serum Th1/Th2 cytokines, progesterone, and β-HCGlevels showed abnormal expression in patients with early threatened abortion combined with SCH. There was a certaincorrelation between serum Th1/Th2 cytokines with progesterone, β-HCG levels, and pregnancy outcome. Combined de-tection detection has good evaluation value for pregnancy outcome.
【Key words】 Early threatened abortion; Th1/Th2 cytokines; Progesterone; β-human chlorionic gonadotropin;Pregnancy outcome; Correlation