血清标志物在异位妊娠早期诊断中的价值

Significance of Serum Markers in Early Diagnosis of Ectopic Pregnancy

目的:研究血清中β-人绒毛膜促性腺激素(β-HCG)、孕酮(P)、癌胚抗原125(CA125)及妊娠相关血浆蛋白A(PAPP-A)在异位妊娠早期诊断中的价值。方法:选择异位妊娠的患者(异位妊娠组)和同期来院要求终止妊娠的早孕患者(宫内妊娠组)各100例,根据停经天数将以上2组又分为停经>7周组和停经≤7周组。分别检测其血清β-HCG、P、CA125及PAPP-A的水平。采用ROC曲线确定各指标诊断异位妊娠的截断点、灵敏度及特异度。结果:宫内妊娠组的血清CA125、PAPP-A、P和β-HCG水平明显高于异位妊娠组;在宫内妊娠组,停经≤7周的血清β-HCG小于停经>7周者,差异有统计学意义(P<0.01),停经天数与β-HCG、PAPP-A呈正相关。在异位妊娠组,停经≤7周与停经>7周者的血清β-HCG、PAPP-A、P、CA125差异均无统计学意义(P>0.05),4种血清标志物与停经天数均不相关。CA125诊断异位妊娠的截断点为34.925mU/L,灵敏度80%,特异度73.2%。PAPP-A诊断异位妊娠的截断点为5.405mIU/L,灵敏度为76%,特异度为73.2%。β-HCG诊断异位妊娠的截断点为4761.4IU/L,灵敏度为92%,特异度为81.3%。P诊断异位妊娠的截断点为17.21μg/L,灵敏度为96%,特异度为100%。结论:单次检测血清P对于诊断早期异位妊娠的价值最高,P与β-HCG联合检测的效果最优。

Objective：To explore the importance of the early diagnostic value of serum β-chorionic gonadotrophin （HCG）,progesterone （P）,carcinoembryonic antigen 125 （CA125） and pregnancy-associated plasma protein （PAPP）-A in ectopic pregnancy.Methods：The serum levels of β-HCG,P,PAPP-A and CA125 were measured in 100 women with atypical ectopic pregnancy,100 women with normal interuterine pregnancy （nIUP）.Patients were subdivided into 7 weeks suppressed menstruation group and ≤7 weeks group.Data was analyzed by SPSS 13.0.Results：The serum levels of CA125,PPAPP-A,P and β-HCG were significantly higher in interuterine pregnancy group than those of ectopic pregnancy group.In interuterine pregnancy group there was a lower serum level of β-HCG in ≤7 weeks suppressed menstruation group than that of 7 weeks group （P 0.01）.There was a positive correlation between days of suppressed menstruation and levels of β-HCG and PAPP-A.In ectopic pregnancy group there were no significant differences in serum levels of β-HCG,PAPP-A,P and CA125 between ≤7 weeks suppressed menstruation group than that of 7 weeks group （P 0.05）.There was no correlation between the 4 serum markers and the days of suppressed menstruation.The diagnostic critical value was CA125≤34.925 mU/L,diagnostic sensitivity was CA125 80% and the specificity was CA125 73.2% in ectopic pregnancy group.The diagnostic critical value was PAPP-A≤5.405 mU/L,diagnostic sensitivity was PAPP-A 76% and the specificity was PAPP-A 73.2% in ectopic pregnancy group.The diagnostic critical value was β-HCG≤4 761.4 IU/L,diagnostic sensitivity was β-HCG92% and the specificity was β-HCG 81.3% in ectopic pregnancy group.The diagnostic critical value was P≤17.21 μg/L,diagnostic sensitivity was P 96% and the specificity was P 100.0%.in ectopic pregnancy group.Conclusion：The serum levels of β-HCG,P,CA125 and PAPP-A can be used as diagnostic markers of ectopic pregnancy,in which the serum level of P or P combined with β-HCG was the best.