孕11~13^(+6)周超声联合妊娠相关血浆蛋白A诊断胎盘植入性疾病的价值  

Diagnostic Value of Ultrasound Combined with Pregnancy-Associated Plasma Protein-A at 11-13^(+6) Weeks of Gestation for Placenta Accreta Spectrum Disorders

作　　者：李战宾 甄艳华[1] LI Zhanbin;ZHEN Yanhua(Department of Ultrasound Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院超声医学科,河南郑州450000

出　　处：《河南医学研究》2025年第7期1304-1308,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划项目(LHGJ20210371)。

摘　　要：目的探讨超声检查联合血清妊娠相关血浆蛋白A(PAPP-A)在孕11~13^(+6)周诊断胎盘植入性疾病的应用价值。方法选取178例合并剖宫产史的孕妇为研究对象,根据分娩后的情况将病例分为胎盘植入性疾病组和对照组,并根据胎盘植入的程度,将诊断为胎盘植入性疾病的病例进一步分成粘连型胎盘植入组、植入型胎盘植入组和穿透型胎盘植入组;所有病例在孕11~13^(+6)周检测血清PAPP-A值,回顾性分析所有病例的超声征象,并对超声征象进行评分,比较胎盘植入性疾病组和对照组的超声征象评分以及血清PAPP-A值,将PAPP-A的浓度值转换为同孕周的中位数倍数值(MoM)来进行计算;进一步比较粘连型组、植入型组和穿透型组的血清PAPP-A值。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),获得预测胎盘植入性疾病的超声征象评分和血清PAPP-A的MoM值最佳临界值。结果入组的178例病例中,胎盘植入性疾病组112例,其中粘连型胎盘植入39例(34.82%)、植入型胎盘植入27例(24.11%)、穿透型胎盘植入46例(41.07%);未合并胎盘植入性疾病的对照组66例。胎盘植入性疾病组的超声征象评分高于对照组,差异有统计学意义(P<0.05);胎盘植入性疾病组的PAPP-A的MoM值高于对照组,差异有统计学意义(P<0.05)。在不同类型的胎盘植入性疾病分组中,穿透型组的超声征象评分高于植入型组和粘连型组,差异有统计学意义(P<0.001);穿透型组PAPP-A的MoM值高于粘连型组和植入型组,差异有统计学意义(P<0.001)。绘制ROC曲线显示,超声征象评分诊断胎盘植入性疾病的最佳临界值为4.00分,AUC为0.876;血清PAPP-A的MoM值诊断胎盘植入性疾病的最佳临界值为1.28,AUC为0.903;超声征象评分联合PAPP-A诊断胎盘植入性疾病的AUC为0.941,高于超声征象评分和PAPP-A单独预测,两者联合的灵敏度高于超声征象和PAPP-A单独预测,特异度高于PAPP-A单独预测(P<0.05)Objective To evaluate the diagnostic value of ultrasound combined with serum pregnancy-associated plasma protein-A(PAPP-A)at 11-13^(+6) weeks of gestation for placenta accreta spectrum(PAS)disorders.Methods A total of 178 pregnant women with a history of cesarean delivery were enrolled.Based on postpartum outcomes,cases were divided into a PAS group and a control group.PAS cases were further subclassified into placenta accreta,placenta increta,and placenta percreta groups according to invasion depth.Serum PAPP-A levels were measured at 11-13^(+6) weeks,and ultrasound features were retrospectively analyzed and scored.Ultrasound scores and PAPP-A multiples of the median(MoM)were compared between the PAS and control groups.Subgroup comparisons of PAPP-A MoM values were performed among accreta,increta,and percreta groups.Receiver operating characteristic(ROC)curves was constructed,and the area under the curve(AUC)was calculate to determine optimal cutoff values for ultrasound scores and PAPP-A MoM in predicting PAS,and their diagnostic performance was evaluated.Results Among 178 cases,112 were diagnosed with PAS[39 accreta(34.82%),27 increta(24.11%),and 46 percreta(41.07%)]and 66 served as controls.The PAS group exhibited significantly higher ultrasound scores and PAPP-A MoM values than the control group(P<0.05).The percreta subgroup demonstrated significantly higher ultrasound scores and PAPP-A MoM values compared to increta and accreta subgroups(P<0.001).ROC analysis revealed optimal cutoff values of 4.00 for ultrasound score(AUC=0.876)and 1.28 for PAPP-A MoM(AUC=0.903).The AUC of ultrasound sign score combined with PAPP-A for diagnosis of placental implantation disease was 0.941,which was higher than that of ultrasound sign score and PAPP-A alone.The sensitivity of the combination of both was higher than that of ultrasound sign and PAPP-A alone,and the specificity was higher than that of PAPP-A alone(P<0.05).Conclusion Ultrasound scoring and serum PAPP-A at 11-13^(+6) weeks of gestation are reliable predictors of

关 键 词：超声征象 妊娠相关血浆蛋白A 胎盘植入性疾病 早期诊断 

分 类 号：R714.56[医药卫生—妇产科学]