产前不同超声征象诊断胎盘植入价值的meta分析

The diagnostic value of prenatal different ultrasound signs for placenta accreta: a meta analysis

目的:应用meta分析探讨不同超声征象在产前诊断胎盘植入的价值。方法:检索2006年1月至2016年10月发表的有关产前不同超声征象评价胎盘植入的中英文文献,通过QUADAS-2评价系统对纳入的文献进行质量评价。用Review Manager 5.3和Meta-Di Sc 1.4软件绘制计算不同征象的敏感度、特异度绘制森林图,汇总敏感度(SEN)、汇总特异度(SPE)及相应的95%的置信区间(CI),得出阴性似然比和阳性似然比、诊断比值比(DOR),绘制综合受试者工作特征曲线(SROC),计算面积(AUC)。针对≥5篇文献报道过的超声征象纳入本研究。结果:共纳入12篇文献。结果显示,胎盘后间隙消失/破坏:SEN 0.83(0.78~0.88)、SPE 0.86(0.83~0.88)、AUC 0.9042;胎盘漩涡:SEN 0.71(0.67~0.76)、SPE 0.83(0.81~0.85)、AUC 0.8580;子宫膀胱交界面破坏:SEN 0.46(0.38~0.54)、SPE 0.98(0.96~0.99)、AUC 0.9083;胎盘/子宫膀胱交界面丰富血流信号:SEN 0.67(0.60~0.72)、SPE 0.95(0.93~0.96)、AUC 0.9470。结论:高危孕妇中,尤其是前置胎盘伴有剖宫产史或子宫手术史,上述超声征象在评估胎盘植入方面均具有一定的价值。判断胎盘漩涡时,应结合彩色多普勒漩涡内血流信号。所有征象中,多普勒示胎盘/子宫膀胱交界面丰富血流信号诊断准确性最高。

Objective：To explore the diagnostic value of prenatal different ultrasound signs for placenta accreta by a meta-analysis.Method：Studies were searched in databases（2006.1-2016.10）.Only the English and Chinese literatures were included.The eligible studies were evaluated the quality according to the QUADAS-2 evaluation system.The study was used the Review Manager 5.3 and Meta-Disc 1.4 software to draw the plots and do some calculations.The pooled sensitivity（SEN）,specificity（SPE）,negative（LR-） and positive likelihood ratio（LR＋）,the diagnostic odds ratio（DOR） and their 95%CI,summary receiver operating characteristic curves（SROC） and area under curves（AUC） for the different sighs which were more than 5 studies reference were calculated.Result：A total of 12 studies were included.In summary,the ultrasound sighs were as follows：Loss or irregular of retroplacental clear space：SEN 0.83（0.78-0.88）,SPE 0.86（0.83-0.88）,AUC 0.9042.Placenta lacunae in placenta：SEN 0.71（0.67-0.76）,SPE 0.83（0.81-0.85）,AUC 0.8580.Bladder-border abnormalities：SEN 0.46（0.38-0.54）,SPE 0.98（0.96-0.99）,AUC 0.9083.Hypervascularity of placenta/uterine-bladder interface：SEN 0.67（0.60-0.72）,SPE 0.95（0.93-0.96）,AUC 0.9470.Conclusion：All of the different ultrasound signs have the accuracy of prenatal diagnosis of placenta accreta in high risk woman.Placenta lacunae as a ultrasound sign should be combined with the color doppler flow.Hypervascularity of placenta/uterine-bladder interface has best diagnostic value in all ultrasound signs.