胎盘下血流收缩期峰值流速的测定对异常侵入性胎盘的产前超声诊断  

Determination of peak flow velocity of systolic blood flow under placenta for prenatal ultrasound diagnosis of abnormal invasive placenta

作　　者：孙建华 周颖[1] 漆洪波[1] Sun Jianhua;Zhou Ying;Qi Hongbo(Dept of Gynaecology and Obstetrics,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400010)

机构地区：[1]重庆医科大学附属第一医院妇产科,重庆400010

出　　处：《安徽医科大学学报》2020年第9期1426-1429,共4页Acta Universitatis Medicinalis Anhui

基　　金：2016 年国家卫计委重点研发计划: 中国高龄孕妇早产防治策略和发生机制研究( 编号: 2016YFC1000407)。

摘　　要：目的探讨胎盘下血流收缩期峰值流速的测定对异常侵入性胎盘的产前超声诊断。方法选择接受前置胎盘治疗的妊娠晚期(≥28周)孕妇133例为研究对象,包括完全性前置胎盘和胎盘下缘距离宫颈内口≤2 cm。采用美国GE公司VOLUSON E8彩超检查胎盘后声带区缺失、胎盘后肌层厚度<1 mm、胎盘腔隙腔流≥10 cm/s、收缩期峰值流速(PSV)等特征。采用受试者工作特征(ROC)曲线分析PSV等超声特征预测异常侵入性胎盘的准确性。结果与非侵入性胎盘患者比较,侵入性胎盘患者平均孕龄减小、之前剖宫产次数增多、PSV升高,差异有统计学意义(P<0.05)。侵入性胎盘患者阻力指数(RI)与非侵入性胎盘患者比较差异无统计学意义(P>0.05)。PSV在预测异常侵入性胎盘的ROC曲线下面积为0.910(P<0.001,95%CI:0.873~0.962);RI在预测异常侵入性胎盘的ROC曲线下面积为0.562(P=0.336,95%CI:0.461~0.663)。当子宫前壁下部的胎盘下血流PSV≥41 cm/s时,诊断为异常侵入性胎盘的灵敏度为89.47%,特异度为84.21%,阳性预测值为80.95%,阴性预测值为91.43%。结论胎盘下血流收缩期峰值流速的测定可能是超声诊断异常侵入性胎盘的新标志,具有较高的灵敏度和特异性。Objective To investigate the prenatal ultrasound diagnosis of abnormal invasive placenta by measuring the peak flow velocity of systolic blood flow under placenta.Methods A total of 133 pregnant women(≥28 weeks of gestation)who received placenta previa were enrolled,including complete placenta previa and anterior placenta with≤2 cm distance between the placental edge and internal os.The US company VOLUSON E8 color Doppler ul-trasound was used to examine the absence of the vocal cord area behind the placenta,the thickness of the posterior placental muscle layer<1 mm,the flow of the placental cavity≥10 cm/s,and the peak systolic velocity(PSV).Ultrasound characteristics such as PSV were used to predict the accuracy of abnormal invasive placenta using re-ceiver operating characteristic(ROC)curves.Results Compared with non-invasive placenta patients,the average gestational age of patients with invasive placenta decreased,the number of previous cesarean section increased,and PSV increased(P<0.05).There was no significant difference in the resistance index(RI)between patients with invasive placenta and non-invasive placenta(P>0.05).The area of PSV under the ROC curve predicting abnor-mal invasive placenta was 0.910(P<0.001,95%CI:0.873~0.962)while the area of RI under the ROC curve predicting abnormal invasive placenta was 0.562(P=0.336,95%CI:0.461~0.663).When the blood flow PSV under the placenta of the anterior wall of the uterus was≥41 cm/s,the sensitivity of the abnormally invasive placenta was 89.47%,the specificity was 84.21%,the positive predictive value was 80.95%,and the negative predictive value was 91.43%.Conclusion The measurement of peak flow velocity during systolic blood flow in placenta may be a new marker for ultrasound diagnosis of abnormal invasive placenta,with high sensitivity and spe-cificity.

关 键 词：收缩期峰值流速 阻力指数 异常侵入性胎盘 产前超声诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]