目的 探讨免疫球蛋白联合黄体酮和人绒毛膜促性腺激素治疗抗心磷脂抗体阳性复发性流产的临床疗效。方法 选取2013年8月—2018年5月在东莞市第三人民医院诊治的ACA阳性复发性流产患者72例作为研究对象，根据治疗方法将患者分为对照组和观察组，每组各36例。对照组患者给予传统方法治疗，从确诊为早孕开始治疗，肌注黄体酮注射液，20 mg，1次/d。隔日1次肌注注射用绒促性素，2 000 U，直至孕12周。观察组患者在对照组治疗的基础上给予免疫球蛋白治疗，妊娠前卵泡期给予静注人免疫球蛋白2 mL，妊娠后立即再用1次，隔日1次肌注注射用绒促性素2 000 U，以后每隔4周1次，直至孕12周停药。比较两组患者的黄体生成激素（LH）、睾酮（T）、抗缪勒管激素（AMH）与肿瘤坏死因子相关蛋白12（CTRP12）水平、妊娠情况。结果 两组治疗后的血清LH与T水平都显著低于治疗前，同组比较差异具有统计学意义（P<0.05）；治疗后，观察组性激素水平显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者血清AMH水平显著低于治疗前，CTRP12水平显著高于治疗前，同组比较差异具有统计学意义（P<0.05）；治疗后，观察组血清AMH和CTRP12水平显著优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，观察组的妊娠成功率为86.1%，显著高于对照组的47.2%，两组比较差异具有统计学意义（P<0.05）。结论 免疫球蛋白治疗ACA阳性复发性流产能改善机体的性激素分泌平衡，提高患者生育功能与妊娠成功率，且安全性好。

Objective To investigate the clinical efficacy of immunoglobulin combined with progesterone and human chorionic gonadotrophin in treatment of ACA-positive recurrent spontaneous abortion. Methods Patients (72 cases) with ACA-positive recurrent spontaneous abortion in Third People's Hospital of Dongguan from August 2013 to May 2018 were divided into control and observation group, each group had 36 cases. Patients in the control group were treated with traditional methods, starting from the diagnosis of early pregnancy, and injected with Progesterone Injection, 20 mg, once daily. Intramuscular injection of Chorionic Gonadotrophin for Injection 2 000 U every other day up to 12 weeks of gestation. Patients in the observation group were given immunoglobulin treatment on the basis of control group, before pregnancy, 2 mL of Human Immunoglobulin (pH4) for Intravenous Injection was given intravenously in the follicular phase, and then it was used once immediately after pregnancy. Every other day, 2000 U of Chorionic Gonadotrophin for Injection was injected intramuscularly, and then it was stopped every 4 weeks until the 12th week of pregnancy. After treatment, the levels of LH, T, AMH, CTRP12, and pregnancy result in two groups were compared. Results After treatment, the serum levels of LH and T in two groups were significantly decreased, the difference in the same group was statistically significant (P<0.05). After treatment, sex hormone levels in the observation group were significantly lower than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, the serum levels of AMH in two groups was significantly decreased, but CTRP12 was significantly increased, the difference in the same group was statistically significant (P<0.05). After treatment, AMH and CTRP12 levels in the observation group were significantly better than those in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, the pregnancy success rate in the observation group was 86.1%, which was significantly higher than 47.2% in the control group, the difference between two groups was statistically significant (P<0.05). Conclusion Immunoglobulin in treatment of patients with ACA-positive recurrent spontaneous abortion can improve the balance of sexual hormone secretion, improve the fertility and pregnancy success rate of patients, which has a good safety.

R984

东莞市社会科技发展（重点）项目（201750715024450）；广东省科技计划项目（2012B032000015）