彩色多普勒超声与脐动脉血流动力学指标在胎盘植入诊断中的应用

Diagnostic value of color Doppler ultrasound and umbilical artery hemodynamics in placenta implantation

目的探究彩色多普勒超声与脐动脉血流动力学指标对胎盘植入的诊断价值。方法选取2016年9月至2018年9月期间于上海市金山区中西医结合医院行产前检查的妊娠晚期孕妇142例作为研究对象,所有孕妇均行彩色多普勒超声检查及脐动脉血流多普勒频谱检测,记录脐动脉收缩末期峰值与舒张末期峰值的比值(S/D)。将病理诊断作为金标准,评估彩色多普勒超声检查应用于胎盘植入中的诊断价值。用Logistic回归分析脐动脉S/D值与胎盘植入的相关性,并用ROC曲线下面积(AUC)分析脐动脉S/D值及其联合剖宫产次数、胎盘厚度诊断胎盘植入的诊断价值。结果疑似胎盘植入的孕妇34例中,经病理诊断确定为胎盘植入的孕妇有31例,彩色多普勒超声检查确定的孕妇有28例;彩色多普勒超声检查的灵敏度、特异度、漏诊率、误诊率及正确指数分别为90.32%、94.59%、9.68%、5.41%、0.85;将孕妇年龄、流产史、剖宫产次数、胎盘厚度、S/D值视为自变量,胎盘植入与否视为因变量,对胎盘植入的影响因素行Logistic回归分析,结果表明,剖宫产次数、胎盘厚度、S/D值为胎盘植入的独立危险因素(P<0.05);在确定剖宫产次数、胎盘厚度、S/D值为胎盘植入的独立危险因素基础上,再对其作ROC曲线分析,结果表明,脐动脉S/D值AUC为0.998、剖宫产次数AUC为0.968和胎盘厚度AUC为0.971,剖宫产次数、胎盘厚度与S/D值的AUC比较,差异均无统计学意义(P>0.05)。结论彩色多普勒超声检查应用于胎盘植入的诊断效果较好,脐动脉血流动力学指标S/D值及剖宫产次数、胎盘厚度等可作为超声检查胎盘植入的辅助诊断指标。

Objective To explore the diagnostic value of color Doppler ultrasound and umbilical artery hemodynamics in placenta implantation.Methods A total of 142 pregnant women with early pregnancy who were prenatally examined in the Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai City from September 2016 to September 2018 were selected as subjects.All pregnant women underwent color Doppler ultrasonography and umbilical arterial blood flow,and the ratio of the peak end-systolic peak to the end-diastolic peak(S/D)of the umbilical artery was recorded.Pathological diagnosis was used as a gold standard to evaluate the diagnostic value of color Doppler ultrasonography in placenta implantation.Logistic regression was used to analyze the correlation between umbilical artery S/D value and placenta accreta.The area under the ROC curve(AUC)was used to analyze the umbilical artery S/D value and the number of combined cesarean section and placental thickness.Results Among the 34 pregnant women with suspected placental implants,31 were diagnosed as having placenta by pathological diagnosis and 28 were identified by color Doppler ultrasonography.The sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,and correct index of color Doppler ultrasonography were 90.32%,94.59%,9.68%,5.41%,and 0.85,respectively.The age of pregnant women,history of abortion,number of cesarean section,placental thickness,S/D value were regarded as independent variables,placenta implantation was regarded as dependent variable,and the factors affecting placenta implantation were analyzed by logistic regression analysis.The results showed that the number of cesarean section,placental thickness,and S/D value were independent risk factors for placental implantation(P<0.05).Based on the determination of the number of cesarean section,placental thickness,and S/D value as independent risk factors for placental implantation,ROC curve analysis was performed.The results showed that the area under the curve(AUC)of the umbilical artery S/D value was 0.998,and the AUC of the cesarean section was 0.968 and the placental thickness AUC was 0.971.There was no significant difference in the AUC of the cesarean section,placental thickness,and S/D value(P>0.05).Conclusion The diagnostic effect of color Doppler ultrasonography in placenta implantation is better.Umbilical artery hemodynamic index S/D,the number of caesarean section,and placental thickness can be used as assistant diagnostic indicators for placental implantation.