血清β-HCG 阴道超声阈值联合子宫内膜厚度诊断异位妊娠的价值

The diagnostic value of the discriminatory zone of serum β-HCG for transvaginal sonography combined with the endometrial thickness for ectopic pregnancy in Chinese women

目的:探讨血清β-HCG阴道超声阈值及其联合子宫内膜厚度诊断异位妊娠的价值。方法:回顾分析1456例可疑异位妊娠患者的临床资料,其中异位妊娠1056例,宫内早孕400例。记录血清β-HCG值及其即日的阴道超声检查(包括子宫内膜厚度),使用受试者工作特征(ROC)曲线分析血清β-HCG阴道超声阈值,并评估血清β-HCG阴道超声阈值联合子宫内膜厚度等指标诊断异位妊娠的灵敏度、特异度和准确度。结果:血清β-HCG浓度为1536IU/L时,其Youden指数最大。以血清β-HCG浓度为1500IU/L为预测值,其灵敏度为84.9%,特异度为89.6%,ROC曲线下面积为0.922(P<0.001)。子宫内膜厚度为10mm时,Youden指数最大,其灵敏度为55.9%,特异度为80.9%,ROC曲线下面积为0.727(P<0.001)。以血清β-HCG浓度1500IU/L和子宫内膜厚度10mm为鉴别异位妊娠和宫内早孕的预测值,两指标平行实验诊断异位妊娠的灵敏度为94.7%,特异度为83.7%,ROC曲线下面积为0.907(P<0.001),两指标系列实验的灵敏度为78.3%,特异度为92.4%,ROC曲线下面积为0.886(P<0.001)。结论:中国妇女血清β-HCG的阴道超声阈值为1500IU/L,血清β-HCG阴道超声阈值联合子宫内膜厚度(<10mm)可提高诊断异位妊娠的准确性。

Objective：To discuss the discriminatory zone of serum β-HCG for transvag-inal sonography combined with the endometrial thickness in the diagnosis of ectopic pregnancy in Chinese women. Methods：We reviewed 1456 women with the suspicion of ectopic pregnancy（1056 women with ectopic pregnancy and 400 women with intrauterine pregnancy）. Transvagi-nal ultrasonography was performed and a blood sample was taken on the same day to measure serum HCG in order to determine the discriminatory zone. The endometrial thickness was tested as a predictor for the diagnosis of ectopic pregnancy. All patients were then managed till the fi-nal outcome was diagnosed. ROC was used to evaluate the sensitivity,specificity and accuracy in diagnosis of the discriminatory zone of serum β-HCG for transvaginal ultrasound combined with the endometrial thickness. Results：The discriminatory zone of serum β-HCG for transvagi-nal ultrasound was 1500IU/ L. At this level,an intrauterine gestational sac should be visualized. The discrepancy of endometrium between intrauterine pregnancy and ectopic pregnancy was sig-nificant. Taking 10mm of endometrial thickness as threshold value,sensitivity of ectopic preg-nancy diagnose was 55. 9% ,specificity was 80. 9% . When serum β-HCG level was 1500IU/ L and the endometrial thickness was 10mm,the sensitivity of parallel test and serial test in the di-agnosis of ectopic pregnancy were 94. 7% and 78. 3% ,the specificity were 83. 7% and 92. 4% . Conclusion：The discriminatory zone of serum β-HCG for transvaginal ultrasound in Chi-nese women was 1500IU/ L. It combined with the endometrial thickness（〈10mm）has important value in the diagnosis of early ectopic pregnancy.