在妊娠 9 周内通过血清雌二醇、孕酮和β-人绒毛膜促性腺激素预测早期流产。
Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation.
机构信息
Department of Obstetrics and Gynecology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China.
Department of Obstetrics and Gynecology, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, 101100, P. R. China.
出版信息
BMC Pregnancy Childbirth. 2022 Feb 10;22(1):112. doi: 10.1186/s12884-021-04158-w.
PURPOSE
To predict miscarriage outcome within 12 weeks of gestational age by evaluating values of serum estradiol, progesterone and β-human chorionic gonadotropin (β-HCG) within 9 weeks of gestation.
METHODS
One hundred sixty-five women with singleton pregnancies were retrospectively studied. Estradiol, progesterone and β-HCG levels were measured at 5-6 weeks of gestation and the measurements were repeated at 7-9 weeks. According to pregnancy outcome at 12 weeks of gestation, 71 cases were categorized into miscarriage group, and 94 cases into group of normal pregnancy. Each group was further divided into 5-6 and 7-9 weeks of gestation sub-group. Predictive values of estradiol, progesterone and β- HCG levels at 5-6 weeks and 7-9 weeks of gestation were analyzed with receiver operating characteristic (ROC) curves and logistic regression.
RESULTS
Serum levels of estradiol at 7-9 weeks identified miscarriage with an area under the ROC curve (AUC) of 0.866 (95% CI 0. 793 ~ 0.938, P = 0.000), diagnostic cutoff value of 576 pg/ml, sensitivity of 0.804, and specificity of 0.829 respectively at the optimal threshold, according to Youden index. Progesterone levels at 7-9 weeks were with AUC of 0.766 (95% CI 0. 672 ~ 0.861, P = 0.000), cutoff value of 15.27 ng/ml, sensitivity of 0.921, and specificity of 0.558, respectively; Estradiol at 5-6 weeks were with AUC of 0.709 (95% CI 0. 616 ~ 0.801, P < 0.001), the diagnostic cutoff value of 320 pg/ml, sensitivity of 0.800, and specificity of 0.574, respectively. The performance of the dual markers of estradiol and progesterone analysis (AUC 0.871, CI 0.793-0.950), three-markers analysis (AUC 0.869, CI 0.759-0.980)were slightly better than the single marker at 7-9 weeks. β-HCG or progesterone provide additional utility of estradiol prediction at 5-6 weeks with AUC 0.770 (0.672-0.869) for β-HCG and estradiol, AUC0.768(CI 0.670-0.866) for β-HCG, estradiol and progesterone and AUC 0.739 (CI 0.651-0.827) for progesterone and estradiol.
CONCLUSIONS
Low serum levels such as dual of estradiol and progesterone or estradiol alone at 7-9 weeks, β-HCG or progesterone combing estradiol at 5-6 weeks of gestation can be used better to predict miscarriage in first trimester.
目的
通过评估妊娠 5-6 周时雌二醇、孕酮和β-人绒毛膜促性腺激素（β-HCG）的水平，预测妊娠 9 周内妊娠 12 周内的流产结局。
方法
回顾性分析 165 例单胎妊娠孕妇。5-6 孕周时测量雌二醇、孕酮和β-HCG 水平，7-9 孕周时重复测量。根据 12 周妊娠结局，71 例分为流产组，94 例分为正常妊娠组。每组进一步分为 5-6 孕周和 7-9 孕周亚组。采用受试者工作特征（ROC）曲线和 logistic 回归分析妊娠 5-6 周和 7-9 周时雌二醇、孕酮和β-HCG 水平的预测值。
结果
妊娠 7-9 周时血清雌二醇水平诊断流产的 ROC 曲线下面积（AUC）为 0.866（95%CI 0.793-0.938，P=0.000），诊断界值为 576pg/ml，灵敏度为 0.804，特异度为 0.829，根据 Youden 指数为最佳阈值。妊娠 7-9 周时孕酮水平 AUC 为 0.766（95%CI 0.672-0.861，P=0.000），诊断界值为 15.27ng/ml，灵敏度为 0.921，特异度为 0.558。妊娠 5-6 周时雌二醇 AUC 为 0.709（95%CI 0.616-0.801，P<0.001），诊断界值为 320pg/ml，灵敏度为 0.800，特异度为 0.574。雌二醇和孕酮联合分析（AUC 0.871，CI 0.793-0.950）和三联标志物分析（AUC 0.869，CI 0.759-0.980）的双标志物和三联标志物分析（AUC 0.869，CI 0.759-0.980）的性能略优于妊娠 7-9 周时的单一标志物。β-HCG 或孕酮与妊娠 5-6 周时雌二醇联合分析（AUC 0.770，0.672-0.869），β-HCG、雌二醇和孕酮联合分析（AUC0.768，CI 0.670-0.866），孕酮和雌二醇联合分析（AUC 0.739，CI 0.651-0.827）的 AUC 均优于β-HCG。
结论
妊娠 7-9 周时血清雌二醇水平较低，如雌二醇和孕酮联合检测或妊娠 5-6 周时单独检测β-HCG 或孕酮，可更好地预测早孕期流产。
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