血激素值联合B超检查预测宫内妊娠早期阴道流血结局的临床价值

Clinical value of blood hormone values coupled with ultrasonography in the prediction of the outcome of early vaginal bleeding in intrauterine pregnancy

目的探讨血激素,即β-人体绒膜促性腺激素(β-HCG)、孕酮、雌二醇联合超声监测对宫内妊娠早期阴道流血结局的预测。方法本研究选择2016年2月至2017年2月于解放军第三医院因阴道流血初诊为先兆流产的患者151例,按妊娠结局分为流产组64例和继续妊娠组87例,同时选取正常早孕妇女80例作为对照组。于当日放射免疫法检测血β-HCG、孕酮和雌二醇,联合腹部B超检查;48 h后复查血β-HCG。结果 (1)流产组血清β-HCG、孕酮和雌二醇水平均明显低于继续妊娠组和对照组(P<0.01);继续妊娠组血激素值β-HCG、孕酮和雌二醇水平与对照组相比,差异无统计学意义(P>0.05)。(2)行腹部B超检查提示流产组仅21.88%(14/64)出现胚芽。其中4例于7~8孕周时B超检查到胎心搏动,但于12孕周时发生稽留流产。对于首次B超未见胎心的继续妊娠组患者,1~2周后复查均见胎心搏动。于11~13孕周B超提示胎儿正常者均随访至妊娠晚期。结论对于宫内妊娠早期阴道流血需进行动态监测,通过血β-HCG、孕酮、雌二醇联合B超检查多方结果的评估才能够对其妊娠结局进行准确评估。

Objective To investigate the clinical value of blood β-HCG,progesterone（P）and estradiol（E2） coupled with ultrasonography in the prediction of the outcome of early vaginal bleeding in intrauterine pregnancy. Methods One hundred and fifty patients who were hospitalized from February 2016 to February 2017 and diagnosed as threatened abortion due to vaginal bleeding were enrolled in the study. In accordance with the pregnancy outcome,the patients were divided into the abortion group（ n = 64） and the continuing pregnancy group（ n = 87）,and another 80 normal pregnant women were selected as the control group. On the day upon admission,the patients received radioimmunoassay to detect blood β-HCG,P and E2,in addition to abdominal ultrasonography,and 48 hours later β-HCG level was reexamined. Results（1） The levels of β-HCG,P and E2 in the abortion group were all significantly lower than those of the continuing pregnancy group and the normal group（ P〈0. 01）. But there was no statistical significance in the levels of β-HCG,P and E2 in the continuing pregnancy group as compared with those of the normal control group（ P〈0. 05）.（2） Abdominal ultrasonography showed that in the abortion group only 21. 88%（14/64） of the cases had embryo bud,of which 4 cases could be detected to have fetal heart beat at 7-8 week of pregnancy,but at week 12 missed abortion occurred. For those cases that were detected to have no fetal heart in the primary ultrasonography,fetal heart beat was detected 1-2 weeks later. For those cases with normal fetuses with ultrasonography at 11-13 weeks of pregnancy,they were advised to have medical follow-ups till late pregnancy. Conclusion Dynamic monitoring should be made in the cases of early vaginal bleeding in intrauterine pregnancy. Detection results of β-HCG,P and E2 coupled with abdominal ultrasonography could be used for accurate evaluation of pregnant outcome.