天津医药

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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

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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