基于血清BPA PAPP-A水平变化探究不同剂量黄体酮对早孕先兆流产患者疗效机制研究

doi:10.3969/j.issn.1006-6233.2026.01.020

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摘要 目的: 分析不同剂量黄体酮对早孕先兆流产患者血清双酚A(BPA)、妊娠相关血浆蛋白A(PAPP-A)水平影响及疗效机制研究。方法: 选96例2023年7月至2024年7月我院收治的早孕先兆流产患者作为研究对象为观察组。采用不同黄体酮剂量的治疗方法进行治疗,将观察组96例患者随机分为低剂量组(A组)、中剂量组(B组)、高剂量组(C组),各32例。采用计算机生成随机数字表进行随机分组,并由专人保管分组方案实现分配隐藏。采用酶联免疫吸附试验法(ELISA)进行检测血清BPA、PAPP-A水平变化,分析保胎情况,根据观察组的保胎结局将其分为保胎有效组(n=66)和保胎无效组(n=30)。明确血清BPA、PAPP-A水平与早孕先兆流产患者不同剂量黄体酮保胎治疗效果的关系。结果: 治疗后,相比于A组,B组、C组BPA表达水平得到下降,PAPP-A表达水平得到上升(P<0.05)。与C组相比,A组、B组保胎成功率升高(P<0.05)。与保胎无效组相比,保胎有效组早孕先兆流产患者BPA表达水平下降,PAPP-A表达水平上升(P<0.05)。BPA与低剂量、中剂量、高剂量保胎治疗效果均呈现负相关性(P<0.05)。PAPP-A与低剂量、中剂量、高剂量保胎治疗效果均呈现正相关性(P<0.05)。Logistic回归分析显示,早孕先兆流产患者BPA、PAPP-A是影响早孕先兆流产患者行黄体酮保胎治疗效果的主要危险因素(P<0.05)。采用ROC分析得出,血清BPA、PAPP-A联合预测早孕先兆流产患者行黄体酮保胎治疗效果,预测价值较高(P<0.05)。结论: 进行不同剂量黄体酮对早孕先兆流产患者进行保胎治疗,能显著提升患者保胎率,降低流产风险,其中中剂量黄体酮的治疗效果最佳,显著改善血清BPA、PAPP-A表达水平,提高患者妊娠结局。

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关键词 ：早孕, 先兆流产, 双酚A, 妊娠相关血浆蛋白A, 黄体酮, 不同剂量

Abstract：Objective: To analyze the effects of different doses of progesterone on serum bisphenol A (BPA) and pregnancy-related plasma protein A (PAPP-A) levels in patients with threatened abortion in early pregnancy. Methods: A total of 96 cases with threatened abortion in early pregnancy admitted to our hospital from July 2023 to July 2024 were selected as the study subjects and assigned to the observation group. The patients were treated with different doses of progesterone, and randomly divided into a low-dose group (Group A), a medium-dose group (Group B) and a high-dose group (Group C), with 32 cases in each group.Randomization was performed using a computer-generated random number table, and the allocation concealment was ensured by a dedicated person managing the grouping scheme. Serum levels of BPA and PAPP-A were measured using the enzyme-linked immunosorbent assay (ELISA) to analyze the pregnancy maintenance outcomes. Based on the outcomes,the cases in the observation group was further classified into an effective pregnancy maintenance group (n=66) and an ineffective pregnancy maintenance group (n=30). The relationship was clarified between serum levels of BPA and PAPP-A and the efficacy of different progesterone doses in pregnancy maintenance treatment for patients with threatened abortion in early pregnancy.Results: After treatment, compared with Group A, the BPA expression levels in Groups B and C decreased, while the PAPP-A expression levels increased (P<0.05). Compared with Group C, the success rates of pregnancy maintenance in Groups A and B were higher (P<0.05). In comparison to the ineffective pregnancy maintenance group, the expression levels of BPA were decreased and those of PAPP-A were increased in the effective pregnancy maintenance group in patients with threatened abortion in early pregnancy (P<0.05). BPA exhibited a negative correlation with the efficacy of low-dose, medium-dose, and high-dose pregnancy maintenance treatments (P<0.05), while PAPP-A showed a positive correlation with the efficacy of these treatments (P<0.05). Logistic regression analysis indicated that BPA and PAPP-A in patients with threatened abortion in early pregnancy were the primary risk factors influencing the efficacy of progesterone-based pregnancy maintenance treament (P<0.05). ROC analysis revealed that the combination of serum BPA and PAPP-A for the efficacy of progesterone-based pregnancy maintenance treatment in patients with threatened abortion in early pregnancy had high predictive value (P<0.05).Conclusion: Pregnancy maintenance treatment with different doses of progesterone in patients with threatened abortion in early pregnancy can significantly improve the pregnancy maintenance rate and reduce the risk of abortion. Among them, the medium-dose progesterone has the best treatment effect, which can significantly improve the serum levels of BPA and PAPP-A, and enhance the pregnancy outcomes of patients.

Key words： Early pregnancy Threatened abortion Bisphenol A Pregnancy-related plasma protein A Progesterone Different doses

基金资助:国家自然科学基金资助项目,(编号:82074259);山东省重点研发计划项目,(编号:GG201709280194)

通讯作者: 薛德娜

引用本文:

方笑白, 张翠萍, 邢瑞生, 焦娜, 薛德娜, 张跃辉. 基于血清BPA PAPP-A水平变化探究不同剂量黄体酮对早孕先兆流产患者疗效机制研究[J]. 河北医学, 2026, 32(1): 122-128.
FANG Xiaobai, et al. Study on the Efficacy Mechanism of Different Doses of Progesterone in Patients with Threatened Abortion in Early Pregnancy Based on the Changes of Serum BPA and PAPP-A Levels. HeBei Med, 2026, 32(1): 122-128.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2026.01.020 或 http://www.hbyxzzs.cn/CN/Y2026/V32/I1/122

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