经阴道三维超声联合血清糖类抗原125、血管内皮生长因子和抗米勒管激素对异位妊娠的早期诊断价值研究

Early diagnosis of ectopic pregnancy by transvaginal three⁃dimensional ultrasound combined with serum CA125,VEGF and AMH

目的 探讨经阴道三维超声联合血清糖类抗原125(CA125)、血管内皮生长因子(VEGF)和抗米勒管激素(AMH)对异位妊娠的早期诊断价值。方法 选取2019年5月至2022年6月诊治的96例异位妊娠患者作为异位妊娠组,48例正常宫内妊娠孕妇作为宫内妊娠组,比较2组超声参数[血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)]、血清CA125、血清VEGF和血清AMH;采用Logistic回归模型构建超声参数(VI、FI、VFI)、血清指标(CA125、VEGF、AMH)6项联合诊断模型;采用受试者操作特征(ROC)曲线分别分析超声参数、CA125、VEGF、AMH及6项联合诊断异位妊娠的曲线下面积(AUC)、敏感度和特异度。结果 异位妊娠组VI、FI、VFI、AMH均低于宫内妊娠组(P<0.05),CA125、VEGF高于宫内妊娠组(P<0.05)。ROC曲线分析显示,VI、FI、VFI、CA125、VEGF、AMH和6项联合诊断早期异位妊娠的AUC分别为0.753、0.644、0.765、0.763、0.768、0.739和0.995,6项联合诊断的AUC高于VI、FI、VFI、CA125、VEGF、AMH分别诊断的AUC(P<0.05)。结论 经阴道三维超声及血清CA125、VEGF、AMH联合诊断早期异位妊娠价值较高,值得临床推广。

Objective To investigate the early diagnosis of ectopic pregnancy by transvaginal three-dimensional ultrasound combined with serum carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF)and anti-Müllerian hormone(AMH).Methods Totally 96 patients with ectopic pregnancy and 48 pregnant women with normal intrauterine pregnancy diagnosed and treated from May 2019 to June 2022 were selected as study objects.Ultrasonographic parameters(vascularization index[VI],flow index[FI],vascularization flow index[VFI]),and serum CA125,VEGF and AMH were compared between ectopic pregnancy group and intrauterine pregnancy group.Logistic regression model was used to construct diagnostic models by ultrasonic parameters,serum CA125,VEGF and AMH ultrasonic parameters,serum CA125,VEGF and AMH,and six combined parameters.Receiver operating characteristic(ROC)curve was used to evaluate the area under the curve(AUC)values,sensitivities and specificities of ultrasonic parameters(VI,FI,VFI),CA125,VEGF,AMH,and six combined parameters for the diagnosis of ectopic pregnancy.Results The ectopic pregnancy group had lower VI,FI,VFI and AMH and higher CA125 and VEGF than the intrauterine pregnancy group(all P<0.05).ROC curve analysis showed that the AUC of VI,FI,VFI,CA125,VEGF,AMH and combined parameters for the diagnosis of ectopic pregnancy were 0.753,0.644,0.765,0.763,0.768,0.739 and 0.995,respectively.The AUC of the combined parameters was larger than those of VI,FI,VFI,CA125,VEGF and AMH(P<0.05).Conclusion Transvaginal three-dimensional ultrasound combined with serum CA125,VEGF and AMH has high diagnostic value for early ectopic pregnancy and is worthy of clinical application.