血清孕酮和妊娠相关血浆蛋白A用于早期诊断未破裂型输卵管妊娠的应用价值  

The value of serum progesterone and PAPP-A in the diagnosis of un-ruptured tubal pregnancy

作　　者：谌小卫[1] 吴志喜[2] 李小毛[1] 

机构地区：[1]中山大学附属第三医院妇产科,510630 [2]广东东莞市人民医院,523018

出　　处：《新医学》2011年第2期78-81,F0003,共5页Journal of New Medicine

摘　　要：目的:探讨血清孕酮、妊娠相关血浆蛋白-A(PAPP-A)用于早期诊断未破裂型输卵管妊娠(TP)的价值。方法:测定41名正常宫内妊娠(nIUP)孕妇与52例未破裂型TP患者的血清孕酮、PAPP-A,其中血清孕酮采用化学发光法,PAPP-A采用酶联免疫吸附法,对两组血清指标进行对比分析,绘制受试者工作特征(ROC)曲线分析两项指标用于诊断TP的敏感度及特异度。结果:TP组患者血清孕酮、PAPP-A水平均低于同孕周nIUP组(P均<0.01)。TP患者血清孕酮、PAPP-A的ROC曲线下面积分别为0.96,0.92。以血清孕酮<60.1 nmol/L为诊断阈值,诊断TP敏感度为92.7%,特异度为83.3%;以PAPP-A<0.49 mg/L为诊断阈值,诊断TP敏感度为84.6%,特异度为87.8%。取血清孕酮与PAPP-A乘积<41.0为诊断阈值,诊断TP的敏感度为97.9%,特异度为87.8%。结论:在TP早期诊断或在定位不明部位妊娠时,测定血清孕酮及PAPP-A均具有一定的临床价值,血清孕酮及PAPP-A乘积有助于早期诊断输卵管妊娠。Objective： To explore the clinical diagnostic value of progesterone （P） and pregnancy associated plasma protein A （PAPP-A） for unruptured tubal pregnancy （TP）. Methods： Serum P and PAPP-A were measured in 52 cases of un-ruptured TP and 41 cases of normal inter-uterine pregnancy （nIUP）. Receiver operating characteristic curves （ROC） of all indexes were drawn and the areas under the ROC curves were calculated to evaluate diagnostic value. Results： Levels of serum P and PAPP-A were significantly lower in TP group compared with nlUP group in the same pregnancy weeks. The areas under the ROC curves of serum P and PAPP-A were 0. 96 and 0. 92 respectively. To differentiate TP from nIUP, the threshold for P was less than 60. 1 nmol/L, with 91.7% sensitivity and 87.8% specificity; while the threshold value for PAPP-A was less than 0. 49 mg/L, with 84. 6% sensitivity and 87.8% specificity. The areas under the ROC curves of combination of P x PAPP-A was 0. 96, and the threshold for combination of P x PAPP-A was less than 41.0, with 97.9% sensitivity and 87.8% specificity. Conclusion ： Detection of serum PAPP-A and P may be helpful for the diagnosis of unruptured TP, combination of P x PAPP-A had the best diagnostic value.

关 键 词：未破裂型输卵管妊娠 早期诊断 孕酮 妊娠相关血浆蛋白A 

分 类 号：R714.2[医药卫生—妇产科学]