β-hCG比值联合子宫内膜厚度预测早期不明位置妊娠者异位妊娠的临床价值

目的:探讨血清β-hCG比值联合子宫内膜厚度预测早期不明位置妊娠(PUL)者异位妊娠的价值。方法:采用前瞻性研究方法,对350例PUL者进行追踪随访,观察血清β-hCG水平变化、子宫内膜厚度及妊娠结局,通过受试者工作特征(ROC)曲线确定预测异位妊娠的最佳指标和阈值,评价各指标对异位妊娠的诊断价值。结果:350例PUL者最终确诊为自然流产180例(自然流产组),宫内妊娠120例(宫内妊娠组),异位妊娠50例(异位妊娠组)。异位妊娠组血清β-hCG比值(48h/0h)低于宫内妊娠组和自然流产组(P0.01,P0.05);子宫内膜厚度3组差异无统计学意义(P0.05);血清β-hCG比值、子宫内膜厚度诊断异位妊娠的截断点(cut-off)分别为1.6和7.9mm;血清β-hCG比值、子宫内膜厚度及两者联合预测异位妊娠的ROC曲线下面积分别为0.8、0.553、0.89;β-hCG比值诊断异位妊娠的敏感度为88%,特异度为94%;子宫内膜厚度诊断异位妊娠的敏感度为63%,特异度为54%;两者联合诊断异位妊娠的敏感度为90%,特异度为96%。结论:血清β-hCG比值对于早期PUL者预测异位妊娠具有较好临床价值,联合检测子宫内膜厚度可提高预测的敏感度和特异度。     

妊娠相关血浆蛋白A和游离β-hCG在预测稽留流产和异位妊娠中的诊断价值

目的：探讨检测孕妇血清妊娠相关血浆蛋白A（PAPP-A）和游离β-人绒毛促性腺激素（β-hCG）水平,在预测异位妊娠及稽留流产中的诊断价值。方法：选取早期妊娠孕妇164例,其中正常妊娠组80例、异位妊娠组36例、稽留流产组48例,用时间分辨荧光法测定孕妇血清PAPP-A及游离β-hCG的浓度。结果：在正常妊娠组、稽留流产组及异位妊娠组妇女PAPP-A及游离β-hCG的中位值呈递减趋势,且各组间差异有统计学意义（P〈0.001）;与正常组比较,稽留流产组及异位妊娠组的血清游离β-hCG和PAPP-A的中位值水平差异有统计学意义（P〈0.001）;与稽留流产组比较,异位妊娠组血清游离β-hCG和PAPP-A的中位值水平下降,差异有统计学意义（P〈0.001）。结论：孕早期母血清筛查PAPP-A和游离β-hCG指标对稽留流产及异位妊娠有一定预测价值。     

早期异位妊娠多指标联合监测的诊断价值

目的：探讨早期异位妊娠患者血清人绒毛膜促性腺激素β亚单位（β-hCG）、孕酮及子宫内膜厚度（EST）监测的诊断价值。方法：选择2008年7月—2010年5月就诊且尿妊娠试验阳性者共127例,经超声及病理证实确诊后分为异位妊娠组（48例）、正常早孕组（40例）和妊娠流产组（39例）。应用电化学发光（ECL）法检测血清β-hCG和孕酮水平,通过超声检测EST,通过计算受试者工作特征曲线（ROC曲线）下面积（AUC）来确定各检测指标的诊断价值。结果：异位妊娠组β-hCG水平比值（β-hCG 48 h/0 h）相对于正常妊娠组和妊娠流产组倍增不明显（P＜0.05）;异位妊娠组孕酮水平和EST均较正常妊娠组和妊娠流产组低（P＜0.05）。ROC曲线显示,3项联合检测的诊断准确度最高（AUC=0.915）,其次分别为血β-hCG 48 h/0 h（AUC=0.875）、孕酮（AUC=0.806）和EST（AUC=0.782）。结论：单项检测血清β-hCG 48 h/0 h、孕酮和EST均有一定的早期诊断价值,3项联合检测诊断准确度最高,高于单项检测。     

