异位妊娠患者绒毛膜促性腺激素、孕酮及子宫内膜厚度三项指标的联合检测诊断价值

发布时间：2018-05-30 03:38

本文选题：宫外孕 + 免疫化学发光技术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:异位妊娠(ectopic pregnancy,EP)-孕卵在子宫腔以外着床发育的异常妊娠过程,也称“宫外孕”。异位妊娠是妇产科常见的急腹症之一,当异位妊娠发生破裂或流产后,可造成急性腹腔内出血,严重者危及患者生命,是妊娠相关疾病死亡率很高的疾病。临床实践中大部分异位妊娠患者在目前的诊疗技术支持下,在发生严重内出血之前即能诊断,并得到及时治疗;但是也有不少个体,特别是临床症状和体征不典型时,常易导致误诊,因此对异位妊娠病例的早期发现,及时终止妊娠是降低母体大出血和死亡率的有效方法。加之近年来国内外文献时有报道异位妊娠的发病率呈明显上升趋势,而且越来越年轻化,所以探索诊断方法使之早期、快速的诊断异位妊娠迫在眉睫。本研究探讨联合应用人绒毛膜促性腺激素(β-HCG)、孕酮及B超测定子宫内膜厚度的相关数据分析在宫外孕的早期诊断中的价值。方法:1选择正定县人民医院于2016年1月-2017年1月期间在我院妇产科收治的70例宫外孕患者作为异位妊娠组,并且这些患者最终均经手术和病理筛查明确诊断为宫外孕;同期选择正常早孕孕妇70例作为正常早孕组(对照组)。检测并且对比两组患者的:人绒毛膜促性腺激素(β-HCG)、孕酮及B超探测子宫内膜厚度,之后研究各项指标单独检测和联合检测对异位妊娠早期诊断的特异性、敏感性、误诊率、漏诊率、诊断符合率。2指标检测:所有患者在膀胱充盈之后采用飞利浦彩色超声诊断仪进行腹部检查,测定子宫内膜厚度;贝克曼库尔特化学发光仪检测血清βHCG、孕酮水平。取子宫内膜厚度、血清βHCG、孕酮的相关数据进行分析。3统计学方法:采用SPSS 22.0统计软件进行数据处理。计量资料符合正态分布的资料以?x±s表示,两组间数据比较采用t检验,非正态分布资料经过对数转换后,采用非参数的秩和检验。计数资料采用例或者百分率进行统计描述,卡方检验进行分析。均以P0.05表示差异有统计学意义。结果:1异位妊娠组与正常早孕组一般资料比较:两组在基本资料年龄、身高、体重、月经周期、停经天数等基本资料方面比较,差异无统计学意义(P0.05)。2诊断指标。异位妊娠组患者β-HCG、Prog及子宫内膜厚度水平分别为(4877.4±1072.1miu/ml)、(3.47±0.71 ng/ml)、(5.97±0.95mm),均低于正常早孕组(11141.5±2162.2miu/ml)、(38.69±9.02ng/ml)、(15.87±1.6mm)(P0.05)。3单项指标诊断评价。血清β-HCG的灵敏度80%,特异性56.3%,漏诊率20%,误诊率43.7%,诊断符合率75.6%;孕酮的灵敏度77.1%,特异性81.3%,漏诊率22.9%,误诊率18.7%,诊断符合率77.9%;超声子宫内膜厚度的灵敏度82.9%,特异性87.5%,漏诊率17.1%,误诊率12.5%,诊断符合率83.7%。4指标协同诊断评估。三项指标项联合其三项指标联合测定的灵敏度87.1%,特异性92.8%,诊断符合率88.4%.均有所提升,漏诊率12.9%,误诊率6.2%,均有大幅度的下降。结论:单项指标中超声子宫内膜厚度检测的灵敏度、漏诊率、和诊断符合率优于单独检测β-HCG和孕酮;单独检测孕酮的特异度、误诊率、优于单独检测β-HCG;而单独β-HCG检测的漏诊率、灵敏度和诊断符合率优于单独检测孕酮。而三项联合诊断其灵敏度、特异度、诊断符合率均大幅度提升;而误诊率和漏诊率大幅度下降。为临床检测异位妊娠提供更好的快速无创的诊断方法。
[Abstract]:Objective: ectopic pregnancy (ectopic pregnancy, EP) - the abnormal pregnancy process of pregnancy outside the uterine cavity, also known as "ectopic pregnancy". Ectopic pregnancy is one of the most common acute abdomen in obstetrics and gynecology. When ectopic pregnancy breaks or abortions, it can cause acute intraperitoneal hemorrhage, the serious person endangers the patient's life and is the death of pregnancy related diseases. Most of the ectopic pregnancy patients in clinical practice can be diagnosed and treated in time before severe internal hemorrhage, but there are many individuals, especially when the symptoms and signs are untypical, often lead to misdiagnosis, so early discovery of ectopic pregnancy cases, in time end. Pregnancy is an effective way to reduce maternal bleeding and mortality. In addition, in recent years, the incidence of ectopic pregnancy is obviously rising in the literature at home and abroad, and it is becoming more and more young. Therefore, the diagnosis method makes it early and fast to diagnose ectopic pregnancy in the eyebrow. This study is to discuss the combined application of human chorionic gonadotropin. The value of the correlation data of hormone (beta -HCG), progesterone and B-ultrasound in the determination of endometrium thickness in the early diagnosis of ectopic pregnancy. Methods: 1 the 70 cases of ectopic pregnancy treated in the obstetrics and Gynecology Department of Zhengding County in January 2016 -2017 year were selected as ectopic pregnancy group, and these patients were eventually performed by surgical and pathological screening. The diagnosis was diagnosed as ectopic pregnancy, and 70 normal preconception pregnant women were selected as the normal early pregnancy group (control group) at the same time. The