王颖 高艳珠 张月莲

[摘要] 目的 探讨血清孕酮（P）、血β-人绒毛膜促性腺激素（β-HCG）、促甲状腺激素（TSH）联合检测在预测早期妊娠结局中的临床价值。 方法 回顾性分析2013年12月～2015年5月在山西医学科学院就诊的100例正常妊娠患者（正常妊娠组）、80例继续妊娠患者（继续妊娠组）和80例难免流产患者（难免流产组），采用美国贝克曼公司的DXI800化学发光免疫分析仪及配套试剂测定三组患者血清中的P、β-HCG 、TSH值。 结果 P、β-HCG、TSH的受试者工作特征曲线（ROC） 下面积分别为 0.702、0.776、0.468，联合检测的ROC曲线下面积为 0.999。血清P、β-HCG、TSH预测活胎与难免流产的cut-off 值分别为12.90 ng/ml、10 258 mIU/ml、2.5 mIU/L。将各项激素的cut-off 值设定为临界值，得出难免流产组的P、β-HCG水平显著低于正常妊娠组和继续妊娠组，阳性率高于正常妊娠组和继续妊娠组，TSH水平和阳性率均显著高于正常妊娠组和继续妊娠组（P均<0.05）； 3项激素中，β-HCG的阳性率（68.00%）最高；P、β-HCG、TSH联合检测的灵敏度为68.75%，特异度为71.50%，阳性预测值为51.56%，阴性预测值为72.36%，各指标均高于单项检测（P<0.05）。 结论 单项激素预测早期妊娠结局的价值不高。P、β-HCG、TSH联合检测有助于提高难免流产的诊断性能和早期检出率，3项激素联合检测是预测难免流产较理想的标志物组合。

[关键词] 孕酮；β-人绒毛膜促性腺激素；促甲状腺激素；妊娠

[中图分类号] R446.11+2 [文献标识码] A [文章编号] 1674-4721（2016）03（c）-0113-04

[Abstract] Objective To investigate the clinical value of combined detection of serum progesterone （P），blood β-human chorionic gonadotropin （β-HCG） and thyroid stimulating hormone （TSH） in the prediction of early pregnancy outcome. Methods 100 patients with normal pregnancy （normal pregnancy group），80 patients continuing pregnancy （continuing pregnancy group） and 80 patients with inevitable abortion （inevitable abortion group） treated by Shanxi Acadmey of Medical Science from December 2013 to May 2015 were retrospectively analyzed.DXI800 chemiluminescence immunoassay analyzer and supporting reagent in Beckman company of America was used to detect the serum P，β-HCG，and TSH value in three groups. Results The area under of receiver operating characteristic curve （ROC） was 0.702，0.776，0.468 respectively，and the area under of ROC for combined detection was 0.999.Cut-off value of serum P，β-HCG，TSH predicting live birth and inevitable abortion was 12.90 ng/ml，102 58 mIU/ml，2.5 mIU/L respectively.Cut-off value of each hormone was set as the critical value，it showed that P and β-HCG level in inevitable abortion group was significantly lower than that of normal pregnancy group and continuing pregnancy group respectively，positive rate was higher than that of normal pregnancy group and continuing pregnancy group respectively，and TSH level and positive rate was significantly higher than that of normal pregnancy group and continuing pregnancy group respectively （all P<0.05）.Among 3 kinds of hormone，positive rate of β-HCG was highest （68.00%）；sensitivity was 68.75%，the specificity was 71.50%，the positive predictive value was 51.56%，the negative predictive value was 72.36% of combined detection of P，β-HCG and TSH，and each index was higher than that of single detection （P<0.05）. Conclusion The value of single hormone predicting early pregnancy outcome is not high.Combined detection of P and hCG and TSH helps to improve the diagnostic performance and early detection rate of inevitable abortion.Combined detection of 3 hormone an more ideal marker combination predicting inevitable abortion.

[Key words] Progesterone；β-human chorionic gonadotropin；Thyroid stimulating hormone；Pregnancy

早期先兆流产是妇产科常见病与多发病，据统计60%～65%的患者在休息或保胎治疗后可继续妊娠。虽如此，仍有35%的患者因各种原因最终导致难免流产。目前，临床上多采用监测β-人绒毛膜促性腺激素（β-human chorionic gonadotropin，β-HCG）及孕酮（progesterone，P）的动态变化来预测结局并指导治疗，但为了提高预测的准确性，近年来，理论上和临床上都建议选取相关的指标进行联合检测。到目前为止，预测流产的最佳指标组合尚无定论。本文拟通过联合检测孕早期妇女血清中P、β-HCG、促甲状腺激素（thyroid-stimulating hormone，TSH） 的水平，进一步探讨此种联合方式对预测难免流产的临床意义。……