血清孕酮检测在异位妊娠诊治中的诊断价值探讨

Study on the value of serum progesterone measurement in the diagnosis and treatment of ectopic pregnancy

目的:探讨血清孕酮在异位妊娠诊断和治疗中的价值。方法:对于我院2016年4月—2017年1月确诊的早期异位妊娠患者64例,同期宫内早孕患者199例,通过相应的化学发光法,对宫内早孕和异位妊娠患者外周血中孕酮水平进行检测。所有受试患者由护士采取空腹静脉血5 mL,放置于干燥的采血管中并静止后离心,离心后提取外周血清,将提取的血清放置于-20℃的冰箱内保存待检。结果:异位妊娠组血清孕酮含量中位数为28.3 nmo1/L,宫内早孕组为66.2 nmo1/L,数据为偏态分布资料,经Wilcoxon秩和检验,两组差别有统计学意义(P <0.05);以36 nmo1/L为诊断异位妊娠的Cut-off值,诊断试验的敏感性和特异性分别为77.71%和68.49%, ROC曲线下面积(AUC)为0.84。在MTX治疗成功的患者中,血清孕酮降至正常水平以下的时间显著短于血HCG降至正常水平以下的时间(P <0.01)。结论:异位妊娠的血清孕酮值显著低于正常宫内妊娠,其检测简便、快捷,在治疗异位妊娠的过程中可以作为一种早期诊断异位妊娠的手段,孕酮降至正常的时间显著短于HCG降至正常的时间,因此它可以作为监测治疗异位妊娠成败与否的良好标志物。

Objective:To investigate the value of serum progesterone in the diagnosis and treatment of ectopic pregnancy.Methods:64 cases of ectopic pregnancy patients diagnosed in our hospital from April 2016 to January 2017 and 199 cases of patients with early intrauterine pregnancy were selected,the corresponding chemiluminescence detection of intrauterine pregnancy and progesterone levels in the peripheral blood of patients with ectopic pregnancy was given.Ectopic pregnancy was mainly confirmed by pathological diagnosis after laparoscopic or exploratory laparotomy.Intrauterine early pregnancy was followed up by transvaginal ultrasound to the uterine cavity,and the pregnancy sac or the original heart beat was diagnosed.All the patients were taken with fasting venous blood 5mL,placed in the dry blood vessel,and then centrifuged after resting.After centrifugation,the peripheral serum was extracted,and the extracted serum was stored in the refrigerator at-20 centigrade for preservation.Results:Ectopic pregnancy serum progesterone content was 28.3nmo1/L,intrauterine pregnancy group was 66.2nmo1/L.The data were the skewed distribution of data,after Wilcoxon rank sum test,there was significant difference between the two groups(P<0.05);36nmo1/L was the Cut-off value for the diagnosis of ectopic pregnancy,the diagnostic test sensitivity and specificity was 77.71%and 68.49%respectively,the area under the ROC curve(AUC)was 0.84.In patients with successful MTX treatment,the time of serum progesterone below normal level was significantly shorter than the time of hCG below normal(P<0.01).Conclusion:The serum progesterone of ectopic pregnancy was significantly lower than that of normal pregnancy,the detection was simple and fast,in the treatment of ectopic pregnancy it could be used as a means of early diagnosis of ectopic pregnancy,the time progesterone decreased to normal level was significantly shorter than that of hCG,so it could be used to monitor the success of the treatment of ectopic pregnancy good marker.