血清标志物孕酮、β-HCG、E2和INHA在孕6周异位妊娠诊断中的价值

Value of serum markers progesterone,β-HCG,E2 and INHA in diagnosis of ectopic pregnancy at the 6th week of gestation

目的探讨β人绒毛膜促性腺激素(β-HCG)、孕酮、雌二醇(E2)、抑制素A(INHA)、游离β人绒毛膜促性腺激素(F-β-HCG)、妊娠相关血浆蛋白A(PAPP-A)、糖类抗原125(CA125)、甲胎蛋白(AFP)8项血清标志物及联合检测在异位妊娠早期诊断中的价值。方法随机选取2018年8-10月就诊于该院并确诊为异位妊娠患者68例、宫内妊娠流产患者100例、正常宫内妊娠患者100例分别作为异位妊娠组、宫内妊娠流产组和对照组。检测3组人群8项血清标志物的水平,研究其水平变化趋势;计算受试者工作特征曲线(ROC曲线)的曲线下面积(AUC),确定截断值并评价各血清标志物及联合检测的诊断效能。结果异位妊娠组与对照组8项血清标志物比较,差异均有统计学意义(P<0.05);宫内妊娠流产组与对照组比较,只有孕酮和E2水平差异有统计学意义(P<0.05)。比较各标志物ROC曲线的AUC值,发现在异位妊娠诊断中,诊断价值由高到低的顺序依次为孕酮、E2、INHA、β-HCG、F-β-HCG、PAPP-A、CA125、AFP。其中效能较高的前4项血清标志物联合检测,其AUC可达到0.970,灵敏度可达到86.8%,特异度为98.0%。孕酮、E2、INHA、β-HCG 4项检测在异位妊娠早期孕6周左右诊断中具有重要的临床价值,分别以孕酮15.02ng/mL,E2221.00pg/mL,INHA 17.25pg/mL,β-HCG 1285.00mIU/mL作为截断值。结论为提高异位妊娠早期诊断的正确率,建议采用孕酮、E2、INHA、β-HCG 4项联合检测方式来提高诊断效能。

Objective To explore the value of 8 serum markers,such asβhuman chorionic gonadotropin(β-HCG),progesterone,estradiol(E2),inhibin A(INHA),freeβhuman chorionic gonadotropin(F-β-HCG),pregnancy associate plasm a protein-A(PAPP-A),carbohydrate antigen 125(CA125),alpha-fetoprotein(AFP)and their combined detection in early diagnosis of ectopic pregnancy.Methods Sixty-eight patients with ectopic pregnancy,100 patients with abortion after intrauterine pregnancy,and 100 patients with normal intrauterine pregnancy were randomly enrolled as three groups of subjects in the study from August to October 2018.The concentration of 8 serum markers in three groups were detected,and the variation trend of their concentration were studied.The area under the curve(AUC)of the Receiver Operating Characteristic(ROC)curre were calculated,the cut-off values were determined and diagnostic efficacy of serum markers and combined detection was evaluated.Results The difference of 8 serum markers between the ectopic pregnancy group and the normal pregnancy group was statistically significant(P<0.05);the difference between the abortion group and the control group was statistically significant(P<0.05).In the diagnosis of ectopic pregnancy,the order of diagnostic value from high to low was progesterone,E2,INHA,β-HCG,F-β-HCG,PAPPA,CA125 and AFP.The area of ROC curve was 0.970,the sensitivity was 86.8%,and the specificity was98.0%.The detection of progesterone,E2,INHA andβ-HCG has an important clinical value in the diagnosis of ectopic pregnancy at around the 6 th week of gestation.The cut-off values were progesterone 15.02 ng/mL,E2221.00 pg/mL,INHA 17.25 pg/mL,β-HCG 1285.00 mIU/mL,respectively.Conclusion In order to improve the accuracy of ectopic pregnancy in early diagnosis,it is suggested to use progesterone,E2,INHA,β-HCG combined detection to improve the diagnostic efficiency.