Efficacy of vaginal ultrasound measurement of bilateral pulsatility in2022-01-16dex in combination with serum estrogen and progesterone testing in the diagnosis of ectopic pregnancy
-
摘要:
目的 研究阴式超声测量双侧搏动指数(PI)结合血清雌孕激素水平检测在异位妊娠患者诊断中的效能。 方法 选取2019年2月~2021年2月在本院诊断并治疗的107例异位妊娠患者为观察组，另选取同期在本院同期产检的宫内早孕组患者107例作为对照组，比较两组患者的阻力指数(RI)、功能侧PI、非功能侧PI、峰值流速、舒张末期流速、卵泡雌激素、黄体生成素、孕酮激素以及雌二醇(E2)水平。分析功能侧PI、非功能侧的PI、E2及孕酮激素联合检测对异位妊娠的诊断效能。 结果 观察组患者的RI低于对照组(t=51.534，P < 0.001)，功能侧PI(t=5.884，P < 0.001)、非功能侧PI(t=8.565，P < 0.001)、峰值流速(t=45.597，P < 0.001)、舒张末期流速(t=12.302，P < 0.001)水平高于对照组; 观察组患者的卵泡雌激素(t=3.676，P < 0.001)、黄体生成素(t=6.334，P < 0.001)、E2(t=28.259，P < 0.001)、孕酮激素(t=48.787，P < 0.001)水平低于对照组。功能侧PI、非功能侧的PI、孕酮激素联合E2检测在诊断异位妊娠中的特异度明显较单独检测高。通过ROC曲线分析，功能侧PI、非功能侧PI、E2及孕酮激素联合检测对异位妊娠的诊断的曲线下面积高于单独检测，功能侧PI、非功能侧的PI、E2及孕酮激素临界值依次为2.58、2.76、422.56 pmol/L、15.13 ng/mL。 结论 阴式超声测量双侧PI结合血清雌孕激素水平对于异位妊娠患者诊断具有显著的意义。 Abstract:Objective To evaluate the efficacy of vaginal ultrasound measurement of bilateral pulsatility index (PI) in combination with serum estrogen and progesterone testing in the diagnosis of ectopic pregnancy. Methods A total of 107 women with ectopic pregnancy diagnosed and treated in Chongming Branch of Xinhua Hospital from February 2019 to February 2021 were selected as observation group, and another 107 women in early intrauterine pregnancy who underwent prenatal examination in our hospital during the same period were selected as control group. Parameters including resistance index (RI), bilateral PI, peak systolic velocity, end-diastolic velocity, follicle-stimulating hormone, luteinizing hormone, estradiol (E2) and progesterone were detected in both groups. Then the diagnostic efficacy of combined detection of PI, E2 and progesterone for ectopic pregnancy were evaluated. Results Compared with control group, observation group had a decrease in RI (t=51.534, P < 0.001), along with an increase in functional PI (t=5.884, P < 0.001), non functional PI (t=8.565, P < 0.001), peak systolic velocity (t=45.597, P < 0.001) and end-diastolic velocity (t=12.302, P < 0.001). Observation group had significantly lower levels of follicle-stimulating hormone (t=3.676, P < 0.001), luteinizing hormone (t=6.334, P < 0.001), E2 (t=28.259, P < 0.001) and progesterone (t=48.787, P < 0.001) compared with control group. The combined detection of bilateral PI, progesterone and E2 achieved higher diagnostic efficacy than the separate detection. ROC curve indicated that the area under the curve of combined detection of bilateral PI, progesterone and E2 in the diagnosis of ectopic pregnancy was larger than that of separate detection, and the cut- off values of functional PI, non functional PI, E2 and progesterone were 2.58, 2.76, 422.56 pmol/L and 15.13 ng/mL, respectively. Conclusion Application of vaginal ultrasound measurement of bilateral PI in combination with serum estrogen and testing is of great significance in the clinical diagnosis of ectopic pregnancy. -
Key words:
- vaginal ultrasound /
- pulsatility index /
- ectopic pregnancy /
- estradiol /
- progesterone
-
表 1 两组患者一般资料对比
Table 1. Comparison of general data (n=107, Mean±SD)
组别 年龄(岁) BMI(kg/m2) 停经时间(d) 观察组 27.45±2.71 24.59±2.23 44.52±2.62 对照组 27.22±1.69 24.60±2.17 44.19±3.27 t 0.745 0.033 0.815 P 0.457 0.974 0.416 
下载: 导出CSV
表 2 两组患者的超声指标比较
Table 2. Comparison of ultrasonic indexes between the two groups (n=107, Mean±SD)
组别 RI 功能侧PI 非功能侧PI PSV(cm/s) EDV(cm/s) 观察组 0.41±0.05 2.66±0.11 2.88±0.25 29.44±1.33 11.55±1.45 对照组 0.88±0.08 2.54±0.18 2.62±0.19 20.37±1.57 9.21±1.33 t 51.534 5.884 8.565 45.597 12.302 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 RI: 阻力指数; PI: 搏动指数; PSV: 峰值流速; EDV: 舒张末期流速.
