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目的:应用受试者工作特征(ROC)曲线评价孕酮在妊娠早期预测妊娠结局的临床价值。方法:回顾性分析妊娠早期(≤6周)195例先兆流产患者、93例稽留流产患者与88例异位妊娠患者血清中孕酮的水平,应用ROC曲线对孕酮水平进行分析评价。结果:①先兆流产组孕酮(25.39±9.98)ng/ml高于稽留流产组(10.48±8.92)ng/ml和异位妊娠组(6.73±5.45)ng/ml,差异有统计学意义(P<0.01),稽留流产组孕酮高于异位妊娠组,差异有统计学意义(P<0.05);②血清孕酮诊断宫内与宫外妊娠的ROC曲线下面积为0.861,最佳临界值(Cut-off值)为11.90 ng/ml,此时灵敏度(SE)为0.760、特异性(SP)为0.830、阳性预测值(PPV)为0.934、阴性预测值(NPV)为0.514,阳性似然比(+LR)为4.471和阴性似然比(-LR)为0.289;③血清孕酮诊断活胎与胎儿停止发育的ROC曲线下面积为0.931,Cut-off值为12.90 ng/ml,此时SE为0.949、SP为0.796、PPV为0.833、NPV为0.935,+LR为4.652和-LR为0.064。结论:孕酮水平可用于判断早期异常妊娠的结局,尤其判断活胎与胎儿停止发育的准确性要高于判断宫内与宫外妊娠。
OBJECTIVE: To evaluate the clinical value of progesterone in predicting pregnancy outcomes in early pregnancy by using receiver operating characteristic (ROC) curves. Methods: The levels of progesterone in serum of 195 patients with early pregnancy (≤6 weeks), 93 patients with missed abortion and 88 patients with ectopic pregnancy were retrospectively analyzed. The level of progesterone was analyzed by ROC curve. Results (1) Progesterone in threatened abortion group (25.39 ± 9.98) ng / ml was higher than that in missed abortion group (10.48 ± 8.92) ng / ml and ectopic pregnancy group (6.73 ± 5.45) ng / ml (P <0.05). ② The area under the ROC curve of serum progesterone in diagnosing intrauterine and extrauterine pregnancy was 0.861, the best cut-off value (Cut-off value) was 11.90 ng / ml, the sensitivity (SE) was 0.760, the specificity (SP) was 0.830, the positive predictive value (PPV) was 0.934 and the negative predictive value (NPV) (+ LR) was 4.471 and the negative likelihood ratio (LR) was 0.289; ③ The area under the ROC curve of serum progesterone in diagnosing the termination of fetus and fetus was 0.931 and the Cut-off value was 12.90 ng / ml. At this time SE was 0.949, SP was 0.796, PPV was 0.833, NPV was 0.935, + LR was 4.652 and -LR was 0.064. Conclusion: The level of progesterone can be used to judge the outcome of early abnormal pregnancy. In particular, the accuracy of stopping development of live fetus and fetus is higher than judging intrauterine and extrauterine pregnancy.