基于临床高危因素及MRI征象的评分模型预测胎盘植入不良临床结局的价值  

The value of the scoring model based on clinical risk factors and MRI signs in predicting adverse clinical outcomes of placenta accreta spectrum

作　　者：李秋炎 周艳[1] 梁婷 刘传[1] 王宁[1] 杜莹莹[1] 赵先兰[1] 郭瑞霞[1] Li Qiuyan;Zhou Yan;Liang Ting(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院妇产科,郑州450052

出　　处：《现代妇产科进展》2023年第7期494-497,503,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨基于临床高危因素及MRI征象的评分模型对胎盘植入不良临床结局的预测价值。方法:收集2016年1月至2019年1月于郑州大学第一附属医院收治的466例胎盘植入患者的临床资料。筛选可能的临床高危因素及MRI征象后基于预测价值进行赋分建立评分模型,并绘制受试者工作特性(ROC)曲线,计算曲线下面积(AUC)、灵敏度、特异度和约登指数。结果:剖宫产次数≥2次、血红蛋白<110g/L、合并完全性前置胎盘、与肌层分界欠清、胎盘内T2W1低信号带、胎盘内异常增生的血管、肌层变薄、胎盘突入膀胱征象是胎盘植入发生不良临床结局的独立危险因素(P<0.05),根据OR值进行赋分,分别为2、2、3、2、3、4、3、4,建立评分模型,该模型预测不良临床结局的AUC值为0.825,当分值≥13,灵敏度为0.683,特异度为0.835。结论:基于MRI征象与临床高危因素的评分模型对于胎盘植入不良临床结局的预测有一定价值。Objective:To investigate the predictive value of the scoring model based on clinical risk factors and MRI signs for adverse clinical outcomes of patients with pacenta accreta.Methods:This retrospective cohort study involved 466 patients with placenta accreta delivered at the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2019.The clinical risk factors and MRI data were collected to develop a scoring system for the prediction of adverse clinical outcomes.Results:The number of cesarean section times≥2,preoperative hemoglobin level<110g/L,complete placenta previa,the unclear boundary between the placenta and muscular layer,T2W1 dark intraplacental bands,abnormal intraplacental vascularization,muscular layer thinning,signs of bladder invasion were independent risk factors for adverse clinical outcomes(P<0.05),the score were 2,2,3,2,3,4,3,4.The scoring model predicted adverse clinical outcomes with an AUC of 0.825.When the score was≥13 points,the predictive sensitivity was 0.683 and the specificity was 0.835.Conclusion:The scoring model based on clinical risk factors and MRI signs is valuable for predicting adverse pregnancy outcomes in patients with placenta accreta.

关 键 词：胎盘植入程度 磁共振成像 预测 

分 类 号：R714[医药卫生—妇产科学]