Clinical value of transvaginal and abdominal ultrasound combined with serum β-human chorionic gonadotropin and progesterone detection in the diagnosis of ectopic pregnancy
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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. -
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. 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 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 -
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