彩色多普勒超声检查联合AFP、CK监测对产前胎盘植入诊断的价值研究

目的 探讨彩色多普勒超声检查联合血清甲胎蛋白(AFP)和肌酸激酶(CK)对产前胎盘植入的诊断价值.方法 选择120例有胎盘植入高危因素的孕晚期孕妇作为高危组,所有孕妇均接受产前彩色多普勒超声检查,并根据分娩后病理诊断结果 分为植入组(n=44)和未植入组(n=76),对比超声检查结果 与病理结果 的差异,另选择健康查体的孕晚期孕妇35例作为对照组,检查所有入选孕妇血清AFP和CK,分析超声、AFP、CK单项和联合检测对胎盘植入的诊断价值.结果 病理诊断为产前胎盘植入的44例患者超声诊断为产前胎盘植入15例,漏诊29例,一致性分析显示,超声对产前胎盘植入诊断结果 与病理结果 的一致性较差(Kappa=0.108,P>0.05);植入组血清AFP和CK显著高于未植入组和对照组,差异均有统计学意义(t值分别为16.331、15.291、16.893、15.763,均P<0.05),未植入组和对照组血清AFP和CK比较差异无统计学意义(t值分别为1.023、1.278,均P>0.05);超声诊断产前胎盘植入的敏感度较低,特异度较高,联合AFP和CK可以将超声诊断产前胎盘植入的敏感度提高到95.45%.结论 彩色多普勒超声对胎盘植入的产前诊断具有一定的价值,但漏诊率高,联合血清AFP和CK监测可以提高对产前胎盘植入诊断的敏感度,具有重要的意义.

Value of color Doppler ultrasonography combined with AFP and CK monitoring on diagnosing prenatal placenta increta

Objective To explore the diagnostic value of color Doppler ultrasonography combined with alpha fetal protein (AFP) and creatine kinase ( CK) on prenatal placenta increta. Methods Totally 120 cases of pregnant women in late pregnancy with high-risk factors of placenta increta were set in high-risk group and were checked by prenatal color Doppler ultrasound. They were divided into implant group (n=44) and no implant group (n=76) according to the pathological diagnosis after childbirth, and the difference between ultrasonic results and pathologic results were explored. Another 35 cases of healthy pregnant women in late pregnancy were set in control group. Serum AFP and CK were measured and the diagnostic value of individual ultrasonography, AFP and CK and joint detection of them on placenta increta was analyzed. Results Among 44 cases of placenta increta confirmed by pathological diagnosis, 15 cases were diagnosed with placenta increta by ultrasonography and 29 cases were missed diagnosed. Consistency analysis showed that ultrasonography in prenatal diagnosis of placenta increta had poor consistency with pathologic results (Kappa=0. 108, P>0. 05). The serum AFP and CK levels in implant group were significantly higher than those in no implant group and the control group, and the differences had statistical significance (t value was 16. 331, 15. 291, 16. 893 and 15. 763, respectively, all P<0. 05). The serum AFP and CK levels were not statistically different between implant group and the control group (t value was 1. 023 and 1. 278, respectively, both P>0. 05). Prenatal ultrasound diagnosis of placenta increta was low in sensitivity but high in specificity. Combination of AFP and CK could enhance the sensitivity of prenatal ultrasound diagnosis of placenta increta to 95. 45%. Conclusion Color Doppler ultrasonography in diagnosing placenta increta has certain value, but the missed diagnosis is high. The combination of serum AFP and CK monitoring may enhance the sensitivity to prenatal diagnosis of placenta increta, and it has vital significance.