超声 RI和 ET联合血β-hCG在宫外孕诊断中的价值研究

目的：探讨超声联合血清人绒毛膜促性腺激素（β-hCG）检查在宫外孕中诊断价值。方法选择湖北省鄂州市中心医院2013年2月至2016年1月早期疑似异位妊娠的189例患者，按照术后及病理证实分为正常宫内妊娠组（ A组）、宫内妊娠而自然流产组（ B组）和异位妊娠组（ C组），分析不同组别子宫内膜血流参数值及β-hCG的变化，子宫内膜参数值包括收缩期最大血流流速（VS）、舒张末期流速（VD）及阻力指数（RI）。建立ROC曲线分析各超声指标联合β-hCG在宫外孕中的诊断效能。结果 A组β-hCG、双层子宫内膜厚度（ET）均显著高于B、C组（t值分别为6．24、4．39、4．66、5．75，均P＜0．05），而VS、VD及RI均显著低于B、C组（t值分别为4．36、5．54、5．61、4．71、7．72、6．73，均P＜0．05），C组VS、RI、附件区包块大小与B组比较有显著性差异（ t值分别为5．17、4．61、8．28，均P＜0．05）。 RI、ET及β-hCG三者联合诊断时，其敏感度、特异性、阳性预测值、阴性预测值分别为93．83％、98．38％、99．81％、95．16％，其曲线下面积（ AUC）为0．918，优于RI ＋β-hCG、ET＋β-hCG诊断价值（ Z＝5．541，P＝0．025）。结论超声诊断子宫内膜厚度、阻力指数联合β-hCG有助于提高早期宫外孕的诊断价值。

Value of ultrasound RI and ET combined with chorionic gonadotropin in diagnosing ectopic pregnancy

Objective To investigate the diagnostic value of ultrasound combined with β-human chorionic gonadotropin (β-hCG) in ectopic pregnancy .Methods Totally 189 patients suspected with early ectopic pregnancy during February 2013 to January 2016 in Central Hospital of Ezhou City were selected , and they were divided into normal intrauterine pregnancy group ( group A ) , intrauterine pregnancy and spontaneous abortion group ( group B ) and ectopic pregnancy group ( group C ) according to postoperative pathological confirmation . Analysis was conducted on the changes of endometrial blood flow parameter values including Vs , VD and resistance index (RI), and β-hCG among different groups .ROC curve was set up to analyze diagnostic efficacy of ultrasound indexes combined with β-hCG in ectopic pregnancy .Results In group A β-hCG and endometrium thickness ( ET ) were significantly higher than in group B and C ( t value was 6.24, 4.39, 4.66 and 5.75, respectively, all P<0.05), but VS, VD and RI were lower than in group B and C (t value was 4.36, 5.54, 5.61, 4.71, 7.72 and 6.73, respectively, all P<0.05).In group C VS, RI and the size of the attachment area mass were significantly different from group B (t value was 5.17, 4.61 and 8.28, respectively, all P<0.05).The sensitivity, specificity, positive predictive value and negative predictive value of joint diagnosis of RI , ET and β-hCG were 93.83%, 98.38%, 99.81% and 95.16%, respectively.The area under the curve (AUC) was 0.918, which was better than diagnostic value of RI +β-hCG and ET+β-hCG (Z=5.541, P =0.025).Conclusion Ultrasound diagnosis of endometrial thickness , RI combined with β-hCG is helpful to improve the diagnostic value of early ectopic pregnancy .