腹腔与静脉血中生化标志物的比值对输卵管妊娠破裂的诊断作用
Value of ratios of biomarkers of celiac blood and venous blood for diagnosis of ruptured tubal pregnancy

目的 分析输卵管妊娠患者腹腔血与静脉血清中糖类抗原125 （CA125）、β-人绒毛膜促性腺素（β-hCG）、孕酮（P）、肌酸激酶（CK）和血管内皮生长因子（VEGF）含量及其比值，分析各指标与不同类型输卵管妊娠间的关系，寻找早期诊断输卵管妊娠破裂的生化标志物。方法 测定322例输卵管妊娠患者静脉血清及腹腔血中CA125、β-hCG、P、CK和VEGF的含量，计算腹腔血与静脉血清中各标志物的比值（Rv/p），绘制受试者工作特征曲线（ROC曲线）并确定各项值诊断输卵管妊娠破裂型的最佳界值，评价其诊断输卵管妊娠破裂的灵敏度和特异度。结果 ①CA125v、β-hCGv、Pv、CKv、VEGFv诊断输卵管妊娠破裂型的ROC曲线下面积(AUCROC)分别为0.528、0.674、0.570、0.643和0.542。②CA125p、β-hCGp、Pp、CKp、VEGFp诊断输卵管妊娠破裂型的AUCROC分别为0.896、0.595、0.656、0.586和0.682。③Rv/p-CA125、Rv/p-(β-hCG)、Rv/p-P、Rv/p-CK和Rv/p-VEGF诊断输卵管妊娠破裂型的AUCROC分别为0.883、0.757、0.607、0.628和0.598。④当CA125p<400.15 U/mL时，其诊断输卵管妊娠破裂的灵敏度为73.68%，特异度达92.83%。⑤当Rv/p-CA125<15.20时，其诊断输卵管妊娠破裂的灵敏度和特异度分别为73.68%和89.81%。结论 当CA125p<400.15 U/mL或Rv/p-CA125<15.20时可诊断为输卵管妊娠破裂型，而CA125p<400.15 U/mL的特异度更高。
： Objective To analyze the levels and ratios of carbohydrate antigen 125 (CA125), β-human chorionic gonadotropin (β-hCG), vascular endothelial growth factor (VEGF), creatine kinase (CK), and progesterone (P) of both celiac blood and venous blood of patients with tubal pregnancy, explore the correlation of biomarkers and tubal pregnancy types, and identify biomarkers for the early diagnosis of ruptured tubal pregnancy. Methods The levels of CA125, β-hCG, VEGF, CK, and P of both celiac blood and venous blood of 322 patients with tubal pregnancy were detected. Ratios (Rv/p) of biomarkers of celiac blood and venous blood were calculated. The receiver operating characteristic (ROC) curve was drawn. Best diagnostic thresholds for ruptured tubal pregnancy were determined and their sensitivity and specificity for the diagnosis of ruptured tubal pregnancy were evaluated. Results ①The areas under ROC curve (AUCROC) of CA125v, β-hCGv, Pv, CKv, and VEGFv for the diagnosis of ruptured tubal pregnancy were 0.528, 0.674, 0.570, 0.643, and 0.542, respectively. ②AUCROC of CA125p, β-hCGp, Pp, CKp, and VEGFp for the diagnosis of ruptured tubal pregnancy were 0.896, 0.595, 0.656, 0.586, and 0.682, respectively. ③AUCROC of Rv/p-CA125, Rv/p-(β-hCG), Rv/p-P, Rv/p-CK, and Rv/p-VEGF for the diagnosis of ruptured tubal pregnancy were 0.883, 0.757, 0.607, 0.628, and 0.598, respectively. ④When CA125p<400.15 U/mL, the sensitivity and specificity of diagnosing ruptured tubal pregnancy were 73.68% and 92.83%. ⑤When Rv/p-CA125<15.20, the sensitivity and specificity of diagnosing ruptured tubal pregnancy were 73.68% and 89.81%. Conclusion When CA125p<400.15 U/mL or Rv/p-CA125<15.20, ruptured tubal pregnancy can be diagnosed and the specificity of CA125p<400.15 U/mL is higher