摘要
目的 检测β-人绒毛促性腺激素(β-hCG)、碱性磷酸酶(ALP)、癌胚抗原125(CA125)在宫外孕(EP)患者血清中表达水平,探讨经腹彩色超声联合β-hCG、ALP、CA125对EP的诊断价值.方法 选取2023年6月-2024年4月西藏自治区人民医院妇产科门诊就诊的EP患者79例作为病例组,另选正常宫内妊娠孕早期女性82例作为对照组.测定2组受试者血清β-hCG、ALP、CA125水平,腹部彩色超声检查子宫内膜厚度、盆腔积液;采用Pearson相关分析病例组血清β-hCG、ALP、CA125与腹部彩色超声参数相关性;多因素Logistic回归分析EP发生的影响因素;受试者工作特征(ROC)曲线分析经腹彩色超声联合血清β-hCG、ALP、CA125对EP的诊断价值.结果 病例组 β-hCG、ALP 低于对照组(t=21.390、19.690,P＜0.001),CA125 高于对照组(t=33.390,P 均＜0.001);与对照组比较,病例组子宫内膜厚度变薄(t=14.440,P＜0.001);子宫内膜厚度与血清β-hCG、ALP呈正相关,与CA125水平呈负相关(r=0.685、0.632、-0.701,P均＜0.001);多因素Logistic回归分析,子宫内膜增厚、血清β-hCG高以及ALP高水平是宫外孕发生的保护因素[OR(95％CI)=0.937(0.896～0.972)、0.873(0.804～0.948)、0.077(0.034～0.097)],血清CA125高水平、盆腔积液增多是宫外孕发生的危险因素[OR(95％CI)=1.232(1.161～1.307)、2.955(1.887～4.626)];子宫内膜厚度、盆腔积液、β-hCG、ALP、CA125及5项联合预测EP的AUC分别为0.843、0.802、0.942、0.843、0.916、0.988,5 项联合优于各自单独预测效能(Z/P=2.370/0.018、2.147/0.032、2.001/0.039、1.990/0.046、2.676/0.007).结论 EP患者子宫内膜变薄、盆腔积液增多、血清β-hCG水平低、ALP水平低、CA125水平高,腹部彩色超声联合血清β-hCG、ALP、CA125水平检测可提高EP的诊断效能.
Abstract
Objective To assess the serum expression levels of beta-human chorionic gonadotropin(beta-hCG),al-kaline phosphatase(ALP),and carcinoembryonic antigen 125(CA125)in patients with ectopic pregnancy(EP),and to inves-tigate the diagnostic value of transabdominal color Doppler ultrasound combined with beta-hCG,ALP,and CA125 for EP.Methods Seventy-nine EP patients who were admitted to the Gynecology Department of the Tibet Autonomous Region People's Hospital from June 2023 to April 2024 were selected as the case group,and 82 early pregnant women were selected as the control group.The levels of β-hCG,ALP,and CA125 in the serum of the two groups were measured,and the thick-ness of the endometrium and the amount of pelvic fluid were examined by transabdominal color Doppler ultrasound.The correlation between the serum β-hCG,ALP,and CA125 levels and the ultrasound parameters was analyzed by Pearson cor-relation analysis.The influencing factors of EP occurrence were analyzed by multivariate logistic regression analysis.The di-agnostic value of transabdominal color Doppler ultrasound combined with serum β-hCG,ALP,and CA125 for EP was ana-lyzed by receiver operating characteristic(ROC)curve.Results In the case group,the level of β-hCG,ALP were signifi-cantly lower than those in the control group(t=21.390,19.690,P＜0.001).Conversely,the levels of CA125 was notably higher(t=33390,P＜0.001).Furthermore,compared with the control group,the endometrial thickness was observed to be significantly thinner in the case group(t=14.440,P＜0.001).Additionally,a positive correlation was found between endome-trial thickness and serum β-hCG and ALP levels(r=0.685,0.632;P＜0.001),while a negative correlation was observed with CA125 level(r=-0.701;P＜0.001).Finally,multivariate logistic regression analysis showed that endometrial thickening,high serum β-hCG levels,and high ALP levels were protective factors for ectopic pregnancy[OR(95％CI)=0.937(0.896-0.972),0.873(0.804-0.948),0.077(0.034-0.097)],while high serum CA125 levels and increased pelvic fluid were risk fac-tors for ectopic pregnancy[OR(95％CI)=1232(1.161-1.307),2.955(1.887-4.626)].The thickness of the endometrial lin-ing,pelvic effusion,β-hCG,ALP,and CA125 demonstrated AUC values of 0.843,0.802,0.942,0.843,and 0.916 respectively.The combined AUC of these parameters was calculated to be 0.988 which indicated a superior predictive efficacy compared to individual parameters(Z=2.370,2.147,2.001,1.990,2.676,P=0.018,0.032,0.039,0.046,0.007).Conclusion EP patients have thin endometrial lining,increased pelvic fluid,low serumbeta-hCGlevels,low ALP levels,and high CA125 levels.Com-bining abdominal color ultrasound with serum beta-hCG,ALP,and CA125 levels can improve the diagnostic efficacy of EP.
基金项目
西藏自治区自然科学基金(XZ2023ZR-ZY12Z)
中国医学科学院中央级公益性科研院所基本科研(2022-RW320-02)
国家科技期刊平台
NSTL
万方数据