首页|输卵管妊娠药物治疗前血中人绒毛膜促性腺激素变化趋势对疗效的预测作用

输卵管妊娠药物治疗前血中人绒毛膜促性腺激素变化趋势对疗效的预测作用

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[目的]探讨治疗前血中人绒毛膜促性腺激素(β-HCG)变化趋势对输卵管妊娠药物治疗疗效的预测作用.[方法]收集从2017年1月至2022年6月广州中医药大学第一附属医院收治的接受药物治疗的380例输卵管妊娠患者的临床资料,根据治疗方案的不同,分为纯中药治疗组(简称纯中药组)271例和中西医结合治疗组(简称中西医结合组)109例,对可能影响不同治疗方案治疗结局的相关因素进行分析,使用Logistic回归分析控制混杂因素,分析治疗前血β-HCG的变化趋势对不同治疗方案治疗结局的影响;使用受试者工作特征(ROC)曲线评估治疗前血β-HCG变化值对疗效的预测价值.[结果](1)单因素分析结果显示:纯中药组和中西医结合组的治疗前2次检测的血β-HCG初始值、β-HCG变化趋势和变化值均与治疗结局有关,差异均有统计学意义(P<0.05或P<0.01).(2)多因素回归分析结果显示:在纯中药组中,治疗前2次检测的血β-HCG值、β-HCG变化趋势与治疗结局存在相关性,差异均有统计学意义(P<0.05或P<0.01);在中西医结合组中,停经时间、治疗前第2次检测的血β-HCG值与治疗结局存在相关性,差异均有统计学意义(P<0.05).(3)控制混杂因素后,纯中药组治疗前β-HCG变化趋势与治疗结局相关,差异有统计学意义(OR=3.35,95%CI为1.69-6.65,P = 0.001);而中西医结合组的β-HCG变化趋势则不影响治疗结局,差异无统计学意义(P>0.05).(4)通过受试者工作特征(ROC)曲线分析,纯中药组ROC曲线下面积(AUC)为0.74,cutoff值为-0.14,其敏感度为71.3%,特异度为67.8%.中西医结合组AUC为0.67,cutoff值为0.10,其敏感度为73.6%,特异度为60.7%.[结论]治疗前血β-HCG变化趋势可以有效预测中药治疗输卵管妊娠的疗效,而不具有预测中西医结合治疗输卵管妊娠疗效的价值;治疗前血β-HCG变化值可以作为早期预测输卵管妊娠药物治疗结局的有价值的参考值.
Study on Variation Trend of Pre-treatment Blood Human Chorionic Gonadotropin in Predicting Efficacy of Tubal Pregnancy Treated by Drug Therapy
Objective To investigate the role of variation trend of pre-treatment blood beta human chorionic gonadotropin(β-HCG)in predicting the efficacy of tubal pregnancy(TP)treated by drug therapy.Methods Clinical data of 380 TP patients treated by drug therapy at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to June 2022 were collected.The patients were divided into 271 cases in the pure Chinese medicine(CM)treatment group(shortened as pure CM group)and 109 cases in the combination of Chinese medicine and western medicine group(shortened as combination group)according to the therapy.The relevant factors that may affect the outcomes of the therapy were analyzed,and logistic regression analysis was used for the control of confounding factors.The influences of pre-treatment β-HCG on the outcomes of TP treated by various therapies were investigated,and the value of variation trend of pre-treatment β-HCG in predicting the efficacy of TP treated by drug therapy was assessed using the receiver operating characteristic curve(ROC curve).Results(1)The results of univariate analysis showed that the initial value of blood β-HCG,the variation trend of β-HCG and the difference value of β-HCG detected for 2 times before treatment were correlated with the treatment outcomes in the pure CM group and the combination group,and the differences were all statistically significant(P<0.05 or P<0.01).(2)The results of multivariate regression analysis showed that in the pure CM group,the blood β-HCG values and the variation trend of β-HCG detected for 2 times before treatment were correlated with the treatment outcomes,and the differences were all statistically significant(P<0.05 or P<0.01);in the combination group,the menopausal time and blood β-HCG value detected at the second time before treatment were correlated with the treatment outcomes,and the differences were all statistically significant(P<0.05).(3)After controlling for the confounding factors,the variation trend of pre-treatment β-HCG in the pure CM group was correlated with the treatment outcomes,and the difference was statistically significant(OR=3.35,95%CI being 1.69-6.65,P = 0.001).However,the variation trend of pre-treatment β-HCG in the combination group did not affect the treatment outcomes,and the difference was not statistically significant(P>0.05).(4)The ROC curve analysis showed that the area under the curve(AUC)in the pure CM group was 0.74,the cutoff value was-0.14,the sensitivity was 71.3%and the specificity was 67.8%.The AUC in the combination group was 0.67,the cutoff value was 0.10,the sensitivity was 73.6%and the specificity was 60.7%.Conclusion The variation trend of pre-treatment blood β-HCG can effectively predict the efficacy of Chinese medicine for the treatment of TP,but has no value for predicting the efficacy of the combination of Chinese medicine and western medicine in treating TP.The variation value of pre-treatment blood β-HCG can be used as a valuable reference indicator for the early prediction of the outcomes of TP treated by drug therapy.

tubal pregnancydrug therapyvariation trend of human beta chorionic gonadotropin(β-HCG)receiver operating characteristic curve(ROC curve)

张家旗、袁烁

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广州中医药大学,广东广州 510405

广州中医药大学第一附属医院妇科/国家华南区中医妇科区域诊疗中心,广东广州 510405

输卵管妊娠 药物治疗 β-HCG变化趋势 受试者工作特征(ROC)曲线

国家自然科学基金项目国家自然科学基金项目广东省自然科学基金项目

82174417818041342018A030313469

2024

广州中医药大学学报
广州中医药大学

广州中医药大学学报

CSTPCD
影响因子:1.055
ISSN:1007-3213
年,卷(期):2024.41(1)
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