人类软骨糖蛋白-39和甲胎蛋白联合超声在植入性前置胎盘中的应用  

Application of human cartilage glycoprotein 39 and alpha-fetoprotein combined ultrasound in prenatal diagnosis of implanted placenta previa

作　　者：姚扣云 杜丹丽[1] 李祥 YAO Kou-yun;DU Dan-li;LI Xiang(Department of Gynecology and Obstetrics,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院妇产科,安徽蚌埠233004

出　　处：《中华全科医学》2022年第5期824-827,共4页Chinese Journal of General Practice

基　　金：安徽省自然科学基金青年项目(2008085QH407)。

摘　　要：目的探讨孕晚期人类软骨糖蛋白-39(YKL-40)、甲胎蛋白(AFP)联合超声对植入性前置胎盘的评估价值。方法收集2020年11月—2021年5月于蚌埠医学院第一附属医院分娩的前置胎盘孕妇90例为研究组,依据术中所见和(或)术后病理结果,分为植入组(穿透性4例,植入性17例,粘连性29例)50例和非植入组40例,并收集同期正常孕妇40例为对照组,入院均行YKL-40、AFP与超声检查。结果非植入组和对照组YKL-40、AFP水平低于植入组(均P<0.05),其中粘连性前置胎盘YKL-40低于植入性,植入性低于穿透性(均P<0.05),植入性和粘连性前置胎盘AFP低于穿透性(均P<0.05)。ROC曲线分析,血清YKL-40、AFP的最佳截断值分别为320.284 pg/mL、277.895μg/mL,其曲线下的面积为0.780、0.812。联合诊断的AUC(0.895)、约登指数(0.675)、灵敏度(90.0%)、阴性预测值(85.3%)均高于单项检测。结论血清YKL-40、AFP水平联合超声有利于提高植入性前置胎盘的诊断效能。Objective To evaluate the value of human cartilage glycoprotein-39(YKL-40)and alpha fetoprotein(AFP)combined with ultrasound in placenta previa implantation.Methods A total of 90 pregnant women with placenta previa who delivered in the First Affiliated Hospital of Bengbu Medical College from November 2020 to May 2021 were enrolled as the research group.According to the intraoperative and/or postoperative pathological results,they were divided into the implantation group(4 cases of penetrating type,17 cases of implantation type and 29 cases of adhesion type),50 cases of non-implantation group and 40 cases of non-implantation group.In addition,40 normal pregnant women in the same period were collected as the control group,and all received YKL-40,AFP and ultrasound examination.Results The levels of YKL-40 and AFP in the non-implantable group and control group were lower than those in the implantable group(all P<0.05).The levels of YKL-40 in the implantable group were lower than those in the implantable group,and those in implantable group were lower than those in the penetrating group(all P<0.05).AFP in the implantable group and implantable group were lower than those in the penetrating group(all P<0.05).ROC curve analysis showed that the optimal cut-off values of serum YKL-40 and AFP were 320.284 pg/mL and 277.895μg/mL,respectively,and the areas under the curve were 0.780 and 0.812,respectively.The AUC(0.895),Yuden index(0.675),sensitivity(90.0%)and negative predictive value(85.3%)of combined diagnosis were higher than those of single tests.Conclusion Serum YKL-40 and AFP levels combined with ultrasound can improve the diagnostic efficiency of placenta previa.

关 键 词：植入性前置胎盘 人类软骨糖蛋白-39 甲胎蛋白 超声 

分 类 号：R714.462[医药卫生—妇产科学] R445.1[医药卫生—临床医学]