经阴道彩色超声检查联合血清学指标对异位妊娠保守治疗结局的预测  

Clinical Value of TVCDS and Serum Markers in Predicting Outcome of Nonsurgical Treatment of Ectopic Pregnancy

作　　者：蒋学风[1] 李瑞满[1] 罗新[1] 王晓玉[1] 祖月娥[2] 王文慧[1] 杨斌健[1] 

机构地区：[1]暨南大学附属第一医院,广州510630 [2]湖南长沙市妇幼保健院,长沙410007

出　　处：《生殖与避孕》2009年第9期593-597,共5页Reproduction and Contraception

摘　　要：目的:了解阴道彩色超声波检查(TVCDS)联合血清学指标对异位妊娠保守治疗结局的预测价值。方法:根据TVCDS血流信号联合血清学β-hCG、孕酮(P)建立异位妊娠保守治疗评分表,并以Elito评分表为对照,对122例拟行保守治疗的异位妊娠进行评分,采用氨甲蝶呤联合米非司酮进行保守治疗并追踪治疗结局。结果:阴道彩超联合血清学3项指标评分法曲线下面积显著高于Elito法曲线下面积(0.936vs0.890,P<0.05)。本法评分值≤6分是预测保守治疗成功的最佳临界值,准确度为92.6%,阳性预测值达95.9%。血清β-hCG<5000U/L、P<47.55nmol/L、阴道彩超血流信号<半环的保守治疗成功率显著升高(P<0.001)。结论:经TVCDS联合血清学指标评分法;评分≤6可有效预测异位妊娠保守治疗的成功。Objective： To assess transvaginal color doppler sonography （TVCDS） and serum markers in predicting outcome of nonsurgical treatment of ectopic pregnancy. Methods： A total of 122 cases with ectopic pregnancy had been scored before received with MTX and RU486 by 3 factors soring from TVCDS and serum markers （E2 and P） and the outcome of ectopic pregnancy was further prospective observed compared with the way designed by Elito. Results： Among 122 patients, 98 cases succeed with nonsurgical treatment and 24 cases turned to surgery. The success rate was 80.3%. Areas under ROC curve were 0.936 for 3 factors （95%CI： 0.902-0.970） higher than that of Elito （0.890）, （95%CI： 0.854-0.926）（P〈0.05）. The optimum cutoff value for 3 markers score was ≤ 6, which had the highest sensitivity and specificity （94.9% and 84.3%）, achieving an accuracy of 92.6% and positive predictive values of 95.9%. Serum β-hCG〈5 000 U/L, P〈47.55 nmol/L and blood flow ring 〈1/2 showed from TVCDS played a critical role in predicting sucess of nonsurgical treatment of tubal pregnancy （P〈0.001）. Conclusion： TVCDS and serum markers can predict effectively the success of nonsurgical treatment of ectipic pregnancy.

关 键 词：异位妊娠(EP) 保守治疗 经阴道彩超(TVCDS) 预测 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.22[医药卫生—诊断学]