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血清标志物在异位妊娠早期诊断中的价值

郭艳巍1,刘新伟2   

  1. 1. 河北承德医学院附属医院产科
    2. 河北承德医学院附属医院麻醉科
  • 收稿日期:2011-04-08 修回日期:2011-07-06 出版日期:2011-11-15 发布日期:2011-11-15
  • 通讯作者: 郭艳巍

Significance of Serum Markers in Early Diagnosis of

  • Received:2011-04-08 Revised:2011-07-06 Published:2011-11-15 Online:2011-11-15

摘要: 摘要 目的:研究血清中β-人绒毛膜促性腺激素(β-HCG)、孕酮(P)、癌胚抗原125(CA125)及妊娠相关血浆蛋白A ( PAPP-A)在异位妊娠早期诊断中的价值。方法:选择异位妊娠的患者(异位妊娠组)和同期来院要求终止妊娠的早孕患者(宫内妊娠组)各100例,根据停经天数将以上2组又分为停经>7周组和停经≤7周组。分别检测其血清β-HCG、P、CA125及PAPP-A的水平。采用ROC曲线确定各指标诊断异位妊娠的截断点、灵敏度及特异度。结果:宫内妊娠组的血清CA125、PPAPP-A、P和β-HCG水平明显高于异位妊娠组;在宫内妊娠组,停经≤7周的血清β-HCG小于停经>7周者,差异有统计学意义(P<0.001),停经天数与β-HCG、PAPP-A呈正相关。在异位妊娠组,停经≤7周与停经大于7周者的血清β-HCG、PAPP-A、P、CA125差异均无统计学意义(P>0.05),4种血清标志物与停经天数均不相关。CA125诊断异位妊娠的截断点为34.925 mU/L,灵敏度80%,特异度73.2%。PAPP-A诊断异位妊娠的截断点为5.405 mIU/L,灵敏度为76%,特异度为73.2%。β-HCG诊断异位妊娠的截断点为4761.4 IU/L,灵敏度为92%,特异度为81.3%。P诊断异位妊娠的截断点为17.21 μg/L,灵敏度为96.0%,特异度为100%。结论:单次检测血清P对于诊断早期异位妊娠的价值最高,P与β-HCG联合检测的效果最优。

关键词: β-人绒毛膜促性腺激素(β-HCG), 孕酮(P), 癌胚抗原125(CA125), 妊娠相关血浆蛋白A(PAPP-A), 异位妊娠

Abstract: Abstract Objective: To explore the importance of the early diagnostic value of serum β- chorionic gonadotrophin (HCG),progesterone (P),carcinoembryonic antigen 125 (CA125) and pregnancy-associated plasma protein (PAPP)-A in ectopic pregnancy. Methods: The serum levels of β-HCG, P, PAPP-A and CA125 were measured in 100 cases of women with atypical ectopic pregnancy, 100 cases of women with normal interuterine pregnancy (nIUP) and control group.Patients were subdivided into >7 weeks suppressed menstruation group and ≤7 weeks group. Data was analyzed by SPSS13.0. Results: The serum levels of CA125, PPAPP-A, P and β-HCG were significantly higher in interuterine pregnancy group than those of ectopic pregnancy group. In interuterine pregnancy group there was a lower serum level of β-HCG in ≤7 weeks suppressed menstruation group than that of >7 weeks group (P<0.001). There was a positive correlation between days of suppressed menstruation and the levels of β-HCG and PAPP-A. In ectopic pregnancy group there were no significant differences in the serum levels of β-HCG, PAPP-A, P and CA125 between ≤7 weeks suppressed menstruation group than that of >7 weeks group (P>0.05). There was no correlation between the 4 serum marker and the days of suppressed menstruation. The diagnostic critical value was CA125≤34.925U/mL, diagnostic sensitivity was CA125:80% and the specificity was CA125:73.2% in ectopic pregnancy group. The diagnostic critical value was PAPP-A≤5.405mU/L, diagnostic sensitivity was PAPP-A:76% and the specificity was PAPP-A:73.2% in ectopic pregnancy group. The diagnostic critical value was β-HCG≤4761.4mIU/mL,diagnostic sensitivity was β-HCG92% and the specificity was β-HCG:81.3% in ectopic pregnancy group. The diagnostic critical value was P≤17.21ng/mL,diagnostic sensitivity was P:96% and the specificity was P:100.0%. in ectopic pregnancy group. Conclusion: The serum levels of β-HCG,P, CA125 and PAPP - A can be used as diagnosis markers of ectopic pregnancy, in which the serum level of P or P combined with β-HCG was the best.

Key words: Beta- people human chorionic gonadotropin (β-HCG), progesterone (P), cancer embryo antigen(CA125), pregnancy associate plasma protein-A(PAPP - A ), ectopic pregnancy