甲胎蛋白、hCG检测联合多普勒彩超评估凶险性前置胎盘合并胎盘植入价值

Value of levels of alpha fetoprotein and hCG combined with color Doppler ultrasound screening in assessing women with pernicious placenta previa and placenta accreta

目的:探讨甲胎蛋白(AFP)、人绒毛膜促性腺激素(hCG)检测联合多普勒彩超对凶险性前置胎盘(PPP)合并胎盘植入的评估价值。方法:选取2014年1月—2017年12月本院收治的经手术及病理确诊的PPP患者86例为病例组,并选取同期30例正常孕妇为对照组,产前均行外周血AFP、hCG检测及多普勒彩色超声检查。结果:血清AFP、hCG水平病例组均高于对照组,病例组中胎盘植入者高于非胎盘植入者(均P<0.05)。ROC曲线分析,血清AFP、hCG诊断PPP合并胎盘植入的最佳临界值分别为221.25ng/ml、337.56ng/ml,其曲线下面积为0.774、0.735。血清检测AFP、hCG、多普勒彩色超声三者联合诊断PPP合并胎盘植入敏感度、准确度、阳性预测值(80.4%、86.1%、94.1%)均高于单项检测(均P<0.05)。结论:AFP、hCG检测及多普勒彩色超声联合诊断PPP合并胎盘植入,可显著提高诊断效能。

Objective:To evaluate the value of levels of alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG) combined with color Doppler ultrasound screening in assessing women with pernicious placenta previa (PPP) and placenta accreta.Methods:86 patients with PPP diagnosed by operation and pathology were selected in study group from January 2014 to December 2017,and 30 normal pregnant women were selected in control group during the same time.The levels of serum AFP and hCG of all included women were detected,and all included women were screened by color Doppler ultrasonography before delivery.Results:The levels of serum AFP and hCG of women in study group were significant higher than those of women in control group,and those of women with placenta accreta were significant higher than those of women without placenta accreta (P <0.05).ROC curve analysis showed that the optimal cut off values of serum AFP level and hCG level for diagnosing women with PPP and placental accreta were 221.3 ng/ml and 337.6 ng/ml,respectively,and the area under curve (AUC) were 0.774 and 0.735,respectively.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of combination of levels of serum AFP and hCG,and color Doppler ultrasound screening for diagnosing women with PPP and placenta accreta were 80.4%,90.0%,86.1%,94.1%,77.1%,respectively,which were significant higher than those of AFP level,hCG level,or color Doppler ultrasound screening only (P <0.05).Conclusion:Combination of levels of serum AFP and hCG,and color Doppler ultrasound screening for diagnosing women with PPP and placenta accreta can significantly improve the sensitivity and specificity.