二维超声及彩色多普勒超声对胎盘植入的诊断价值  

Values of two-dimensional and color Doppler ultrasound to the diagnosis of placenta implantation

作　　者：赵丽娟[1] 韩丽萍[2] 岳红利 ZHAO Li-juan;HAN Li-ping;YUE Hong-li(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China;Department of Gynecology、the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学第一附属医院超声科,河南郑州450003 [2]郑州大学第一附属医院妇科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2021年第6期625-627,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技创新团队项目(18IRTSTHN024)。

摘　　要：目的分析孕晚期孕妇二维超声及彩色多普勒超声声像特征,探讨其对胎盘植入的诊断价值。方法162例孕晚期孕妇均行二维超声、彩色多普勒超声检查,根据组织病理检查结果分为胎盘植入组48例和非植入组114例;记录是否有剖宫产史及超声声像图特征,并进行2组间比较;采用多因素logistic回归分析孕晚期孕妇发生胎盘植入的影响因素;根据影响因素构建评分系统并进行赋值,绘制ROC曲线,分析评分系统对胎盘植入的诊断效能。结果胎盘植入组患者前置胎盘(47.9%)、胎盘漩涡(27.1%)、胎盘后间隙消失(58.3%)、胎盘后肌层变薄或消失(16.7%)、胎盘后方血流丰富(45.8%)、剖宫产史(54.2%)比率均高于非植入组(38.6%、21.1%、39.5%、15.8%、39.5%、35.1%)(P<0.05),2组胎盘厚度、胎盘附着处局部包块形成比率比较差异均无统计学意义(P>0.05)。前置胎盘(OR=1.646,95%CI:0.741~2.890,P=0.027)、胎盘漩涡(OR=1.393,95%CI:0.639~3.038,P<0.001)、胎盘后间隙消失(OR=2.147,95%CI:1.081~4.262,P=0.026)、胎盘后方血流丰富(OR=1.297,95%CI:0.657~2.563,P=0.026)及剖宫产史(OR=2.186,95%CI:1.101~4.341,P<0.001)为孕晚期孕妇发生胎盘植入的影响因素;4项超声声像特征联合剖宫产史建立的评分系统,最佳截断值为3分时,诊断孕晚期孕妇发生胎盘植入的AUC为0.978(95%CI:0.878~0.996,P<0.001),灵敏度为89.1%,特异度为88.7%。结论应用二维超声及彩色多普勒声像特征,结合剖宫产史对孕晚期孕妇胎盘植入有较高诊断价值。Objective To analyze the image features of two-dimensional and color Doppler ultrasound of pregnant women in the third trimester,and to explore the their values to the diagnosis of placenta implantation.Methods Totally 162 pregnant women in the third trimester received two-dimensional ultrasound and color Doppler ultrasound,and were divided into placenta implantation group(n=48)and non-implantation group(n=114)according to the histopathological results.The history of cesarean section and ultrasonographic image features were recorded and compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of placenta implantation in the third trimester.The scoring system was constructed and assigned according to the influencing factors,and ROC curve was drawn to analyze the diagnostic efficiency of the scoring system on placental implantation.Results The percentages of placenta previa(47.9%),placenta vortex(27.1%),disappearance of retroplacental space(58.3%),thinning or disappearance of posterior muscular layer of placenta(16.7%),abundant blood flow behind placenta(45.8%),and history of cesarean section(54.2%)in placenta implantation group were higher than those in non-implantation group(38.6%,21.1%,39.5%,15.8%,39.5%,35.1%)(P<0.05).There were no significant differences in the percentages of placenta thickening and local mass formation in placenta attachment between two groups(P>0.05).Placenta previa(OR=1.646,95%CI:0.741-2.890,P=0.027),placenta vortex(OR=1.393,95%CI:0.639-3.038,P<0.001),disappearance of postplacental space(OR=2.147,95%CI:1.081-4.262,P=0.026),abundant blood flow behind the placenta(OR=1.297,95%CI:0.657-2.563,P=0.026),and history of cesarean section(OR=2.186,95%CI:1.101-4.341,P<0.001)were the influencing factors of placenta implantation in the third trimester.When the optimal cut-off value of these four ultrasound image features combined with cesarean section history scoring system was 3,the AUC for the diagnosis of placenta implantation was 0.978(95%CI:0.878-0.996

关 键 词：胎盘植入 二维超声 彩色多普勒超声 剖宫产 产前诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.4[医药卫生—诊断学]