腹腔血与静脉血hCG比值在诊断异位妊娠中的价值  

Clinical value of hCG ratio of blood in peritoneal cavity versus venous blood in diagnosis of ectopicpregnancy

作　　者：王玉东[1] 赵文霞[3] 陆琦[1] 滕银成[2] 孙峰[1] 程蔚蔚[1] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院妇产科,200030 [2]上海交通大学附属第六人民医院妇产科 [3]上海市江湾医院妇产科

出　　处：《中华妇产科杂志》2013年第3期177-179,共3页Chinese Journal of Obstetrics and Gynecology

基　　金：上海交通大学“新百人计划”研究项目;上海市卫生局“妇科常见病和多发病“重点项目（20124027）

摘　　要：目的探讨腹腔血与静脉血hCG比值（RPhCG／VHCG）在诊断异位妊娠中的价值。方法前瞻性分析2009年3月至2012年10月在上海交通大学医学院附属国际和平妇幼保健院、上海交通大学附属第六人民医院以及上海市江湾医院就诊的可疑异位妊娠患者321例，其中明确异位妊娠共268例（异位妊娠组），宫内妊娠合并腹腔积血（hIUP）53例（hIUP组）。所有患者均同时取腹腔积血（后穹隆穿刺或术中抽取）和静脉血，送同位素室双盲测定hCG值并计算RPhCG／VhCG。散点分析和受试者工作特征（ROC）曲线分析RPhCG／VhCG鉴别异位妊娠与hIUP的临界值，并评估其术前诊断异位妊娠的敏感度、特异度及准确度。结果异位妊娠组中位RPhCG／VhCG为4．35，明显高于hIUP组中位RPhCG／VhCG0．81，两组比较，差异有统计学意义（P〈0．01）；散点分析显示，异位妊娠与hIUP的RPhCG／VhCG的临界值为1．0。以RPhCG／VhCG〉1．0为诊断标准，诊断异位妊娠的敏感度为98％，特异度为100％，阳性预测值100％，阴性预测值93％。结论以RPhCG／VhhCG〉1．0为标准可以快速、准确地协助诊断异位妊娠，有利于术前和术中执行正确的决策。Objective To study the value of hCG ratio of blood in peritoneal cavity versus venous blood （RPhcc/VhCG） in diagnosis of early ectopic pregnancy （EP）. Methods From Mar. 2009 to Oct. 2012, 268 cases with EP （EP group） and 53 women with intrauterine pregnancy with haemoperitoneum （hIUP） （hIUP group） from International Peace Maternity and Child Health Hospital of Shanghai Jiaotong University School of Medicine, Shanghai 6th People Hospital and Shanghai Jiangwan Hospital were enrolled in this prospective study. The HCG of all subjective were measured in blood in peritonea cavity and venous blood, then calculate the ratio of RPhCG/VhCG. Scatter point analysis and ROC were used to differentiate EP, determine threshold of hIUP and evaluate the sensitivity, specificity and accuracy in diagnosis EP preoperatively. Results The mean RPhCG/VhCG of EP group was 4. 35, which was significantly higher than 0. 81 in hIUP group （ P 〈 0. 01 ）. Scatter point analysis showed that the threshold value of RPhcG/VhCG between eetopic pregnancy and hIUP was 1.0. The overall sensitivity of RPhCG/VhcG in the diagnosis of EP was 98% , the specificity was 100% , the positive predictive value was 100% and the negtive predictive value was 93%. Conclusion RPhCG/VhCG 〉 1. 0 could be used to diagnose and differentiate EP from hIUP accurately.

关 键 词：妊娠 异位 绒毛膜促性腺激素 腹腔 静脉 血液 诊断 

分 类 号：R714.22[医药卫生—妇产科学]