妊娠早期雌二醇监测对妊娠结局预测价值的探讨
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摘要
目的探讨雌二醇(estradiol,E2)早期监测对预测妊娠结局的临床价值。方法收集浙江中医药大学附属温州中医院妇产科门诊及住院收治的自然妊娠孕妇721例为研究对象,根据最后妊娠结局分组,其中正常妊娠病例170例为正常妊娠组,稽留流产447例为稽留流产组,异位妊娠104例为异位妊娠组。入选的孕妇均在就诊当日抽取静脉血,检测血清E2表达水平。结果三组孕妇的年龄、停经时间比较,差异均无统计学意义(F=0. 314、0. 287,均P>0. 05);三组孕妇的血清E2值比较,差异有统计学意义(F=12. 463,P <0. 05)。E2判断正常妊娠和稽留流产的cut-off值为738. 9 pmol/L,此点的敏感度为0. 835、特异度为0. 902、阳性预测值为0. 763、阴性预测值为0. 935,漏诊率为0. 065。E2判断正常妊娠和异位妊娠的cut-off值为480. 6 pmol/L,此点的敏感度为0. 882、特异度为0. 904、阳性预测值为0. 938、阴性预测值为0. 825,漏诊率为0. 175。结论本研究发现血清E2值的高低可用于指导判断早期宫内妊娠的结局,正常妊娠和稽留流产的最佳临界值为738. 9 pmol/L,正常妊娠和异位妊娠的最佳临界值为480. 6 pmol/L,对于判断早孕预后有一定的指导价值。
Objective To study the clinical value of early monitoring of estradiol(E2) in predicting pregnancy outcome.Methods Seven hundred and twenty-one natural pregnant women were collected from outpatients and inpatients in Department of Obstetrics and Gynecology,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University to serve as the research subjects. According to the final pregnancy outcomes,the subjects were divided into the normal pregnancy group(n = 170),the missed abortion group(n = 447) and the ectopic pregnancy group(n = 104). Venous blood samples of pregnant women of the three groups were collected on the day of the visiting,and then their serum E2 levels were detected. Results No statistically significant differences were found in age and menopause time among the three groups(F = 0. 314,F = 0. 287,both P> 0.05),but there was a statistically significant difference in the serum E2 value among the three groups(F = 12. 463,P< 0.05).The cut-off value of E2 to judge normal pregnancy and missed abortion was 738. 9 pmol/L,and its sensitivity,specific degree,positive predictive value,negative predictive value and missed diagnosis rate were 0.835,0.902,0.763,0.935 and 0.065 respectively. The cut-off value of E2 to judge normal pregnancy and ectopic pregnancy was 480.6 pmol/L,and its sensitivity,specific degree,positive predictive value,negative predictive value and missed diagnosis rate were 0.882,0.904,0.938,0.825 and 0.175 respectively. Conclusions This study indicates that serum E2 value can be used to judge the outcome of early intrauterine pregnancy. The best critical value to judge normal pregnancy and missed abortion is 738.9 pmol/L,and the best critical value to judge normal pregnancy and ectopic pregnancy is 480. 6 pmol/L,they have certain guide value to judging the prognosis of early pregnancy.
Objective To study the clinical value of early monitoring of estradiol(E2) in predicting pregnancy outcome.Methods Seven hundred and twenty-one natural pregnant women were collected from outpatients and inpatients in Department of Obstetrics and Gynecology,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University to serve as the research subjects. According to the final pregnancy outcomes,the subjects were divided into the normal pregnancy group(n = 170),the missed abortion group(n = 447) and the ectopic pregnancy group(n = 104). Venous blood samples of pregnant women of the three groups were collected on the day of the visiting,and then their serum E2 levels were detected. Results No statistically significant differences were found in age and menopause time among the three groups(F = 0. 314,F = 0. 287,both P> 0.05),but there was a statistically significant difference in the serum E2 value among the three groups(F = 12. 463,P< 0.05).The cut-off value of E2 to judge normal pregnancy and missed abortion was 738. 9 pmol/L,and its sensitivity,specific degree,positive predictive value,negative predictive value and missed diagnosis rate were 0.835,0.902,0.763,0.935 and 0.065 respectively. The cut-off value of E2 to judge normal pregnancy and ectopic pregnancy was 480.6 pmol/L,and its sensitivity,specific degree,positive predictive value,negative predictive value and missed diagnosis rate were 0.882,0.904,0.938,0.825 and 0.175 respectively. Conclusions This study indicates that serum E2 value can be used to judge the outcome of early intrauterine pregnancy. The best critical value to judge normal pregnancy and missed abortion is 738.9 pmol/L,and the best critical value to judge normal pregnancy and ectopic pregnancy is 480. 6 pmol/L,they have certain guide value to judging the prognosis of early pregnancy.
