血清指标联合经阴道腹部超声对早期异位妊娠的诊断价值

Value of serum indicators combined with transvaginal and transabdominal ultrasound in diagnosis of early ectopic pregnancy

目的分析血清β-人绒毛膜促性腺激素(β-HCG)、癌抗原199(CA199)、孕酮(P)水平检测联合经阴道、腹部超声对早期异位妊娠的诊断价值。方法选取2020年10月至2023年10月烟台市烟台山医院收治的93例拟诊早期异位妊娠患者作为研究对象,其中经术后病理确诊为早期异位妊娠患者82例(观察组),年龄(31.35±3.16)岁;另选取同期正常宫内妊娠产妇105例作为对照组,年龄(31.57±3.22)岁。回顾性收集研究对象的临床资料,分析两组研究对象的血清β-HCG、CA199、P水平,经阴道、经腹部超声声像表现及早期异位妊娠的诊断结果。统计比较采用t检验、χ^(2)检验,绘制受试者操作特征曲线(ROC)。结果观察组血清β-HCG、CA199、P水平均低于对照组(均P<0.05)。93例初诊早期异位妊娠患者均进行病理学检查,82例为阳性;经阴道超声检查:72例真实早期异位妊娠;经腹部超声检查:69例真实早期异位妊娠。经腹部超声检查中子宫直肠窝积液、原始心管搏动、附件区包块、宫内未见孕囊的患者占比均低于经阴道超声(均P<0.05)。绘制ROC,经阴道超声、经腹部超声、血清β-HCG、CA199、P水平单独及联合检测的曲线下面积(AUC)分别为0.716、0.657、0.630、0.605、0.691、0.910,灵敏度为65.85%、63.41%、70.73%、58.54%、68.29%、86.59%,特异度为72.73%、72.73%、63.64%、72.68%、63.64%、81.82%。结论早期异位妊娠患者中血清β-HCG、CA199、P水平及经阴道、经腹部超声检测均存在异常表达情况,联合检测对早期异位妊娠患者具有较高的诊断价值,可作为早期异位妊娠临床诊治的靶点。

Objective To analyze the value of the levels ofβ-human chorionic gonadotropin(β-HCG),cancer antigen 199(CA199),and progesterone(P)combined with transvaginal and transabdominal ultrasound in the prediction of early ectopic pregnancy.Methods From October 2020 to October 2023,a total of 93 patients suspected with early ectopic pregnancy treated in Yantai Yantaishan Hospital were selected as the study objects;among which,82 patients who were(31.35±3.16)years were confirmed with early ectopic pregnancy by postoperative pathological diagnosis and were set as an observation group.Another 105 women with normal intrauterine pregnancy during the same period were selected as a control group;they were(31.57±3.22)years old.The objects'clinical data were retrospectively collected.The serum levels ofβ-HCG,CA199,and P,transvaginal and transabdominal ultrasound signs,and diagnostic results of early ectopic pregnancy in the two groups were analyzed and compared by t test andχ^(2) test.The receiver operating characteristic curves(ROC)were drawn.Results The serum levels ofβ-HCG,CA199,and P in the observation group were lower than those in the control group(all P<0.05).All the 93 patients took pathological examination,and 82 were positive.The transvaginal ultrasound results showed that 72 cases had early ectopic pregnancy.The transabdominal ultrasound results showed that 69 cases had early ectopic pregnancy.The proportions of the patients with uterine and rectal effusion,original cardiac tube pulsation,adnexal mass,and no pregnancy sac in utero by abdominal ultra sound were lower than those by transvaginal ultrasound(all P<0.05).The areas under the ROC's of transvaginal ultrasound,transabdominal ultrasound,β-HCG,CA199,P,and their combination were 0.716,0.657,0.630,0.605,0.691,and 0.910;the sensitivities were 65.85%,63.41%,70.73%,58.54%,68.29%,and 86.59%;the specificities were 72.73%,72.73%,63.64%,72.68%,63.64%,and 81.82%.Conclusion Abnormal expressions of levels of serumβ-HCG,CA199,and P and transvaginal and transabdominal ultrasound are found in patients with early ectopic pregnancy,and their combined detection has high diagnostic value for patients with early ectopic pregnancy,and may be used as a target for clinical diagnosis and treatment of early ectopic pregnancy.