阴道超声联合血清AMH、CA125检测对早孕期先兆流产的诊断及预后价值

Values of transvaginal ultrasound examination combined with the serum anti Mullerian hormone and carbohydrate antigen-125 levels for diagnosing and evaluating the prognosis of the threatened abortion of women during the first trimester of pregnancy

目的:探讨阴道超声联合血清抗苗勒管激素(AMH)、糖类抗原125(CA125)对早孕期孕妇先兆流产的诊断及不良妊娠结局评估价值。方法:回顾性收集2019年6月—2022年6月本院产前检查孕妇248例临床资料,其中正常早孕80例(对照组),先兆流产168例。根据先兆流产的保胎结局分为继续妊娠组(105例)和妊娠失败组(63例)。采用酶联免疫吸附法检测血清AMH、CA125水平。采用受试者工作特征(ROC)曲线评价超声参数、血清AMH、CA125对先兆流产的诊断及预后评估价值。结果:妊娠失败组血清CA125(54.24±12.86 mIU/ml)高于继续妊娠组(34.89±9.47 mIU/ml)及对照组(24.63±6.32 mIU/ml),AMH(7.75±1.79μg/L)低于继续妊娠组(10.16±3.01μg/L)及对照组(11.75±3.32μg/L),超声参数孕囊绒毛间隙动脉血流的阻力指数(RI)、收缩期上升支加速度时间(ACT)、卵黄囊直径均高于继续妊娠组及对照组,收缩期峰值流速(PSV)、孕囊直径均低于继续妊娠组及对照组(均P<0.05)。阴道超声参数联合AMH、CA125检测诊断先兆流产和不良妊娠结局的曲线下面积(AUC)分别为0.966、0.993,均高于单项指标检测(均P<0.05)。结论:血清AMH、CA125水平联合阴道超声检测可显著提高先兆流产诊断及预后评估效能。

Objective:To investigate the values of transvaginal ultrasound examination combined with the serum anti Mullerian hormone(AMH)and carbohydrate antigen-125(CA125)levels for diagnosing and evaluating the prognosis of the threatened abortion of women during the first trimester of pregnancy.Methods:The clinical data of 248 pregnant women who came to hospital for antenatal examination during the first trimester of pregnancy from June 2019 to June 2022 were selected as the research objects,including 80 cases with normal pregnancy in control group and 168 cases with threatened abortion in study group.According to the outcomes of the threatened abortion,the women in the study were further divided into group A(105 cases with continued pregnancy)and group B(63 cases with abortion).Enzyme linked immunosorbent assay(ELISA)was used to detect the expression levels of serum AMH and CA-125 of the women.The values of the ultrasound parameters and the AMH and CA-125 levels of the women for diagnosing and evaluating the prognosis of the women with threatened abortion were analyzed by receiver operator characteristic(ROC)curve.Results:The level of serum CA125(54.24±12.86 mIU/ml)of the women in group B was significantly higher than that(34.89±9.47 mIU/ml)of the women in group A and that(24.63±6.32 mIU/ml)of the women in the control group.The AMH level(7.75±1.79μg/L)of the women in group B was significantly lower than that(10.16±3.01μg/L)of the women in group A and that(11.75±3.32μg/L)of the women in the control group.The ultrasonic parameters values of intervillous artery flow,such as resistance index(RI),ascending acceleration time(ACT)of systolic branch,and yolk sac diameter of the women in group B were significantly higher than those of the women in group A and in the control group.The values of peak systolic flow velocity(PSV)and the diameter of gestational sac of the women in group B were significantly lower than those of the women in group A and in the control group(all P<0.05).The area under the curve(AUC)of the parameters values of transvaginal ultrasonography combined with the levels of AMH and CA125 of the pregnant women for diagnosing their threatened abortion and adverse pregnancy outcomes were 0.966 and 0.993,which were significantly higher than those of the parameters values of transvaginal ultrasonography or the levels of AMH and CA125 alone(all P<0.05).Conclusion:The combination of the levels of AMH and CA125 and the parameters values of transvaginal ultrasonography of the pregnant women for diagnosing their threatened abortion can obviously improve the diagnostic efficacy and the evaluative efficacy of the prognosis of the women.