复发性流产患者病因构成分析

背景复发性流产(RSA)发病率呈逐年上升趋势,严重影响妇女身心健康,目前现代医学对RSA的病因和发病机制尚未完全明确。目的了解RSA病因的分布情况,以及流产孕周与流产次数和RSA病因之间的关系。方法选取2018年在新疆医科大学第二附属医院确诊为RSA的患者198例,收集患者的一般资料包括年龄、自然流产次数、流产孕周,并筛查患者的病因:染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常等,并对这些资料进行回顾性分析。根据患者的流产孕周,分为早期RSA组(<12周)(155例)和晚期RSA组(≥12周)(43例);根据流产次数分为2次组(123例)和≥3次组(75例)。分析RSA患者各病因所占比例,以及RSA病因在不同流产孕周组和不同流产次数组间的差异。结果198例RSA患者,染色体异常9例(4.55%),生殖道解剖结构异常11例(5.56%),内分泌系统异常36例(18.18%),生殖道感染14例(7.07%),自身免疫异常30例(15.15%),不明病因98例(49.49%)。晚期RSA组患者生殖道解剖结构异常发生率大于早期RSA组,不明病因发生率低于早期RSA组(P<0.05);早期RSA组与晚期RSA组患者染色体异常、内分泌系统异常、生殖道感染、自身免疫异常发生率比较,差异均无统计学意义(P>0.05)。流产次数2次组和流产次数≥3次组患者染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常、不明病因发生率比较,差异均无统计学意义(P>0.05)。结论导致RSA的病因有多种,包括染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常及不明病因等多种因素,其中不明病因的RSA占多数;生殖道解剖结构异常对妊娠晚期的影响大于妊娠早期。

Etiological Factors of Recurrent Spontaneous Abortion

Background　The incidence of recurrent spontaneous abortion（RSA） is increasing year by year，which seriously affects women's physical and mental health.However，the etiology and pathogenesis of RSA in modern medicine are not completely clear.Objective　To investigate the etiology distribution of RSA，and its association with the gestational age of abortion and number of abortions.Methods　198 cases of RSA were recruited from the Second Affiliated Hospital of Xinjiang Medical University in 2018.Retrospective analyses were performed on general information such as age，number of abortions，and gestational age of abortion，and etiological factors of abortion，such as chromosomal abnormalities in the couple，anatomic abnormality of the female reproductive tract，autoimmune abnormality，infections of the female reproductive tract，and female endocrine abnormality.They were stratified into early RSA group（<12 weeks，n=155） and late RSA group（≥12 weeks，n=43） by gestational age of abortion，and were stratified into 2 times group（n=123），and more than 2 times group（n=75） by the number of abortions.The distribution of various etiological factors for RSA was analyzed in all patients，and was further analyzed by the gestational age of abortion，and number of abortions.Results　Of the 198 cases，the prevalence of chromosomal abnormalities in the couple，anatomic abnormality of the female reproductive tract，female autoimmune abnormality，female reproductive tract infections，female endocrine abnormality，and unknown causes was 4.55%（n=9），5.56%（n=11），18.18%（n=36），7.07%（n=14），15.15%（n=30），and 49.49%（n=98），respectively.Late RSA group showed higher prevalence of anatomic abnormality of the female reproductive tract，and lower prevalence of unknown causes compared with early RSA group（P<0.05），but the prevalence of other etiological factors for RSA was similar in both groups（P>0.05）.The prevalence of such etiological factors for RSA was not associated with the number of abortions，either 2 times or more（P>0.05）.Conclusion　There are many factors leading to RSA，such as chromosomal abnormalities in the couple，anatomic abnormality and infections of the female reproductive tract，female endocrine and autoimmune abnormalities and unknown causes.Among them，unknown causes account for the majority.The third trimester of pregnancy is influenced more by anatomic abnormality of the female reproductive tract than the first trimester of pregnancy.