血清孕酮、β-人绒毛膜促性腺激素联合检测预测先兆流产结局的意义

Values of detection of serum progesterone and β-HCG in prediction of outcomes of early threatened abortion

目的 探讨血清孕酮、β-人绒毛膜促性腺激素（β-HCG）单项及联合检测在预测先兆流产结局中的意义.方法 选择2010年3月～2013年4月中航工业三二○一医院收治的孕龄为5～7周的孕妇305例.根据妊娠结果其分为3组,其中正常妊娠组169例,先兆流产组95例,难免流产组41例.检测并比较各组患者的血清孕酮和β-HCG水平,计算各指标对难免流产的诊断灵敏度、特异度和准确率,采用ROC曲线评价各指标诊断价值.结果 ①先兆流产组及难免流产组孕妇阴道出血患者均随访至孕12周,其中95例继续妊娠,41例就诊后3～7 d流产,行清宫术.正常妊娠组孕妇均继续妊娠.②正常妊娠组及先兆流产组血清孕酮、β-HCG值均显著高于难免流产组,差异有高度统计学意义（P＜ 0.01）;正常妊娠组与先兆流产组间孕酮、β-HCG差异无统计学意义（P＞0.05）;难免流产组血清孕酮、β-HCG值的95％CI的上限分别为15.5 mg/L、6015 U/L,认为孕龄5～7周孕妇血清孕酮＜15.5 mg/L、β-HCG＜6015 U/L时会发生难免流产.③血β-HCG、孕酮及二者联合检测的ROC曲线下面积分别为0.85、0.89、0.94,其中,二者联合检测的AUC值明显高于各项单独检测（P＜0.01）.结论 血清孕酮、β-HCG二者联合检测更具优越性,可以提高难免流产的检出率,对比单项测定指标的预测准确率明显提高,具有重要的临床意义.

Objective To investigate the values of detection of serum progesterone and β-HCG in prediction of preg nant women outcomes of early threatened abortion.Methods 305 pregnant women of 5-7 gestational weeks from March 2010 to April 2013 in 3201 Hospital of Aviation Industry Corporation of China were selected and divided into normal pregnancy group （169 cases）,threatened abortion group （95 cases）,inevitable abortion group （41 cases）.The serum levels of progesterone and human chorionic gonadotropin （β-HCG） were detected of three groups were detected and compared; the diagnostic sensitivity,specificity and accuracy rate of each index were calculated; the diagnostic values of each index were evaluated by ROC curve.Results ①The pregnant women in threatened abortion group and inevitable abortion group were followed-up for 12 weeks,95 cases were continued gestation,41 cases were treated with abortion 3-7 days after the treatment.169 cases in normal pregnancy group were continued pregnancy.②Serum progesterone and β-HCG in normal pregnancy group and threatened abortion group were higher than those in inevitable abortion group,the differences were high statistically significant （P 〈 0.01）; the differences of progesterone and β-HCG between normal pregnancy group and threatened abortion group were not statistically significant （P 〉 0.05）.The upper limit of 95%CI of progesterone and β③-HCG in inevitable abortion group were 15.5 mg/L,6015 U/L respectively; inevitable abortion of pregnant women with 5-7 gestational weeks was occurred by progesterone 〈 15.5 mg/L,β-HCG 〈 6015 U/L.③The area under ROC curve of β-HCG,progesterone and joint detection were 0.85,0.89,and 0.94 respectively,A UC value of joint detection was higher than that of single detection （P 〈 0.01）.Conclusion Joint detection of serum progesterone,β-HCG has obvious superiority,which can increase the detection rate of inevitable abortion,compared with detection of single index,the accurate rate of diagnosis of joint detection increases significantly,thus,the method has an important clinical significance.