术前对凶险型前置胎盘进行临床分级诊断的预测价值

Predictive value of preoperative clinical grading diagnosis of pernicious placenta previa

目的评价术前分级诊断方法对凶险型前置胎盘凶险程度的预测价值。方法选取2015年6月-2018年5月在我院住院分娩术前根据影像学检查结果诊断凶险型前置胎盘孕妇总病例数251例,进行临床分级诊断,Ⅰ级32例;Ⅱ级100例;Ⅲ级69例;Ⅳ级50例;再根据术中主刀医生判断胎盘情况结合术后病理诊断标准,同样进行临床分级诊断,计算其灵敏度、特异度、阳性预测值、阴性预测值,绘制术前对凶险型前置胎盘进行临床分级诊断的受试者操作特性(ROC)曲线,计算ROC曲线下面积。结果根据术前分级诊断总数251例中,术中、术后再进行临床分级诊断的病例有200例,Ⅰ级77例;Ⅱ级90例;Ⅲ级18例;Ⅳ级15例;对术前对凶险型前置胎盘进行临床分级诊断灵敏度为47.40%;特异度为83.50%;阳性预测值为55.85%;阴性预测值为78.29%;绘制术前对凶险型前置胎盘进行临床分级诊断的ROC曲线,可以得到曲线下面积为0.701。结论术前对凶险型前置胎盘进行规范临床分级诊断可进一步提高预测此疾病的凶险程度,提高诊断水平,为进一步规范化治疗手术方案提供依据。

Objective To evaluate the predictive value of preoperative grading diagnosis method for the risk of pernicious placenta previa. Methods A total of 251 cases of gestational placenta previa were diagnosed according to the results of imaging examination before the hospitalization of our hospital from June,2015 to May,2018. The clinical grade diagnosis was performed,32 cases of grade I;grade Ⅱ 100 cases;69 cases of grade Ⅲ;50 cases of grade Ⅳ;according to the intraoperative surgeon's judgment of placenta combined with postoperative pathological diagnosis criteria,the same clinical classification diagnosis,calculation of sensitivity,specificity,positive predictive value,negative predictive value,The operating characteristic (ROC) curve of the patient's clinically graded diagnosis of the pernicious placenta previa was plotted before surgery,and the area under the ROC curve was calculated. Results According to the preoperative grading diagnosis in 251 cases in which 200 cases were classified according to the preoperative and postoperative clinical grading diagnosis,77 cases of grade I;90 cases of grade Ⅱ;18 cases of grade Ⅲ;15 cases of grade Ⅳ;The sensitivity of preoperative diagnosis of pernicious placenta previa was 47.40%;the specificity was 83.50%;the positive predictive value was 55.85%;the negative predictive value was 78.29%;the preoperative diagnosis of sinister placenta previa was performed. The ROC curve of the diagnosis can be obtained with an area under the curve of 0.701. Conclusion Preoperative standardized clinical grading diagnosis of pernicious placenta previaa can further improve the chance of predicting the disease,improve the diagnostic level,and provide a basis for further standardized surgical treatment.