应用ROC曲线分析孕酮、β-HCG比值在预测异位妊娠中的价值

目的应用诊断试验评价方法及受试者工作特征曲线（ROC曲线）评价孕酮与β-HCG比值在预测异位妊娠中的价值。方法测定68例异位妊娠、65例先兆流产患者的血清孕酮、48hβ-HCG比值,建立ROC曲线,确定诊断异位妊娠的最佳阂值,并评价这两个指标对异位妊娠诊断的准确性。结果通过ROC曲线确定诊断异位妊娠的临界值：孕酮为18．95μg/L,48hβ-HCG比值为1.90;孕酮的敏感度和特异度较高;ROC曲线下面积,孕酮和48hβ-HCG比值分别为0．993和0．953。结论应用ROC曲线确定孕酮和48hβ-HCG比值的临界值对早期异位妊娠有较好的预测价值,孕酮是较48hβ-HCG更好的预测异位妊娠的指标。     

应用ROC曲线分析孕酮、β-HCG比值在预测异位妊娠中的价值

目的应用诊断试验评价方法及受试者工作特征曲线(ROC曲线)评价孕酮与β-HCG比值在预测异位妊娠中的价值。方法测定68例异位妊娠、65例先兆流产患者的血清孕酮、48hβ-HCG比值,建立ROC曲线,确定诊断异位妊娠的最佳阈值,并评价这两个指标对异位妊娠诊断的准确性。结果通过ROC曲线确定诊断异位妊娠的临界值:孕酮为18.95μg/L,48hβ-HCG比值为1.90;孕酮的敏感度和特异度较高;ROC曲线下面积,孕酮和48hβ-HCG比值分别为0.993和0.953。结论应用ROC曲线确定孕酮和48hβ-HCG比值的临界值对早期异位妊娠有较好的预测价值,孕酮是较48hβ-HCG更好的预测异位妊娠的指标。     

生化妊娠的血清学及超声检测意义

目的研究早孕6周内伴阴道流血患者的血清学及超声变化特点,探讨生化妊娠的及时诊断特点减少将其误诊为异位妊娠或盲目保胎的过度医疗。方法选取2012年1月-2015年2月该院妇科及产前门诊就诊的,早孕6周内伴阴道流血、阴道超声未见宫内宫外孕囊的患者103例为研究对象,回顾性分析其血清孕酮、人绒毛膜促性腺激素β亚基(β-hCG)水平和超声测量子宫内膜厚度等指标,根据孕≥7周妊娠结局分为:宫内早孕组42例、生化妊娠组38例、异位妊娠组23例。结果3组平均血清β-hCG水平差异有统计学意义(F=6.82,P0.01),宫内早孕组大于异位妊娠组(q=591.65,P0.05),当血清β-hCG水平在1 000~2 400 IU/L时,生化妊娠组所占比率为65.79%,生化妊娠组高于异位妊娠组,差异有统计学意义(χ~2=18.20,P0.01),生化妊娠组48 h血清β-hCG上升幅度小于异位妊娠组,差异有统计学意义(χ~2=36.16,P0.01),下降比率高于异位妊娠组(χ~2=18.21,P0.01),差异有统计学意义。3组的平均血清P水平差异有统计学意义(F=14.82,P0.01),生化妊娠组大于异位妊娠组(P0.01)。就诊当日及第7日3组间平均子宫内膜厚度差异有统计学意义(F=5.56,P0.01;F=6.40,P0.05),且生化妊娠组较异位妊娠组平均厚度大,差异均有统计学意义(P0.01)。结论以血清β-hCG2400 IU/L,48 h血清β-hCG水平上升50%尤其呈下降趋势、P72.60 nmol/L及子宫内膜厚度10 mm联合检测作为早孕≤6周时的生化妊娠预测界限,可提高早期诊断的准确性和及时性。     