下载: 导出CSV
表 3 两组患者的性激素水平比较
Table 3. Comparison of sex hormone levels between the two groups (n=107, Mean±SD)
组别 FSH(mU/mL) LH(mU/mL) E2(pmol/L) 孕酮激素(ng/mL) 观察组 6.51±0.95 4.63±1.33 414.21±11.77 15.65±1.45 对照组 6.99±0.96 3.37±1.57 459.26±11.55 24.37±1.33 t 3.676 6.334 28.259 48.787 P < 0.001 < 0.001 < 0.001 < 0.001 FSH: 卵泡雌激素; LH: 黄体生成素; E2: 雌二醇.
下载: 导出CSV
表 4 功能侧PI、非功能侧PI以及孕酮激素、E2联合检测对异位妊娠的诊断效能分析
Table 4. Analysis of diagnostic efficacy of combined detection of functional side PI, non functional side PI and E2 in ectopic pregnancy
诊断方法 假阳例数(n) 真阳例数(n) 假阴例数(n) 真阴例数(n) 敏感度(%) 准确率(%) 阳性预测值(%) 特异性(%) 阴性预测值(%) 功能侧PI 58 60 47 49 56.07 50.93 50.85 45.79 51.04 非功能侧PI 56 59 48 51 55.14 51.40 51.30 47.66 51.52 E2 52 58 49 55 54.21 52.80 52.73 51.40 52.88 孕酮激素 55 57 50 52 53.27 50.93 50.89 48.60 50.98 联合检测 11 55 52 96 51.40 70.56 83.33 89.72 64.86
下载: 导出CSV
表 5 ROC曲线分析
Table 5. ROC curve analysis
诊断方法 标准误 AUC 95% CI P 功能侧PI 0.034 0.731 0.664~0.797 < 0.001 非功能侧PI 0.032 0.775 0.713~0.838 < 0.001 E2 0.030 0.833 0.775~0.891 < 0.001 孕酮激素 0.034 0.772 0.706~0.838 < 0.001 联合检测 0.022 0.921 0.879~0.964 < 0.001
下载: 导出CSV
-
[1] 刘菊芳, 朱思来, 徐丹. 经阴道超声联合经腹部超声在异位妊娠诊断中的应用[J]. 影像科学与光化学, 2021, 39(3): 483-5. https://www.cnki.com.cn/Article/CJFDTOTAL-GKGH202103029.htm [2] 倪梁红, 童陶然, 胡海燕, 等. 阴道超声联合血清β-hGG、P检测诊断未破裂异位妊娠效能[J]. 中国计划生育学杂志, 2021, 29(3): 524-7, 532, 635. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202103025.htm [3] 李美娜, 潘慧君, 卞敏, 等. 阴道超声测量子宫内膜厚度、阻力指数结合β-HCG检测与异位妊娠患者临床症状的关系[J]. 分子影像学杂志, 2020, 43(4): 717-20. doi: 10.12122/j.issn.1674-4500.2020.04.37 [4] 李军, 冯永恒, 高瑞雪, 等. 经阴道超声联合经腹超声对宫外孕的诊断研究[J]. 影像研究与医学应用, 2020, 4(21): 110-1. doi: 10.3969/j.issn.2096-3807.2020.21.062 [5] 陈琳娜. 腹部超声与阴道超声联合检查在早期异位妊娠诊断中的准确率对比[J]. 现代医用影像学, 2021, 30(12): 2349-51, 2370. doi: 10.3969/j.issn.1006-7035.2021.12.050 [6] 彭梦凡, 董刚, 王兆瑞, 等. 超声引导经皮射频消融治疗异位妊娠的临床效果[J]. 中华超声影像学杂志, 2021, 30(4): 312-6. doi: 10.3760/cma.j.cn131148-20201108-00864 [7] 陈绪娇, 闫凯麟, 宋蓉蓉, 等. 输卵管异位妊娠患者首诊超声图像特征结合血清β-hCG与临床治疗方式的关系研究[J]. 中国超声医学杂志, 2021, 37(7): 806-10. doi: 10.3969/j.issn.1002-0101.2021.07.027 [8] 赵方方, 许丽娟, 王北大. 异位妊娠经腹部超声与经阴道超声诊断确诊率的meta分析[J]. 重庆医学, 2020, 49(12): 1993-7. doi: 10.3969/j.issn.1671-8348.2020.12.023 [9] Liang JL, Ye GL, Guo JW, et al. Reducing false-positives in lung nodules detection using balanced datasets[J]. Front Public Health, 2021, 9: 671070. doi: 10.3389/fpubh.2021.671070 [10] Altay MM, Mert SA, Gemici A, et al. Successful technique of manual vacuum aspiration for treatment of type 2 cesarean scar pregnancies: evaluation of 40 cases[J]. J Matern Fetal Neonatal Med, 2021, 34 (16): 2693-700. doi: 10.1080/14767058.2019.1670807 [11] George R, Powers E, Gunby R. Abdominal ectopic pregnancy[J]. Proc Bayl Univ Med Cent, 2021, 34(4): 530-1. doi: 10.1080/08998280.2021.1884932 [12] Matuzak AR. Sonographic diagnosis of bilateral tubal pregnancies[J]. J Diagn Med Sonogr, 2021, 37(4): 394-8. doi: 10.1177/8756479321992351 [13] Iwasawa T, Takahashi T, Maeda E, et al. Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study[J]. Reprod Biol Endocrinol, 2021, 19(1): 84. doi: 10.1186/s12958-021-00764-7 [14] 王慧芳, 苏雪燕, 赵晓峰, 等. 宫外妊娠者子宫动脉血流的改变[J]. 前卫医药杂志, 2000, 17(6): 353-4. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY200006022.htm [15] Al Naimi A, Moore P, Brüggmann D, et al. Ectopic pregnancy: a single-center experience over ten years[J]. Reprod Biol Endocrinol, 2021, 19(1): 79. doi: 10.1186/s12958-021-00761-w [16] Talom AK, Essiben F, Ombaku KS, et al. Pregnancy on bicornuate unicollis uterus: diagnosis, management and prognosis in underprivileged areas: about a case, yaoundé-Cameroon[J]. Open J Obstet Gynecol, 2021, 11(5): 602-9. doi: 10.4236/ojog.2021.115056 [17] 马丽, 马燕. 经阴道超声在体外受精-胚胎移植术后宫内外复合妊娠诊断中的应用[J]. 广西医学, 2019, 41(14): 1832-5. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX201914032.htm [18] 师淑静, 宋文龄, 唐瑶, 等. 正常孕妇早期妊娠子宫动脉血流图参数初步研究[J]. 中国产前诊断杂志: 电子版, 2014, 6(3): 32-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCQ201403009.htm [19] 陈江娟, 陈双和, 赵利萍. 子宫内膜血流参数、厚度及血清β-hCG联合检测对中青年女性异位妊娠的早期诊断价值[J]. 中国妇幼保健, 2020, 35(15): 2861-3. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202015042.htm [20] Venkatesh M, Awal SS. Hemiuterus with functional non-communicating horn in a young female[J]. Egypt J Radiol Nucl Med, 2021, 52: 127. doi: 10.1186/s43055-021-00507-z [21] Mahmoud SA, Munkaila A, Ussi AM, et al. Intraligamentary pregnancy with recurrent urine retention: case report[J]. Open J Obstet Gynecol, 2021, 11(5): 516-22. doi: 10.4236/ojog.2021.115048 [22] Gersh FL, O'Keefe JH, Lavie CJ, et al. The renin-angiotensin-aldosterone system in postmenopausal women: the promise of hormone therapy[J]. Mayo Clin Proc, 2021, 96(12): 3130-41. doi: 10.1016/j.mayocp.2021.08.009 [23] Kaneko M, Nozawa H, Rokutan H, et al. Ectopic decidua of the appendix: a case report[J]. Surg Case Rep, 2021, 7(1): 117. doi: 10.1186/s40792-021-01204-9 [24] Wang Y, Shao RF, He CH, et al. Emerging progress on diagnosis and treatment of female genital tuberculosis[J]. J Int Med Res, 2021, 49 (5): 1-8. [25] 王洪玲, 张琰. 早期异位妊娠患者β-HCG、E2和P水平变化及预测分析[J]. 现代预防医学, 2019, 46(1): 58-61. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201901014.htm -
点击查看大图
图(1) / 表(5)
计量
- 文章访问数: 241
- HTML全文浏览量: 96
- PDF下载量: 5
- 被引次数: 0
