Clinical value of progesterone and β-HCG levels combined with subchorionic hemorrhage predicting early pregnancy outcome in threatened abortion patients
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摘要:
目的探讨超声绒毛膜下血肿(SCH)联合血清孕酮、β-绒毛膜促性腺激素（β-HCG）预测早孕期结局的临床价值。 方法选取2020年6~12月因先兆流产来我院检查的324例患者，行超声检查及血清孕酮、β-HCG检测，随访至孕14周，观察其妊娠结局，其中治疗后继续妊娠者为先兆流产组（n=254），发展为难免流产者为流产组（P < 070）。比较组间的孕酮、β-HCG水平以及SCH阳性率差异性，采用受试者工作特征（ROC）曲线分析孕酮与β-绒毛膜促性腺激素对流产的预测价值。 结果流产组血清孕酮、β-HCG水平明显低于先兆流产组，流产组患者SCH阳性率明显高于先兆流产组，差异均具有统计学意义(P < 0.05)。血清孕酮的ROC曲线下面积为0.90（95%CI：0.85~0.94），当cut-off值为18.5时，其预测流产的敏感度和特异性分别为92.5%和74.3%。血清β-HCG的ROC曲线下面积为0.89（95%CI：0.84~0.94），当cut-off值为6926时，其预测流产的敏感度和特异性分别为78.6%和92.9%。血清孕酮、β-HCG及SCH阳性联合检测预测先兆流产结局的敏感度、特异性、阳性预测值和阴性预测值分别为70.8%、98.3%、97.1%和80.8%。 结论超声SCH和血清孕酮、β-HCG水平对预测先兆流产患者早期妊娠结局具有一定的价值，三者联合检测可提高预测的特异性和阳性预测值。 -
关键词:
- 超声 /
- 绒毛膜下血肿 /
- 血清孕酮 /
- β-人绒毛膜促性腺激素 /
- 先兆流产
Abstract:ObjectiveTo explore the clinical value of subchorionic hemorrhage(SCH)combined with progesterone and β-HCG for predicting early pregnancy outcome in threatened abortion patients. MethodsA total of 324 patients who came to our hospital due to threatened abortion from June 2020 to December 2020 were selected for serum progesterone, β-HCG and ultrasound examination. They were followed up for 14 weeks of gestation to observe the pregnancy outcome. The patients who continued pregnancy after treatment were defined threatened abortion group, and those who developed inevitable abortion were defined abortion group. The differences of progesterone, β-hCG and the positive rate of SCH between two groups were compared. The prediction value of progesterone and β-hCG for abortion were analyzed by receiver operating characteristic (ROC) curve. ResultsThe 254 cases were in threatened abortion group and 70 cases were in abortion group. The levels of serum progesterone and β-hCG in abortion group were significantly lower than those in threatened abortion group, and the positive rate of SCH in abortion group was significantly higher than those in threatened abortion group (P < 0.05). The area under ROC curve of serum progesterone was 0.90 (95% CI: 0.85-0.94). When cut off value was 18.5, the sensitivity and specificity of predicting abortion were 92.5% and 74.3%, respectively. The area under ROC curve of serum β-hCG was 0.89 (95% CI: 0.84-0.94). When cut off value was 6926, the sensitivity and specificity of predicting abortion were 78.6% and 92.9%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of serum progesterone, β-hCG and SCH were 70.8%, 98.3%, 97.1% and 80.8% respectively. ConclusionsThe SCH, Serum progesterone and β-HCG level have certain value for predicting the early pregnancy outcome in threatened abortion patients. The combined detection of the three indicators can improve the specificity and positive predictive value. -
Key words:
- ultrasound /
- subchorionic hemorrhage /
- serum progesterone /
- β-HCG /
- threatened abortion
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图 1 血清孕酮预测难免流产的ROC曲线
Figure 1. ROC curve of serum progesterone in predicting inevitable abortion.
图 2 血清β-HCG预测难免流产的ROC曲线
Figure 2. ROC curve of serum β-HCG in predicting inevitable abortion.
表 1 组之间孕酮、β-HCG及SCH结果的比较
Table 1. Comparison of the results of progesterone, β-HCG and SCH among the three groups
组别 孕酮（ng/mL, Mean±SD) β-HCG（U/L, Mean±SD） SCH阳性[n(%)] 先兆流产组（n=254） 23. 99±3. 15 8606.00±1864.00 103(40.6) 流产组（n=70） 17. 21±3. 29 6031.64±1028.00 59(84.3) P < 0.05 < 0.05 < 0.05 β-HCG：β-人绒毛膜促性腺激素，SCH：绒毛膜下血肿. 
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表 2 各指标对难免流产预测价值的比较
Table 2. Comparison of the predictive value of each index for inevitable abortion(%)
检测指标 敏感度 特异性 阳性预测值 阴性预测值 孕酮 92.5 74.3 76.1 79.0 β-HCG 78.6 90.9 76.9 85.7 SCH 88.3 61.7 65.2 88.1 联合检测 80.8 98.3*#△ 97.1*#△ 85.8 *P < 0.05 vs孕酮；#P < 0.05 vs β-HCG；△P < 0.05 vs SCH.
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