多指标联合快速诊断异位妊娠的价值  

Clinical value of multi-index in rapid diagnosis of ectopic pregnancy

作　　者：陆琦[1] 史宏[1] 郎虓[1] 葛雅芳 王玉东[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,200030

出　　处：《中国妇产科临床杂志》2014年第5期409-412,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：上海交通大学"新百人计划"研究项目(沪交医人[2011]11号);上海市卫生局"妇科常见病和多发病"的重点项目(20124027);上海市级医院适宜技术(SHDC2014208)

摘　　要：目的探讨人绒毛膜促性腺激素(hCG)、孕酮(P)和肌酸激酶(CK)的腹腔血与静脉血比值(Rp/v-hCG、Rp/v-P、Rp/v-CK)联合诊断异位妊娠的价值。方法前瞻性分析120例可疑异位妊娠患者,其中明确异位妊娠共104例(异位妊娠组),宫内妊娠合并腹腔积血(hIUP组)16例。所有患者同时取腹腔积血(后穹隆穿刺或术中抽取)和静脉血,双盲测定hCG、P、CK值并计算Rp/v-hCG、Rp/v-P、Rp/v-CK,使用受试者工作特征(ROC)曲线分析鉴别异位妊娠与hIUP的临界值,评估各指标及联合指标对诊断异位妊娠的敏感度、特异度。结果异位妊娠组中位Rp/v-hCG(5.74)及Rp/v-P(2.40)明显高于hlUP组(分别是0.57、0.74,P<0.05);异位妊娠组的中位Rp/v-CK(0.87)与hlUP组(0.91)差异无统计学意义(P>0.05)。以Rp/v-hCG>1.0诊断异位妊娠的灵敏度为94.23%,特异度为93.7%;以Rp/v-P>1.0诊断异位妊娠的灵敏度为77.88%,特异度为93.75%;平行实验的灵敏度为96.15%,特异度为87.5%。系列实验的灵敏度为75.96%,特异度为100%。结论 Rp/v-hCG>1.0联合Rp/v-P>1.0可提高快速诊断异位妊娠的准确性,有利于术前和术中执行正确的决策。Objective To study the value of hCG, Progestone （P） and CK ratio of blood in peritoneal cavity versus venous blood （Rp/v- hCG, Rp/v - P and Rp/v - CK） in the diagnosis of early ectopic pregnancy （EP）. Methods 104 cases with EP and 16 women with intrauterine pregnancy with hemoperitoneum （hlUP） were en- rolled in this prospective study. The level of hCG, P and CK in all subjective were measured in blood in peritoneal cavity and venous blood, then calculate the ratio of Rp/v - hCG, Rp/v- P and Rp/v - CK. ROC was used to differentiate EP, determine threshold of hlUP and evaluate the sensitivity, specificity and accuracy in diagnosis EP pre- operatively. Results The median Rp/v - hCG （5.74） and Rp/v - P （2. 40） of EP group were significantly higher than that in hIUP group （0. 57 and 0. 74 respectively, P〈0.05）. The median Rp/v - CK had no significantly difference between EP group （0.87） and hIUP group （0. 91, P〈0.05）. The threshold value of Rp/v- hCG and Rp/v - P between EP and hIUP was 1.0. The sensitivity of Rp/v - hCG, Rp/v - P, parallel test and serial test in the diagnosis of EP were 94.23%, 77.88%, 96.15% and 75.96%, the specificity were 93.7%, 93.75%, 87.5% and 100%, respectively. Conclusion Rp/v- hCG〉I. 0, Rp/v- P 〉1.0, parallel test and serial test could be used to di- agnose and differentiate EP from hIUP accurately.

关 键 词：异位妊娠 绒毛膜促性腺激素 孕酮 血清肌酸激酶 

分 类 号：R714.22[医药卫生—妇产科学]