散点图对妊娠结局预测模式的评价

目的利用散点图直观分析正常早孕、自然流产与异位妊娠妇女血清绒毛膜促性腺激素（β-HCG）及孕酮（P）水平配对分布趋势,结合孕龄的差异,建立一种新的妊娠结局预测模式。方法选择正常早期单胎妊娠对照组191例,自然流产患者150例、异位妊娠患者204例。用电发光免疫法测血清β-HCG及P水平。结果正常早孕组孕龄血清β-HCG平均值为（7812.52±3599.29）IU/L,P平均值为（35.27±12.91）nmol/L;自然流产组血清β-HCG平均值为（1298.07±1808.83）IU/L,P平均值为（6.66±4.42）nmol/L;异位妊娠组β-HCG平均值为（2118.23±2905.75）IU/L,P平均值为（6.37±5.58）nmol/L;自然流产组血清β-HCG及P水平明显低于正常早孕对照组,独立样本T检验t=21.75,P=0.000（95%CI：5925.31-7103.79）及t=28.49,P=0.000（95%CI：26.52-30.46）,差异有显著性意义;异位妊娠组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验,t=17.25,P=0.000（95%CI：5045.02-6〈343.57）及t=28.32,P=0.000（95%CI：26.79-30.79）,差异有显著性意义;自然流产组与异位妊娠组血清β-HCG差异有显著性意义,t=﹣3.27,P=0.001（P〈0.05）,两组P水平差异无统计学意义,t=0.57,P=0.57（P〉0.05）;通过绘制血清β-HCG及P水平分布散点图直观显示正常早孕组聚集在以P为纵坐标25-60nmol/L,以血清β-HCG为横坐标的5000-10000IU/L范围内（发生率59.69%）,而自然流产组与异位妊娠组聚集在P〈10nmol/L,HCG〈2000IU/L范围（发生率64.78%）。在孕龄≤49天,P〉20nmol/L均为正常早孕,孕龄〉70天,P〈10nmol/L,均为非正常早孕。结论 P较β-HCG水平具有更好的预测非正常妊娠的能力;结合孕龄利用散点图P与β-HCG联合预测更为准确、直观;随妊娠时间的延长,正常早孕β-HCG水平有迅速增加的趋势,异位妊娠有缓慢增加的趋势,而自然流产则有降低趋势;P水平不能有效区分然流产与异位妊娠。孕龄≤49天,P〉20nmol/L可作为正常早孕的诊断标准,孕龄〉70天,P〈10nmol/L可作为非正常早孕的诊断标准。

Discriminant model for distinction of failing intrauterine from normal intrauterine pregnancies

Objective：To establish criteria for failing intrauterine,we developed and evaluated a discriminant model for differential diagnosis between failing intrauterine （spontaneous abortion and ectopic pregnancy） and normal intrauterine.Methods：The study evaluated 545 naturally conceived and asymptomatic first trimester （204 ectopic pregnancy,150 failing and 191normal intrauterine） with maternal serum beta HCG and P.Results：β-HCG and P level was significantly higher in normal intrauterine than that in spontaneous abortion and ectopic pregnancy,t=21.75,P=0.000 （95% CI：5925.31-7103.79） and t=28.49,P=0.000 （95% CI：26.52-30.46）.The level of P was negatively in spontaneous abortion and ectopic pregnancy,P 0.05.Conclusion：The elevated level of β-HCG and P is associated with the failing intrauterine.The ability of P to distinguish the failing intrauterine from the normal intrauterine is higher than that of β-HCG.The difference between spontaneous abortion and ectopic pregnancy can＇t be predicted by β-HCG and P.The predictive power of P combined with β-HCG measurements according with time of pregnancy in the outcome of threatened miscarriage is highest and more directly on the scatter plots.