Li T C, Spuijbroek M D, Tuckerman E, Anstie B, Loxley M, Laird S
Jessop Hospital for Woman, Sheffield, UK.
BJOG. 2000 Dec;107(12):1471-9. doi: 10.1111/j.1471-0528.2000.tb11670.x.
To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriage
Prospective, case study
Recurrent miscarriage clinic, Jessop Hospital for Women, Sheffield
One hundred and forty-four women with unexplained recurrent (> or =3) miscarriages
A blood sample was obtained in early follicular phase (day 3-5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid-follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid-luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology.
Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid-luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.
Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.
探讨不明原因复发性流产女性的内分泌及子宫内膜因素
前瞻性病例研究
谢菲尔德杰西普妇女医院复发性流产诊所
144例不明原因复发性（≥3次）流产的女性
在卵泡早期（第3 - 5天）采集血样，检测卵泡刺激素、黄体生成素、催乳素、雄激素及甲状腺功能；从卵泡中期开始每日采集血/尿样，检测黄体生成素，直至确定黄体生成素高峰；在黄体中期进行子宫内膜活检，并采集另一血样检测孕酮。进行经阴道超声检查以评估卵巢形态。
分别有8%和7.8%的女性存在黄体生成素分泌过多或多囊卵巢疾病的超声特征。14.6%的受试者游离雄激素指数升高。在黄体中期，17.4%的女性孕酮水平低，27.1%的女性子宫内膜发育延迟。尽管复发性流产且子宫内膜发育延迟的女性孕酮水平显著低于子宫内膜发育正常的女性，但只有8/24的女性黄体中期孕酮水平低于30 nmol/L。复发性流产与高催乳素血症或甲状腺功能检查异常无关。
约四分之一不明原因复发性流产的女性存在内分泌及子宫内膜异常。
