Soltes B, Molo M W, Binor Z, Rawlins R G, Radwanska E
Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Fertil Steril. 1993 Apr;59(4):810-4. doi: 10.1016/s0015-0282(16)55864-6.
To describe the hormonal profiles of chromosomally abnormal pregnancies during the first trimester.
A prospective study from 1984 through 1990 in which infertility patients who conceived were monitored weekly with serum E2, P, and beta-hCG levels.
The infertility practice at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois.
Study included 15 women who had dilatation and curettage for first trimester fetal losses with confirmed abnormal karyotype, 6 women with chromosomally normal male abortuses, and 60 consecutive women whose pregnancies yielded normal term infants.
After natural conception, E2 demonstrated a moderate rise in both normal and chromosomally abnormal pregnancies to approximately 300 pg/mL by day 29 (6 weeks of gestation). In normal gestations, E2 continued a steady increase to exceed the level of 1,000 pg/mL by day 64 (11 weeks of gestation). In chromosomally abnormal pregnancies, the mean E2 plateaued and remained at approximately 200 pg/mL until fetal demise was noted. In stimulated conceptions, the rise of E2 was sharp and early (1,200 pg/mL by day 29); in normal pregnancies, E2 steadily increased to an average of 1,400 pg/mL by the end of the first trimester, whereas in karyotypically abnormal gestations, E2 declined to approximately 200 pg/mL by day 64. In pregnancies yielding a male abortus, a sharp decline and plateau at 800 pg/mL by day 56 (10 weeks of gestation) was observed. In both natural and stimulated normal pregnancies, hCG levels first demonstrated a linear rise, followed by a curvilinear increase from day 29 until day 56, with a peak of approximately 110,000 mIU/mL. The beta-hCG in chromosomally abnormal pregnancies, as well as in pregnancies yielding a male abortus, was characterized by a slow and gradual rise to a maximum of 40,000 mIU/mL, which remained relatively linear until day 64 when fetal demise was detected in all cases. Progesterone level data were excluded from analysis because of frequent P supplementation.
There were significant differences in the hormonal profiles of chromosomally normal and abnormal pregnancies. Serial measurements of serum E2 and beta-hCG from the 6th week of gestation may be useful in predicting an abnormal karyotype sooner than other current diagnostic tests.
描述孕早期染色体异常妊娠的激素谱。
1984年至1990年的一项前瞻性研究，对受孕的不孕症患者每周监测血清雌二醇（E2）、孕酮（P）和β-人绒毛膜促性腺激素（β-hCG）水平。
伊利诺伊州芝加哥市拉什-长老会-圣卢克医疗中心的不孕症诊疗机构。
研究纳入15例因孕早期胎儿丢失行刮宫术且核型确诊异常的女性、6例染色体正常的男性流产患者以及60例妊娠至足月分娩正常婴儿的连续病例。
自然受孕后，正常妊娠和染色体异常妊娠的E2均有适度升高，至第29天（妊娠6周）时约为300 pg/mL。在正常妊娠中，E2持续稳步上升，至第64天（妊娠11周）时超过1000 pg/mL。在染色体异常妊娠中，E2均值达到平台期并维持在约200 pg/mL，直至观察到胎儿死亡。在促排卵受孕中，E2升高迅速且较早（第29天时达1200 pg/mL）；在正常妊娠中，E2在孕早期末稳步升至平均1400 pg/mL，而在核型异常妊娠中，E2在第64天时降至约200 pg/mL。在男性流产的妊娠中，观察到第56天（妊娠10周）时急剧下降并在800 pg/mL达到平台期。在自然受孕和促排卵受孕的正常妊娠中，hCG水平最初呈线性上升，随后从第29天至第56天呈曲线上升，峰值约为110,000 mIU/mL。染色体异常妊娠以及男性流产妊娠中的β-hCG表现为缓慢逐渐上升至最大值40,000 mIU/mL，直至第64天在所有病例中均检测到胎儿死亡时一直保持相对线性。由于频繁补充P，孕酮水平数据被排除在分析之外。
染色体正常和异常妊娠的激素谱存在显著差异。从妊娠第6周开始连续测量血清E2和β-hCG可能比目前其他诊断测试更早地预测核型异常。
