Clinical value of transvaginal and abdominal ultrasound combined with serum β-human chorionic gonadotropin and progesterone detection in the diagnosis of ectopic pregnancy
-
摘要:
目的 研究阴道超声、腹部超声与β人绒毛膜促性腺激素(β-HCG)、孕酮在诊断宫外孕中的价值。 方法 开展回顾性分析，将医院妇产科2019年1月~2022年10月收治的63例宫外孕患者纳为宫外孕组，同期60例妊娠时间相似的正常孕早期妇女作为对照组。比较两组阴道超声及腹部超声检查资料及β-HCG、孕酮水平，分析阴道超声、腹部超声、β-HCG及孕酮水平在诊断宫外孕中的价值。 结果 宫外孕组患者外周血β-HCG、孕酮水平及子宫内膜厚度均低于对照组，差异有统计学意义(P < 0.05)。阴道超声附件区包块检出率高于腹部超声，差异有统计学意义(P < 0.05)，两组胎芽、胎心搏动、盆腔积液、同侧卵巢显示及对侧卵巢显示率比较，差异无统计学意义(P > 0.05)。β-HCG、孕酮及子宫内膜厚度单独应用时在诊断宫外孕中的效能分别为AUC= 0.732，95% CI：0.642~0.823；AUC=0.719，95% CI：0.626~0.812；AUC=0.803，95% CI：0.720~0.885，三指标联合应用在诊断宫外孕中的价值最高(AUC=0.862，95% CI：0.790~0.934)。 结论 阴道超声、经腹超声及β-HCG、孕酮联合应用可有效提高宫外孕诊断效果。 Abstract:Objective To evaluate the clinical value of transvaginal and abdominal ultrasound combined with serum β-human chorionic gonadotropin (β-HCG) and progesterone detection in the diagnosis of ectopic pregnancy. Methods A retrospective analysis was performed. Sixty-three patients with ectopic pregnancy admitted to obstetrics and gynecology department of our hospital from January 2019 to October 2022 were included in ectopic pregnancy group, and 60 normal early pregnant women with similar gestational weeks were enrolled as control group. The data including transvaginal and abdominal ultrasound results, and serum levels of β-HCG and progesterone were compared between two groups. Then the value of transvaginal ultrasound, abdominal ultrasound, β-HCG and progesterone levels in the diagnosis of ectopic pregnancy were evaluated. Results Compared with control group, ectopic pregnancy group had lower levels of β-HCG and progesterone in peripheral blood and thinner endometrial thickness, with statistical difference (P < 0.05). The detection rate of pelvic adnexal mass of transvaginal ultrasound was higher than that of abdominal ultrasound (P < 0.05), while no statistical difference was found in the detection rates of embryo bud, fetal heart beat, pelvic effusion, and the display in both ipsilateral and contralateral ovarian (P > 0.05). The efficacy of β- HCG, progesterone and endometrial thickness alone in the diagnosis of ectopic pregnancy was as follow: AUC=0.732, 95% CI: 0.642- 0.823; AUC=0.719, 95% CI: 0.626- 0.812; AUC=0.803, 95% CI: 0.720- 0.885, and the combined detection of three indexes in diagnosis of ectopic pregnancy had the highest value than that of separate detection (AUC=0.862, 95% CI: 0.790-0.934). Conclusion The combined application of transvaginal and abdominal ultrasound combined with serum β-HCG and progesterone detection can effectively improve the diagnostic efficacy of ectopic pregnancy. -
图 1 阴道超声
Figure 1. Vaginal ultrasound. The thickness of the endometrium was 11 mm, and there was no gestational sac in the uterine cavity. A clear mass was seen near the left side, presenting as a donut sign ultrasound image.
图 2 阴道超声：患者一
Figure 2. Vaginal ultrasound. The thickness of the endometrium was 4 mm, and there was no gestational sac in the uterine cavity. There was a clear mass in the right adnexal area, and fluid accumulation could be seen in the pelvic cavity.
图 3 腹部超声：患者二
Figure 3. Abdominal ultrasound. The thickness of the endometrium was 7 mm, and there was no gestational sac in the uterine cavity. The corpus luteum was seen in the left ovary, and there was a clear mass in the left adnexal area, pre-senting as a Donut sign ultrasound image.
图 4 各指标单独应用时在诊断宫外孕中的价值分析
Figure 4. Value analysis of each indicator when applied separately in the diagnosis of ectopic pregnancy.
表 1 宫外孕组与对照组β-HCG及孕酮水平比较
Table 1. Comparison of β-HCG and progesterone levels of ectopic pregnancy group and control group (Mean±SD)
Group β-HCG(mU/mL) Progesterone(ng/mL) Extrauterine pregnancy group (n=63) 4769.48±427.55 3.69±0.46 Control group (n=60) 11262.69±536.69 38.47±5.99 t 74.394 45.954 P < 0.05 < 0.05 β-HCG: β-human chorionic gonadotropin. 
