孕期前半期激素测定的预测价值。

Predictive value of hormone determinations in the first half of pregnancy.

作者信息

Gerhard I, Runnebaum B

出版信息

Eur J Obstet Gynecol Reprod Biol. 1984 Apr;17(1):1-17. doi: 10.1016/0028-2243(84)90075-3.

PMID:6203784

Abstract

In a prospective randomized study serial hormone determinations (beta-hCG, HPL, P, 17-OHP, E2 and E3) were performed with 1125 pregnant women from the detection of pregnancy until delivery (n = 994) or abortion (n = 131). In 605 women carrying to term blood sampling started before the 16th wk of gestation, while 389 patients were admitted to hospital between the 16th and 20th wk of gestation. The first value of most of the hormone determinations at the time of diagnosis of pregnancy before the 16th wk was normal in more than 90% (beta-hCG 95%, P 94%, E3 94%, E2 92%, HPL 64%). In the case of women with abortion the first hormone determination was low in more than 50% (beta-hCG 51%, P 56%, E3 54%, E2 62%, HPL 62%). The predictive value was highest for beta-hCG (75%) and E2 (70%) and lowest for HPL (18%). In 249 women with threatened abortion blood samples were obtained at the first days of bleeding. At this time the highest sensitivity in detecting early abortions (before the 16th wk of pregnancy) was 82% for E2, followed by beta-hCG 74%, E3 65%, P 63%, 17-OHP 52% and HPL 34% (n = 112). In late abortion (after the 16th wk of pregnancy, n = 19) the sensitivity of all methods tested was below 40%. In the case of women with bleeding and continuation of pregnancy (n = 118) normal values were found in 95% by P, 94% by beta-hCG, 93% by HPL and E3, and 83% by 17-OHP respectively. Serial determinations in women with abortion revealed that in a normal population trophoblastic disorders with reduced beta-hCG concentrations were most common. Of the remaining patients with normal beta-hCG concentrations every third woman had low P or E2 values. The combined determination of all hormones allowed conclusions to be drawn on the cause of pregnancy failure. It could be established that prior to the 6th wk of pregnancy the determination of beta-hCG was most valuable. From the 7th wk onwards the measurement of E2 or E3 showed the highest sensitivity. Between the 11th and 14th wk of pregnancy the discriminating potency of all methods tested was equally high. After the 14th wk of pregnancy hormone determinations were of little diagnostic value.

摘要

在一项前瞻性随机研究中，对1125名孕妇进行了系列激素测定（β-人绒毛膜促性腺激素、人胎盘催乳素、孕酮、17-羟孕酮、雌二醇和雌三醇），从妊娠检测直至分娩（n = 994）或流产（n = 131）。605名足月分娩的妇女在妊娠16周前开始采血，而389名患者在妊娠16至20周期间入院。在妊娠16周前诊断妊娠时，大多数激素测定的首个值在90%以上是正常的（β-人绒毛膜促性腺激素95%、孕酮94%、雌三醇94%、雌二醇92%、人胎盘催乳素64%）。在流产妇女中，超过50%的首个激素测定值较低（β-人绒毛膜促性腺激素51%、孕酮56%、雌三醇54%、雌二醇62%、人胎盘催乳素62%）。β-人绒毛膜促性腺激素（75%）和雌二醇（70%）的预测价值最高，人胎盘催乳素（18%）的预测价值最低。在249名有先兆流产的妇女中，在出血的头几天采集了血样。此时，检测早期流产（妊娠16周前）的最高敏感性，雌二醇为82%，其次是β-人绒毛膜促性腺激素74%、雌三醇65%、孕酮63%、17-羟孕酮52%和人胎盘催乳素34%（n = 112）。在晚期流产（妊娠16周后，n = 19）中，所有检测方法的敏感性均低于40%。在有出血且继续妊娠的妇女中（n = 118），孕酮的正常率为95%，β-人绒毛膜促性腺激素为94%，人胎盘催乳素和雌三醇为93%，17-羟孕酮为83%。对流产妇女的系列测定显示，在正常人群中β-人绒毛膜促性腺激素浓度降低的滋养细胞疾病最为常见。在其余β-人绒毛膜促性腺激素浓度正常的患者中，每三名妇女中有一名孕酮或雌二醇值较低。所有激素的联合测定有助于对妊娠失败的原因得出结论。可以确定，在妊娠6周前，β-人绒毛膜促性腺激素的测定最有价值。从第7周起，雌二醇或雌三醇的测定显示出最高的敏感性。在妊娠11至14周期间，所有检测方法的鉴别能力同样高。妊娠14周后，激素测定的诊断价值不大。