阴道超声联合血清PAPP-A、AMH水平在异位妊娠早期的诊断价值

目的探讨并分析阴道超声联合血清PAPP-A (血清妊娠相关血浆蛋白A)、AMH (血清抗苗勒氏管激素)水平在异位妊娠早期的诊断价值。方法选取2017年2月-2018年2月台州市立医院收治的早期异位妊娠患者48例、正常妊娠孕妇32例及32例正常志愿者,分别作为异位妊娠组、妊娠组及对照组。测定各组受试者血清PAPP-A、AMH浓度,对所有受试者进行超声检查,记录下各组超声诊断结果。采用血清PAPP-A、AMH、超声、超声+PAPP-A+AMH联合等方法作为诊断指标对所有受试者进行诊断,比较上述诊断方法的准确性(包括灵敏度、特异度及一致性)。结果单独的PAPP-A、AMH、超声诊断异位妊娠诊断特异度差异有统计学意义(P<0. 05),其中AMH诊断的特异度显著高于PAPP-A、超声的诊断特异度,PAPP-A诊断的灵敏度显著高于AMH及超声(P<0. 05)。对于平行联合检测,PAPP-A+AMH+超声诊断的灵敏度阴性预测值均显著高于PAPP-A+超声、AMH+超声(P<0. 05);对于系列联合检测,PAPP-A+AMH+超声诊断的特异度显著高于PAPP-A+超声(P<0. 05);采用PAPP-A+AMH+超声诊断时,系列联合检测的灵敏度显著低于平行联合检测,特异度显著高于平行联合检测,差异有统计学意义(P<0. 05)。PAPP-A+超声、AMH+超声及PAPP-A+AMH+超声诊断异位妊娠平行联合检测ROC曲线下面积分别为0. 751、0. 756和0. 915,系列联合检测ROC曲线下面积为0. 740、0. 721和0. 904,PAPP-A+AMH+超声诊断的ROC曲线下面积显著高于PAPP-A+超声、AMH+超声,差异有统计学意义(P<0. 05)。结论超声+PAPP-A+AMH联合诊断较单纯应用PAPP-A、AMH、超声更能有效增加异位妊娠诊断准确率,值得临床推广。

Value of vaginal ultrasound combined with serum PAPP-A and AMH levels in early diagnosis of ectopic pregnancy

Objective To explore and analyze the value of vaginal ultrasound combined with serum pregnancy-associated plasma protein A( PAPP-A) and anti-Müllerian hormone( AMH) levels in early diagnosis of ectopic pregnancy. Methods From February 2017 to February 2018,48 patients with ectopic pregnancy( ectopic pregnancy group),32 normal pregnant women( pregnancy group),and 32 normal volunteers( control group) were selected from Taizhou Municipal Hospital. The levels of serum PAPP-A and AMH were detected,ultrasonography was performed,the results were recorded. All the women were diagnosed using serum PAPP-A,serum AMH,ultrasound,ultrasound+PAPP-A+AMH,respectively,the observation indexes included sensitivity,specificity,and consistency. Results There was statistically significant difference in diagnostic specificity of ectopic pregnancy among PAPP-A,AMH,ultrasound( P<0. 05),the diagnostic specificity of AMH was significantly higher than those of PAPP-A and ultrasound,the diagnostic sensitivity of PAPP-A was significantly higher than those of AMH and ultrasound( P<0. 05). For parallel joint detection,the negative predictive value of PAPP-A+AMH+ultrasound was significantly higher than those of PAPP-A+ultrasound,AMH+ultrasound( P<0. 05);for serial joint detection,the specificity of PAPP-A+AMH+ultrasound was significantly higher than that of PAPP-A+ ultrasound( P < 0. 05);sensitivity of serial joint detection of PAPP-A +AMH+ultrasound was significantly lower than that of parallel combined detection of PAPP-A+AMH+ultrasound,specificity of serial joint detection of PAPP-A+AMH+ultrasound was significantly higher than that of parallel combined detection of PAPP-A+AMH+ultrasound( P<0. 05). The areas of ROC curve of parallel combined detection of PAPP-A+ultrasound,AMH+ultrasound,PAPP-A+AMH+ultrasound in diagnosis of ectopic pregnancy were 0. 751,0. 756,and 0. 915,respectively;the areas of ROC curve of serial joint detection of PAPP-A+ultrasound,AMH+ultrasound,PAPP-A+AMH+ultrasound in diagnosis of ectopic pregnancy were 0. 740,0. 721,0. 904,respectively. The area of ROC curve of PAPP-A+AMH+ultrasound was significantly higher than those of PAPP-A+ultrasound,AMH+ultrasound( P<0. 05).Conclusion Combined diagnosis of ultrasound+PAPP-A+AMH is more effective than PAPP-A,AMH,and ultrasound alone in increasing accuracy rate of ectopic pregnancy diagnosis,which is worthy of clinical promotion.