The potential value of activin B and fibronectin for the triage of pregnancies of unknown location and prediction of first trimester viability.
The potential value of activin B and fibronectin for the triage of pregnancies of unknown location and prediction of first trimester viability.
复制标题
激活素 B 和纤连蛋白对于未知位置妊娠的分类和妊娠早期存活率预测的潜在价值。
DOI：
10.1002/ajum.12090
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发表时间：
2018
影响因子：
--
通讯作者：
Al-Memar M
中科院分区：
文献类型：
--
作者：
Al-Memar M
我们评估了生物标志物激活素B和纤连蛋白（FN 1）单独使用以及加入已建立的标记物后对异位妊娠（EP）低风险或高风险患者进行分类的潜在预测能力。我们还评估了他们的使用作为预测因素的可行性在12周gestation.MethodsExploratory二次分析的前瞻性研究，包括所有妇女归类为怀孕的已知位置（PUL）的基础上，2007年1月至12月在早孕单位的圣乔治医院（伦敦）。我们使用多项逻辑回归来评估生物标志物对并发症高风险PUL的诊断潜力（EP或持续性PUL），和标准二元逻辑回归来预测12周时的妊娠早期存活率。激活素B的受试者工作特征曲线（AUC）下的面积为0.75（95%置信区间0.60-0.85），FN 1为0.55（0.41-0.68）。将激活素B添加到包含β-hCG比率和初始孕酮的多项逻辑回归模型中，失败与高风险PUL的比值比为0.16（0.05-0.55），宫内与高风险PUL的比值比为0.29（0.07-1.19），模型的AUC从0.84增加到0.89。在高风险PUL的风险阈值为5%时，灵敏度从84%增加到87%，特异性从48%增加到64%。对于12周时区分存活（n = 28）和非存活（n = 81）妊娠，两种标记物的AUC均为0.54。结论我们的结果表明，激活素B可能是一种有前途的标记物，除了已建立的标记物外，还可以改善PUL分诊。
AimWe have assessed the potential predictive ability of the biomarkers activin B and fibronectin (FN1) alone and when added to established markers for triaging patients as being at low or high risk of ectopic pregnancy (EP). We also assessed their use as predictors of viability at 12 weeks gestation.MethodsExploratory secondary analysis of a prospective study including all women classified as a pregnancy of known location (PUL) based on transvaginal ultrasonography between January and December 2007 at the early pregnancy unit of St Georges’ Hospital (London). We used multinomial logistic regression to assess the diagnostic potential of the biomarkers to triage PUL at high risk of complications (EP or persistent PUL), and standard binary logistic regression to predict first trimester viability at 12 weeks.ResultsFor discriminating high‐risk (n = 16) from low‐risk PUL (n = 93), the area under the receiver operating characteristic curve (AUC) was 0.75 (95% confidence interval 0.60–0.85) for activin B and 0.55 (0.41–0.68) for FN1. Adding activin B to a multinomial logistic regression model incorporating β‐hCG ratio and initial progesterone yielded odds ratios of 0.16 (0.05–0.55) for failing vs high‐risk PUL and 0.29 (0.07–1.19) for intrauterine vs high‐risk PUL and increased the model's AUC from 0.84 to 0.89. At a risk threshold of 5% for high‐risk PUL, sensitivity increased from 84% to 87% and specificity from 48% to 64%. For discriminating viable (n = 28) from non‐viable (n = 81) pregnancies at 12 weeks, both markers had an AUC of 0.54.ConclusionsOur results suggested that activin B may be a promising marker to improve PUL triage in addition to established markers.