胎盘植入的危险因素分析及超声与磁共振的诊断价值比较

发布时间：2018-03-29 18:05

本文选题：胎盘植入　切入点：磁共振　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:1.研究在孕晚期胎盘位于不同位置时超声与磁共振(MRI)对于胎盘植入(Placental implantation abnormality,PIA)的诊断价值;2.探讨不同类型胎盘植入(PIA)的危险因素及不同类型PIA危险因素的差异;3.力求提高产前诊断及评估PIA的能力,从而降低PIA相关并发症的发生率。方法:1.使用回顾性病例研究了在2013年6月至2014年1月山西医科大学第一临床医学院住院分娩的66名最终确诊为PIA的病例,收集其临床资料并使用SPSS20.0对超声及MRI诊断不同位置胎盘植入的灵敏度(sensitivity,Se),特异度(Specificity,Sp),阳性预测值(positive predictive value,+PV),阴性预测值(negative predictive value,-PV),约登指数(Youden’index,YI),似然比(likelihood ratio,LR),符合率(agreement rate)并分别计算其95%置信区(Confidence Interval,95%CI),分别做出受试者工作特征曲线(ROC曲线),从而进行对比。2.收集2015年1月至2015年12月于山西医科大学第一临床医学院住院分娩,术后病理结果诊断为胎盘植入患者86例、胎盘粘连的患者50例,与114例非胎盘植入患者,记录其年龄、孕周、人工流产次数及既往剖宫产次数,并行回顾性分析。结果:1.胎盘植入的发病率为5.54%-8.23%。2.胎盘植入超声诊断的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate结果分别为77.8%(67.8-87.8),76.7%(66.5,86.9),54.5%,80.0%,74.2%,3.34,0.29,77.3%。3.超声用于胎盘位于前壁的病例的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate的结果,数据分别为83.3%(70.1,96.5),84.6%(71.9,97.3),67.9%,88.2%,78.6%,5.41,0.20,83.9%。4.超声用于胎盘位于后壁及侧壁的病例的诊断Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate结果,数据分别为72.2%(57.4,87.0),70.6%(55.5,85.7),42.8%,72.2%,70.6%,2.46,0.39,71.4%。5.MRI诊断胎盘植入的Se(95%CI)、Sp(95%CI)、YI、+PV,-PV,+LR,-LR,Agreement rate结果分别为81.0%(64.6,97.4),100.0%(100.0,100.0),81.0%,100.0%,20.0%,5.26,0.00,81.8%。6.孕妇的年龄每增长1岁,胎盘植入及侵袭性胎盘植入的发病风险也相应增长12.5%,孕次每增多1次,胎盘植入剂侵袭性胎盘植入的发病风险增长72.6%,既往剖宫产次数每加1次,胎盘植入及侵袭性胎盘植入的发病风险增长264.6%,胎盘粘连的发生与以上危险因素并无明显相关性。结论:高龄、既往剖宫产史、孕次增多均为PIA的危险因素,其中剖宫产次数的增多可使胎盘植入的发生率成倍增长。磁共振在诊断胎盘植入具有补充作用,尤其是对于后壁胎盘的胎盘植入病例诊断价值优于超声。
[Abstract]:Objective: To study the 1. different positions is ultrasonography and magnetic resonance imaging (MRI) in placenta for placenta implantation (Placental implantation abnormality, PIA) the diagnostic value of 2.; explore the different types of placenta implantation (PIA) between the risk factors and risk factors of different types of PIA; 3. in order to improve the ability of prenatal diagnosis and assessment of PIA the incidence rate of PIA, thereby reducing the complications. Methods: 1. cases were retrospectively studied 66 patients diagnosed with hospital delivery in the first clinical medical college of Shanxi Medical University from June 2013 to January 2014 for cases of PIA disease, the clinical data collection and use SPSS20.0 on the sensitivity of ultrasound and MRI in diagnosis of placenta implantation in different positions (sensitivity, Se) specificity, (Specificity, Sp), positive predictive value (positive predictive value, +PV), negative predictive value (negative predictive value, -PV), Jorden (Youden index, Y 'index I (likelihood ratio), likelihood ratio, LR), the coincidence rate (agreement rate) and calculate the 95% confidence interval (Confidence, Interval, 95%CI) were made by the receiver operating characteristic curve (ROC curve), which were collected from January 2015 to December 2015 compared to.2. in the first clinical medical college of Shanxi Medical University hospital, postoperative results the pathological diagnosis of 86 cases of patients with placenta implantation, 50 cases of patients with Placenta Adhesion, and 114 cases of non patients with placenta implantation, recording the age, gestational age, number of abortions and previous cesarean, parallel retrospective analysis. Results: the incidence rate of placenta implantation 1. implanted placenta ultrasound diagnosis of 5.54%-8.23%.2. (Se 95%CI), Sp (95%CI), YI, +PV, -PV, +LR, -LR, Agreement and rate results were 77.8% (67.8-87.8), 76.7% (66.5,86.9), 54.5%, 80%, 74.2%, 3.34,0.29,77.3%.3. ultrasound for placenta located in the anterior wall in case of Se (95%CI), Sp (95%CI) YI, +PV, -PV, +LR, -LR, Agreement, rate, data were 83.3% (70.1,96.5), 84.6% (71.9,97.3), 67.9%, 88.2%, 78.6%, 5.41,0.20,83.9%.4. ultrasound in the diagnosis of Se is located on the back wall and the side wall of the case of the placenta (95%CI), Sp (95%CI), YI, +PV, -PV +LR, -LR, Agreement, rate, data were 72.2% (57.4,87.0), 70.6% (55.5,85.7), 42.8%, 72.2%, 70.6%, 2.46,0.39,71.4%.5.MRI diagnosis of placenta accreta Se (95%CI), Sp (95%CI), YI, +PV, -PV, +LR, -LR, Agreement and rate results were 81% (64.6,97.4), 100% (100.0100.0), 81%, 100%, 20%, 5.26,0.00,81.8%.6. of pregnant women 1 years of age for each growth, the risk of placenta implantation and invasive placenta implantation has also increased 12.5%, every 1 increase in pregnancy, placenta implants invasive placenta implantation risk increase of 72.6%, previous cesarean section plus 1 times each the invasion, placenta implantation and placenta implantation The risk of an increase of 264.6%, the incidence of placental adherence and more risk factors have no obvious correlation. Conclusion: age, previous history of cesarean section, increase pregnancy are risk factors for PIA, including the number of cesarean section increased the incidence of placenta implantation exponentially. MRI has a supplementary role in the diagnosis of placenta implantation in particular, diagnosis value of placenta implantation is superior to ultrasound for wall placenta.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.462;R445

【参考文献】