摘要
目的:探究剖宫产瘢痕妊娠患者血清β-人绒毛膜促性腺激素(β-hCG)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)水平与子宫动脉栓塞术后再妊娠的关系.方法:选取2019年11月-2020年11月本院143例剖宫产瘢痕妊娠患者作为研究对象,依据术后3年再妊娠情况分为再妊娠组86例和未妊娠组57例,记录患者临床资料,采用化学发光法测定术前、术后第1、第3个月经周期血清β-hCG水平,采用ELISA法检测T3、T4水平.血清β-hCG、甲状腺激素水平与剖宫产瘢痕妊娠子宫动脉栓塞术后再妊娠的关系行logistic回归分析;绘制ROC曲线分析血清β-hCG、甲状腺激素水平预测剖宫产瘢痕妊娠子宫动脉栓塞术后再妊娠的价值.结果:血清β-hCG、T3、T4水平在未妊娠组和再妊娠组及术后不同时间点存在交互效应(均P＜0.05);术后血清β-hCG水平呈下降趋势,血清T3、T4水平呈上升趋势.术后第1、第3个月经周期再妊娠组的血清β-hCG水平均低于未妊娠组,血清T3、T4水平均高于未妊娠组(均P＜0.05).术后第1个月经周期血清β-hCG、T3、T4水平预测剖宫产瘢痕妊娠子宫动脉栓塞术后再妊娠的AUC分别为0.827、0.816、0.830,低于三者联合预测的AUC为0.933(Z=2.543、2.807、2.471,均P＜0.05).术后第1、第3个月经周期的血清β-hCG、T3、T4水平均与剖宫产瘢痕妊娠子宫动脉栓塞术后再妊娠有关,其中术后第1、第3个月经周期β-hCG为独立危险因素,T3、T4为保护因素(均P＜0.05).结论:子宫动脉栓塞术后第1个月经周期血清β-hCG、T3、T4水平联合检测可一定程度预测再妊娠情况,进而指导临床治疗.
Abstract
Objective:To investigate the relationship between serum levels of beta-human chorionic gonadotropin(β-hCG),triiodothyronine 3(T3),and thyroxine 4(T4)in patients with cesarean scar pregnancy and re pregnancy after uterine artery embolization.Methods:A total of 143 patients with cesarean scar pregnancy in our hospital from November 2019 to November 2020 were regarded as the study subjects.They were separated into a re pregnancy group of 86 cases and a non pregnancy group of 57 cases based on re pregnancy within 3 years after operation.Clinical data of the patients were recorded,chemiluminescence method was applied to measure serum β-hCG level before surgery and during the first and third menstrual cycles after surgery,ELISA method was applied to detect T3,and T4 levels.The relationship between serum β-hCG and thyroid hormone levels and re pregnancy after cesarean scar pregnancy with uterine artery embolization was analyzed using logistic regression;ROC curve was plotted to analyze the value of serum β-hCG and thyroid hormone levels in predicting re pregnancy after cesarean scar pregnancy with uterine artery embolization.Results:There was an interactive effect of serum β-hCG,T3,and T4 levels between the non pregnancy group and re pregnancy group,and among different postoperative time points(all P＜0.05);Postoperative serum β-hCG level showed a decreasing trend,while serum T3 and T4 levels showed an increasing trend.The serum β-hCG level in the pregnant group during the first and third menstrual cycles after surgery were lower than those in the non pregnant group,while the serum T3,and T4 levels were higher than those in the non pregnant group(all P＜0.05).The AUC of serum β-hCG,T3,and T4 levels in first menstrual cycle for predicting recurrent pregnancy after uterine artery embolization was 0.827,0.816,and 0.830,respectively,which were lower than the AUC of combined prediction,0.933(Z=2.543,2.807,2.471,all P＜0.05).The serum β-hCG,T3,and T4 levels in the first and third menstrual cycles after surgery were all related to re pregnancy after cesarean scar pregnancy with uterine artery embolization,β-hCG in the first and third menstrual cycles after surgery was an independent risk factor,while T3 and T4 were protective factors(all P＜0.05).Conclusion:The combined detection of serum β-hCG,T3,and T4levels in the first menstrual cycle after uterine artery embolization can predict the situation of re pregnancy to a certain extent and guide clinical treatment.
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