血清HCG,AFP联合超声检查对前置胎盘植入类型的相关性分析

发布时间：2019-02-18 16:40

【摘要】：目的:探讨超声对植入胎盘诊断的敏感性及特异性及血清AFP、HCG和不同胎盘植入类型的相关性。方法:选取孕晚期前置胎盘产妇208例,按孕周1:1匹配,选取入无前置胎盘无胎盘植入的产妇208例为对照组。产前对所有研究对象进行胎盘超声学检查,根据术后病理将胎盘植入类型分为粘连性胎盘、植入性胎盘和穿透性胎盘组。同时测定产前、产后3 d、产后4 w血清AFP和HCG水平。结果:208例前置胎盘最终病理确诊胎盘植入67例,占32.21%(其中粘连性胎盘组31例、植入性胎盘组19例、穿透性胎盘组17例),产前超声诊断62例。超声对胎盘植入诊断总的敏感性86.56%,特异性97.16%。对照组、前置胎盘并胎盘植入组、单纯胎盘前置组胎盘厚度平均(2.34±0.63)cm、(3.27±0.78)cm、(2.42±0.61)cm,差异有统计学意义(P0.05)。粘连性胎盘植入组、植入性胎盘组、穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG均明显高于对照组和前置胎盘组,差异有统计学意义(P0.05)。穿透性胎盘组产前、产后3 d、产后4 w各时间点血清AFP、β-HCG高于粘连性胎盘组和植入性胎盘组,差异有统计学意义(P0.05)。结论:超声对穿透性胎盘植入诊断具有较高的特异性和敏感性,但对粘连性胎盘植入诊断的敏感性和特异性不高,血清AFP和HCG水平和胎盘植入类型有一定关系,联合检测有助于胎盘植入类型的诊断。
[Abstract]:Objective: to investigate the sensitivity and specificity of ultrasound in the diagnosis of placenta accreta and the correlation between serum AFP,HCG and different types of placenta accreta. Methods: 208 pregnant women with placenta previa were selected. According to the 1:1 match of gestational week, 208 pregnant women without placenta previa and placenta accreta were selected as control group. The placental accreta types were divided into three groups: adhesive placenta, accreta placenta and penetrating placenta. The levels of serum AFP and HCG were measured at 3 days postpartum and 4 weeks postpartum at the same time. Results: 67 cases (32.21%) were diagnosed as placental accreta by final pathology of placenta previa (31 cases in adherent placenta group, 19 cases in accreta group and 17 cases in penetrating placenta group), 62 cases were diagnosed by prenatal ultrasound. The sensitivity of ultrasound in the diagnosis of placenta accreta was 86.56 and the specificity was 97.16. The average placental thickness in the control group, placenta previa with placenta accreta group and simple placenta previa group was (2.34 卤0.63) cm, (3.27 卤0.78) cm, (2.42 卤0.61) cm, (P0.05). The levels of serum AFP, 尾-HCG in adhesive placenta accreta group, accreta placenta group, penetrating placenta group, 3 days postpartum and 4 weeks postpartum were significantly higher than those in control group and placenta previa group (P0.05). The levels of serum AFP, 尾-HCG in penetrating placenta group were significantly higher than those in adherent placenta group and accreta placenta group at the time points of 3 days postpartum and 4 weeks postpartum (P0.05). Conclusion: ultrasound has high specificity and sensitivity in the diagnosis of penetrating placenta accreta, but it is not high in the diagnosis of adhesive placenta accreta. Serum AFP and HCG levels are related to the type of placenta accreta. Combined detection is helpful for the diagnosis of placental accreta type.
【作者单位】：成都市第五人民医院妇产科;成都市双流县中医院妇产科;昆明医科大学;
【基金】：四川省教育厅科学技术研究项目(2011658) 国家自然科学基金项目(81500377)
【分类号】：R714.2

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