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

Study on the significance of serum β-HCG and the threshold of transvaginal ultrasound combined with measurement of endometrial thickness in diagnosis of ectopic pregnancy

目的探讨血清β人绒毛膜促性腺激素(β-HCG)阴道超声阈值联合子宫内膜厚度诊断异位妊娠时的诊断效能。方法选择198例疑似异位妊娠患者,其中确诊异位妊娠的患者108例为研究组,正常宫内妊娠者90例作为对照组。观察并比较两组血清β-HCG水平和子宫内膜厚度,计算在获得最佳诊断效能时的血清β-HCG阴道超声阈值和子宫内膜厚度。结果当血清β-HCG水平为1 125 IU/L,子宫内膜厚度为8.02 mm时,其约登指数最大。单独采用血清β-HCG水平诊断时的约登指数为0.744,ROC曲线下面积为0.845。单独采用子宫内膜厚度诊断的约登指数为0.615,ROC曲线下面积为0.769。当两者联合检测时能获得更高的诊断效能,其敏感度为88.88%,特异度为90.00%,阳性预测值为91.43%,阴性预测值为87.10%,约登指数为0.788,ROC曲线下面积为0.895。结论对于临床症状不典型的疑似异位妊娠的患者,进行血清β-HCG和子宫内膜厚度联合检测可提高早期异位妊娠的诊断效能。

Objective To explore the signficance of application of serum β- HCG and threshold of transvaginal ultrasound combined with measurement of endometrial thickness in diagnosis of ectopic pregnancy. Methods A total of 198 patients with suspected ectopic pregnancy were collected,among them 108 patients diagnosed as ectopic pregnancy were comprised in study group,90 patients with normal intrauterine pregnancy were listed as control group. Their serum levels of β- HCG and endometrial thickness were observed and compared. Serum levels of β- HCG,the threshold of transvaginal sonography and endometrial thickness at the time of diagnosis were calculated to get the best performance. Results After the data were collected for statistical analysis,the serum level of β- HCG was 1125 IU / L and the endometrial thickness was 8. 02 mm,hence the Youden index was at maximum. When the serum level of β- HCG was applied alone for diagnosis,Youden index was 0. 744,and the area under ROC curve was 0. 845. When only endometrial thickness was applied for diagnosis,the Youden index was 0. 615,and the area under the ROC curve was 0. 769. Combined determination can achieve higher diagnostic efficiency,with the sensitivity at 88. 88% and specificity at 90.00%,then the positive predictive value was 91. 43% and negative predictive value was at 87. 10%. When the Youden index was 0. 788,then the area under ROC curve was 0. 895. Conclusion If patients with atypical clinical symptoms are suspected for ectopic pregnancy,then combined detection of serum level of β- HCG and endometrial thickness can raise the level of early diagnosis of ectopic pregnancy.