多指标联合监测对不典型异位妊娠早期诊断的价值

THE VALUE OF COMBINED MULTI-CRITERIA MONITORING FOR EARLY DIAGNOSIS OF ATYPICAL ECTOPIC PREGNANCY

目的探讨多指标联合监测对不典型异位妊娠早期诊断的价值。方法 160例疑似异位妊娠病人,测定其血清孕酮、人绒毛膜促性腺激素β亚单位(β-hCG)水平,经阴道B超测量子宫内膜厚度,并于48 h后重复测定血清β-hCG水平。根据妊娠结局分为异位妊娠组69例、宫内妊娠组48例、难免流产组43例,对3组上述指标进行比较。结果异位妊娠组血清孕酮水平显著低于宫内妊娠组和难免流产组(F=434.82,q=41.70、16.89,P<0.01),子宫内膜厚度也显著低于宫内妊娠组和难免流产组(F=314.86,q=35.49、14.25,P<0.01)。异位妊娠组48 h血清β-hCG水平上升幅度低于宫内妊娠组(χ2=5.129,P<0.05),其下降幅度低于难免流产组(χ2=9.699,P<0.05)。3项指标联合应用可将不典型异位妊娠诊断准确率提高至92.4%。结论单次血清β-hCG和孕酮水平是确定妊娠的指标,但对于尚未形成B超可见孕囊的异位妊娠和宫内妊娠则难以鉴别。间隔48 h复查血清β-hCG观察其上升或下降幅度,同时结合子宫内膜厚度则可显著提高不典型异位妊娠早期诊断的准确性。

Objective To assess the value of combined multi-criteria monitoring（MCM） in early diagnosis of atypical ectopic pregnancy（EP）.Methods Serum progesterone and β-hCG levels were detected,and endometrial thickness was measured per vagina sonography in 160 suspected EP patients.The detection of β-hCG was repeated after 48 hours.According to the pregnancy outcome,all the patients were divided into three groups as EP group（69 cases）,intrauterine pregnancy（IUP） group（48 cases）,and inevitable abortion（IEA） group（43 cases）.The above parameters of the three groups were compared.Results The progesterone level,and the thickness of endometrium in EP were obviously lower than that in both IUP and IEA groups（F=434.82,314.86;q=14.25-41.70;P〈0.01）,respectively.The rising extent of 48-hour-β-hCG levels in EP group was lower than that in IUP,and that of descending extent was lower than that in IEA（χ^2=5.129,9.699;P〈0.05）.By combination of the above three items,the diagnostic accuracy of EP could be raised to 92.4%.Conclusion A single measurement of serum β-hCG and progesterone is the index for determination of pregnancy,but when a gestational sac that can be seen by ultrasonography is not yet formed,a differential diagnosis between EA and IUP is difficult.A recheck of β-hCG level after 48 hours and observing its rising and falling ranges,combining with measuremnet of thickness of endometrium may significantly improve the accuracy of early diagnosis for atypical EP.