Evaluation of ADAM-12 as a Diagnostic Biomarker of Ectopic Pregnancy in Women with a Pregnancy of Unknown Location 英文参考文献.docVIP

EvaluationofADAM-12asaDiagnosticBiomarkerof EctopicPregnancyinWomenwithaPregnancyof UnknownLocation AndrewW.Horne1*,JeremyK.Brown1,StephenTong2,Tu’uhevahaKaitu’u-Lino2 1MRCCentreforReproductiveHealth,UniversityofEdinburgh,Queen’sMedicalResearchInstitute,Edinburgh,UnitedKingdom,2TranslationalObstetricsGroup,Mercy HospitalforWomen,Heidelberg,Australia Abstract Background:Ectopicpregnancy(EP)remainsthemostlife-threateningacuteconditioninmoderngynaecology.Itremains difficult to diagnose early and accurately. Women often present at emergency departments in early pregnancy with a ‘pregnancyofunknownlocation’(PUL)anddiagnosis/exclusionofEPischallengingduetoalackofreliablebiomarkers. Recent studies suggest that serum levels of a disintegrin and metalloprotease protein-12 (ADAM-12) can be used differentiate EP from viable intrauterine pregnancy (VIUP). Here we describe a prospective study evaluating the performance of ADAM-12 in differentiating EP from the full spectrum of alternative PUL outcomes in an independent patientcohort. Methodology/PrincipalFindings:Serawerecollectedfrom120patientsattheirfirstclinicalpresentationwithaPULand assayed for ADAM-12 by ELISA. Patients were categorized according to final pregnancy outcomes. Serum ADAM-12 concentrationswereincreasedinwomenwithhistologically-confirmedEP(median442pg/mL;25%–75%percentile232– 783pg/mL) compared to women with VIUP (256pg/mL; 168–442pg/mL) or miscarriage (192pg/mL; 133–476pg/mL). Serum ADAM-12 did not differentiate histologically-confirmed EP from spontaneously resolving PUL (srPUL) (416pg/mL; 154–608pg/mL). The diagnostic potential of ADAM-12 was only significant when ‘ambiguous’ PUL outcomes were excludedfromtheanalysis(AROC=0.6633;P=0.03901). Conclusions/Significance:Whenmeasuredinisolation,ADAM-12levelshadlimitedvalueasadiagnosticbiomarkerforEP inourpatientcohort.Thedevelopmentofareliableserumbiomarker-basedtestforEPremainsanongoingchallenge. Citation:HorneAW,BrownJK,TongS,Kaitu’u-LinoT(2012)EvaluationofA