本文選題：宮外孕 + 免疫化學(xué)發(fā)光技術(shù)�。� 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:異位妊娠(ectopic pregnancy,EP)-孕卵在子宮腔以外著床發(fā)育的異常妊娠過程,也稱“宮外孕”。異位妊娠是婦產(chǎn)科常見的急腹癥之一,當(dāng)異位妊娠發(fā)生破裂或流產(chǎn)后,可造成急性腹腔內(nèi)出血,嚴(yán)重者危及患者生命,是妊娠相關(guān)疾病死亡率很高的疾病。臨床實(shí)踐中大部分異位妊娠患者在目前的診療技術(shù)支持下,在發(fā)生嚴(yán)重內(nèi)出血之前即能診斷,并得到及時(shí)治療;但是也有不少個(gè)體,特別是臨床癥狀和體征不典型時(shí),常易導(dǎo)致誤診,因此對(duì)異位妊娠病例的早期發(fā)現(xiàn),及時(shí)終止妊娠是降低母體大出血和死亡率的有效方法。加之近年來國內(nèi)外文獻(xiàn)時(shí)有報(bào)道異位妊娠的發(fā)病率呈明顯上升趨勢(shì),而且越來越年輕化,所以探索診斷方法使之早期、快速的診斷異位妊娠迫在眉睫。本研究探討聯(lián)合應(yīng)用人絨毛膜促性腺激素(β-HCG)、孕酮及B超測(cè)定子宮內(nèi)膜厚度的相關(guān)數(shù)據(jù)分析在宮外孕的早期診斷中的價(jià)值。方法:1選擇正定縣人民醫(yī)院于2016年1月-2017年1月期間在我院婦產(chǎn)科收治的70例宮外孕患者作為異位妊娠組,并且這些患者最終均經(jīng)手術(shù)和病理篩查明確診斷為宮外孕;同期選擇正常早孕孕婦70例作為正常早孕組(對(duì)照組)。檢測(cè)并且對(duì)比兩組患者的:人絨毛膜促性腺激素(β-HCG)、孕酮及B超探測(cè)子宮內(nèi)膜厚度,之后研究各項(xiàng)指標(biāo)單獨(dú)檢測(cè)和聯(lián)合檢測(cè)對(duì)異位妊娠早期診斷的特異性、敏感性、誤診率、漏診率、診斷符合率。2指標(biāo)檢測(cè):所有患者在膀胱充盈之后采用飛利浦彩色超聲診斷儀進(jìn)行腹部檢查,測(cè)定子宮內(nèi)膜厚度;貝克曼庫爾特化學(xué)發(fā)光儀檢測(cè)血清βHCG、孕酮水平。取子宮內(nèi)膜厚度、血清βHCG、孕酮的相關(guān)數(shù)據(jù)進(jìn)行分析。3統(tǒng)計(jì)學(xué)方法:采用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理。計(jì)量資料符合正態(tài)分布的資料以?x±s表示,兩組間數(shù)據(jù)比較采用t檢驗(yàn),非正態(tài)分布資料經(jīng)過對(duì)數(shù)轉(zhuǎn)換后,采用非參數(shù)的秩和檢驗(yàn)。計(jì)數(shù)資料采用例或者百分率進(jìn)行統(tǒng)計(jì)描述,卡方檢驗(yàn)進(jìn)行分析。均以P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1異位妊娠組與正常早孕組一般資料比較:兩組在基本資料年齡、身高、體重、月經(jīng)周期、停經(jīng)天數(shù)等基本資料方面比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2診斷指標(biāo)。異位妊娠組患者β-HCG、Prog及子宮內(nèi)膜厚度水平分別為(4877.4±1072.1miu/ml)、(3.47±0.71 ng/ml)、(5.97±0.95mm),均低于正常早孕組(11141.5±2162.2miu/ml)、(38.69±9.02ng/ml)、(15.87±1.6mm)(P0.05)。3單項(xiàng)指標(biāo)診斷評(píng)價(jià)。血清β-HCG的靈敏度80%,特異性56.3%,漏診率20%,誤診率43.7%,診斷符合率75.6%;孕酮的靈敏度77.1%,特異性81.3%,漏診率22.9%,誤診率18.7%,診斷符合率77.9%;超聲子宮內(nèi)膜厚度的靈敏度82.9%,特異性87.5%,漏診率17.1%,誤診率12.5%,診斷符合率83.7%。4指標(biāo)協(xié)同診斷評(píng)估。三項(xiàng)指標(biāo)項(xiàng)聯(lián)合其三項(xiàng)指標(biāo)聯(lián)合測(cè)定的靈敏度87.1%,特異性92.8%,診斷符合率88.4%.均有所提升,漏診率12.9%,誤診率6.2%,均有大幅度的下降。結(jié)論:單項(xiàng)指標(biāo)中超聲子宮內(nèi)膜厚度檢測(cè)的靈敏度、漏診率、和診斷符合率優(yōu)于單獨(dú)檢測(cè)β-HCG和孕酮;單獨(dú)檢測(cè)孕酮的特異度、誤診率、優(yōu)于單獨(dú)檢測(cè)β-HCG;而單獨(dú)β-HCG檢測(cè)的漏診率、靈敏度和診斷符合率優(yōu)于單獨(dú)檢測(cè)孕酮。而三項(xiàng)聯(lián)合診斷其靈敏度、特異度、診斷符合率均大幅度提升;而誤診率和漏診率大幅度下降。為臨床檢測(cè)異位妊娠提供更好的快速無創(chuàng)的診斷方法。
[Abstract]:Objective: ectopic pregnancy (ectopic pregnancy, EP) - the abnormal pregnancy process of pregnancy outside the uterine cavity, also known as "ectopic pregnancy". Ectopic pregnancy is one of the most common acute abdomen in obstetrics and gynecology. When ectopic pregnancy breaks or abortions, it can cause acute intraperitoneal hemorrhage, the serious person endangers the patient's life and is the death of pregnancy related diseases. Most of the ectopic pregnancy patients in clinical practice can be diagnosed and treated in time before severe internal hemorrhage, but there are many individuals, especially when the symptoms and signs are untypical, often lead to misdiagnosis, so early discovery of ectopic pregnancy cases, in time end. Pregnancy is an effective way to reduce maternal bleeding and mortality. In addition, in recent years, the incidence of ectopic pregnancy is obviously rising in the literature at home and abroad, and it is becoming more and more young. Therefore, the diagnosis method makes it early and fast to diagnose ectopic pregnancy in the eyebrow. This study is to discuss the combined application of human chorionic gonadotropin. The value of the correlation data of hormone (beta -HCG), progesterone and B-ultrasound in the determination of endometrium thickness in the early diagnosis of ectopic pregnancy. Methods: 1 the 70 cases of ectopic pregnancy treated in the obstetrics and Gynecology Department