子宫内膜和肌酸激酶／孕酮诊断异位妊娠的价值

Value of endometrial thickness measurement combined with serum CK/P ratio for diagnosis of EP

目的探讨子宫内膜厚度和肌酸激酶／孕酮比值在异位妊娠早期诊断中的价值。方法以2006年2月-2009年6月在淄博市妇幼保健院就诊的175例疑似异位妊娠患者为研究对象。经阴道超声测量其子宫内膜厚度，检测血清肌酸激酶、孕酮并计算其比值，随访并进行分析。结果154例患者资料完整，其中69例确诊为异位妊娠，44例为稽留流产，41例为正常宫内孕。平均子宫内膜厚度：正常宫内孕组大于异位妊娠组和稽留流产组（t分别为17．39、14．23，均P〈0．05），但异位妊娠组和稽留流产组比较无显著性差异（P〉0．05）。肌酸激酶／孕酮比值：异位妊娠组大于正常宫内孕组和稽留流产组（t分别为6．07、6．28，均P〈0．05），但正常宫内孕组和稽留流产组比较无显著性差异（P〉0．05）。联合阴道超声测量子宫内膜厚度，检测肌酸激酶、孕酮并计算其比值的方法诊断异位妊娠的灵敏度、特异度、阳性预测价值、阴性预测价值分别为88．3％、86．6％、91．6％、90．7％。结论联合子宫内膜厚度及肌酸激酶／孕酮比值对异位妊娠的早期诊断有重要参考价值。

Objective To assess diagnostic value of endometrial thickness measurement and serum creatinekinase/progesterone （CK/P） ratio for diagnosis of ectopic pregnancy （EP）. Methods 175 patients with suspected EP who were treated in Zibo Municipal Maternity and Child Health Hospital in a period from February, 2006 to June, 2009 were selected for study. Their endometrial thickness was measured by transvaginal ultrasonography and their serum levels of CK and P were detected and CK/P ratio was calculated for analysis. Results Among 154 patients with complete clinical data of suspected EP, 69 patients were diagnozed as EP （ study group 1 ） ,44 patients had missed abortion（ study group 2） and 41 women had normal intrauterine pregnancy （study group 3 ）. The average endometrial thickness measured in study group 3 was thicker than that in study group 1 and study group 2 （t = 17.39, 14.23 respectively, both P 〈0.05）. While there was no significant difference in average endometrial thickness between study group 1 and study group 2 （ P 〉 0.05 ）. The CK/P ratio in study group 1 was significantly higher than the other two groups. （ t = 6.07, 6.28 respectively, both P 〈 0.05 ）, while there was no significant difference between study group 2 and study group 3 （ both P 〉 0.05 ）. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of measurement of endometrial thickness by transvaginal ultrasonography combined with detection of serum leves of CK and P and their ratio for EP were 88.3%, 86.6%, 91.6% and 90.7% respectively. Conclusion Measurement of endometrial thickness by transvaginal ultrasonography combined with CK/P ratio is of significant reference value for early diagnosis of EP.