子宫内膜厚度、血流参数联合人绒毛膜促性腺激素及雌激素检测对异位妊娠诊断及预测价值分析

Endometrial thickness,blood flow parameters combined with human chorionic gonadotropin and estrogen in the diagnosis and prediction of ectopic pregnancy

目的:探究子宫内膜厚度及血流参数联合人绒毛膜促性腺激素(β-HCG)及雌激素对异位妊娠诊断及预测价值。方法:选取105例疑似异位妊娠患者为研究对象。根据手术或病理学检测结果将患者分为异位妊娠组(n=73)与宫内早孕组(n=32)。记录并比较两组患者子宫内膜厚度、血流参数[阻力指数(RI)、搏动指数(PI)、舒张末期流速(EDV)及收缩期峰值流速(PSV)]、β-HCG水平、孕酮(P)水平及雌二醇(E_(2))水平,采用Logistics回归分析影响患者发生异位妊娠的相关因素,并采用受试者工作曲线(ROC)评价各指标对患者发生异位妊娠的预测价值。结果:异位妊娠组子宫内膜厚度、EDV及PSV水平均低于宫内早孕组(P<0.05),PI水平高于宫内早孕组(P<0.05);两组患者RI水平比较,差异无统计学意义(P>0.05)。异位妊娠组患者β-HCG、P及E_(2)水平均低于宫内早孕组(P<0.05)。回归分析显示,患者子宫内膜厚度水平较低、β-HCG水平较低、P水平较低及E_(2)水平较低均为患者宫内妊娠的危险因素。ROC曲线分析得知,子宫内膜厚度曲线下面积(AUC)为0.894,敏感度为0.822,特异度为0.844;β-HCG的AUC为0.919,敏感度为0.849,特异度为0.844;P的AUC为0.855,敏感度为0.918,特异度为0.687;E_(2)的AUC为0.857,敏感度为0.877,特异度为0.781。结论:相较于宫内早孕,异位妊娠患者子宫内膜厚度较低、血流博动指数较大及流速较慢,且β-HCG、P及E_(2)水平均较低,因此妊娠者该类指标异常将增加发生异位妊娠风险。

Objective:To explore the value of endometrial thickness,blood flow parameters combined with human chorionic gonadotropin(β-HCG)and estrogen in the diagnosis and prediction of ectopic pregnancy.Methods:105 patients with suspected ectopic pregnancy were divided into ectopic pregnancy group(n=73)and intrauterine early pregnancy group(n=32)according to surgery or pathological testing.Endometrial thickness,blood flow parameters[resistance index(RI),pulsatile index(PI),end-diastolic flow rate(EDV)and peak systolic flow rate(PSV)],β-HCG level,progesterone(P)level and estradiol(E_(2))level were recorded and compared between the two groups,and the factors affecting ectopic pregnancy were analyzed by Logistics regression,and the prediction value of each differential index on ectopic pregnancy was tested by using the subject's work curve(ROC).Results:The endometrial thickness,EDV and PSV levels in the ectopic pregnancy group were lower than those in the intrauterine first pregnancy group,and the PI levels were higher than those in the intrauterine first pregnancy group(P<0.05),and there was no significant difference in RI levels between the two groups(P>0.05).The levels ofβ-HCG,P and E_(2) in the ectopic pregnancy group were lower than those in the intrauterine first trimester pregnancy group(P<0.05).Regression analysis showed that patients with low endometrial thickness,lowβ-HCG level,lower P level and lower E_(2) level were all relevant factors affecting the occurrence of intrauterine pregnancy.The area under the endometrial thickness curve(AUC)=0.894,the sensitivity and the specificity were 0.822 and 0.844,the AUC ofβ-HCG was 0.919,the sensitivity was 0.849,the specificity was 0.844,the AUC of P was 0.855,the sensitivity was 0.918,the specificity was 0.687,and the AUC of E_(2) was=0.857,the sensitivity was 0.877,and the specificity was 0.781.Conclusion:Compared with intrauterine early pregnancy,ectopic pregnancy has lower endometrial thickness,higher blood flow pulsatile index and slower flow rate,and lower levels ofβ-HCG,P and E_(2),which will increase the risk of ectopic pregnancy.