彩色多普勒超声联合母体血浆游离胎盘mRNA对产前胎盘植入的诊断价值  

The diagnostic value of color Doppler ultrasound combined with maternal plasma free placental mRNA in prenatal placental implantation

作　　者：胡隽 朱英 HU Jun;ZHU Ying(Department of Ultrasound,Shaoxing Central Hospital,Shaoxing,Zhejiang 312030,China)

机构地区：[1]绍兴市中心医院超声科,浙江绍兴312030

出　　处：《中国妇幼保健》2022年第11期2111-2114,共4页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2018KY205)。

摘　　要：目的探讨彩色多普勒超声联合母体血浆游离胎盘mRNA对产前胎盘植入(PA)的诊断价值。方法选取绍兴市中心医院2018年11月—2019年12月疑似PA孕妇106例作为研究对象。产前均行彩色多普勒超声;用实时荧光定量PCR(qRT-PCR)测定孕妇血浆游离胎盘β人绒毛膜促性腺激素(β-hCG)、人胎盘催乳素(HPL)mRNA水平。以手术和病理结果作为“金标准”,将106例疑似PA孕妇分为非PA组(64例)和PA组(42例)。根据受试者工作特征曲线(ROC)评估β-hCG、HPL mRNA对产前PA诊断价值;分析β-hCG、HPL mRNA及彩色多普勒超声联合、单项诊断效能。结果与非PA组相比,PA组孕妇血浆游离胎盘β-hCG、HPL mRNA水平显著升高(P<0.05);ROC曲线显示,β-hCG mRNA、HPL mRNA诊断产前PA的曲线下面积分别为0.777(95%CI:0.686~0.852)、0.829(95%CI:0.743~0.895),灵敏度分别为66.67%、76.19%,特异度分别为75.00%、75.00%,准确度分别为71.70%、75.47%,Kappa值分别为0.41、0.50;彩色多普勒超声诊断产前PA的灵敏度为76.19%,特异度73.45%,准确度74.53%,Kappa值为0.41;三者联合诊断灵敏度为92.86%,特异度为79.69%,准确度为83.02%,Kappa值为0.70。联合诊断灵敏度、准确度均高于单项检测,差异有统计学意义(P<0.05)。结论β-hCG、HPL mRNA及彩色多普勒超声对产前PA具有一定的诊断价值,三者联合诊断可提高诊断的灵敏度和准确度。Objective To study the value of color Doppler ultrasound combined with maternal plasma free placental mRNA in the diagnosis of prenatal placental implantation(PA).Methods 106 pregnant women suspected of PA from November 2018 to December 2019 were selected as the study objects.Color Doppler ultrasound was performed before delivery;and the levels of plasma free placentaβhuman chorionic gonadotropin(β-hCG)and human placental prolactin(HPL)mRNA in the plasma of pregnant women were measured by realtime fluorescence quantitative PCR(qRT-PCR).Taking the surgical and pathological results as"gold standard",the 106 suspected PA pregnant women were divided into non PA group(64 cases)and PA group(42 cases).The diagnostic values ofβ-hCG and HPL mRNA for PA were evaluated by receiver operating characteristic curve(ROC);and the efficacies of combined diagnosis and single diagnoses ofβ-hCG,HPL mRNA and color Doppler ultrasound were analyzed.Results Compared with the non PA group,the levels ofβ-hCG and HPL mRNA in the plasma of the pregnant women in PA group were significantly higher(P<0.05);ROC curve showed that the areas under the curve ofβ-hCG mRNA and HPL mRNA in the diagnosis of PA before delivery were 0.777(95%CI:0.686-0.852)and 0.829(95%CI:0.743-0.895),the sensitivities were 66.67%and 76.19%,the specificities were 75.00%and 75.00%,the accuracies were 71.70%and 75.47%,the Kappa values were 0.41 and 0.50,respectively;the sensitivity,specificity,accuracy and Kappa value of color Doppler ultrasound in the diagnosis of PA before delivery were 76.19%,73.45%,74.53%and 0.41 respectively;and the sensitivity,specificity,accuracy and Kappa value of combination of them in the diagnosis of PA before delivery were 92.86%,79.69%,83.02%and 0.70 respectively.The sensitivity and accuracy of combined diagnosis were higher than that of single detection,and the differences were statistically significant(P<0.05).Conclusionβ-hCG,HPL mRNA and color Doppler ultrasound are valuable in the diagnosis of PA before delivery,and the combined diag

关 键 词：彩色多普勒超声 Β人绒毛膜促性腺激素 人胎盘催乳素 胎盘植入 

分 类 号：R445.1[医药卫生—影像医学与核医学]