血清hCG、孕酮水平变化对早期诊断妊娠流产特异性分析

Specificity analysis of serum HCG and progesterone level in early diagnosis of abortion

目的探讨血清绒毛膜促性腺激素(hCG)、孕酮(P)水平检测对于早期诊断流产的临床价值。方法选取2012年3月至2016年9月在十堰市中医医院妇产科门诊进行检查的妊娠妇女490例,追踪其妊娠结局,其中自然流产45例(流产组)、正常妊娠至分娩妇女445例(正常组),对比两组妊娠7~12周时的血清HCG、P水平,并采用受试者工作曲线(receiver operating curve,ROC)求取血清hCG、P水平早期预测自然流产的最佳临界值。结果孕第7~12周,流产组的血清hCG平均值9 368.70±5 958.40m IU/mL、P平均值16.73±3.98μg/L,均显著低于正常组的61 395.50±11 401.70 m IU/mL、27.50±5.54μg/L,差异具有统计学意义(t值分别为73.591、19.788,均P<0.05);通过绘制ROC曲线:当血清hCG水平为10 156.70 m IU/mL时,对应的灵敏度为72.17%、特异度为78.96%、ROC曲线下面积AUC值为0.753;当血清P水平为18.05μg/L时,对应的灵敏度为78.43%、特异度为81.60%、ROC曲线下面积AUC值为0.790;血清hCG联合P检测预测妊娠妇女发生流产:灵敏度为84.69%、特异度为89.57%、漏诊率为15.31%、误诊率为10.43%、ROC曲线下面积AUC值为0.873。结论妊娠早期血清hCG、P水平降低,提示流产风险,血清hCG联合P检测,对预测早期流产具有一定的临床价值。

Objective To investigate the clinical value of serum chorionic gonadotropin（HCG） and progesterone（P） levels in early diagnosis of abortion.Methods From March 2012 to September 2016 490 pregnant women receiving examination in obstetric outpatient department in Shiyan Hospital of Traditional Chinese Medicine were selected and followed up for pregnant outcomes,including 45 cases of spontaneous abortion（abortion group） and 445 cases of normal pregnancy and childbirth women（normal group）.Serum HCG and P levels during 7 to 12 weeks of pregnancy were compared between two groups,and receiver operating curve（ROC） was used to find the optimal threshold of serum HCG and P levels in the early prediction of spontaneous abortion.Results During 7-12 weeks,average level of serum HCG in abortion group was 9 368.7±5 958.4m IU/ml,and average level of P was 16.73±3.98μg/L,which were significantly lower than those in normal group（61 395.5±11 401.7m IU/ml,27.50±5.54μg/L）.The differences were statistically significant（t values was73.591 and 19.788,respectively,both P〈0.05）.ROC curve revealed that when the serum HCG level was 10 156.7m IU/mL,corresponding sensitivity was 72.17% and specificity was 78.96%,and the area under ROC was 0.753.When serum P level was 18.05μg/L,corresponding sensitivity was 78.43% and specificity was 81.60%,and the area under ROC was 0.790.Combining serum HCG with P in predicting abortion,sensitivity was 84.69%,specificity was 89.57%,missed diagnosis rate was 15.31%,misdiagnosis rate was10.43%,and the area under ROC was 0.873.Conclusion The serum levels of HCG and P in the early stage of pregnancy decrease,which suggests risk of abortion.Combining of P and HCG has a certain clinical value in predicting early abortion.