引文
[1]魏璐华,罗艳,戴峻.雌二醇的监测对预测早期先兆流产妊娠结局的重要性探讨[J].中国妇幼保健,2014,29(2):2204-2205.
[2]薛玉华,李连,欧阳贵平.血清β-hCG、雌二醇和孕酮联合检测在异位妊娠早期诊断与保守治疗中的价值[J].中国医学创新,2015,12(12):119-122.
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[7] Hickey M,Hart R,Keelan JA. The relationship between umbilical cord estrogens and perinatal characteristics[J].Cancer Epidemiol Biomarkers Prev,2014,23(6):946-952.
[8]刘居莉,杨焕礼.妊娠期糖代谢监测预防妊娠相关并发症、胎儿不良结局价值分析[J].实用预防医学,2017,15(6):723-725.
[9]赵杨,闻安民,梁洁玲.血β-HCG、孕酮、雌二醇和B超检查预测宫内妊娠早期阴道流血结局[J].中山大学学报(医学科学版),2015,36(1):109-112.
[10]李维艳,刘玉昆,郭仲杰,等.妊娠4~9周孕妇血清雌二醇变化与妊娠结局的关系[J].热带医学杂志,2012,12(4):450-452.
[11]马琳琳,梁琳,吕爱明,等.孕早期首次雌二醇、黄体酮及β-HCG水平及其变化趋势对妊娠结局的预测价值研究[J].中国临床医生杂志,2016,44(2):98-100.
[2]薛玉华,李连,欧阳贵平.血清β-hCG、雌二醇和孕酮联合检测在异位妊娠早期诊断与保守治疗中的价值[J].中国医学创新,2015,12(12):119-122.
[3]易旺云,袁明生.血清雌二醇联合孕酮检测在预测早期宫内妊娠结局中的临床价值研究[J].中国妇幼保健,2015,30(7):1069-1071.
[4]易旺云.妊娠早期血清雌二醇水平预测宫内妊娠结局的临床价值研究[J].中国全科医学,2014,17(18):2130-2132.
[5]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013:47-107.
[6]曹珊,侯灵彤,董建新,等.不同妊娠结局孕早期相关激素水平的变化规律[J].中国综合临床,2014,30(10):1100-1103.
[7] Hickey M,Hart R,Keelan JA. The relationship between umbilical cord estrogens and perinatal characteristics[J].Cancer Epidemiol Biomarkers Prev,2014,23(6):946-952.
[8]刘居莉,杨焕礼.妊娠期糖代谢监测预防妊娠相关并发症、胎儿不良结局价值分析[J].实用预防医学,2017,15(6):723-725.
[9]赵杨,闻安民,梁洁玲.血β-HCG、孕酮、雌二醇和B超检查预测宫内妊娠早期阴道流血结局[J].中山大学学报(医学科学版),2015,36(1):109-112.
[10]李维艳,刘玉昆,郭仲杰,等.妊娠4~9周孕妇血清雌二醇变化与妊娠结局的关系[J].热带医学杂志,2012,12(4):450-452.
[11]马琳琳,梁琳,吕爱明,等.孕早期首次雌二醇、黄体酮及β-HCG水平及其变化趋势对妊娠结局的预测价值研究[J].中国临床医生杂志,2016,44(2):98-100.