经阴道彩色多普勒超声联合血清β-HCG、孕酮检测对IVF-ET术后宫内外复合妊娠的诊断价值

Diagnostic value of transvaginal color Doppler sonography combined with serum β-HCG and progesterone detection for intrauterine and extrauterine compound pregnancy after IVF-ET surgery

摘要

目的 探讨经阴道彩色多普勒超声(TVCDS)联合血清人绒毛膜促性腺激素(β-HCG)、孕酮检测对体外受精-胚胎移植(IVF-ET)术后宫内外复合妊娠(HP)的诊断价值。方法 选取2021年1月至2022年6月于我院行IVF-ET术后发生HP的94例孕妇作为研究组,另选取同期80例于本院行IVF-ET术后正常妊娠者作为对照组。采用受试者工作特征(ROC)曲线分析血清β-HCG和孕酮对IVF-ET术后HP的诊断价值;采用四表格法分析TVCDS、TVCDS联合血清β-HCG和孕酮对IVF-ET术后HP的诊断价值;采用Kappa检验分析TVCDS以及三者联合诊断IVF-ET术后HP与临床诊断的一致性。结果 采用TVCDS检查HP患者宫腔内可见妊娠囊,同时附件区见妊娠囊或异位妊娠包块,其中直接征象37例,间接征象48例;研究组血清β-HCG、孕酮水平均低于对照组(t值分别为14.881和14.705,P<0.001);血清β-HCG、孕酮水平诊断IVF-ET术后HP的曲线下面积(AUC)分别为0.914(95%CI:0.862~0.951)、0.929(95%CI:0.880~0.962),灵敏度分别为90.42%、91.48%,特异度分别为80.00%、82.50%;TVCDS单独诊断IVF-ET术后HP的灵敏度为75.53%,特异度为85.00%,准确度为79.88%,与临床诊断一致性为中度(Kappa值=0.599,P<0.001);TVCDS联合血清β-HCG、孕酮诊断IVF-ET术后HP的灵敏度为95.74%,特异度为77.50%,准确度为87.35%,与临床诊断一致性较高(Kappa值=0.742,P<0.001)。结论 TVCDS联合血清β-HCG、孕酮对IVF-ET术后宫内外复合妊娠具有较高的诊断价值。

Abstract

Objective To explore the diagnostic value of transvaginal color Doppler sonography (TVCDS) combined with serum β-human chorionic gonadotropin (β-HCG) and progesterone testing in the diagnosis of heterotopic pregnancy (HP) after in vitro fertilization and embryo transfer (IVF-ET). Methods A total of 94 pregnant women who experienced HP after IVF-ET in our hospital from January 2021 to June 2022 were selected as the study group. Additionally, 80 patients with normal pregnancies following IVF-ET during the same period were selected as the control group. Receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic value of serum β-HCG and progesterone for postoperative HP after IVF-ET. The fourfold table method was applied to analyze the diagnostic value of TVCDS, as well as the combination of TVCDS with serum β-HCG and progesterone for HP after IVF-ET. Kappa test was performed to analyze the consistency of TVCDS and the combination of the three diagnostic methods with clinical diagnoses for HP after IVF-ET. Results TVCDS examination of patients with HP revealed an intrauterine gestational sac, while an ectopic gestational sac or mass was observed in the adnexal region, with 37 cases showing direct signs and 48 cases showing indirect signs. Serum levels of β-HCG and progesterone in the study group were significantly lower than those in the control group (t=14.881 and 14.705, respectively, P<0.001). The area under the curve (AUC) for serum β-HCG and progesterone in diagnosing HP following IVF-ET were 0.914 (95%CI: 0.862-0.951) and 0.929 (95%CI: 0.880-0.962), respectively, with sensitivities of 90.42% and 91.48%, and specificities of 80.00% and 82.50%. The sensitivity of TVCDS alone in diagnosing HP post-IVF-ET was 75.53%, specificity was 85.00%, and accuracy was 79.88%, demonstrating moderate consistency with clinical diagnosis (Kappa=0.599, P<0.001). When combined with serum β-HCG and progesterone, the sensitivity for diagnosing HP after IVF-ET increased to 95.74%, with a specificity of 77.50% and an accuracy of 87.35%, indicating high consistency with clinical diagnosis (Kappa=0.742, P<0.001). Conclusion TVCDS combined with serum β-HCG and progesterone has high diagnostic value for postoperative HP after IVF-ET.

关键词

经阴道彩色多普勒超声 / 人绒毛膜促性腺激素 / 孕酮 / 体外受精-胚胎移植 / 宫内外复合妊娠

Key words

transvaginal color Doppler sonography / β-human chorionic gonadotropin / progesterone / in vitro fertilization and embryo transfer / heterotopic pregnancy

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基金资助

河北省2022年度医学科学研究课题计划(20220682)