经阴道多普勒彩色超声联合血清人绒毛膜促性腺激素对子宫瘢痕妊娠的诊断价值分析

The Diagnostic Value of Transvaginal Doppler Color Ultrasound Combined with Serum Human Chorionic Gonadotropin in Cesarean Scar Pregnancy

本研究拟探讨经阴道多普勒彩色超声联合血清人绒毛膜促性腺激素(β-HCG)对子宫瘢痕妊娠(CSP)的诊断价值。选取2018年4月~2019年4月于我院妇产科就诊的疑似子宫瘢痕妊娠患者56例作为研究对象,同时行阴道多普勒彩色超声和血清β-HCG水平检查,经手术和(或)病理组织学检查确诊。结果显示,CSP患者经阴道多普勒彩色超声特征征象包括子宫前壁下段肌层可见孕囊、孕囊与膀胱之间的子宫肌层变薄、孕囊周边高速低阻信号。CSP患者48 h血清β-HCG增加幅度低于非CSP患者(t=7.425,P=0.000)。48 h血清β-HCG增加幅度的ROC曲线下面积为0.919,最优界值为64.22%,此时诊断的敏感度为80.00%,特异性为88.90%。与手术和(或)病理检查相比,单一诊断和联合诊断的一致性均较好,且对CSP的诊断的敏感度、特异度、阳性预测值、阴性预测值、准确率比较,差异均无统计学意义(P>0.05)。两种检查手段可以互为参考,降低误诊率与漏诊率。

This study was to investigate the diagnostic value of transvaginal Doppler color ultrasound combined with serum human chorionic gonadotropin(β-HCG)in cesarean scar pregnancy.From April 2018 to April 2019,56 patients with suspected cesarean scar pregnancy in our hospital were selected as subjects.All of them were examined by transvaginal Doppler color ultrasound and serumβ-HCG levels,and confirmed by surgery and/or histopathological examination.The results showed that the characteristics of transvaginal Doppler color ultrasound in patients with CSP included:the gestational sac was visible in the myometrium of lower front wall,thinning of the myometrium between the gestational sac and the bladder,high speed and low resistance signal around the gestational sac.The increase of serumβ-HCG in 48 h in CSP patients was lower than that in non-CSP patients(t=7.425,P=0.000).The area under the ROC curve of the increase of serumβ-HCG in 48 h was 0.919,and the optimal cut-off value was 64.22%.At this time,the sensitivity of diagnosis was 80.00%,and the specificity was 88.90%.Compared with surgery and/or pathological examination,the consistency of single diagnosis and combined diagnosis was good,and there was no difference in the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CSP diagnosis,P>0.05.The two methods can be used as a reference to reduce the misdiagnosis rate and missed diagnosis rate.