术后β-hCG下降程度在剖宫产瘢痕妊娠初次治疗中的预后价值

Value of the decline of postoperativeβ-hCG level in the primary treatment of patients with cesarean scar pregnancy in their prognosis

目的:探讨术后绒毛膜促性腺激素(β-hCG)下降程度在剖宫产瘢痕妊娠(CSP)初次治疗预后中的价值。方法:回顾性分析2009年1月-2019年9月就诊于浙江大学医学院附属妇产科医院的CSP患者临床资料,其中诊断为CSP,初次治疗后失败需再次处理的66例为观察组,1:4匹配在此期间初次治疗成功的CSP患者258例为对照组。对比分析两组术后β-hCG下降程度。结果:两组术后β-hCG下降程度分别为(60.3±14.2)%、(67.9±13.2)%,差异有统计学意义(Z=-3.28、-3.90,P<0.05)。ROC分析曲线显示术后β-hCG水平下降程度最佳临界值为66.6%,诊断CSP治疗失败的敏感度为68.2%,特异度为57.8%。结论:术后β-hCG水平下降百分比<66.6%,提示可能需再行补救治疗。

Objective:To explore the value of the decline of postoperativeβhuman chorionic gonadotropin(hCG)level in the primary treatment of patients with cesarean scar pregnancy(CSP)in their prognosis.Methods:The clinical data of the patients with CSP from January 2009 to September 2019 in Women's Hospital School of Medicine Zhejiang Uni-versity,were analyzed retrospectively.Among them,66 patients who failed in primary treatment and needed to be treated again were included in study group.And 1:4 match was used to seen 258 patients who had been treated suc-cessfully and did not need to be treated again in the control group during this period.The decline percentage rate of theβ-hCG level after surgery of the patients were compared between the two groups.Results:There were significant difference in the decline percentage rate of the postoperativeβ-hCG level(60.3±14.2%vs.67.9±13.2%)of the pa-tients between the two groups(Z=3.28 and 3.90,P<0.05).Receiver operator characteristic(ROC)curve analysis showed that the optimum critical value,the sensitivity,and the specificity of the decline percentage rate of the postoperativeβ-hCG level of the patients for diagnosing their treatment failure were 66.6%,68.2%,and 57.8%,re-spectively.Conclusion:The decline percentage rate of the postoperativeβ-hCG level of the patients is<<66.6%,which suggests that the remedial treatment again should be conducted in these patients.