术后孕酮、hCG预测保守性手术后持续性输卵管妊娠的发生

Prediction of the occurrence of persistent ectopic pregnancy after conservative surgical management combined with postoperative measurements of serum progesterone and hCG levels

目的:探讨术后血清孕酮结合hCG水平测定在预测输卵管保守性手术后持续性输卵管妊娠(per-sistent ectopic pregnancy,PEP)发生中的价值。方法:对确诊为异位妊娠而行保守性手术的患者187例,测定术前24h内、术后3d血清孕酮、hCG水平,用受试者工作特性曲线(receiver operator characteristic curve,ROC曲线)来确定用于预测持续性输卵管妊娠发生的最佳临界点(best critical points)。结果:187例患者中,持续性异位妊娠(PEP)组18例,未发生持续性异位妊娠(None PEP)组169例。两组术前临床表现、B超检查及血清孕酮、hCG水平差异无显著性;术后3d血清孕酮、hCG水平差异有显著性。其中术后血清孕酮≥9ng/ml、术前、术后hCG下降≤50％者发生PEP的危险性明显升高。结论:对异位妊娠行保守性手术的患者,可通过联合测定术后血清孕酮、hCG水平来预测持续性输卵管妊娠发生的危险性。

Objective:To evaluate whether postoperative measurements of the levels of progesterone and hCG in serum can predict the risk of persistent ectopic pregnancy (PEP) after conservative surgical management.Methods: Serum progesterone and hCG were measured preoperatively 4hrs and postoperatively day 3 in 187 cases of EP treated with conservative surgical management from January 2999 to December 2002, and the best critical point to predict the persistent ectopic pregnancy was confirmed with ROC curve.Results:In 187 cases, 18 cases were diagnosed as persistent ectopic pregnancy and 169 cases without PEP. Hiere were no significant differences in preoperative clinical manifestations, B type ultrasonograph-ic findings, serum progesterone and hCG levels between two groups of PEP and none PEP before operation. The risk of the PEP occurrence was obviously elevated when postoperative serum progesterone ≥9 ng/ml and preoperative, post-operative hCG level decreased to ≤50% in both groups. Conclusion :The risk of the PEP occurrence can be predicted by the combined measurements of the postoperative level of serum progesterone and hCG in the PEP patient undergone conservative surgical management.