早期异位妊娠多指标联合监测的诊断价值

Application of the Combined Parameters in the Early Diagnosis of Ectopic Pregnancy

目的:探讨早期异位妊娠患者血清人绒毛膜促性腺激素β亚单位(β-hCG)、孕酮及子宫内膜厚度(EST)监测的诊断价值。方法:选择2008年7月—2010年5月就诊且尿妊娠试验阳性者共127例,经超声及病理证实确诊后分为异位妊娠组(48例)、正常早孕组(40例)和妊娠流产组(39例)。应用电化学发光(ECL)法检测血清β-hCG和孕酮水平,通过超声检测EST,通过计算受试者工作特征曲线(ROC曲线)下面积(AUC)来确定各检测指标的诊断价值。结果:异位妊娠组β-hCG水平比值(β-hCG 48 h/0 h)相对于正常妊娠组和妊娠流产组倍增不明显(P<0.05);异位妊娠组孕酮水平和EST均较正常妊娠组和妊娠流产组低(P<0.05)。ROC曲线显示,3项联合检测的诊断准确度最高(AUC=0.915),其次分别为血β-hCG 48 h/0 h(AUC=0.875)、孕酮(AUC=0.806)和EST(AUC=0.782)。结论:单项检测血清β-hCG 48 h/0 h、孕酮和EST均有一定的早期诊断价值,3项联合检测诊断准确度最高,高于单项检测。

Objective：To evaluate the application of the combined multiple parameters in the early diagnosis of ectopic pregnancy,including serum β-hCG and progesterone,and endometrial thickness （EST）. Methods ：127 cases in our hospital from July 2008 to May 2010 were confirmed by B-Ultrasound and pathological exam after the positive test of urine hCG. Those cases were divided into three groups,the ectopic pregnancy group （48 cases）,the normal pregnancy group （40 cases）,and the pregnancy abortion group （39 cases）. The β-hCG and progesterone levels were analyzed by electrochemilumineseenee （ECL）. EST was measured by B-Ultrasound. The significances of those parameters were compared by the area under curve （AUC） of ROC curve. Results：The increased β-hCG value （the ratio of 48 h/0 h） in the ectopic pregnancy group was smaller,when compared with those in the normal pregnancy group and the pregnancy abortion group （P〈0.05）. Progesterone level in the ectopic pregnancy group,as well as EST value,was significantly lower than those in other groups （P〈0.05）. The ROC curves showed that three combined parameters had the highest diagnostic accuracy （AUC=0.915）. Three parameters had different accuracy to detect respectively the early eetopie pregnancy as follows：β-hCG （the ratio of 48 h/0 h,AUC=0.875）,progesterone （AUC=0.806）,EST （AUC=0.782）. Conclusions： Serum β-hCG （the ratio of 48 h/0 h）,progesterone and EST had limited significances to detect respectively the early ectopic pregnancy. Three combined parameters had the highest diagnosis accuracy,which should be recommended.