CAJ | 학술논문

目的探讨腹腔血与静脉血hCG比值(RPhCG/VhCG)在诊断异位妊娠中的价值.方法前瞻性分析2009年3月至2012年10月在上海交通大学医学院附属国际和平妇幼保健院、上海交通大学附属第六人民医院以及上海市江湾医院就诊的可疑异位妊娠患者321例,其中明确异位妊娠共268例(异位妊娠组),宫内妊娠合并腹腔积血(hIUP) 53例(hIUP组).所有患者均同时取腹腔积血(后穹隆穿刺或术中抽取)和静脉血,送同位素室双盲测定hCG值并计算RPhCG/VhCG0.散点分析和受试者工作特征(ROC)曲线分析RPhCG、VhCG鉴别异位妊娠与hIUP的临界值,并评估其术前诊断异位妊娠的敏感度、特异度及准确度.结果异位妊娠组中位RPhCG/VhCG为4.35,明显高于hIUP组中位RPhCG、VhCG0.81,两组比较,差异有统计学意义(P＜0.01)；散点分析显示,异位妊娠与hIUP的RPhCG/VhCG的临界值为1.0.以RPhCG/VhCG＞ 1.0为诊断标准,诊断异位妊娠的敏感度为98％,特异度为100％,阳性预测值100％,阴性预测值93％.结论以RPhCG、VhCG＞1.0为标准可以快速、准确地协助诊断异位妊娠,有利于术前和术中执行正确的决策.
목적 탐토복강혈여정맥혈hCG비치(RPhCG/VhCG)재진단이위임신중적개치.방법 전첨성분석2009년3월지2012년10월재상해교통대학의학원부속국제화평부유보건원、상해교통대학부속제륙인민의원이급상해시강만의원취진적가의이위임신환자321례,기중명학이위임신공268례(이위임신조),궁내임신합병복강적혈(hIUP) 53례(hIUP조).소유환자균동시취복강적혈(후궁륭천자혹술중추취)화정맥혈,송동위소실쌍맹측정hCG치병계산RPhCG/VhCG0.산점분석화수시자공작특정(ROC)곡선분석RPhCG、VhCG감별이위임신여hIUP적림계치,병평고기술전진단이위임신적민감도、특이도급준학도.결과 이위임신조중위RPhCG/VhCG위4.35,명현고우hIUP조중위RPhCG、VhCG0.81,량조비교,차이유통계학의의(P＜0.01)；산점분석현시,이위임신여hIUP적RPhCG/VhCG적림계치위1.0.이RPhCG/VhCG＞ 1.0위진단표준,진단이위임신적민감도위98％,특이도위100％,양성예측치100％,음성예측치93％.결론 이RPhCG、VhCG＞1.0위표준가이쾌속、준학지협조진단이위임신,유리우술전화술중집행정학적결책.
Objective To study the value of hCG ratio of blood in peritoneal cavity versus venous blood (RPhCG/VhcG) in diagnosis of early ectopic pregnancy (EP).Methods From Mar.2009 to Oct.2012,268 cases with EP (EP group) and 53 women with intrauterine pregnancy with haemoperitoneum (hIUP) (hIUP group) from International Peace Maternity and Child Health Hospital of Shanghai Jiaotong University School of Medicine,Shanghai 6th People Hospital and Shanghai Jiangwan Hospital were enrolled in this prospective study.The HCG of all subjective were measured in blood in peritonea cavity and venous blood,then calculate the ratio of RPhCG/VhCG.Scatter point analysis and ROC were used to differentiate EP,determine threshold of hlUP and evaluate the sensitivity,specificity and accuracy in diagnosis EP preoperatively.Results The mean RPhCG/VhCG; of EP group was 4.35,which was significantly higher than 0.81 in hIUP group (P ＜ 0.01).Scatter point analysis showed that the threshold value of RPhCG/VhCG between ectopic pregnancy and hIUP was 1.0.The overall sensitivity of RPhCG/VhcG in the diagnosis of EP was 98％,the specificity was 100％,the positive predictive value was 100％ and the negtive predictive value was 93％.Conclusion RPhCG/VhCG ＞ 1.0 could be used to diagnose and differentiate EP from hIUP accurately.