血清标记物对早期异位妊娠的诊断价值

目的研究血清孕酮（P）、β-人绒毛膜促性腺激素（13-HCG）及血清激活素A（ACTA）联合检测对早期异位妊娠的诊断价值。方法回顾性分析住院及门诊就诊的83例患者，根据妊娠结局将研究对象分为宫内早孕组（45例）和异位妊娠组（38例），通过电化学发光法检测所有患者血清P、β-HCG及ACTA，计算48h／0h β-HCG比值，ROC曲线下面积（AUC），确定各检查指标的最佳工作点（OOP），并评价单一或联合指标检测对异位妊娠诊断的准确性。结果异位妊娠组P（16．83±15．71）nmol／L、48h／0h β-HCG比值（1．02±0．77）和ACTA（0．26±0．15）μg/L均明显低于于正常早孕组[分别为（75．74±9．76）nmol／L，（2．53±0．34），（0．49±0．43）μg/L]（P〈0．05）。ROC工作曲线显示，血48h／0h β-HCG比值的诊断准确度最高（AUC为0．94），其次为P（AUC为0．91），ACTA的诊断准确度最低（AUC为0．56）；通过ROC曲线确定各指标OOP：孕酮以31．30nmol／L，48h／0h β-HCG比值以1．25，ACTA以0．43μg/L为临界值时对诊断早期异位妊娠有较好准确度；P和β-HCG联合检测对异位妊娠诊断的敏感度（98．4％）和特异度（66．7％）均明显高于其它检测组（均P〈0．05）。结论联合检测P和48h／0hB．HCG比值可进一步提高异位妊娠诊断准确率，而ACTA对异位妊娠诊断意义不大。

Study on the role of serum markers in the diagnosis of early ectopic pregnancy

Objective To evaluate the role of serum progesterone ( P) , β-subunit of human chrionic (β-HCG) and activin A( ACT A) in the diagnosis of ectopic pregnancy (EP). Methods The clinical data of 83 pregnant women were retrospectively reviewed. Serum P,β-HCG and ACT A were measured at visiting day(0 h) ,The values of β-HCG were measured again 48 h later. ROC curve was established and optimal operating point (OOP) of three indexes was ascertained,and the accuracy of each variable was evaluated. Results Serum P( 16.83 ± 15.71) nmol/L,48h/0h β-HCG (1.02 ±0.77) and ACT A(0. 26 ± 0.15)μg/L were significantly lower in ectopic pregnancy group compared with normal pregnancy group[(75. 74 ± 9. 76) nmol/L, (2. 53 ±0. 34) , (0. 49 ± 0. 43) μg/L] (P ＜ 0. 05). ROC curve showed that the highest accuracy rate in the diagnosis of EP was β-HCG 48h/0h( AUC =0.94), the second was progesterone( AUC =0.91) ,the lowest was ACTA( AUC =0.56). In addition,ROC curve showed all OOPs as following:serum P was 31.30nmol/L,48h/0h β-HCG was 1.25 ,ACTA was 0.43μg/L. When the three parameters were in the upper critical value,it had the higher accuracy rate in the diagnosis of EP. The combination of progesterone and β-HCG 48 h/0 h had higher sensitivity(98.4% ) and specificity(66.7% ) than the other two groups in the diagnosis of EP. Conclusion The combination of progesterone and p-HCG 48 h/0 h improved the accuracy rate in the diagnosis of EP, whereas estradiol had no diagnostic value in the diagnosis of EP.