孕囊超声参数联合血清HCG判断孕早期先兆流产的价值分析

Clinical Value of Threatened Abortion in the Early Stage of Severed Pregnancy Estimated by the Ultrasonic Parameters of Gestational Sac Combined with Serum Chorionic Gonadotropin(HCG)

目的:探讨孕囊超声参数联合血清人绒毛膜促性腺激素(HCG)判断孕早期先兆流产的临床价值。方法:收集2017年3月—2019年3月本院及青海省仁济医院产科门诊收治的孕早期先兆流产患者165例作为观察对象,根据妊娠结局分为持续妊娠组(115例)和流产组(50例)。收集两组患者一般资料,通过B超检测患者平均孕囊直径、胎芽长度、平均卵黄囊直径、胎心率水平;采用全自动生化分析仪检测患者血清β-HCG、孕酮(P)水平,以判断孕早期是否有先兆流产。结果:(1)两组间年龄、月经周期、停经时间、盆腔积液比例、身体质量指数(BMI)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异均无统计学意义(P>0.05),流产组腹痛、阴道出血占比均高于持续妊娠组(P<0.05)。(2)流产组平均孕囊直径(16.48±4.83)mm、胚芽长度(4.06±1.15)mm、平均卵黄囊直径(3.38±1.02)mm,均短于持续妊娠组(P<0.05);两组胎心率比较,差异无统计学意义(P>0.05);流产组血清β-HCG(21.47±4.41)IU/m L、P水平(12.74±4.36)ng/m L,均低于持续妊娠组(P<0.05)。(3)先兆流产患者血清β-HCG、P水平与平均孕囊直径、胚芽长度、平均卵黄囊直径呈正相关(P<0.05)。(4)多因素Logistic回归分析结果显示,平均孕囊直径、胚芽长度、β-HCG、P水平偏低是孕早期孕妇发生先兆流产的危险因素(P<0.05)。(5)平均孕囊直径、胚芽长度、β-HCG、P水平预测先兆流产的曲线下面积(AUC)分别为0.723(0.592~0.855)、0.806(0.685~0.926)、0.884(0.798~0.971)、0.742(0.609~0.876),联合检测AUC为0.936(0.816~0.989),均具有较高的预测价值。结论:孕囊超声参数联合血清β-HCG、P检测对于判断孕早期先兆流产结局具有重要价值。

Objective:This study is aimed to detect the ultrasonic parameters of gestational sac combined with serum chorionic gonadotropin(HCG)for clinical value of threatened abortion in the early stage of severed pregnancy.Methods:We collected a total of 165 patients with threatened abortion in early pregnancy treated in the obstetrics clinic of our hospital and the obstetrics outpatient department of Renji hospital in Qinghai province from March 2017 to March 2019 and they were divided into continuous pregnancy group(n=115)and abortion group(n=50)according to the pregnancy outcome.The general data of the two groups were collected,and the average gestational sac diameter,fetal bud length,average yolk sac diameter and fetal heart rate were detected by B-ultrasound,and the levels of serumβ-HCG and progesterone(P)were detected by automatic biochemical analyzer to judge threatened abortion in early pregnancy.Results:(1)There was no significant difference in age,menstrual cycle,menopause time,proportion of pelvic effusion,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low-density lipoprotein-cholesterol(LDL-C)and high-density lipoprotenin-cholesterol(HDL-C)between the two groups.The proportion of abdominal pain and vaginal bleeding in the abortion group was higher than that in the persistent pregnancy group.(2)The average diameter of gestational sac,embryo length and yolk sac diameter in abortion group were(16.48±4.83)mm,(4.06±1.15)mm and(3.38±1.02)mm,respectively,which were shorter than those in persistent pregnancy group(P<0.05).There was no statistically significant difference in fetal heart rate between the two groups(P>0.05).The levels of serumβ-HCG and P in abortion group were lower than those in persistent pregnancy group(P<0.05).The levels of serumβ-HCG(21.47±4.41)IU/mL and P(12.74±4.36)ng/mL in abortion group were lower than those in persistent pregnancy group.(3)The levels of serumβ-HCG and P in patients with threatened abortion were positively correlated with the average diameter of gestational sac,the length of germ and the average diameter of yolk sac.(4)The results of multivariate Logistic regression analysis showed that the average diameter of gestational sac,the length of embryo,the level ofβ-HCG and P were the risk factors of threatened abortion in early pregnancy(P<0.05).(5)The area under the curve(AUC)of average sac diameter,germ length,β-HCG and P levels for predicting threatened abortion were 0.723(0.592~0.855),0.806(0.685~0.926),0.884(0.798~0.971)and 0.742(0.609~0.876),respectively,and the combined detection AUC was 0.936(0.816~0.989),which had high predictive value.Conclusion:The ultrasonic parameters of gestational sac combined with the detection of serumβ-HCG and P plays an important role in judging the outcome of threatened abortion in early pregnancy.