of Zhengding County in January 2016 -2017 year were selected as ectopic pregnancy group, and these patients were eventually performed by surgical and pathological screening. The diagnosis was diagnosed as ectopic pregnancy, and 70 normal preconception pregnant women were selected as the normal early pregnancy group (control group) at the same time. The human chorionic gonadotropin (beta -HCG), progesterone and B-ultrasound were detected and compared with the two groups. The specificity and sensitivity of each index and joint detection for early diagnosis of ectopic pregnancy were studied. Sensibility, misdiagnosis rate, missed diagnosis rate, diagnostic coincidence rate.2 index detection: after the bladder filling, all patients were examined with PHILPS color ultrasonic apparatus for abdominal examination and measured the thickness of endometrium; Beckman Kurt chemiluminescence detector was used to detect the serum beta HCG, progesterone level, the thickness of the endometrium, serum beta HCG, progesterone and the related data. Analysis of.3 statistical method: data processing with SPSS 22 statistical software. The data of measurement data conforms to normal distribution with x + s, and the data of the two groups are compared with t test. After the non normal distribution data are converted to the logarithm, the non parametric rank sum test is used. The statistical description of the use case or percentage of the counting data is described, and the chi square test The difference was statistically significant by P0.05. Results: 1 the general data of the ectopic pregnancy group and the normal pregnancy group: the two groups were compared with the basic data of the basic data age, height, weight, menstrual cycle, and the number of days of menopause (P0.05).2 diagnostic index. The patients with ectopic pregnancy were in beta -HCG, Prog and uterus. The thickness of endometrium was (4877.4 + 1072.1miu/ml), (3.47 + 0.71 ng/ml), (5.97 + 0.95mm), lower than normal early pregnancy (11141.5 + 2162.2miu/ml), (38.69 + 9.02ng/ml), (15.87 + 1.6mm) (15.87 + 1.6mm) (P0.05).3 single index diagnostic evaluation. Serum beta -HCG, specificity 56.3%, 20%, missed diagnosis rate 43.7%, diagnostic coincidence rate 75.6%; progesterone; progesterone The sensitivity was 77.1%, the specificity was 81.3%, the missed diagnosis rate was 22.9%, the misdiagnosis rate was 18.7%, the diagnostic coincidence rate was 77.9%, the sensitivity of the endometrium thickness was 82.9%, the specificity 87.5%, the missed diagnosis rate 17.1%, the misdiagnosis rate 12.5%, the diagnostic coincidence rate 83.7%.4 index cooperative diagnosis evaluation. Three index items combined with the sensitivity 87.1% and specific 92.8% of the combined determination of the three indexes. The diagnostic coincidence rate of 88.4%. was enhanced, the rate of missed diagnosis was 12.9%, the rate of misdiagnosis was 6.2%. Conclusion: the sensitivity of endometrial thickness detection, missed diagnosis rate and diagnostic coincidence rate in single index were better than that of beta -HCG and progesterone alone; the specificity of progesterone and the rate of misdiagnosis were better than that of beta -HCG alone; and the single beta -HCG was compared. The rate of missed diagnosis, sensitivity and diagnostic coincidence rate were superior to that of progesterone alone. The sensitivity, specificity and diagnostic coincidence rate of the three joint diagnosis were greatly improved, and the misdiagnosis rate and missed diagnosis rate decreased greatly. It provided a better and faster non invasive diagnosis method for clinical detection of ectopic pregnancy.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.22

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