文章摘要

孕晚期血清甲胎蛋白联合超声征象评分对前置胎盘并胎盘植入的诊断价值

作者: 1黄菊
1 万宁市人民医院产科，海南 万宁 571500
通讯: 黄菊 Email: huangju19791120@163.com
DOI: 10.3978/j.issn.2095-6959.2022.10.017

摘要

目的：探讨孕晚期血清甲胎蛋白(alpha fetoprotein，AFP)联合超声征象评分对前置胎盘并胎盘植入(placenta accreta，PA)的诊断价值。方法：回顾性分析2019年10月至2021年4月万宁市人民医院产科收治的105例前置胎盘孕妇的相关资料，以剖宫产手术和病理检查结果为金标准，分为PA组(前置胎盘并PA，n=42)与非PA组(前置胎盘不合并PA，n=62)。比较2组产前一般资料、孕晚期血清AFP水平和产前超声征象评分，评价孕晚期血清AFP水平、产前超声征象评分以及二者联合对前置胎盘并PA的诊断价值。结果：PA组孕晚期血清AFP、超声征象评分均显著高于非PA组[分别(267.18±40.15) ng/mL vs (214.28±32.20) ng/mL，4.06±0.45 vs 0.37±0.10，均P<0.05]。前置胎盘孕妇孕晚期血清AFP诊断PA的曲线下面积(area under curve，AUC)为0.798，截断值为239.27 ng/mL，敏感度为83.33%，特异度为68.25%。孕晚期血清AFP联合超声征象评分诊断前置胎盘并PA的敏感度、特异度、准确度依次为95.24%、88.89%、91.43%，其中敏感度明显高于单独超声征象评分78.57%(P<0.05)。二者联合诊断PA与金标准的一致性较好(Kappa=0.827，P<0.05)。结论：前置胎盘并PA孕妇孕晚期血清AFP水平明显升高，血清AFP联合超声征象评分能提高前置胎盘并PA的诊断效能，降低漏诊率。
关键词： 前置胎盘；胎盘植入；甲胎蛋白；超声征象评分

Diagnostic vaule of serum alpha-fetoprotein in the third trimester of pregnancy combined with ultrasonic sign score for placenta previa with placental implantation

Authors: 1HUANG Ju
1 Department of Obstetrics, Wanning People’s Hospital, Wanning Hainan 571500, China

CorrespondingAuthor: HUANG Ju Email: huangju19791120@163.com

DOI: 10.3978/j.issn.2095-6959.2022.10.017

Abstract

Objective: To investigate the diagnostic value of serum alpha-fetoprotein (AFP) in the third trimester of pregnancy combined with ultrasonic sign score for placenta previa and placenta accreta (PA). Methods: The data of 105 pregnant women with placenta previa treated in the Obstetrics Department of Wanning People’s Hospital from October 2019 to April 2021 were analyzed retrospectively. Taking the results of cesarean section and pathological examination as the gold standard, the patients were divided into a PA group (placenta previa with PA, n=42) and a non-PA group (placenta previa without PA, n=63). The prenatal general data, serum AFP level in the third trimester, and prenatal ultrasonic sign score were compared between the 2 groups to evaluate the diagnostic value of serum AFP level in the third trimester, prenatal ultrasonic sign score, and their combination in placenta previa and PA. Results: The scores of serum AFP in the third trimester of pregnancy and ultrasonic sign score in the PA group were significantly higher than those in the non-PA group [(267.18±40.15) ng/mL vs (214.28±32.20) ng/mL, 4.06±0.45 vs 0.37±0.10, both P<0.05]. The area under curve (AUC) of serum AFP in the third trimester of placenta previa was 0.798, the cut-off value was 239.27 ng/mL, the sensitivity was 83.33%, and the specificity was 68.25%. The sensitivity, specificity, and accuracy of serum AFP combined with ultrasonic sign score in the diagnosis of placenta previa complicated with PA in the third trimester of pregnancy were 95.24%, 88.89%, and 91.43% respectively, and the sensitivity was significantly higher than that of ultrasonic sign score alone by 78.57% (P<0.05). The consistency between the combined diagnosis of PA and the gold standard was good (Kappa=0.827, P<0.05). Conclusion: The level of serum AFP in pregnant women with placenta previa and PA is significantly increased in the third trimester. Serum AFP combined with ultrasonic sign score can improve the diagnostic efficiency of placenta previa and PA and reduce the missed diagnosis rate.

Keywords： placenta previa; placenta accreta; alpha fetoprotein; ultrasonic sign score

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