血清中雌酮和雌三醇水平对先兆流产患者妊娠结局的预测价值

王毅; 刘会兰; 青碧兰; 李明芳

doi:10.16766/j.cnki.issn.1674-4152.003509

血清中雌酮和雌三醇水平对先兆流产患者妊娠结局的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003509

广元市妇幼保健院产科，四川广元 628017

基金项目:

四川省医学科研青年创新课题 Q19008

详细信息

通讯作者:
王毅，E-mail：wangyi1245621@163.com

中图分类号: R714.21 R446.11
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- 文章访问数: 163
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- 被引次数: 0
出版历程
- 收稿日期: 2023-08-08
- 网络出版日期: 2024-07-20

Predictive value of serum levels of estrone and estriol for pregnancy outcomes in patients with threatened abortion

Obstetrics Department, Guangyuan Maternal and Child Health Hospital, Guangyuan, Sichuan 628017, China

摘要

摘要: 目的探究先兆流产孕妇血清中雌酮(E1)和雌三醇(E3)水平及其对不良妊娠结局的预测价值，旨在为临床早期干预治疗提供参考。方法选取广元市妇幼保健院2020年1月—2021年12月收治的122例先兆流产孕妇，根据是否流产将先兆流产孕妇分为妊娠结局良好组(80例)和妊娠结局不良组(42例)，同时选取70例相同年龄层在本院分娩的正常妊娠孕妇作为对照组。比较血清中E1和E3水平在不同组别中的差异，通过Pearson分析评估E1、E3水平与血清中相关激素的相关性，通过二元logistic回归分析研究孕妇发生不良妊娠结局的影响因素，通过ROC曲线评估E1、E3水平对孕妇发生不良妊娠结局的诊断价值。结果妊娠结局不良组血清β-人绒毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)、E1及E3水平均较对照组和妊娠结局良好组降低，而血清超敏C反应蛋白、糖类抗原125较对照组和妊娠结局良好组升高(P＜0.05)。血清E1、E3水平与血清β-HCG、P及E2水平呈正相关关系(P＜0.05)。二元logistic回归分析显示，血清E1、E3升高均是不良妊娠结局发生的影响因素(P＜0.05)。ROC曲线显示，血清E1、E3联合诊断的AUC(0.841)明显高于单一E1(0.745)或E3(0.735)诊断，灵敏度和特异度分别为85.71%和86.00%。结论妊娠结局不良的孕妇血清中E1、E3水平降低。E1、E3联合诊断对孕妇发生不良妊娠结局具有良好的诊断效能，可为临床早期干预治疗提供重要的依据。
- 先兆流产 /
- 雌酮 /
- 雌三醇 /
- ROC曲线
Abstract: Objective This study aims to investigate the serum levels of estrone (E1) and estriol (E3) in pregnant women with threatened miscarriage and evaluate their predictive value for adverse pregnancy outcomes. The findings will provide valuable reference for early clinical intervention and treatment. Methods A total of 122 pregnant women with threatened abortion who were admitted to Guangyuan Maternal and Child Health Hospital from January 2020 to December 2021 were selected. Based on whether they experienced a miscarriage, the pregnant women with threatened abortion were divided into two groups: the good pregnancy outcome group (n=80) and the poor pregnancy outcome group (n=42). Additionally, 70 normal pregnant women of the same age who delivered in our hospital were selected as the control group. The levels of E1 and E3 in serum were compared among the different groups. Pearson analysis was used to evaluate the correlation between E1 and E3 levels and other related hormones in serum. Furthermore, we conducted binary logistic analysis to analyze the factors contributing to poor pregnancy outcomes. Lastly, we used ROC curve analysis to assess the diagnostic value of E1 and E3 levels in predicting poor pregnancy outcomes. Results The serum levels of β-human chorionic gonadotropin (β-HCG), progesterone (P), estradiol (E2), E1, and E3 in the poor pregnancy outcome group were lower than those compared to both the control group and the good pregnancy outcome group (P < 0.05).Conversely, the levels of high sensitivity C-reactive protein and cancer antigen 125 in serum were higher compared to the control group and the good pregnancy outcome group (P < 0.05). There was a positive correlation between the serum levels of E1, E3, β-HCG, P, and E2 were positively correlated (P < 0.05). Binary logistic regression analysis showed that elevated E1 and E3 were influencing protective factors against adverse pregnancy outcomes (P < 0.05). The ROC curve demonstrated that the combined diagnosis of E1 and E3 (0.841) had a significantly higher area under the curve (AUC) compared to using E1 (0.745) or E3 (0.735) alone. The sensitivity and specificity of the combined diagnosis were 85.71% and 86.00%, respectively. Conclusion The levels of E1 and E3 in serum decreased in pregnant women experiencing poor pregnancy outcomes. The combined diagnosis of E1 and E3 has a good diagnostic efficiency for identifying poor pregnancy outcomes, offering a valuable foundation for early clinical intervention and treatment.
- Threatened abortion /
- Estrone /
- Estriol /
- ROC curve

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图 1 血清指标预测不良妊娠结局发生的ROC曲线

Figure 1. ROC curve for predicting adverse pregnancy outcomes based on serum indicators

