Relationship between vaginal ultrasound measurement of ET and RI combined with β- HCG and clinical symptoms of EP patients
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摘要:
目的分析阴道超声测量子宫内膜厚度（ET）、血流阻力指数（RI）与β-HCG检测与异位妊娠(EP)患者临床症状的关系及其在EP鉴别诊断中的应用价值。 方法选择2017年1月~2019年3月间收治的60例符合EP患者作为EP组，50例人工中止妊娠及50例自然流产孕妇作为人工中止妊娠组及自然流产组；采用阴道超声测量ET、RI水平，并检测患者血中β-HCG水平；绘制ROC曲线分析ET、RI与β-HCG联合检测在鉴别诊断EP患者中的应用价值，采用logistics多元回归模型分析各指标与EP患者临床症状关系。 结果EP组、自然流产组及人工中止妊娠组患者ET、RI及β-HCG水平差异有统计学意义（P < 0.05），其中EP组患者ET及β-HCG水平最低，RI最高；ET、RI及β-HCG是影响EP患者临床症状的独立性影响因素（P < 0.05）；ET、RI、β-HCG联合应用鉴别诊断在EP中的敏感度、特异度及AUC均明显高于各指标单独应用（P < 0.05）。 结论阴道超声测量ET、RI及血中β-HCG水平是影响EP患者临床症状的独立影响因素，且各指标联合应用可有效提高单独应用的临床应用价值。 Abstract:ObjectiveTo explore the relationship between vaginal ultrasound measurement of ET, RI and β-HCG and clinical symptoms of patients with EP and its application value in the differential diagnosis of EP. MethodsSixty patients with EP who were admitted between January 2017 and March 2019 were selected as the EP group, 50 pregnant women with artificial abortion and 50 pregnant women with spontaneous abortion were selected as the artificial abortion group and spontaneous abortion group; vaginal ultrasound was used to measure ET and RI Level, and detect the β-HCG level in patients' blood; ROC curve was used to analyze the application value of combined detection of ET, RI and β-HCG in differential diagnosis of EP. Logistic multiple regression model was used to analyze the relationship between each index and clinical symptoms of EP patients. ResultsThere were significant differences in the levels of ET, RI and β-HCG in the EP group, spontaneous abortion group and artificial abortion group, and the differences were statistically significant (P < 0.05). Among the patients in the EP group, ET and β-HCG levels were the lowest, and RI was the highest. ET, RI and β-HCG are independent factors influencing the clinical symptoms of EP patients, which are statistically significant (P < 0.05). The sensitivity, specificity, and AUC of differential diagnosis in EP combined with ET, RI, and β-HCG are obviously higher than each index alone, and the difference was statistically significant (P < 0.05). ConclusionVaginal ultrasound measurement of ET, RI, and blood β-HCG levels are independent factors affecting the clinical symptoms of EP patients, and the combined application of each index can effectively increase the value of clinical application of single application. -
Key words:
- vaginal ultrasound /
- endometrial thickness /
- resistance index /
- β-HCG /
- ectopic pregnancy
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图 1 超声检查典型病例
A:异位妊娠组, 空孕囊, 子宫内膜回声弱, 局部肌层变薄或缺如, 脉冲多普勒血流频谱显示局部血流信号丰富, 可探测低速高阻的血流信号; B:自然流产组，妊娠囊大部分着床子宫前臂下段疤痕肌层; C:子宫前壁下段肌层以及宫腔内可见混合回声包块（表现为以囊性为主或以实性为主）, 与正常肌层境界不清，脉冲多普勒血流频谱显示局部血流信号丰富, 可探测高速低阻的血流信号.
Figure 1. Typical cases of ultrasound examination
表 1 不同组别间各指标检测结果（Mean±SD）
Table 1. Test results of various indicators among different groups
组别 ET(imn) RI p-HCG(U/L) EP组(n=60) 11.46 ± 2.93 0.73±0.11 924.38±355.28 自然流产组(n=50) 13.52 ± 1.55 0.53±0.09 1214.95±544.39 人工中止妊娠组(n=50) 15.63±1.89 0.35±0.08 2345.47±621.42 F 3.928 3.794 114.069 P 0.022 0.025 0.000 
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表 2 各指标与EP患者临床症状相关性
Table 2. Correlation between various indicators and clinical symptoms of EP patients
指标 b S.E χ2 P OR 95%CI ET -0.754 0.241 9.788 0.002 0.470 0.293~0.755 RI 0.699 0.203 11.857 0.001 2.012 1.351~2.995 p-HCG -0.675 0.226 8.921 0.003 0.509 1.261~3.059
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表 3 各指标单独及联合应用在鉴别诊断EP价值
Table 3. The value of each index used alone and in combination in the differential diagnosis of EP
指标 敏感度 特异度 AUC ET 81.67(49/60) 85.00(85/100) 0.897 RI 78.33(47/60) 87.00(87/100) 0.889 P-HCG 78.33(47/60) 82.00(82/100) 0.858 联合应用 93.33(56/60) 93.00(93/100) 0.968
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