血清孕酮和妊娠相关血浆蛋白A用于早期诊断未破裂型输卵管妊娠的应用价值

摘要

Objective： To explore the clinical diagnostic value of progesterone (P) and pregnancy associated plasma protein A (PAPP-A) for unruptured tubal pregnancy (TP).Methods： Serum P and PAPP-A were measured in 52 cases of un-ruptured TP and 41 cases of normal inter-uterine pregnancy (nIUP).Receiver operating characteristic curves ( ROC) of all indexes were drawn and the areas under the ROC curves were calculated to evaluate diagnostic value.Results: Levels of serum P and PAPP-A were significantly lower in TP group compared with nIUP group in the same pregnancy weeks.The areas under the ROC curves of serum P and PAPP-A were 0.96 and 0.92 respectively.To differentiate TP from nIUP, the threshold for P was less than 60.1 nmol/L, with 91.7％ sensitivity and 87.8％ specificity; while the threshold value for PAPP-A was less than 0.49 mg/L, with 84.6％ sensitivity and 87.8％ specificity.The areas under the ROC curves of combination of P × PAPP-A was 0.96, and the threshold for combination of P × PAPP-A was less than 41.0, with 97.9％ sensitivity and 87.8％ specificity.Conclusion: Detection of serum PAPP-A and P may be helpful for the diagnosis of unruptured TP, combination of P × PAPP-A had the best diagnostic value.%目的:探讨血清孕酮、妊娠相关血浆蛋白-A(PAPP-A)用于早期诊断未破裂型输卵管妊娠(TP)的价值.方法:测定41名正常宫内妊娠(nIUP)孕妇与52例未破裂型TP患者的血清孕酮、PAPP-A,其中血清孕酮采用化学发光法,PAPP-A采用酶联免疫吸附法,对两组血清指标进行对比分析,绘制受试者工作特征(ROC)曲线分析两项指标用于诊断TP的敏感度及特异度.结果:TP组患者血清孕酮、PAPP-A水平均低于同孕周nIUP组(P均<0.01).TP患者血清孕酮、PAPP-A的ROC曲线下面积分别为0.96,0.92.以血清孕酮＜60.1 nmol/L为诊断阈值,诊断TP敏感度为92.7%,特异度为83.3%;以PAPP-A＜0.49 mg/L为诊断阈值,诊断TP敏感度为84.6%,特异度为87.8%.取血清孕酮与PAPP-A乘积＜41.0为诊断阈值,诊断TP的敏感度为97.9%,特异度为87.8%.结论:在TP早期诊断或在定位不明部位妊娠时,测定血清孕酮及PAPP-A均具有一定的临床价值,血清孕酮及PAPP-A乘积有助于早期诊断输卵管妊娠.