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

Analysis on the Correlation of Serum HCG,AFP Allied by Ultrasound Examination in Implanted Placenta Previa Types

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(P<0.05)。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(P<0.05)。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(P<0.05)。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。

Objective： To research the sensitivity and specificity of ultrasonography in diagnosing implanted placenta and analyze the correlation of serum AFP, HCG and different types of placenta increta. Methods： 208 puerpera in late pregnancy with placenta previa were included in this research. According to gestational age 1：1 matching, 208 puerpera without placenta previa and implanted placenta were included as control group. Prenatal placenta ultrasonics inspections were conducted on all maternal before antenatal. According to the postoperative pathologic diagnosis, the placenta implantation can be classified as the adhesion group, implantation group and pene- （rating group. In the meanwhile, serum AFP and HCG levels were detected at prenatal, postnatal 3 d and 4 w. Results： Among the 208 cases, 67 cases were diagnosed with placenta implantation according to pathologic diagnosis, accounting for 32.21% （including 31 cases of adhesion group, 19 cases of implantation group, 17 cases of penetrating group）. 62 cases were diagnosed with placenta implantation according to prenatal ultrasonography. The sensitivity and specificity of ultrasonography in placenta increta were 86.56% and 97.16% re- spectively. The placenta thickness of control group, placenta previa and implantation group and merely placenta previa group was （2.34±0.63） cm, （3.27±0.78） cm and （2.42±0.61） cm, and the difference was statistically significant （P〈0.05）. The serum AFP and be- ta HCG levels at prenatal and postnatal 3 d, 4 w were higher in the adhesion group, implantation group and penetrating group than in the control group and placenta previa group, and the difference was statistically significant （P〈0.05）. The serum AFP and beta HCG levels at prenatal and postnatal 3 d, 4 w were also higher in the penetrating group than in adhesion group and implantation group （P〈0.05）. Con- clusions： Ultrasonography has high specificity and sensitivity in diagnosing penetrating placenta implantation, but not in diagnosing the adhesion type of placenta implantation. Serum AFP and HCG levels has a certain relationship with the placenta increta types. Joint detec- tion is helpful to the diagnosis of placenta increta.