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图 2 E1、E3水平预测不良妊娠结局发生的ROC曲线

Figure 2. ROC curve for predicting adverse pregnancy outcomes using E1 and E3 levels

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表 1 3组孕妇一般资料比较

Table 1. Comparison of general data among three groups of pregnant women

组别	例数	年龄(x±s, 岁)	妊娠前BMI(x±s)	孕周(x±s, 周)	孕次(x±s, 次)	初产妇[例(%)]	甲亢[例(%)]	吸烟史[例(%)]
对照组	70	27.52±3.51	21.03±1.51	8.75±2.06	1.35±0.39	31(44.29)	5(7.14)	12(17.14)
妊娠结局良好组	80	27.15±3.23	21.22±1.68	8.30±2.23	1.24±0.28	35(43.75)	9(11.25)	15(18.75)
妊娠结局不良组	42	28.03±3.65	21.57±1.29	8.02±2.42	1.29±0.32	17(40.48)	4(9.52)	7(16.67)
统计量		0.916^a	1.614^a	1.576^a	2.044^a	0.171^b	0.742^b	0.106^b
P值		0.402	0.202	0.210	0.132	0.918	0.690	0.948
注：^a为F值，^b为χ²值。

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表 2 3组孕妇血清指标比较(x±s)

Table 2. Comparison of serum indicators in three groups of pregnant women (x±s)

组别	例数	hs-CRP(mg/L)	β-HCG(mIU/L)	P(nmol/L)	E2(ng/mL)	E1(ng/mL)	E3(ng/mL)	CA125(IU/mL)	FSH(ng/mL)	AMH(ng/mL)
对照组	70	5.03±1.38	37 188.52±1 003.21	27.52±5.24	33.16±8.79	5.32±1.18	12.15±3.06	17.23±4.10	5.68±2.06	3.43±0.96
妊娠结局良好组	80	14.19±3.52^a	32 207.15±1 325.23^a	22.62±5.03^a	15.98±4.57^a	2.56±0.59^a	7.26±1.79^a	28.50±6.23^a	5.46±1.96	3.74±0.94
妊娠结局不良组	42	20.67±4.03^ab	29 828.13±1 231.65^ab	18.13±5.78^ab	10.88±3.03^ab	1.07±0.33^ab	4.09±1.06^ab	40.12±10.28^ab	5.43±1.90	3.76±0.95
F值		368.592	577.509	43.151	214.043	396.785	186.749	155.575	0.303	2.389
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.739	0.094
注：与对照组比较，^aP＜0.05；与妊娠结局良好组比较，^bP＜0.05。

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表 3 血清E1、E3水平与血清指标的相关性分析

Table 3. Correlation analysis of serum E1 and E3 levels with serum indicators

项目	E1(ng/mL)		E3(ng/mL)
项目	r值	P值	r值	P值
β-HCG(mIU/L)	0.681	＜0.001	0.714	＜0.001
P(nmol/L)	0.675	＜0.001	0.701	＜0.001
hs-CRP(mg/L)	-0.303	0.082	-0.315	0.069
CA125(IU/mL)	-0.234	0.106	-0.241	0.101
FSH(ng/mL)	0.275	0.091	0.201	0.180
AMH(ng/mL)	-0.164	0.375	-0.147	0.396
E2(ng/mL)	0.826	＜0.001	0.835	＜0.001

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表 4 二元logistic回归模型分析不良妊娠结局的影响因素

Table 4. Binary logistic regression model analysis of adverse pregnancy outcomes factors

变量	B	SE	Waldχ²	P值	OR值	95% CI
β-HCG	-0.529	0.333	2.524	0.112	0.589	0.307~1.132
P	-0.620	0.408	2.309	0.129	0.538	0.242~1.197
hs-CRP	0.526	0.307	2.936	0.087	1.692	0.927~3.089
CA125	0.419	0.340	1.519	0.218	1.520	0.781~2.961
E2	-0.686	0.317	4.683	0.030	0.504	0.271~0.938
E1	-0.569	0.257	4.902	0.027	0.566	0.342~0.937
E3	-0.729	0.301	5.866	0.015	0.482	0.267~0.870

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表 5 各项指标对不良妊娠结局发生的诊断价值

Table 5. Diagnostic value of various indicators for adverse pregnancy outcomes

项目	AUC(95% CI)	最佳截断值	约登指数	灵敏度(%)	特异度(%)
β-HCG	0.623(0.528~0.717)^ab	30 225	0.32	69.05	62.67
P	0.662(0.566~0.757)^ab	19.99	0.30	59.52	70.67
hs-CRP	0.643(0.557~0.729)^ab	18.48	0.27	61.90	65.33
CA125	0.616(0.528~0.704)^ab	36.73	0.27	64.29	62.67
E2	0.655(0.578~0.731)	12.76	0.43	71.43	71.33
E1	0.745(0.673~0.817)	1.58	0.46	69.05	77.33
E3	0.735(0.662~0.808)	4.38	0.45	73.81	72.00
E1+E3	0.841(0.761~0.921)^ab			85.71	86.00
注：与E1比较, ^aP＜0.05;与E3比较, ^bP＜0.05。

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