血清E_(2)、P和Free-β-HCG联合预测孕早期妊娠丢失的价值探讨

Value of serum E_(2),P and Free-β-HCG in predicting pregnancy loss in the first trimester

目的探讨血清雌二醇(E_(2))、孕酮(P)和游离-β亚基-人绒毛膜促性腺激素(Free-β-HCG)联合预测孕早期妊娠丢失的价值。方法回顾性分析2018年1月~2019年5月医院收治的停经、妊娠试验阳性、B超检查显示宫内早孕的167例女性的资料,所有女性于就诊当日测定血清E_(2)、P和Free-β-HCG含量,随访其妊娠结局,根据临床症状和阴道B超检查结果将女性分为妊娠丢失组和妊娠成功组。对比2组女性就诊时血清E_(2)、P和Free-β-HCG水平,使用受试者工作特征(ROC)曲线分析血清E_(2)、P和Free-β-HCG预测孕早期妊娠丢失的价值。结果 167例女性中有26例出现孕早期妊娠丢失情况,发生率为15.57%;妊娠丢失组血清E_(2)、P和Free-β-HCG水平明显低于妊娠成功组(P<0.05);血清E_(2)、P和Free-β-HCG预测孕早期妊娠丢失的Cut-off值分别为559.92ng/L、17.38ng/mL、843.31IU/L,指标联合预测孕早期妊娠丢失的灵敏度为100.00%,明显高于各指标单独预测(P<0.01),联合预测孕早期妊娠丢失的特异度与各指标对比差异无统计学意义(P>0.01),AUC均高于单独指标评估预测(P<0.01)。结论孕早期妊娠丢失风险高,孕早期妊娠丢失孕妇的血清E_(2)、P和Free-β-HCG水平较低,血清E_(2)、P和Free-β-HCG对孕早期妊娠丢失有一定的预测价值,且指标联合的预测价值更佳。

Objective:To explore the value of serum estradiol(E_(2)),progesterone(P)and free β-human chorionic gonadotropin(Free-β-HCG)in predicting pregnancy loss in the first trimester.Methods:The clinical data of 167 women who had menopause,a positive pregnancy test,and a B-ultrasound examination showed early intrauterine pregnancy admitted to the hospital from January 2018 to May 2019 were retrospectively analyzed.Serum E_(2)、P and Free-β-HCG levels were measured on the day upon admission,follow up on pregnancy outcomes,women were divided into pregnancy loss group and pregnancy success group according to the clinical symptoms and vaginal B results.The serum E_(2),P and Free-β-HCG levels on admission of the two groups of women were compared,and the receiver operating characteristic(ROC)curve was used to analyze the value of serum E_(2),P and Free-β-HCG in predicting pregnancy loss in the first trimester.Results:26 out of 167 women had pregnancy loss in the first trimester,the incidence was 15.57%.Serum E_(2),P and Free-β-HCG levels in the early pregnancy loss group were substantially lower than those in the successful pregnancy group(P<0.05).The Cut-off values of serum E_(2),P and Free-β-HCG for predicting pregnancy loss in the first trimester were 559.92ng/L,17.38ng/mL,843.31IU/L,respectively.The sensitivity of the index combination to predict pregnancy loss in the first trimester was 100.00%,which was obviously higher than the sensitivity of the individual index prediction(P<0.01).The specificity of the combined prediction of pregnancy loss in the first trimester was not statistically different from that of each index(P>0.01).And AUC was higher than that of the individual indicators(P<0.01).Conclusion:The risk of pregnancy loss in the first trimester is high,and the serum E_(2)、P and Free-β-HCG levels of pregnant women in pregnancy loss in the first trimester are lower.Serum E_(2),P and Free-β-HCG have a certain predictive value for pregnancy loss in the first trimester,and the combination of indicators has a better predictive value.