侵入性凶险性前置胎盘腹主动脉球囊封堵下剖宫产大出血的MRI预测模型构建  

A MRI-based model for prediction of massive hemorrhage during abdominal aorta balloon occlusion-assisted cesarean section in patients with invasive pernicious placenta previa

作　　者：杨冯棱 赖华 王志刚 敬怀波 张倩 YANG Feng-leng;LAI Hua;WANG Zhi-gang(Department of Radiology,Chengdu Women’s&Children’s Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院放射科,成都611731 [2]电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院产科,成都611731

出　　处：《放射学实践》2022年第2期195-201,共7页Radiologic Practice

基　　金：成都市医学科研课题项目(2021030)。

摘　　要：目的:探讨产前MRI检查在预测侵入性凶险性前置胎盘(IPPP)产妇腹主动脉球囊封堵联合剖宫产(AABO-CS)大出血中的价值并构建MRI预测模型。方法:回顾性分析122例(粘连型23例,植入型77例,穿透型22例)经手术和/或病理证实的IPPP产妇的临床及MRI资料,根据AABO-CS术中出血量的差异将其分为大出血组和非大出血组,采用独立样本t检验、Mann-Whitney U检验及χ^(2)检验分析出血量与临床特征、MRI征象的关系,将单因素分析中有统计学差异的MRI征象进行多因素Logistic回归分析,建立回归模型,采用Hosmer-Lemeshow goodness-of-fit检验及受试者工作特性(ROC)曲线评估此模型的诊断效能。结果:单因素分析结果显示胎盘穿透、胎盘主体附着于子宫前壁下段、胎盘增厚、胎盘凹陷征、T_(2)WI胎盘低信号带、子宫局限性膨凸、子宫肌层欠连续、浆膜下异常血管影、胎盘内异常血管影及宫颈形态异常在大出血与非大出血两组间的差异有统计学意义(P值均<0.05)。多因素分析结果显示胎盘内异常血管影(X1:OR=6.971,P=0.001)、浆膜下异常血管影(X2:OR=6.306,P=0.002)、胎盘增厚(X3:OR=5.490,P=0.008)及宫颈形态异常(X4:OR=5.012,P=0.007)为预测AABO-CS术中大出血的独立危险因素,Logistic回归模型为Logit P=-3.899+1.942X1+1.841X2+1.703X3+1.612X4,该模型的诊断准确率为86.9%,ROC曲线下面积为0.923(95%CI:0.873~0.972),Hosmer-Lemeshow goodness-of-fit检验表明模型的拟合度较好(P=0.582),当最佳预测概率>45.4%时,其敏感度、特异度分别为82.0%、90.3%。结论:产前MRI对IPPP产妇AABO-CS术中大出血有提示作用,本研究建立的MRI回归模型能够较好地量化评估其出血风险,为个体化治疗方案的制定提供参考。Objective:To explore the value and construct athe performance of predictive model of the prenatal MRI in predicting massive hemorrhage during abdominal aorta balloon occlusion-assisted cesarean section(AABO-CS)in patients with invasive pernicious placenta previa(IPPP).Methods:This retrospectively study included 122 patients(23 cases with adhesion,77 cases with implantation and 22 cases with penetration)who confirmed by operation and/or pathology.The clinical and MRI data of 122 patients(23 cases with adhesion,77 cases with implantation and 22 cases with penetration)with invasive pernicious placenta previa confirmed by operation and/or pathology were analyzed retrospectively.These patients were divided into massive hemorrhage group and control group according to the amount of intraoperative hemorrhage.The independent sample t-test,Mann-Whitney U test and χ^(2) test were tested to analysis the relationships between the amount of hemorrhage and clinical characteristics and MRI signs.The relationship between the amount of hemorrhage and clinical characteristics and MRI signs was analyzed by independent sample t-test,Mann-Whitney U test and Chi-square test.Multivariate logistic regression analysis was used to establish a regression model for the MRI signs with statistical differences in univariate analysis.The diagnostic performance of the model were analyzed using Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic(ROC)curve.The diagnostic efficacy of the model was assessed by Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic curve(ROC).Results:Univariate analysis showed significant differences in placenta percreta,placenta attachment to the lower anterior uterine wall,placental thickening,placental recess sign,intraplacental T2 dark band,focal uterine bulge,local interruption of myometrium,abnormal subserosal vascularity,abnormal intraplacental vascularity and cervical morphologic abnormalities were independent factors for between massive hemorrhage group and control

关 键 词：凶险性前置胎盘 腹主动脉球囊封堵 剖宫产术 出血风险 磁共振成像 预测模型 

分 类 号：R714.4[医药卫生—妇产科学] R445.2[医药卫生—临床医学]