经阴道超声能量多普勒血流分级与血人绒毛膜促性腺激素在输卵管妊娠保守治疗中的应用

Transvaginal Ultrasound-energy Doppler Flow Grading and Serum β-human Chorionic Gonadotropin in Conservative Treatment of Tubal Pregnancy

目的探讨结合经阴道超声能量多普勒血流分级与妊娠初期血人绒毛膜促性腺激素(β-hCG)水平对输卵管妊娠保守治疗的临床应用价值。资料与方法经阴道超声检查与血β-hCG确诊为输卵管异位妊娠并选择保守治疗(肌内注射氨甲蝶呤)的48例患者,治疗前经阴道超声检查并用能量多普勒根据血流分布范围进行分级,同时检测治疗前及治疗后第4天血β-hCG水平。比较不同血流分级患者保守治疗的成功率。采用受试者工作特征(ROC)曲线确定诊断效果及诊断截断值。结果 48例输卵管异位妊娠患者能量多普勒血流分级Ⅰ级25例,成功率为96.00%(24/25);Ⅱ级13例,成功率为84.61%(11/13);Ⅲ级10例,成功率为50.00%(5/10),不同血流分级患者保守治疗成功率比较,差异有统计学意义(x^2=10.903,P=0.004)。治疗前血β-hCG水平预测保守治疗成功的ROC曲线下面积为0.74,截断值为1478 m IU/ml,诊断敏感度和特异度分别为87.5%和57.5%。保守治疗第4天β-hCG水平变化率的敏感度和特异度分别为87.5%和65.0%,ROC曲线下面积为0.76。结论经阴道超声能量多普勒对输卵管妊娠包块血流分级与血清β-hCG检测对于预测保守治疗结果有较大价值。

Purpose To investigate the clinical value of combined transvaginal ultrasound-energy Doppler flow grading and early pregnancy serum β-human chorionic gonadotropin (β-hCG) level for conservative treatment of tubal pregnancy. Materials and Methods Forty-eight patients diagnosed as tubal ectopic pregnancy by transvaginal ultrasonography and serum β-hCG and received conservative treatment (intramuscular injecting Methotrexate) were selected. They got vaginal ultrasonography and were graded according to the distribution of blood flow by energy Doppler before the treatment. Meanwhile, serum β-hCG levels were measured before treatment and on the 4th day during the treatment. The success rates of conservative treatment in patients with different blood flow grading were compared. The receiver operating characteristic (ROC) curve was used to determine diagnostic effects and diagnostic cutoff values. Results The power Doppler flow classification of 48 patients with tubal ectopic pregnancy, including 25 cases of grade Ⅰ, with a success rate of 96.00%(24/25);13 cases of grade Ⅱ, with a success rate of 84.61%(11/13);10 cases of grade Ⅲ, with a success rate of 50.00%(5/10), and the difference in the success rate of conservative treatment among patients with different blood flow grading was statistically significant (χ^2=10.903, P=0.004). The pre-treatment serum β-hCG level predicted that a successful conservative treatment with a ROC area of 0.74 and a cutoff value of 1478 mIU/ml, which with a diagnostic sensitivity of 87.5% and specificity of 57.5%. The sensitivity and specificity of hCG level change rate on the 4th day of conservative treatment were 87.5% and 65.0%, and the area under the ROC curve was 0.76. Conclusion Transvaginal ultrasound-energy Doppler blood flow grading of tubal pregnancy mass and blood serum β-hCG detection have great value in predicting conservative treatment results.