human chorionic gonadotropin (beta -HCG), progesterone and B-ultrasound were detected and compared with the two groups. The specificity and sensitivity of each index and joint detection for early diagnosis of ectopic pregnancy were studied. Sensibility, misdiagnosis rate, missed diagnosis rate, diagnostic coincidence rate.2 index detection: after the bladder filling, all patients were examined with PHILPS color ultrasonic apparatus for abdominal examination and measured the thickness of endometrium; Beckman Kurt chemiluminescence detector was used to detect the serum beta HCG, progesterone level, the thickness of the endometrium, serum beta HCG, progesterone and the related data. Analysis of.3 statistical method: data processing with SPSS 22 statistical software. The data of measurement data conforms to normal distribution with x + s, and the data of the two groups are compared with t test. After the non normal distribution data are converted to the logarithm, the non parametric rank sum test is used. The statistical description of the use case or percentage of the counting data is described, and the chi square test The difference was statistically significant by P0.05. Results: 1 the general data of the ectopic pregnancy group and the normal pregnancy group: the two groups were compared with the basic data of the basic data age, height, weight, menstrual cycle, and the number of days of menopause (P0.05).2 diagnostic index. The patients with ectopic pregnancy were in beta -HCG, Prog and uterus. The thickness of endometrium was (4877.4 + 1072.1miu/ml), (3.47 + 0.71 ng/ml), (5.97 + 0.95mm), lower than normal early pregnancy (11141.5 + 2162.2miu/ml), (38.69 + 9.02ng/ml), (15.87 + 1.6mm) (15.87 + 1.6mm) (P0.05).3 single index diagnostic evaluation. Serum beta -HCG, specificity 56.3%, 20%, missed diagnosis rate 43.7%, diagnostic coincidence rate 75.6%; progesterone; progesterone The sensitivity was 77.1%, the specificity was 81.3%, the missed diagnosis rate was 22.9%, the misdiagnosis rate was 18.7%, the diagnostic coincidence rate was 77.9%, the sensitivity of the endometrium thickness was 82.9%, the specificity 87.5%, the missed diagnosis rate 17.1%, the misdiagnosis rate 12.5%, the diagnostic coincidence rate 83.7%.4 index cooperative diagnosis evaluation. Three index items combined with the sensitivity 87.1% and specific 92.8% of the combined determination of the three indexes. The diagnostic coincidence rate of 88.4%. was enhanced, the rate of missed diagnosis was 12.9%, the rate of misdiagnosis was 6.2%. Conclusion: the sensitivity of endometrial thickness detection, missed diagnosis rate and diagnostic coincidence rate in single index were better than that of beta -HCG and progesterone alone; the specificity of progesterone and the rate of misdiagnosis were better than that of beta -HCG alone; and the single beta -HCG was compared. The rate of missed diagnosis, sensitivity and diagnostic coincidence rate were superior to that of progesterone alone. The sensitivity, specificity and diagnostic coincidence rate of the three joint diagnosis were greatly improved, and the misdiagnosis rate and missed diagnosis rate decreased greatly. It provided a better and faster non invasive diagnosis method for clinical detection of ectopic pregnancy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22

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