The evaluation of clinical efficiency of β-HCG, VEGF, PAPP-A uniting with three-dimensional transvaginal ultrasonography in diagnosing tubal ectopic pregnancy
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摘要:
目的 研究β-HCG、VEGF、PAPP-A联合经阴道三维彩超在早期输卵管异位妊娠中的诊断和临床效率评价。 方法 将我院收治的符合纳入条件和排除条件的32例早期异位妊娠患者作为实验组，根据同质性原则随机抽选32例正常宫内妊娠者作为对照组，抽取外周静脉血比较两组人员血清中β-HCG、VEGF、PAPP-A的差异，并通过计算实验组β-HCG、VEGF、PAPP-A的百分位数（P85、P15）作为诊断切割值，通过计算切割值单独、两者联合、三者联合、三者联合经阴道三维超声诊断早期输卵管异位妊娠的诊断符合率、敏感度、特异度、阳性预测值、阴性预测值的变化来评价不同诊断方式在诊断早期输卵管异位妊娠中的临床效率。 结果 实验组中β-HCG、PAPP-A浓度明显降低，分别为：3064.43±916.87 U/L、102.55±26.30 μg/L，而VEGF浓度则明显升高，浓度为：487.02±128.98 pg/mL；对照组中β-HCG、PAPP-A浓度差分别为：8532.84±1281.97 U/L、193.24±51.77 μg/L，VEGF浓度为：116.77±60.71 pg/mL，差异均有统计学意义（P<0.001）。以实验组中β-HCG、PAPP-A百分位数P85值，以及VEGF的百分位数P15值作为诊断切割值，确定妊娠8周后血清β-HCG低于4026.02 U/L、PAPP-A低于132.28 μg/L、VEGF高于347.94 pg/mL作为诊断早期异位妊娠和正常宫内妊娠的界限值。当以上述指标单独作为输卵管异位妊娠的诊断标准时，其诊断的符合率分别为69.88%、70.71%、73.29%。当任意两者进行联合诊断时，符合率分别为85.03%、84.89%、86.10%。3者联合进行诊断时符合率达91.87%。而同时联合经阴道三维超声诊断时，诊断的符合率提高至97.88%。 结论 β-HCG、VEGF、PAPP-A的表达可作为早期输卵管异位妊娠诊断的参考指标，联合经阴道三维超声检查时可以获取满意的诊断符合率及诊断效率，值得临床工作中的广泛推广和常规化使用。 Abstract:Objective To evaluate the clinical efficiency of β-HCG, VEGF, PAPP-A uniting with three-dimensional transvaginal ultrasonography in diagnosing tubal ectopic pregnancy. Method 32 tubal ectopic pregnancy patient who satisfied with inclusion criteria and exclusion criteria were acting as experimental group, then 32 normal pregnancy women who were selected by random principle and homogenization principle were acting as control group. Peripheral blood was collected, to detect the concentration of β-HCG, VEGF, PAPP-A, then comparing the difference between experimental group and control group. Calculate the P85 of β-HCG, PAPP-A and P15 of VEGF in experimental group to be partition value in diagnosing tubal ectopic pregnancy, then use signal, two, tree partition value or three partition value uniting with three-dimensional transvaginal ultrasonography in diagnosing tubal ectopic pregnancy, then evaluate the clinical efficiency. Result The concentration of β-HCG, PAPP-A were decreasing significantly in experimental group, 3064.43±916.87 IU/L, 102.55±26.30 ug/L respectively, but VEGF was increasing significantly, the concentration was 487.02±128.98 pg/mL; By contrast, the concentration of β-HCG, PAPP-A were: 8532.84±1281.97 IU/L, 193.24±51.77 ug/L, and VEGF was 116.77±60.71 pg/mL in control group, all P<0.001. P85 of β-HCG, PAPP-A and P15 of VEGF in experimental group were acted as partition value, After pregnancy 8 weeks, using the concentration of β-HCG <4026.02 IU/L, PAPP-A<132 28="" ug="" l="" vegf="">347.94 pg/mL in peripheral blood as the partition value in diagnosing tubal ectopic pregnancy. When use signal partition value to diagnosing, the coincidence rates are 69.88%, 70.71%, 73.29%, respectively; when use two partition value to diagnosing, the coincidence rates are 85.03%, 84.89%, 86.10%. When use three partition value, the coincidence rate is 91.87%, if three partition value plus three-dimensional transvaginal ultrasonography, the coincidence rate is soaring to 97.88%. Conclusion β-HCG, VEGF, PAPP-A could be used as indicators in diagnosing tubal ectopic pregnancy, and they united with three-dimensional transvaginal ultrasonography would get much better clinical efficiency and it is worthy of generalizing in early stage tubal ectopic pregnancy diagnosing. -
表 1 实验组和对照组之间血清中β-HCG、VEGF、PAPP-A含量比较（Mean±SD）
组别 β-HCG（U/L） VEGF（pg/mL） PAPP-A（μg/L） 实验组（n=32） 3064.43±916.87 487.02±128.98 102.55±26.30 对照组（n=32） 8532.84±1281.97 116.77±60.71 193.24±51.77 F 19.627 14.693 8.835 P <0.001 <0.001 <0.001 
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表 2 不同检测项目组合对早期输卵管异位妊娠诊断的效率评价
诊断指标 标准 灵敏度 特异度 阳性预测值 阴性预测值 诊断符合率（%） β-HCG <4026.02 U/L 67.43 68.74 64.83 71.46 69.88 VEGF >347.94 pg/L 71.14 70.35 66.07 74.39 70.71 PAPP-A <132.28 μg/L 74.62 72.03 65.39 75.91 73.29 β-HCG+VEGF 如上 83.27 85.16 79.63 87.26 85.03 β-HCG+PAPP-A 如上 85.63 83.30 77.20 86.95 84.89 VEGF+PAPP-A 如上 85.09 86.76 79.18 87.47 86.10 β-HCG+VEGF+PAPP-A 如上 93.50 91.53 89.75 94.85 91.87 β-HCG+VEGF+PAPP-A+经阴道三维超声 如上方法所述 96.28 97.48 94.67 99.03 97.88
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