孕中、晚期母体血清甲胎蛋白测定联合影像学对前置胎盘合并胎盘植入诊断价值探讨  

The value of maternal serum alphafetoprotein level combined with imaging for diagnosing of placenta previa and placental accrete

作　　者：朱晓童 陈晓[2] 钱天烨 王新新 孔祥 ZHU Xiaotong;CHEN Xiao;QIAN Tianye;WANG Xinxin;KONG Xiang(Taizhou People's Hospital, Jiangsu Province, 225700;Dalian Medical University;Clinical Medical College of Yangzhou University)

机构地区：[1]江苏省泰州市人民医院 [2]大连医科大学,225001 [3]扬州大学临床医学院

出　　处：《中国计划生育学杂志》2020年第4期519-523,共5页Chinese Journal of Family Planning

基　　金：江苏省研究生科研与实践创新计划项目(SJCX17_0633)。

摘　　要：目的:探讨孕中、晚期母体血清甲胎蛋白(AFP)、肌酸激酶(CK)测定及影像学检查对于前置胎盘合并胎盘植入的诊断价值。方法:选取2016年10月-2018年3月在本院产科行剖宫产术分娩的前置胎盘单胎妊娠孕妇80例,依据术中所见及术后病理组织学结果分为胎盘植入组36例及非植入组44例。另选取有前置胎盘高危因素且分娩方式为剖宫产分娩的单胎妊娠孕妇54例为对照组。比较3组孕中期、孕晚期母体血清AFP、CK值,以及彩色多普勒超声和磁共振(MRI)检查结果。结果:孕中、孕晚期植入组AFP均高于非植入组和对照组(P<0.05);孕晚期CK在各组间均无差异(P>0.05)。经ROC曲线分析,孕中期AFP诊断临界值为55.1μg/L,曲线下面积为0.75;孕晚期AFP诊断临界值为276.5μg/L,曲线下面积为0.81。孕中晚期AFP值、彩色多普勒超声及MRI检查结果联合诊断灵敏度为94.4%,特异度为88.6%,均高于单项检测。结论:在前置胎盘合并胎盘植入的诊断中,孕中期及孕晚期母体血清AFP值检测具有一定的意义,影像学联合血清AFP值能提高诊断的灵敏度和特异度,优于单项指标检测,具有一定的诊断价值。Objective:To explore the value of maternal serum levels of alphafetoprotein(AFP)and creatine kinase(CK)measurement combined with imaging for diagnosing of placenta previa and placental accrete.Methods:80 pregnant women with single pregnancy and placenta previa who had delivered by cesarean section were selected as study subjects from October 2016 to March 2018.According to the intraoperative findings and postoperative histopathology results,these women were divided into group A(36 women with placenta implantation),group B(44 women out placenta implantation).And another 54 pregnant women with single pregnancy who had high risk factors for placenta previa and delivered by cesarean section were selected in group C.The level of maternal serum AFP of women during the second trimester of pregnancy and the levels of maternal serum AFP and CK of women during the third trimester of pregnancy,and the results by color Doppler ultrasound and magnetic resonance imaging(MRI)were compared among the three groups.Results:The AFP level of women in group A during the second and third trimester of pregnancy was significant higher than that of women in group B and C(P<0.05).There was no statistically significant difference in CK level during the third trimester of pregnancy of women among the three groups(P>0.05).According to ROC curve analysis,the critical value of AFP level during the second and the third trimester of pregnancy for diagnosing placenta praevia were 55.1ug/L and 276.5ug/L,which’s area under the curve,was 0.75 and 0.81.The value of AFP level during the third trimester of pregnancy for diagnosing placenta praevia and placental implantation was slightly higher than that of AFP level during the second trimester of pregnancy.The diagnostic sensitivity and specificity of AFP level combined with color Doppler ultrasound and MRI during the second and third trimester of pregnancy were 94.4%and 88.6%,which were all significant higher than those of diagnosed by AFP level,color Doppler ultrasound,or MRI only.Conclusion:The det

关 键 词：前置胎盘 胎盘植入 甲胎蛋白 超声检查 核磁共振扫描 

分 类 号：R71[医药卫生—妇产科学]