孕酮联合人绒毛膜促性腺激素β检测对先兆流产结局的预测价值。

Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage.

机构信息

Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, 610041 Sichuan, People's Republic of China.

出版信息

Arch Gynecol Obstet. 2011 Mar;283(3):431-5. doi: 10.1007/s00404-010-1367-7. Epub 2010 Jan 28.

DOI:10.1007/s00404-010-1367-7

PMID:20107822

Abstract

PURPOSE

To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (β-HCG) measurements in the outcome of threatened miscarriage.

METHODS

This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients with ongoing pregnancies until delivery and 67 patients with inevitable miscarriages. Control group included 70 pregnant women. Serum concentrations of progesterone and β-HCG were measured by Microparticle enzyme immunoassay between the fourth and fifth gestational weeks. The discrimination attained between the two study groups (ongoing pregnancies and inevitable miscarriages) was evaluated by logistic regression and receiver operating characteristic curve analysis.

RESULTS

The mean serum levels of progesterone and β-HCG in patients with inevitable miscarriages (13.76 ± 5.52 ng/ml, 3,647.00 ± 2,123.00 mIU/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (31.67 ± 5.86 ng/ml, 13,437.00 ± 6,256.00 mIU/ml, respectively) and ongoing pregnancies (25.47 ± 6.18 ng/ml, 8,492.00 ± 2,389.00 mIU/ml, respectively) (P < 0.001). Serum progesterone combined with β-HCG measurements, with a diagnostic accuracy of 85.7% (sensitivity 88.1%, specificity 84.3%), had the best prognostic reliability and significant differences were found when this parameter was compared with the predictive value of a single progesterone (diagnostic accuracy 72.5%, sensitivity 76.1%, specificity 70.4%) or β-HCG (diagnostic accuracy 74.8%, sensitivity 64.1%, specificity 81.4%) determinations. A combination of two biochemical parameters shows substantial improvement over a single-marker strategy.

CONCLUSIONS

Progesterone combined with β-HCG measurements may be useful for predicting the outcome of threatened miscarriage.

摘要

目的

探讨孕激素联合人绒毛膜促性腺激素（β-HCG）检测对先兆流产结局的预测价值。

方法

本回顾性研究纳入了 2006 年 1 月至 2008 年 10 月期间 245 例宫内妊娠患者。175 例因阴道出血就诊的先兆流产患者接受了外源性孕激素补充治疗。其中 108 例患者继续妊娠直至分娩，67 例患者难免流产。对照组包括 70 例妊娠妇女。在妊娠第 4-5 周采用微粒酶免疫分析法检测血清孕激素和β-HCG 浓度。通过逻辑回归和受试者工作特征曲线分析评估两组（继续妊娠组和难免流产组）之间的差异。

结果

难免流产患者的血清孕激素和β-HCG 水平均值分别为 13.76±5.52ng/ml 和 3647.00±2123.00mIU/ml，显著低于正常宫内妊娠患者的 31.67±5.86ng/ml 和 13437.00±6256.00mIU/ml，以及继续妊娠患者的 25.47±6.18ng/ml 和 8492.00±2389.00mIU/ml（P<0.001）。血清孕激素联合β-HCG 检测的诊断准确率为 85.7%（灵敏度 88.1%，特异性 84.3%），其预后可靠性最佳，与单个孕激素（诊断准确率 72.5%，灵敏度 76.1%，特异性 70.4%）或β-HCG（诊断准确率 74.8%，灵敏度 64.1%，特异性 81.4%）测定值相比，差异均有统计学意义。两种生化参数的联合显著优于单个标志物策略。