血清外体RNA及AFP对胎盘植入的临床诊断价值

发布时间：2018-03-23 08:01

本文选题：胎盘植入　切入点：外体RNA　出处：《河北大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过研究经术中及术后病理确诊的胎盘植入患者血清外体RNA(exosomal RNA)及甲胎蛋白(AFP)的浓度,来探讨二者对胎盘植入的诊断价值。方法:选取2014年1月至2016年12月于我院产科行剖宫产分娩的凶险性前置胎盘的单胎孕妇76例(凶险性前置胎盘是指既往有剖宫产史,此次妊娠为前置胎盘,且胎盘附着于子宫下段原剖宫产切口瘢痕处,发生胎盘植入机率约为50%)。根据剖宫产手术及术后病检结果分为胎盘植入组(32例)与非胎盘植入组(44例),另外选取同期行剖宫产分娩的既往有剖宫产手术史,此次妊娠胎盘位置正常,无其他妊娠合并症及并发症的单胎孕妇50例作为对照组。分别在产前抽取3组孕妇的外周肘静脉血,提取血清中的exosomal RNA并测定其浓度,检测AFP水平,对比分析三组之间的差异,利用受试者工作特征曲线(ROC曲线)找出其临床诊断的最佳临界值(cut off值),比较exosomal RNA、AFP及两者联合时对胎盘植入的产前诊断价值。结果:1.三组患者的一般情况比较无统计学意义(P0.05);胎盘植入组患者血清exosomal RNA浓度与非胎盘植入组及对照组相比均有显著差异(P0.05),而AFP在胎盘植入组患者中的浓度较非胎盘植入组及对照组也明显增高,均有显著的统计学意义(P0.05见表2)。2.血清exosomal RNA及AFP在胎盘植入中的临床诊断最佳临界值(cut off值)分别为40.28ng/ml和256.56U/L。3.Exosomal RNA以40.28ng/ml作为临床诊断阈值时,其诊断胎盘植入的灵敏度、特异度及准确度分别为90.6%、75.5%、81.6%;AFP以256.56U/L作为临床诊断阈值时的灵敏度、特异度及准确度分别为78.1%、85.1%、81.6%;而两者联合时平行诊断试验的灵敏度、准确度分别为93.8%、76.3%;系列诊断试验的特异度、准确度分别为95.5%、86.8%。结论:在胎盘植入的产前诊断中,exosomal RNA及AFP均有一定的价值,两者单独应用时exosomal RNA的诊断价值略高于AFP,而二者平行及系列联合时可显著提高产前诊断的灵敏度及特异度,优于血清exosomal RNA及AFP单项检测。
[Abstract]:Objective: to study the concentrations of RNA(exosomal and AFP in the serum of placental accreta patients confirmed by intraoperative and postoperative pathology. Methods: from January 2014 to December 2016, 76 pregnant women with dangerous placenta previa who were delivered by cesarean section in our hospital were selected. The pregnancy was placenta previa, and the placenta attached to the scar of the former cesarean incision in the lower part of the uterus. According to the results of cesarean section and postoperative disease examination, the placenta accreta group (32 cases) and the non-placental accreta group (44 cases) were divided into two groups. 50 cases of single pregnancy with normal placenta position and no complications and complications were used as control group. The peripheral venous blood was extracted from three groups of pregnant women before antepartum, the serum exosomal RNA was extracted and its concentration was measured, and the level of AFP was measured. Comparing and analyzing the differences between the three groups, Using the operating characteristic curve of subjects to find out the best critical value of off for clinical diagnosis, to compare the value of exosomal off and its combination in the prenatal diagnosis of placenta accreta. Results: 1. The general condition of the three groups was no more than that of the control group. The concentration of serum exosomal RNA in placenta accreta group was significantly higher than that in non-placental accreta group and control group, and the concentration of AFP in placenta accreta group was significantly higher than that in non-placental accreta group and control group. There was significant statistical significance (P0.05) in Table 2. 2.The best critical value of serum exosomal RNA and AFP in clinical diagnosis of placenta accreta was 40.28ng/ml and 256.56U/L.3.Exosomal RNA. The sensitivity of 40.28ng/ml and 256.56U/L.3.Exosomal RNA in the diagnosis of placenta accreta was obtained when 40.28ng/ml was used as the diagnostic threshold of placenta accreta. The specificity and accuracy were 90.6 and 75.5 respectively. The sensitivity, specificity and accuracy of 256.56U/L as the diagnostic threshold were 78.1 and 81.6, respectively; and the sensitivity and accuracy of parallel diagnostic tests were 93.85.30.The specificity and accuracy of the series of diagnostic tests were respectively 93.85.30.The specificity and accuracy of the series of diagnostic tests were respectively 78.1% and 85.6%, respectively. Conclusion: RNA and AFP are valuable in prenatal diagnosis of placenta accreta. The diagnostic value of exosomal RNA was slightly higher than that of AFP alone, and the sensitivity and specificity of prenatal diagnosis could be significantly improved by parallel and serial combination of them, which was superior to serum exosomal RNA and single detection of AFP.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.2

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