输卵管间质部妊娠术后持续性异位妊娠的相关因素及预测指标研究  

Risk factors and predictors of persistent ectopic pregnancy after interstitial pregnancy surgery

作　　者：毛溯 朱兰[1] 孙智晶[1] 樊庆泊[1] 于昕[1] 戴毓欣[1] Mao Su;Zhu Lan;Sun Zhijing;Fan Qingbo;Yu Xin;Dai Yuxin(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,National Clinical Research Center for Obstetric and Gynecologic Diseases,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院妇产科,国家妇产疾病临床医学研究中心,北京100730

出　　处：《中华医学杂志》2022年第34期2690-2695,共6页National Medical Journal of China

基　　金：中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2020-PT320-003)。

摘　　要：目的研究输卵管间质部妊娠患者术后发生持续性异位妊娠(PEP)的相关因素及早期预测指标。方法收集2013年1月至2021年8月在北京协和医院妇产科接受手术治疗的输卵管间质部妊娠患者的临床资料,根据是否发生PEP分为2组(PEP组患者为8例,未发生PEP组患者为124例)。采用倾向性评分匹配(PSM)分析法,对两组患者的基础数据、手术方式、术前/术后β-人绒毛膜促性腺激素(β-hCG)比值、β-hCG降至正常时间等进行比较和分析,研究输卵管间质部妊娠术后发生PEP的相关因素。绘制受试者工作特征(ROC)曲线,评估术后24~48 hβ-hCG水平与术前β-hCG水平的比值对于预测术后发生PEP的灵敏度与特异性。结果PSM前,PEP组和非PEP组患者年龄分别为(30.0±4.0)和(32.4±5.0)岁(P>0.05)。PSM后,匹配成功的PEP组患者为8例,匹配成功的非PEP组患者有29例;两组患者年龄分别为(30.0±4.0)和(30.1±3.2)岁(P>0.05),孕次、产次、停经天数、术前β-hCG水平、病灶最大径线等差异亦均无统计学意义(均P>0.05)。PEP组患者病灶最大径线≤2.6 cm的患者所占的比例(6/8)高于对照组(31.0%,9例)(P=0.025)。PEP组患者术后24~48 hβ-hCG/术前β-hCG比值M(Q1,Q3)为52.9%(49.9%,59.7%),高于对照组31.5%(23.8%,39.0%)(P=0.001);PEP组患者β-hCG降至<6 U/L的时间M(Q1,Q3)为52.0(34.8,92.0)d,大于对照组的24.0(20.5,31.0)d(P<0.001)。两组患者术后24~48 hβ-hCG/术前β-hCG比值预测术后发生PEP的ROC曲线下面积(AUC)为0.892(95%CI:0.725~1.000,P=0.001),预测PEP的cut-off值为48.5%,此时诊断的灵敏度为87.5%,特异度为93.1%。结论输卵管间质部妊娠手术中,病灶最大径线≤2.6 cm是术后发生PEP的相关因素。手术后24~48 hβ-hCG与术前比值>48.5%是预测术后PEP发生并指导治疗的参考指标。Objective To explore the related factors and early predictors of persistent ectopic pregnancy(PEP)in patients with interstitial pregnancy after operation.Methods The clinical data of patients with interstitial pregnancy who underwent surgery in the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital from January 2013 to August 2021 were collected.Patients were divided into two groups according to whether PEP occurred(8 patients in PEP group and 124 patients in non-PEP group).Using propensity score matching(PSM)analysis,the basic data,surgical methods,the ratio of postoperative to preoperative serumβ-human chorionic gonadotropin(β-hCG),the duration of when the serumβ-hCG had decreased to normal after the operation were compared and analyzed to find the related factors of PEP after interstitial pregnancy surgery.The sensitivity and specificity of the ratio of 24-48 hours postoperativeβ-hCG to preoperativeβ-hCG in predicting postoperative PEP were evaluated by drawing receiver operating characteristic(ROC)curve.Results Before PSM,the ages of patients in PEP group and non-PEP group were(30.0±4.0)and(32.4±5.0)years old,respectively,P>0.05.After PSM,8 PEP patients in the study group and 29 patients in the control group were matched successfully,and the ages of the two groups were(30.0±4.0)and(30.1±3.2)years old,respectively,P>0.05.After PSM,there was no significant difference in gravidity,parity,menopausal days,preoperativeβ-hCG level and maximum diameter of lesions,all P>0.05.After PSM,the proportion of patients with maximum diameter≤2.6 cm in PEP group(6/8)was significantly higher than that in control group(31.0%,9/29),P=0.025.The median(Q1,Q3)of the ratio of 24-48 hours postoperativeβ-hCG to preoperativeβ-hCG ratio was 52.9%(49.9%,59.7%)in the PEP group,which was significantly higher than 31.5%(23.8%,39.0%)in the control group(P=0.001);The median(Q1,Q3)of duration of when the serumβ-hCG had decreased to normal after the operation in PEP group was 52.0(34.8,92.0)d,which was

关 键 词：妊娠 间质部妊娠 持续性异位妊娠 危险因素 预测指标 

分 类 号：R714.221[医药卫生—妇产科学]