ROC曲线评价孕酮预测妊娠结局的临床价值

Clinical value of progesterone predict pregnancy outcome by ROC curve

目的:应用受试者工作特征(ROC)曲线评价孕酮在妊娠早期预测妊娠结局的临床价值。方法:回顾性分析妊娠早期(≤6周)195例先兆流产患者、93例稽留流产患者与88例异位妊娠患者血清中孕酮的水平,应用ROC曲线对孕酮水平进行分析评价。结果:①先兆流产组孕酮(25.39±9.98)ng/ml高于稽留流产组(10.48±8.92)ng/ml和异位妊娠组(6.73±5.45)ng/ml,差异有统计学意义(P<0.01),稽留流产组孕酮高于异位妊娠组,差异有统计学意义(P<0.05);②血清孕酮诊断宫内与宫外妊娠的ROC曲线下面积为0.861,最佳临界值(Cut-off值)为11.90 ng/ml,此时灵敏度(SE)为0.760、特异性(SP)为0.830、阳性预测值(PPV)为0.934、阴性预测值(NPV)为0.514,阳性似然比(+LR)为4.471和阴性似然比(-LR)为0.289;③血清孕酮诊断活胎与胎儿停止发育的ROC曲线下面积为0.931,Cut-off值为12.90 ng/ml,此时SE为0.949、SP为0.796、PPV为0.833、NPV为0.935,+LR为4.652和-LR为0.064。结论:孕酮水平可用于判断早期异常妊娠的结局,尤其判断活胎与胎儿停止发育的准确性要高于判断宫内与宫外妊娠。

Objective： To evaluate the clinical value of progesterone in predict pregnancy outcome during early pregnancy by applying receiver operating characteristic curve （ROC） . Methods： On early pregnancy （ ≤ 6 weeks）, the serum levels of progesterone in 195 cases with threatened abortion groups, 93 cases with missed abortion groups and 88 cases with ectopic pregnancy groups were analyzed retrospectively. The level of progesterone were analyzed and evaluated by ROC curve. Results：①The serum level of progesterone in patients with threatened abortion groups （25139 ng/ml ± 9.98 ng/ml） was significantly higher than that of missed abortion groups （ 10. 48 ng/ml ±8. 92 ng/ml） （ P 〈 0. 01 ） and ectopic pregnancy groups （6. 73 ng/ ml ± 5.45 ng/ml） （P 〈 0. 01 ）, the serum level of progesterone in patients with missed abortion groups was higher than that of ectopic pregnancy groups （P 〈0.05） . ②The area under the ROC curve of serum progesterone in judging intrauterine and extrauterine pregnancy was 0. 861. The best threshold was 11.90 ng/ml. In this case, the sensitivity, specificity, ＋ PV, - PV, ＋ LR and - LR were 0. 760, 0. 830, 0. 934, 0. 514, 4. 471 and 0. 289. ③The area under the ROC curve of serum progesterone in judging vital fetus and abortion or fetal development stops was 0. 966. The best threshold was 12. 90 ng/ml. The sensitivity, specificity, ＋ PV, - PV, ＋ LR and - LR were 0. 949, 0. 796, 0. 833, 0. 935, 4. 652 and 0. 064. Conclusion ： The level of progesterone can be used to judge the final result of early abnormal pregnancy, especially in estimating the accuracy of vital fetus and fetal development stops higher than that of in intrauterine and extrauterine pregnancy.