ROC曲线对妊娠结局预测模式的评价

Serum beta human chorionic gonadotropin(β-HCG) and Progesterone predict the failing intrauterine and normal intrauterine pregnancies by ROC curve

目的通过监测正常早孕、自然流产与异位妊娠妇女血清绒毛膜促性腺激素(β-HCG)及孕酮(P)水平,建立正常早孕、自然流产与异位妊娠的妊娠结局预测模式,并利用ROC曲线评价其预测妊娠结局的能力。方法选择正常早期单胎妊娠对照组191例,自然流产患者150例、异位妊娠患者204例。用电发光免疫法测血清β-HCG及P水平,建立单独β-HCG、P以及β-HCG和P联合积分预测模式。结果正常早孕组孕龄血清β-HCG平均值为(7812.52±3599.29)IU/L,P平均值为(35.27±12.91)nmol/L;自然流产组血清β-HCG平均值为(1298.07±1808.83)IU/L,P平均值为(6.66±4.42)nmol/L;异位妊娠组β-HCG平均值为(2118.23±2905.75)IU/L,P平均值为(6.37±5.58)nmol/L;自然流产组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验t=21.75,P=0.000(95%CI:5925.31-7103.79)及t=28.49,P=0.000(95%CI:26.52-30.46),差异有显著性意义;异位妊娠组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验t=17.25,P=0.000(95%CI:5045.02-6﹤343.57)及t=28.32,P=0.000(95%CI:26.79-30.79),差异有显著性意义;自然流产组与异位妊娠组血清β-HCG差异有显著性意义,t=-3.27,P=0.001(P<0.05),两组P水平差异无统计学意义,t=0.57,P=0.57(P>0.05);通过ROC曲线分析血清β-HCG、P水平及联合积分预测妊娠结局的能力,曲线下面积分别为0.879、0.973、0.984,(P值均<0.05),95%CI分别为(0.845-0.913)、(0.959-0.986)、(0.973-0.994)。结论单独P较β-HCG水平具有更好的预测非正常妊娠的能力;联合积分预测妊娠结局的能力最强;单独P和联合积分与单独β-HCG预测妊娠结局的能力的差异有统计学意义,但二者的差异无统计学意义;随妊娠时间的延长,正常早孕β-HCG水平有迅速增加的趋势,异位妊娠有缓慢增加的趋势,而自然流产则有降低趋势;P水平不能有效区分自然流产与异位妊娠。

Objective：The current study was undertaken to find out the predictive value of human chorionic gonadotropin and Progesterone between normal intrauterine pregnancies,spontaneous abortion and ectopic pregnancy.Methods：The study evaluated 545 naturally conceived and asymptomatic first trimester（204 ectopic pregnancy,150 failing and 191 normal intrauterine） with maternal serum beta HCG and P.Results：β-HCG and P level was significantly higher in normal intrauterine than that in spontaneous abortion and ectopic pregnancy,t=21.75,P=0.000（95%CI：5925.31-7103.79） and t=28.49,P=0.000（95%CI：26.52-30.46）.The level of P was negatively in spontaneous abortion and ectopic pregnancy,P0.05.Conclusion：The elevated level of β-HCG and P is associated with the failing intrauterine.The ability of P to distinguish the failing intrauterine from the normal intrauterine is higher than that of β-HCG.The difference between spontaneous abortion and ectopic pregnancy can′t be predicted by β-HCG and P.The predictive power of P combined with β-HCG measurements in the outcome of threatened miscarriage is highest.