腹腔血β-hCG定性诊断异位妊娠的探讨

目的：探讨以腹腔血β-hCG定性检测诊断异位妊娠的临床应用价值。方法：采用尿试纸法定性检测90例腹腔内出血患者的腹腔血β-hCG，并与其尿β-hCG定性和血清β-hCG定量分析结果进行比较。结果：在74例异位妊娠中，腹腔血β-hCG定性法5～10min能出结果，诊断异位妊娠的特异性为100．0％，敏感性为98．5％，准确性为99．0％，与血清β-hCG定量分析结果基本一致，结合其他辅助方法能快速诊断异位妊娠，明显优于尿β-hCG定性检查。结论：对腹腔内出血患者采用腹腔血β-hCG定性检测，能方便、快速和准确地诊断异位妊娠。     

血清妊娠相关血浆蛋白A和游离β-人绒毛膜促性腺激素水平检测在预测异位妊娠及稽留流产中的诊断价值

目的分析血清妊娠相关血浆蛋白A(PAPP-A)和游离β-人绒毛膜促性腺激素(β-hCG)水平检测在预测异位妊娠及稽留流产中的诊断价值,为临床诊断提供参考依据。方法选取2016年3月-2017年8月秦皇岛市军工医院妇产科门诊收治的早期妊娠患者116例为研究对象,其中正常早期妊娠患者45例为正常妊娠组、异位妊娠患者30例为异位妊娠组、稽留流产患者41例为稽留流产组。采用酶联免疫吸附法检测研究对象血清PAPP-A及β-hCG水平,分析其水平检测在预测异位妊娠及稽留流产中的诊断价值。结果异位妊娠组与稽留流产组患者孕8～10周血清PAPP-A及β-hCG水平均明显低于正常妊娠组,差异均有统计学意义(P<0.05);异位妊娠组患者血清PAPP-A及β-hCG水平均明显低于稽留流产组,差异均有统计学意义(P<0.05);随孕周增加,异位妊娠组与稽留流产组血清PAPP-A及β-hCG水平逐渐增加。PAPP-A与β-hCG联合检测的灵敏度、特异度及准确性均高于单项检测,差异有统计学意义(P<0.05)。结论孕早期妇女血清PAPP-A和游离β-hCG水平检测能够在一定程度上预测孕妇不良妊娠结局,具有较高的临床诊断价值。     

胚胎移植14天血β-hCG及孕激素对IVF-ET妊娠结局的预测

目的：探讨体外受精-胚胎移植（IVF-ET）后14 d血清人绒毛膜促性腺激素β亚单位（β-hCG）和孕酮对妊娠早期结局的预测价值。方法：回顾性分析2010年4月—2011年11月IVF/胞浆内单精子注射（ICSI）的554例患者胚胎移植后14 d的血清β-hCG和孕酮水平。根据早期妊娠结局的不同分为正常妊娠组（包括单胎和多胎组）、异常妊娠组（包括妊娠早期流产、异位妊娠、生化妊娠）及未妊娠组,比较各组β-hCG和孕酮的水平。结果：①ET 14 d正常妊娠组血清β-hCG高于妊娠早期流产组、异位妊娠组、生化妊娠组和未妊娠组,除妊娠早期流产组与异位妊娠组间血清β-hCG差异无统计学意义（P＞0.05）外,其余各组两两比较差异均有统计学意义（P＜0.05）。②正常妊娠组血清孕酮高于异常妊娠组和未妊娠组（P＜0.05）;多胎妊娠组血清孕酮高于单胎妊娠组（P＜0.05）。③单次β-hCG＞197.27 IU/L时,正常妊娠的可能性为88.9%。β-hCG＞613.94 IU/L,妊娠结局较好,但有多胎妊娠的可能。结论：ET 14 d血清β-hCG和孕酮可作为预测IVF-ET后早期妊娠结局的良好指标。     

动态测定血β-hCG在异位妊娠诊疗中的临床应用价值

目的:探讨监测动态β-人绒毛膜促性腺激素(β-hCG)的含量对异位妊娠诊疗中的价值。方法:用化学发光免疫分析方法测定异位妊娠组57例、正常早孕组51例、先兆流产组55例血清β-hCG水平,并对异位妊娠组以用药前血清β-hCG的含量是否>2 500 IU/L为界值分为两组分别进行统计学分析。结果:异位妊娠组血清β-hCG含量明显低于正常早孕组和先兆流产组;先兆流产组血清β-hCG下降水平明显高于异位妊娠组;血清β-hCG的含量越高,药物保守治疗有效率越低。结论:早期检测血清β-hCG对异位妊娠的诊断和鉴别诊断、选择方案具有重要意义。     

Early diagnosis of ectopic pregnancy: can we do it accurately using a biochemical profile?