下载: 导出CSV
表 2 宫外孕组阴道超声及腹部超声表现比较
Table 2. Comparison of vaginal ultrasound and abdominal ultrasound findings in ectopic pregnancy group (n)
Performance Abdominal ultrasound Vaginal ultrasound χ2 P Attachment area package block 20 43 16.794 < 0.001 Embryonic bud 7 10 0.612 0.434 Fetal heartbeat 5 6 0.100 0.752 Pelvic fluid accumulation 17 24 1.772 0.183 Ipsilateral ovarian display 38 48 3.663 0.056 Contralateral ovarian display 42 58 0.603 0.437
下载: 导出CSV
表 3 各指标单独应用时在诊断宫外孕中的价值分析
Table 3. Value analysis of each indicator when applied separately in the diagnosis of ectopic pregnancy
Diagnostic methods AUC P AUC 95% CI Cut-off value Sensitivity (%) Specificity (%) Upper limit Lower limit β-HCG(mU/mL) 0.732 < 0.001 0.642 0.823 79.50.11 76.7 71.4 Progesterone(ng/mL) 0.719 < 0.001 0.626 0.812 18.31 73.3 74.6 Endometrial thickness(mm) 0.803 < 0.001 0.720 0.885 9.12 83.3 77.8 Joint predictive factor 0.862 < 0.001 0.790 0.934 - 85.0 85.7
下载: 导出CSV
-
[1] 颜晓钏, 卢亦彬, 马大正. 宫外孕方联合西药保守治疗异位妊娠的临床研究[J]. 中国妇幼保健, 2020, 35(4): 703-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB202004038.htm [2] 颜雪萍, 田圆, 吴青京. 血清β- HCG、P及阴道超声评估在未破裂宫外孕诊断中的应用[J]. 分子诊断与治疗杂志, 2020, 12(3): 353-357 https://www.cnki.com.cn/Article/CJFDTOTAL-YXYQ202003023.htm [3] 曾丽活, 黄燕. 孕早期血清β-人绒毛膜促性腺激素与孕酮检测在宫外孕诊断中的应用研究[J]. 大医生, 2021(18): 114-5. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201501025.htm [4] 宋娟, 李涛, 牟燕琳. 血清β-Hcg、孕酮在宫外孕患者诊断中的临床价值[J]. 中国实验诊断学, 2022, 26(9): 1315-8. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD202209014.htm [5] 胡淑瑞, 李雪芹, 张菲霞. 超声联合血清β-HCG孕酮检测对宫外孕的诊断价值[J]. 临床心身疾病杂志, 2019, 25(3): 128-30. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHBJ201308039.htm [6] 王泽华. 妇产科学. 5版[M]. 北京: 人民卫生出版社, 2004. [7] 赵冉冉. 血清β-HCG、孕酮在宫外孕诊断中的意义分析[J]. 中国实用医药, 2021, 16(33): 60-2. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202133021.htm [8] 王阿妮, 杨艳萍, 张芳芳. 腹部超声与阴道超声在异位妊娠诊断中的价值[J]. 贵州医药, 2021, 45(11): 1796-7. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202111066.htm [9] Balafoutas D, Diessner J, Kiesel M, et al. Laparoscopic management of a heterotopic pregnancy in the tubal stump[J]. J Minim Invasive Gynecol, 2021, 28(4): 752-3. doi: 10.1016/j.jmig.2020.07.008 [10] de Souza RS, Berger GS. Fallopian tube anatomy predicts pregnancy and pregnancy outcomes after tubal reversal surgery[J]. Stat Methods Med Res, 2021, 30(8): 2004-14. doi: 10.1177/09622802211023543 [11] Ma D, Yang RQ, Chen YL, et al. Identification of noninvasive diagnostic biomarkers for ectopic pregnancy using dataindependent acquisition (DIA)proteomics: a pilot study[J]. Sci Rep, 2022, 12(1): 19992. doi: 10.1038/s41598-022-23374-8 [12] 刘光兰, 叶校根, 袁磊, 等. 腹部B超、血清βHCG、孕酮、雌二醇分别及协同对宫外孕早期诊断的临床价值[J]. 中国地方病防治杂志, 2016, 31(7): 799. https://www.cnki.com.cn/Article/CJFDTOTAL-DYBF201607050.htm [13] Karavani G, Gutman-Ido E, Herzberg S, et al. Recurrent tubal ectopic pregnancy management and the risk of a third ectopic pregnancy[J]. J Minim Invasive Gynecol, 2021, 28(8): 1497-502. doi: 10.1016/j.jmig.2020.12.005 [14] Po L, Thomas J, Mills K, et al. Guideline No. 414: management of pregnancy of unknown location and tubal and nontubal ectopic pregnancies[J]. J Obstet Gynaecol Can, 2021, 43(5): 614-30. e1. doi: 10.1016/j.jogc.2021.01.002 [15] Lu Q, Wang YW, Sun X, et al. The diagnostic role of the β-hCG discriminatory zone combined with the endometrial pattern for ectopic pregnancy in Chinese women[J]. Sci Rep, 2019, 9(1): 13781. doi: 10.1038/s41598-019-50151-x [16] 王俊英. 宫外孕患者的血清β-HCG及孕酮水平及超声图像特征分析[J]. 临床医药文献电子杂志, 2017, 4(49): 9637-8. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201749101.htm [17] Shah NJ, Pereira N, Romanski PA, et al. Tubal ectopic pregnancy with undetectable initial serum β- human chorionic gonadotropin level[J]. J Minim Invasive Gynecol, 2021, 28(1): 142-5. doi: 10.1016/j.jmig.2020.06.015 [18] Zhang LY, Jiang FX, Qi RH, et al. Pregnancy outcomes in patients with tubal infertility following laparoscopic treatment: a multivariate predictive study[J]. Ann Palliat Med, 2021, 10(1): 462. doi: 10.21037/apm-20-2347 [19] Rueangket P, Rittiluechai K, Prayote A. Predictive analytical model for ectopic pregnancy diagnosis: statistics vs. machine learning[J]. Front Med: Lausanne, 2022, 9: 976829. doi: 10.3389/fmed.2022.976829 -
点击查看大图
计量
- 文章访问数: 139
- HTML全文浏览量: 57
- PDF下载量: 3
- 被引次数: 0
