TVS、TAS与β-HCG、孕酮、E_(2)在早期输卵管妊娠中的联合诊断价值

The combined diagnostic value of TVS and TAS withβ-HCG,progesterone and E_(2) in early tubal pregnancy

目的 探究经阴道超声(TVS)、经腹部超声(TAS)与β-人绒毛膜促性腺激素(β-HCG)、孕酮、雌二醇(E_(2))在早期输卵管妊娠中的联合诊断价值。方法 选取北京市通州区妇幼保健院2020年1月—2021年1月疑似输卵管妊娠患者117例作为研究对象,均行TVS、TAS检查及血清β-HCG、孕酮、E_(2)水平检测。结果 117例疑似输卵管妊娠患者经临床确诊90例为输卵管妊娠,27例为正常妊娠。受试者工作特征(ROC)曲线分析显示,TVS、TAS检查及两者联合检查诊断输卵管妊娠的ROC曲线下面积(AUC)分别为0.715、0.661、0.728。输卵管妊娠组血清β-HCG、孕酮、E_(2)水平低于正常妊娠组(P<0.05);血清β-HCG、孕酮、E_(2)及三者联合诊断输卵管妊娠的AUC分别为0.908、0.922、0.701、0.944。TVS、TAS阳性检出率与血清β-HCG、孕酮、E_(2)水平呈负相关(P<0.05)。TVS、TAS检查联合血清β-HCG、孕酮、E_(2)诊断输卵管妊娠的AUC为0.967,95%CI为0.940~0.994,敏感度为87.78%,特异度为96.30%,高于各项检查单一诊断价值、TAS联合TVS诊断价值及血清β-HCG、孕酮、E_(2)联合诊断价值。结论 早期输卵管妊娠TVS、TAS阳性检出率与血清β-HCG、孕酮、E_(2)水平呈负相关,联合诊断价值较高,能为临床诊断早期输卵管妊娠提供较为全面、可靠的参考依据。

Objective To investigate the combined diagnostic value of transvaginal ultrasound(TVS)and transabdominal ultrasound(TAS)withβ-human chorionic gonadotropin(β-HCG),progesterone,and estradiol(E_(2))in early tubal pregnancy.Methods A total of 117 patients with suspected tubal pregnancy who were admitted to Beijing Tongzhou Maternal and Child Health Care Hospital from January 2020 to January 2021 were enrolled.They underwent TVS and TAS imaging,and their levels of serumβ-HCG,progesterone,and E_(2) were measured.Results Among 117 patients with suspected tubal pregnancy,90 cases were clinically diagnosed with tubal pregnancy,with 27 normal pregnancy cases.The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of TVS,TAS examination and the combined examination was 0.715,0.661 and 0.728,respectively.The tubal pregnancy group showed remarkably lower levels of serumβ-HCG,progesterone and E_(2) than the normal pregnancy group(P<0.05).The AUC of serumβ-HCG,progesterone,E_(2) and their combination for the diagnosis of tubal pregnancy was 0.908,0.922,0.701 and 0.944,respectively.The positive detection rate of TVS and TAS were negatively correlated with the levels of serumβ-HCG,progesterone and E_(2)(P<0.05).The AUC of TVS and TAS examinations combined with serumβ-HCG,progesterone and E_(2) for the diagnosis of tubal pregnancy was 0.967(95%CI 0.940-0.994),with a sensitivity of 87.78%and a specificity of 96.30%,which were significantly higher than the diagnostic value of each examination,the diagnostic value of TAS combined with TVS and the combined diagnostic value of serumβ-HCG,progesterone,and E_(2).Conclusions The detection positive rates of TVS and TAS in early tubal pregnancy were negatively correlated with serumβ-HCG,progesterone and E_(2) levels,and the combined diagnostic value is high,which can provide more comprehensive and reliable reference for clinical practice.