We wanted to evaluate the utility of seven biochemical markers in the early diagnosis of ectopic pregnancy. Women with pain and bleeding suspicious for ectopic pregnancy were evaluated prospectively. Each woman had a transvaginal sonogram and serum determination of beta-human chorionic gonadotropin (beta-hCG), progesterone, estradiol (E2), creatine phosphokinase (CPK), CA-125, 17-hydroxyprogesterone, and androstenedione. The women were grouped in two ways, and there was considerable overlap between the two groups. One grouping included those with <45 days of amenorrhea, and the other included those whose beta-hCG was <2500 mIU/ml. Each marker was analyzed by univariate and multivariate logistic regression to see which could best distinguish ectopic pregnancies from nonectopic pregnancies. In the group of women with <45 days of amenorrhea, ectopic pregnancies were distinguished by a low progesterone and a high CPK. None of the other biochemical markers were significantly associated with ectopic pregnancy in the multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve was constructed for the CPK/progesterone ratio. As an example of different cut points, a CPK/progesterone ratio >15 was 87% sensitive and 83% specific in the diagnosis of ectopic pregnancy. In the group of women with beta-hCG <2500 mIU/ml, the only biochemical marker found to be significantly associated with ectopic pregnancy was CPK. An ROC curve was constructed for CPK in this group. As an example of different cut points, a CPK >70 had a 78% sensitivity and 81% specificity in the diagnosis of ectopic pregnancy. We conclude that the CPK/progesterone ratio is helpful in those women with <45 days of amenorrhea, and serum CPK levels are helpful in women whose beta-hCG is <2500 mIU/ml. Although serum levels of CPK and the ratio of CPK/progesterone are the most helpful in making the diagnosis of early ectopic pregnancy, they are not good enough to be used alone in clinical practice.     

A simple method for the early detection of pregnancy: (A) Comparative study with radioimmunoassay of beta-HCG: and (B) Fallacies compared to other immunological pregnancy tests

A simple, sensitive and reliable non-radioactive method for the detection of hCG in concentrated urine for the diagnosis of early pregnancy is reported. Twenty ml of urine were sampled, filtered and concentrated by ultrafiltration with ultra-microporous membrane under reduced pressure (Immersible Molecular Separator, Millipore Co) and the hCG in the concentrate was detected by the ordinary latex agglutination inhibition method using beta-hCG antiserum to avoid cross-reaction with high levels of hLH and hMG. Concentrated and unconcentrated urine samples taken at different periods of amenorrhoea (1, 2 and 3 weeks) were also tested by two-slide pregnancy tests and one-tube pregnancy test. Blood and urine samples taken at one and two weeks amenorrhea were assayed for beta-hCG by a specific RIA. Results were compared to the new method. Retention characteristics and concentration efficacy of the ultra-microporous membrane were checked by performing recovery experiments using commercial hCG and lyophilization procedure. The new test proved to be more sensitive, specific and reliable than other nonradioactive methods in detecting low levels of urinary hCG for diagnosing pregnancy as early as one week after missed period in regularly menstruating women. In addition, it is simpler and safer than the serum RIA presently used to detect low levels of hCG.     

