母体相关血清指标联合影像学对胎盘植入诊断价值的研究  

Value of maternal related serum indexes combined with imaging in the diagnosis of placenta accrete

作　　者：尧美茜 毛锦江[1] 甘冰[1] YAO Meiqian;MAO Jinjiang;GAN Bing(Department of Obstetrics and Gynecology,Guangxi Guigang People's Hospital,Guigang 537100,Guangxi,China)

机构地区：[1]广西贵港市人民医院产科,广西贵港537100

出　　处：《中国性科学》2022年第11期67-71,共5页Chinese Journal of Human Sexuality

基　　金：贵港市自筹经费科研项目(贵科项2000038)。

摘　　要：目的探讨母体相关血清指标联合影像学对胎盘植入(PA)的诊断价值。方法回顾性分析2016年2月至2021年2月广西贵港市人民医院收治的80例定期产检孕中期B超提示胎盘附着位置异常的的孕妇的临床资料(观察组);另将同期进行产检且分娩方式为剖宫产的60例孕妇纳入对照组。依据术中所见及术后病理组织学结果,将观察组分为PA组与非PA组;查阅孕妇病历资料,记录并比较PA组、非PA组与对照组的基线资料,孕16~18周、孕28~32周血清甲胎蛋白(AFP)、肌酸激酶(CK)水平,孕22~26周超声评分,孕28~32周磁共振成像的表观弥散系数(ADC)值;分析血清AFP、CK联合超声评分系统、ADC值对PA的诊断价值。结果根据术中所见及术后病理组织学检查,80例孕妇中PA 47例(58.75%),非PA 33例(41.25%);PA组孕28~32周血清AFP、CK水平及超声评分、ADC值最高,其次为非PA组,对照组最低(P<0.05);绘制受试者工作特征(ROC)曲线,结果显示,血清AFP、CK、超声评分、ADC值单独及联合诊断PA的曲线下面积(AUC)>0.70,具有一定的诊断价值,且联合诊断价值最高;当上述指标cut-off值分别取140.385μg/L、120.705U/L、4.500分、2.010mm^(2)/s时,可获得最佳诊断价值。结论母体血清AFP、CK水平联合超声评分、ADC值诊断PA具有较高的临床价值。Objective To investigate the diagnostic value of maternal related serum indexes combined with imaging in placenta accreta(PA).Methods Retrospective analysis was performed on the clinical data of 80 pregnant women with abnormal placenta attachment position indicated by B-ultrasound during the second trimester of regular labor examination and admitted to Guangxi Guigang People's Hospital from February 2016 to February 2021(observation group).In addition,60 pregnant women with cesarean section were included in the control group.According to the intraoperative and postoperative histopathological results,the observation group was divided into PA group and non-PA group.The medical records of pregnant women were consulted,and baseline data of PA group,non-PA group and control group were recorded and compared,including serum alpha fetoprotein(AFP)at 16 to 18 weeks and 28 to 32 weeks of gestation,and creatine kinase(CK)levels,ultrasound score at 22 to 26 weeks of gestation,and apparent diffusion coefficient(ADC)values of magnetic resonance imaging at 28 to 32 weeks of gestation.The diagnostic value of serum AFP,CK combined with ultrasound scoring system and ADC value for PA were analyzed.Results Through intraoperative findings and postoperative histopathological examination,the results showed that among 80 pregnant women,there were 47 cases of PA(58.75%)and 33 cases of non-PA(41.25%);the levels of serum AFP,CK,ultrasound score and ADC value of pregnant women in PA group at 28 to 32 weeks of gestation were the highest,followed by non-PA group and the lowest in control group(P<0.05);the ROC curve showed that,AUC of serum AFP,CK,ultrasound score and ADC value on single and combined diagnosis of PA were>0.70,which had certain diagnostic value,and the combined diagnostic value was the highest;when the cut-off values of the above indicators were 140.385μg/L,120.705 U/L,4.500 score,2.010 mm^(2)/s respectively,the best diagnostic value could be obtained.Conclusions Maternal serum AFP and CK levels combined with ultrasound score

关 键 词：胎盘植入 甲胎蛋白 肌酸激酶 超声评分系统 磁共振成像 诊断价值 

分 类 号：R714[医药卫生—妇产科学]