血清孕酮对异位妊娠的诊断价值探讨

The Value of Serum Progesterone in the Diagnosis of Ectopic Pregnancy

目的 :对血清 β-hCG <15 0 0mIU/ml的患者进行血清P测定 ,探讨血清P对异位妊娠的诊断价值。方法 :通过对 1999年 6月～ 2 0 0 1年 12月因停经 /腹痛 /阴道流血来我院就诊的尿妊娠试验阳性的患者进行血清 β -hCG及血清P测定 ,对 β -hCG <15 0 0mIU/ml的患者进行随访并依据妊娠结果分为NIUP ,EP ,AB 3组 ,并进行回顾性分析。结果 :10 6位患者 β -hCG<15 0 0mIU/ml,其中EP4 7例 ,NIUP31例 ,AB2 8例。EP患者血清P平均值明显低于NIUP患者 (P <0 .0 1) ,而在EP和AB间无明显差异 (P >0 .0 5 )。以EP血清P第 90百分位数为临界值 (P90 =9.0ng/ml) ,区分EP与NIUP的敏感性为91.5 % ,特异性为 90 .3% ,区分EP与AB的特异性为 2 1.7%。结论 :当β -hCG <15 0 0mIU/ml时 ,以血清P值 9.0ng/ml区分EP和NI UP有较高的敏感性和特异性 ,有一定诊断价值 ,但不能鉴别EP与AB。

Objective: To investigate the diagnostic accuracy of serum progesterone (P) and to identify a cutoff value that provides the best compromise between test sensitivity and specificity in patients with beta-hCG<1500mIU/ml. Methods: A prospective study of progesterone level was performed in patients with positive qualitative urine hCG, and with or without abdominal pain and vaginal bleeding from June 1999 to December 2001 and with a quantitative beta-hCG<1500mIU/ml. Results: Of a total 106 patients, 47 patients with ectopic pregnancy, 31 patients with normal intrauterine pregnancy and 28 patients with abortion. The mean serum P level in patients with ectopic pregnancy and abortion was much lower than inpatients with normal intrauterine pregnancy, but there was no significant difference between ectopic pregnancy and abortion. When the cutoff value of serum progesterone was 9ng/ml, sensitivity and specificity to detect ectopic pregnancy and normal intrauterine pregnancy was 91.5%, but specificity between ectopic pregnancy and abortion was 21.7%. Conclusion:Serum progesterone has high diagnostic accuracy for differentiating ectopic pregnancy from normal intrauterine pregnancy when beta-hCG<1500mIU/ml, but it cannot efficiently differentiate ectopic pregnancy and abortion.