Accuracy of a semi-quantitative urine pregnancy test compared to serum beta-hCG measurement: a possible screening tool for ongoing pregnancy after medication abortion

PURPOSE: Medication abortion protocols commonly rely on ultrasound or serum hCG measurement to confirm completion. In order to explore the use of a urine-based test to screen for ongoing pregnancy, we compared the diagnostic accuracy of a recently developed semi-quantitative urine pregnancy test to serum beta-hCG testing. METHODS: We evaluated the urine test with 97 women in early pregnancy at a hospital and private clinic in Mexico City. The results of the urine test (hCG level > or <1000 IU/L) were correlated with those of a serum quantitative beta-hCG immunoradiometric assay. RESULTS: The sensitivity of the urine test to identify individuals with a serum beta-hCG level >1000 IU/L was 88.6% (95% CI 74.6- 95.7%), and its specificity was 71.7% (95% CI 57.4-82.8%). CONCLUSION: The reasonably high sensitivity of this urine test suggests it might be useful as a screening test to detect ongoing pregnancy after medication abortion. Future research should evaluate its utility in clinical follow-up protocols.     

Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination

BACKGROUND: Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. CASE: A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions. CONCLUSION: Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.     

甲氨蝶呤联合中西药治疗同浓度血β-hCG宫外孕的临床研究

目的：探讨米非司酮联合甲氨蝶呤和宫外孕Ⅱ号方在治疗不同血β-hCG（人绒毛膜促性腺激素）值宫外孕中的疗效。方法：选取211例宫外孕住院患者,将患者随机分为A组和B组,并根据血β-hCG≤1000 U/L和1000 U/L〈β-hCG≤2000 U/L两种浓度进行分层,A组服用甲氨蝶呤和宫外孕Ⅱ号方,B组服用甲氨蝶呤和宫外孕Ⅱ号方以及米非司酮。根据患者β-hCG值转阴时间、腹痛消失时间、包块消失时间来评估各组患者的治疗效果。结果：血β-hCG≤1000 U/L时,两组治疗效果比较差异无统计学意义（P〉0.05）。血1000 U/L〈β-hCG≤2000 U/L时,两组治愈率、β-hCG值转阴时间、腹痛消失时间、包块消失时间比较差异均有统计学意义（P〈0.05）。结论：甲氨蝶呤联合中西药治疗宫外孕疗效显著。     

异位妊娠发病相关因素及其与盆腔手术的相关性分析

目的：分析异位妊娠发病相关因素及其与盆腔手术的相关性。方法：随机选取80例异位妊娠与80例正常妊娠孕妇,分别为观察组与对照组,对两组进行问卷调查,对盆腔手术史、附件炎、盆腔炎、流产史、异位妊娠史、不孕史、子宫病变史以及宫内节育器放置等相关情况予以统计,比较与异位妊娠发生的相关性。结果：以上几项指标均与异位妊娠的发生具有相关性,盆腔手术是发生异位妊娠的高危因素。结论：明确发生异位妊娠的相关因素,并积极采取有效的预防措施,严格执行盆腔手术,利于降低异位妊娠发生率。     

异位妊娠早期超声诊断371例临床分析

目的:探讨早期异位妊娠超声图像表现及误漏诊原因。方法:对本院2007～2010年诊断为异位妊娠的371例临床资料、声像图表现及超声漏误诊情况进行回顾分析。结果:371例异位妊娠经检查确诊249例,漏诊96例,误诊15例。111例超声复查显示异位妊娠未破裂型97例(87%),破裂型14例(13%)。结论:对临床疑诊病例子宫及附件进行超声扫查及分析,遇图像不典型时,详细追问病史,结合hCG检查,提出超声复查时间及检查注意事项,以减少早期异位妊娠的误漏诊率。     

运用临床路径对异位妊娠患者健康教育的效果观察

目的:分析运用临床路径对异位妊娠保守治疗患者进行健康教育的应用效果,探索更为有效的健康教育模式。方法:将96例异位妊娠保守治疗患者随机分为治疗组48例和对照组48例,治疗组运用临床路径进行健康教育,对照组按常规给予指导,比较两组患者健康教育的效果。结果:治疗组对健康教育知识的掌握情况、对医护工作的满意度及保守治疗后随访复诊情况均优于对照组(P<0.05)。结论:在异位妊娠保守治疗患者中运用临床路径进行健康教育,可提高患者对健康知识的掌握程度、对护理工作的满意度,可以提高异位妊娠保守治疗的成功率,值得推广。