二维超声与三维彩色多普勒超声联合AFP、CK检测对瘢痕子宫并前置胎盘植入的诊断价值

The diagnostic value of two-dimensional ultrasound and three-dimensional color Doppler ultrasonography combined with AFP and CK in the diagnosis of scar uterus and placenta previa implantation

目的对比二维超声与三维彩色多普勒超声分别联合甲胎蛋白(AFP)、肌酸激酶(CK)检测对瘢痕子宫并前置胎盘植入的诊断价值。方法选择2013年2月至2017年1月在本院进行建档分娩的孕晚期孕妇120例作为研究对象,根据分娩后病理诊断结果分为植入组(44例,前置胎盘植入)和未植入组(76例,无前置胎盘植入),记录两组二维超声与三维彩色多普勒超声诊断特征与效果,检测两组孕妇血清AFP、CK表达情况。结果所有孕妇血清中均有AFP与CK的表达,植入组孕妇血清中AFP与CK表达量[(152.80±11.66)μg/L、(125.98±16.67)IU/L]明显高于非植入组[(80.65±22.84)μg/L、(77.55±23.32)IU/L],差异有统计学意义(P<0.05)。超声诊断胎盘植入39例,非胎盘植入81例;AFP+CK诊断胎盘植入38例,非胎盘植入82例;超声联合AFP、CK诊断为胎盘植入43例,非胎盘植入77例,联合诊断的敏感度明显高于单独诊断(P<0.05)。ROC曲线图显示超声的曲线下面积=0.879,AFP+CK=0.835,超声更优于AFP+CK。结论二维超声与三维彩色多普勒超声分别联合AFP、CK检测可提高瘢痕子宫并前置胎盘植入的诊断效能,有很好的临床应用价值。

Objective To compare the diagnostic value of two-dimensional ultrasound and three-dimensional color Doppler ultrasonography combined with alpha-fetoprotein （AFP） and creatine kinase （CK） in the diagnosis of scar uterus and placenta previa implantation. Methods 120 cases of pregnancy delivery documented in our hospital from February 2013 to January 2017 were selected as the research object. All cases were divided into implantation group and non implantation group accorded to the pathological diagnosis. The implantation group of 44 cases were diagnosed as placenta previa implantation and the non implantation group of 76 cases were diagnosed as non placenta previa implantation. Two-dimensional uhrasound and three-dimensional color Doppler ultrasound diagnosis characteristic and effect in the two groups were recorded. The AFP, CK expression in the two groups were also detected. Results AFP and CK expression were detected in the serum levels of all pregnant women. The AFP and CK expression in the implantation group were （ 152. 80 ±11.66） μg/L and （ 125.98 ±16. 67）IU/L, significantly higher than non implantation group [ （80. 65 ±22. 84）μg/L and （77.55 ±23.32） IU/L, P 〈 0. 05 ]. Ultrasonic diagnosis of placenta implantation in 39 cases, and non placenta previa implantation81 cases ; there were 38 cases of placenta accreta and 82 cases of non placenta previa implantation judged by AFP and CK expression ; 43 cases of placenta previa implantatio, and 77 cases of non placenta previa implantation judged by ultrasound combined with AFP and CK. So the combined diagnostic sensitivity were significantly higher than that of single diagnostic sensitivity （ P 〈 0. 05 ）. The receiver operating characteristic （ROC） curve shows that the area under the curve of ultrasound is = 0. 879, AFP and CK = 0. 835, and the ultrasound was better than AFP and CK. Conclusions The two-dimensional ultrasound and three-dimensional color Doppler uhrasonography combined with AFP and CK in the diagnosis of scar uterus and placenta previa implantation can improve the diagnostic effect, and they have very good application values.