血清CA125水平对妊娠早期自然流产的预测价值

Prognostic value of serum CA125 in first trimester spontaneous abortion

目的评估血清CA125水平对妊娠结局的预测价值。方法采用前瞻性观察研究方法,分别选取2016年1月—2018年5月期间在温州市中西医结合医院妇科就诊的先兆流产患者(先兆流产组)160例、非先兆流产妊娠妇女(对照组)105例、非孕期正常妇女(非孕组)40例。根据入组时B超提示有无绒毛膜下血肿(SCH)将先兆流产组再分为妊娠合并SCH亚组(SCH+组,n=65),妊娠未合并SCH亚组(SCH-组,n=95)。所有妊娠妇女随访至孕12周,根据妊娠结局将先兆流产组分为流产亚组(n=54)、继续妊娠亚组(n=106);将对照组分为无临床症状而B超提示胚胎停育者(无症状流产亚组,n=45)及正常妊娠者(正常妊娠亚组,n=60)。应用电化学发光法检测妊娠妇女孕6~9周及非孕妇女卵泡期的血清CA125水平。比较各组血清CA125水平的差异并应用受试者工作特征(ROC)曲线分析CA125对妊娠结局的预测价值。结果正常妊娠亚组CA125水平为(40.37±17.80)IU/mL,显著高于非孕组[(15.82±7.07)IU/mL,P<0.001]。流产亚组CA125水平[(96.20±60.05)IU/mL]显著高于正常妊娠亚组及继续妊娠亚组[(39.74±19.08)IU/mL](P均<0.001)。无症状流产亚组CA125水平[(20.05±9.52)IU/mL]显著低于正常妊娠亚组及继续妊娠亚组(P均<0.001)。先兆流产患者SCH+组的CA125水平[66.16(37.19,95.64)IU/mL]显著高于SCH-组[27.98(15.43,52.75)IU/mL](P<0.001)。对孕6~9周先兆流产患者当血CA125≥54.19IU/mL时妊娠结局不良,其敏感度为83.4%,特异度为78.4%,曲线下相对面积为0.86。对孕6~9周无临床症状的早孕妇女时,当血清CA125≤18.82IU/mL时,妊娠结局不良,其敏感度为96.0%,特异度为65.8%,曲线下相对面积为0.87。结论CA125在正常妊娠早期会升高,但过高或过低表达均不利于妊娠持续发展。CA125可以反映蜕膜破坏的程度及蜕膜发育状况,是早期预测妊娠结局的有效指标。

Objective To assess the clinical value of serum CA125 for predicting pregnancy outcome. Methods This prospective observational study enrolled 160 threatened abortion patients (threatened abortion group), 105 non-threatened abortion pregnant women (control group) and 40 non-pregnant normal women (non-pregnant group) who were admitted to the Gynecology Department of Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to May 2018. According to ultrasonography with or without subchorionichematoma (SCH), the threatened abortion group was divided into SCH+ group (n=65) and SCH- group (n=95). All pregnant women were followed up until 12 weeks of gestation. According to the pregnancy outcome, the threatened abortion group was divided into symptomatic abortion subgroup (54 cases of abortion outcome) and ongoing pregnancy subgroup (106 cases of ongoing pregnancy). Control group was divided into 45 cases without clinical symptoms which ultrasound indicated embryo abortion (no symptom abortion subgroup) and 60 cases with normal pregnancy (normal subgroup). Serum CA125 levels were measured at the gestational age between 6-9 weeks or follicular phase in non-pregnant women by electro-chemiluminescence. The differences of serum CA125 levels in each group were compared and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of CA125 for pregnancy outcomes. Results The CA125 level in normal pregnancy subgroup [(40.37±17.80) IU/mL] was significantly higher than that in non-pregnant group [(15.82±7.07) IU/mL](P=0.001). The CA125 levels were significantly higher in symptomatic abortion subgroup [(96.20±60.05) IU/mL] than in normal group and ongoing pregnancy subgroup [(39.74±19.08) IU/mL](P<0.001). The CA125 level in the asymptomatic abortion subgroup [(20.05±9.52) IU/mL] was significantly lower than that in normal group and ongoing group (P<0.001). The CA125 level was significantly higher in SCH+ group [66.16(37.19,95.64) IU/mL] as compared with the SCH- group [27.98(15.43,52.75) IU/mL](P<0.001). The pregnancy outcome of patients with threatened abortion was poor when CA125≥54.19 IU/mL at 6-9 weeks. The sensitivity, specificity and area under curve (AUC) were 83.4%, 78.4% and 0.86 respectively. For threatened abortion patients in early pregnancy, the pregnancy outcomes were poor when CA125≤18.82 IU/mL at 6-9 weeks. The sensitivity, specificity and AUC were 96.0%, 65.8% and 0.87 respectively. Conclusion Maternal serum levels of CA125 was higher during the first trimester of normal pregancy. Both too high or too low is not conducive to the process of pregnancy. It can be useful to reflect the extent of decidual destruction or the defective decidual development which is directly related to the outcome of pregnancy. CA125 is valid early predictors of the outcome of pregnancy.