CAJ | 학술논문

目的：探讨超声及血清β-人绒毛膜促性腺激素（β-hCG）检查对早期未知部位妊娠（ PUL）结局的评估价值。方法选取2011年5月—2013年5月在新疆医科大学第一附属医院住院的109例PUL患者，均有明确停经史，停经4~6周；尿或血清β-hCG检查阳性；入院首次超声检查显示宫腔内外均未见典型孕囊，且于入院当天及48 h后行血清β-hCG检查。按照妊娠结局分为3组：宫内妊娠活胎组（ IUP组，31例）、宫内妊娠流产组（ IUPM组，21例）及异位妊娠组（ EP组，57例）。分析并比较3组的子宫内膜厚度、妊娠黄体血流分布情况及血清β-hCG 48 h增长值。结果超声检查显示：IUP组子宫内膜厚度〔（1.25±0.22） cm〕较IUPM组〔（0.78±0.30）cm〕、EP组〔（0.75±0.31）cm〕厚（P<0.001），IUPM组与EP组子宫内膜厚度间差异无统计学意义（P>0.05）。IUPM组和EP组妊娠黄体血流信号缺失率高于IUP组，EP组高于IUPM组（ P<0.05）。IUP组血清β-hCG 48 h增长值〔（2569±1033）mmol/L〕高于IUPM组〔（234±264）mmol/L〕和EP组〔（456±571）mmol/L〕，EP组高于IUPM组（P<0.05）；IUP组血清β-hCG 48 h增长率>60%者比例〔93.5%（29/31）〕高于IUPM组〔14.3%（3/21）〕和EP组〔33.3%（19/57）〕，EP组高于IUPM组（P<0.017）。结论超声检测子宫内膜厚度、妊娠黄体血流信号缺失情况及血清β-hCG 48 h增长率对PUL的结局评估有一定临床指导价值。
목적：탐토초성급혈청β-인융모막촉성선격소（β-hCG）검사대조기미지부위임신（ PUL）결국적평고개치。방법선취2011년5월—2013년5월재신강의과대학제일부속의원주원적109례PUL환자，균유명학정경사，정경4~6주；뇨혹혈청β-hCG검사양성；입원수차초성검사현시궁강내외균미견전형잉낭，차우입원당천급48 h후행혈청β-hCG검사。안조임신결국분위3조：궁내임신활태조（ IUP조，31례）、궁내임신유산조（ IUPM조，21례）급이위임신조（ EP조，57례）。분석병비교3조적자궁내막후도、임신황체혈류분포정황급혈청β-hCG 48 h증장치。결과초성검사현시：IUP조자궁내막후도〔（1.25±0.22） cm〕교IUPM조〔（0.78±0.30）cm〕、EP조〔（0.75±0.31）cm〕후（P<0.001），IUPM조여EP조자궁내막후도간차이무통계학의의（P>0.05）。IUPM조화EP조임신황체혈류신호결실솔고우IUP조，EP조고우IUPM조（ P<0.05）。IUP조혈청β-hCG 48 h증장치〔（2569±1033）mmol/L〕고우IUPM조〔（234±264）mmol/L〕화EP조〔（456±571）mmol/L〕，EP조고우IUPM조（P<0.05）；IUP조혈청β-hCG 48 h증장솔>60%자비례〔93.5%（29/31）〕고우IUPM조〔14.3%（3/21）〕화EP조〔33.3%（19/57）〕，EP조고우IUPM조（P<0.017）。결론초성검측자궁내막후도、임신황체혈류신호결실정황급혈청β-hCG 48 h증장솔대PUL적결국평고유일정림상지도개치。
Objective To investigate the clinical values of combined detection of ultrasound and serum beta human chorionic gonadotropin(beta-hCG)examination in predicting early pregnancy of unknown location(PUL)outcome. Methods 109 cases of PUL admitted to the First Affiliated Hospital of Xinjiang Medical University from May 2011 to May 2013 were se-lected. All the cases had a history of menopause for 4 to 6 weeks,and had positive outcome of urine or serum beta-hCG examina-tion. The first ultrasound examination after admission showed no typical fertilized egg both inside and outside the uterus,and then the beta-hCG examination was performed on the day of admission and 48 h later. All the cases were divided into IUP group(31 cases),IUPM group(21 cases)and EP group(57 cases). The 48 h growth of endometrial thickness,pregnancy luteal blood flow distribution and serum beta-hCG were compared between the three groups. Results The ultrasound examination showed that the IUP group had thicker endometrial thickness〔(1. 25 ± 0. 22)cm〕compared with the IUPM group〔(0. 78 ± 0. 30)cm〕and EP group〔(0. 75 ±0. 31)cm〕(P<0. 001),while the endometrial thickness between the IUPM group and EP group showed no statistically significant difference ( P >0. 05 ) . IUPM group and EP group blood signal loss rate were higher than that of IUP group,EP group was higher than in IUPM group(P<0. 05). The beta-hCG 48 h growth value in the IUP group〔(2 569 ±1 033)mmol/L〕was higher than the IUPM group〔(234 ±264)mmol/L〕and EP group〔(456 ±571)mmol/L〕,and the EP group was also higher than the IUPM group ( P<0. 05 ) . The proportion of beta-hCG 48 h growth>60% in IUP group〔93. 5%(29/31)〕was higher than the IUPM group〔14. 3%(3/21)〕and EP group〔33. 3%(19/57)〕,and the EP group was also higher than the IUPM group(P<0. 017). Conclusion Ultrasonic detection of endometrial thickness,pregnancy lute-al blood flow signal loss and serum beta-hCG 48 h growth rate has certain clinical value in evaluating the PUL pregnancy out-come.