胚胎移植后14天单次血HCG预测妊娠结局的探讨

A Single Serum HCG Detection on the 14 Days after Embryo Transfer in Predicting Pregnancy Outcome

目的:评估在胚胎移植(ET)后14天单次血HCG测定对妊娠结局的预测价值。方法:选择我院行ET并符合研究条件的182例病例,于ET后14天查血清HCG,并监测至妊娠12周以后,根据血清HCG值、B超、病理检查或腹腔镜检查分为:包括生化妊娠、空孕囊、早期流产的不良妊娠组(A),异位妊娠组(B),正常单胎妊娠组(C),双胎妊娠组(D)和三、四胎妊娠组(E)。比较各组血清HCG值。结果:A组的血HCG浓度与C组比较差异有非常显著性(P<0.01);D组和E组的血HCG浓度与C组比较差异有非常显著性(P<0.01);D组的血HCG浓度与E组比较差异有非常显著性(P<0.01);B组的血HCG浓度与C组比较差异无显著性(P>0.05)。以血清HCG<140U/L界定不良妊娠(不包括异位妊娠),阳性预测价值达79.2%,阴性预测价值为96.7%;以血清HCG>650U/L界定多胎妊娠与单胎妊娠,阳性预测价值为83.9%,阴性预测价值为75.3%;以血清HCG>1500U/L界定三/四胎妊娠与单胎妊娠,阳性预测价值为100%,阴性预测价值为94.3%。结论:ET后14天单次血HCG值是早期预测妊娠结局的良好指标。

Objective：To assess the clinical value of a single serum HCG assay on the 14 days after embryo transfer in predicting pregnancy outcome. Methods： During 2002-2004, we studied 182 embryo transfer cycles resulting in pregrancy defined as a serum HCG concentration on the day 14 following embryo transfer, Serum HCG levels were measured by chemiluminescence assay. Pregnancies were classified as non-viable （biochemical pregnancy, miscarriage, empty gestational sac） （group A）, ectopic pregnancy （group B）, and viable （live fetus at no less than 12 weeks） singleton （group C）, twin （group D） or pregnancies more than twin （group E） according to HCG value,B ultrasound, pathological examination or laparascopy. Meantime, serum HCG value was compared among each group. Results： The mean HCG concentration was 90.39 U/L, 383.87 U/L, 883.50 U/L and 1 831.47U/L in nonviable pregnancies, viable singleton pregnancies, twins, and pregnancies more than twin, respectively, and there was significant difference among them （P〈 0.01）. But there was no difference between Group B and Group C （ P〉0.05）. An HCG value of 〈 140.0 U/L was the cut-off point to predict non-viable pregnancy, the positive predictive value and negative predictive value was 83.9% and 75.3%, respectively; When defined HCG value 〉650U/L to predict multiple pregnancy, the positive predictive value and negative predictive value was 100% and 94.3%, respectively. Conclusions： A single serum HCG assay on the day 14 after embryo transfer is an early marker to predict the pregnancy outcome well.