Kırıcı Pınar, Tanrıverdi Elif Seren
Obstetrics and Gynaecology, Adıyaman University, Adıyaman, TUR.
Microbiology, İnönü University, Malatya, TUR.
Cureus. 2021 Nov 7;13(11):e19333. doi: 10.7759/cureus.19333. eCollection 2021 Nov.
Background and objective This study aimed to investigate how different doses of progesterone influence the concentrations of interleukin-6 (IL-6) and tumor necrotizing factor-alpha (TNF-α), which are proinflammatory cytokines, as well as that of IL-10, which is an anti-inflammatory cytokine, in pregnant women with threatened abortion. Materials and methods This is a prospective, single-center, randomized controlled trial conducted with 221 patients with a threatened abortion diagnosis. Group 1 consisted of IL-6, IL-10, and TNF-α values in pre-treatment blood samples from 221 patients diagnosed with imminent abortion. Group 2 included 81 patients who received natural oral 100 mg micronized progesterone MP twice a day for two weeks. Group 3 included 83 patients who were administered oral 200 mg of natural micronized progesterone MP twice a day for two weeks. Group 4 included 57 patients who received oral 200 mg of natural micronized progesterone MP twice a day for two weeks, and one depot progesterone was added to the treatment by administering it at a dosage of 500 mg/day intramuscularly. Results IL-6 values between groups were lower in group 4 compared to group 3 (p=0.007). When IL-10 values were compared between the groups, the IL-10 ratio was highest in group 4 and lowest in group 2 (p<0.001, p=0.003, p<0.001). When the TNF-α values between the groups were compared, the value in group 4 was decreased compared to groups 1 and 2 (p=0.031, p<0.001). In the logistic regression analysis, the IL-6 value above 12.01 increased the abortion imminens rate 1.01 times, and a TNF-α value above 11.04 increased the abortion imminens rate 1.21 times. Conclusion Progesterone used to treat imminent abortion reduces the levels of proinflammatory cytokines, such as IL-6 and TNF-α, while increasing those of anti-inflammatory cytokine IL-10 in proportion to the dose administered. Progesterone can prevent imminent abortion by generating an anti-inflammatory environment.
背景与目的 本研究旨在探讨不同剂量的孕酮如何影响先兆流产孕妇体内促炎细胞因子白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）以及抗炎细胞因子IL-10的浓度。材料与方法 这是一项前瞻性、单中心、随机对照试验，对221例诊断为先兆流产的患者进行了研究。第1组由221例诊断为难免流产患者治疗前血样中的IL-6、IL-10和TNF-α值组成。第2组包括81例患者，他们每天口服2次100mg天然微粉化孕酮（MP），持续2周。第3组包括83例患者，他们每天口服2次200mg天然微粉化孕酮（MP），持续2周。第4组包括57例患者，他们每天口服2次200mg天然微粉化孕酮（MP），持续2周，并通过每天500mg的剂量肌肉注射添加一次长效孕酮进行治疗。结果 第4组的IL-6值低于第3组（p=0.007）。比较各组的IL-10值时，第4组的IL-10比值最高，第2组最低（p<0.001，p=0.003，p<0.001）。比较各组的TNF-α值时，第4组的值低于第1组和第2组（p=0.031，p<0.001）。在逻辑回归分析中，IL-6值高于12.01使难免流产率增加1.01倍，TNF-α值高于11.04使难免流产率增加1.21倍。结论 用于治疗难免流产的孕酮可降低促炎细胞因子如IL-6和TNF-α的水平，同时按给药剂量比例增加抗炎细胞因子IL-10的水平。孕酮可通过产生抗炎环境来预防难免流产。
