联合检测血清VGEF、孕酮、抑制素A及激活素A对早期异位妊娠的诊断价值
摘要
目的研究血清血管内皮生长因子(VEGF)、孕酮、抑制素A及激活素A(ACVA)在早期异位妊娠中的诊断价值。方法选取100例异位妊娠患者作为实验组,另选取与实验组患者年龄与孕期相似的100例正常妊娠孕妇作为对照组。检测并比较两组研究对象血清人绒毛膜促性腺激素(β-hCG)、孕酮、抑制素A、ACVA、VEGF的表达水平。结果实验组患者血清β-hCG表达水平为1210(18,18216)mIU/ml,明显低于对照组的7543(43, 34321)mIU/ml,差异有统计学意义(P<0.05)。实验组患者的抑制素A、孕酮、ACVA分别为94.33(4.0, 1426.8)pg/ml、14.14(2.4, 112.2)ng/ml、463.5(199.5, 3654.5)pg/ml,均明显高于对照组的6.25(4.0, 1255.6)pg/ml、3.03(0.5, 33.4)ng/ml、343.5(102.3, 2140.3)pg/ml,而VEGF水平为28.87(21.0, 626.8)pg/ml,明显低于对照组的183.44(19.0, 1423.2)pg/ml,差异均有统计学意义(P<0.05)。抑制素A+孕酮+VEGF+ACVA联合检测的整体诊断率41.5%虽低于抑制素A+孕酮+VEGF联合检测的45.0%,但准确率98%略高于抑制素A+孕酮+VEGF联合检测的97%。结论单个标志物在诊断异位妊娠过程中并无显著价值,选择抑制素A+孕酮+ACVA、抑制素A+孕酮+VEGF+ACVA等多种血清标志物联合检测可以显著提高异位妊娠的诊断价值,其中后者的诊断准确率稍高。
引文
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[2]Barnhart KT.Clinical practice.Ectopic pregnancy.N Engl J Med,2009,361(4):379-387.
[3]Arck P,Hansen PJ,Mulac Jericevic B,et al.Progesterone during pregnancy:endocrine-immune cross talk in mammalian species and the role of stress.Am J Reprod Immunol,2007,58(3):268-279.
[4]郑婷萍,薛薇,孙爱军.孕酮用于早孕保胎治疗相关研究进展.中国实用妇科与产科杂志,2012,28(9):709-712.
[5]朱前勇,李力,杨志玲,等.血清孕酮早期诊断异位妊娠的前瞻性临床研究.第三军医大学学报,2004,26(15):1395-1397.
[6]Kirk E,Papageorghiou AT,Van Calster B,et al.The use of serum inhibin A and activin A levels in predicting the outcome of pregnancies of unknown location.Hum Reprod,2009,24(10):2451-2456.
[7]Segal S,Gor H,Correa N,et al.Inhibin A:marker for diagnosis of ectopic and early abnormal pregnancies.Reprod Biomed Online,2008,17(6):789-794.
[8]Florio P,Severi FM,Bocchi C,et al.Single serum activin a testing to predict ectopic pregnancy.J Clin Endocrinol Metab,2007,92(5):1748-1753.