血清孕酮、血管内皮生长因子及抑制素A联合检测在异位妊娠早期诊断中的价值

摘要

目的 研究正常宫内妊娠与异位妊娠患者血清中孕酮(P)、血管内皮生长因子(VEGF)及抑制素A(INH-A)水平的变化,探讨三者在异位妊娠早期诊断中的临床价值.方法 选取65例临床确诊为异位妊娠的患者(观察组)及同期就诊的65例正常宫内妊娠者(对照组)进行病例对照研究.检测所有入选者的血清P、VEGF及INH-A,并对其进行对比分析.绘制受试者工作特征(ROC)曲线,确定各指标诊断异位妊娠的截断点,并评价各指标单独及联合应用对异位妊娠早期诊断的灵敏度和特异度.结果 观察组患者血清P、INH-A水平均低于对照组(P值均＜0.01),观察组患者血清P、INH-A的ROC曲线下面积分别为0.89、0.82;观察组患者VEGF水平高于对照组(P＜0.01),观察组患者血清VEGF的ROC曲线下面积为0.83.以血清P＜ 60.9 nmol/L为截断点,诊断异位妊娠的灵敏度为95.4％,特异度为70.8％；以血清INH-A＜ 11.5 pg/ml为截断点,诊断EP的灵敏度为89.8％,特异度为88.7％；以血清VEGF＞236.8 pg/ml为截断点,诊断EP的灵敏度为81.5％,特异度为90.3％；三指标联合检测的ROC曲线下面积为0.95,灵敏度为97.1％,特异度为91.2％.结论 在异位妊娠早期诊断或在定位不明部位妊娠时,测定血清P、VEGF及INH-A均有一定的临床价值,三项指标联合应用可进一步提高诊断的灵敏度和特异度.%Objective To explore the clinical value of single and combined detection of serum markers,serum progestone (serum P),vascular endothelial growth factor (VEGF) and inhibin-A (INH-A),in the early diagnosis of ectopic pregnancy.Methods Serum P,VEGF and INH-A were measured in 65 patients with ectopic pregnancy (the study group) and 65 healthy pregnant women (the control group).Receiver operating characteristic curves (ROC)of all indexes were drawn,and the areas under the receiver operating characteristic curves (AUC) were calculated to evaluate the diagnostic value.Results The levels of serum P and INH-A in the study group were significantly lower than those in the control group (P＜0.01),and the AUC of serum P and INH-A were 0.89 and 0.82.The level of VEGF in the study group were significantly higher than that in the control group (P＜0.01),and the AUC of VEGF was 0.83.Taking serum P＜60.9 nmol/L as the cut-off point,the sensitivity of the diagnosis was 95.4％,and the specificity was 70.8％; taking serum INH-A＜11.5 pg/ml as the cut-offpoint,the sensitivity was 89.8％ and the specificity was 88.7％;taking serum VEGF＞236.8 pg/ml as the cut-off point,the sensitivity was 81.5％ and the specificity was 90.3％.The AUC of the combination of the three markers was 0.95,with the sensitivity of 97.1％ and the specificity of 91.2％.Conclusion Detection of serum progestone,vascular endothelial growth factor,inhibin-A are helpful for the early diagnosis of ectopic pregnancy.But combination of them has more advantage compared to single determination of serum markers,with higher sensitivity and specificity.