胎盘组织中色素上皮衍生因子联合磁共振检查预测凶险性前置胎盘的诊断价值

The diagnostic value of pigmented epithelium-derived factor combined with magnetic resonance imaging in predicting dangerous placenta previa

目的探究色素上皮衍生因子(PEDF)在凶险性前置胎盘组织中的表达及联合磁共振成像(MRI)检查对凶险性前置胎盘的诊断价值。方法选取2018年1月—2020年1月重庆开州区人民医院收治的97例凶险性前置胎盘产妇根据手术病理结果分为凶险性前置胎盘植入组(n=59)与凶险性前置胎盘非植入组(n=38),所有产妇进行MRI检测,采用免疫组化法检测胎盘组织中PEDF表达,以受试者工作特征曲线(ROC)分析探究PEDF的诊断价值,对比PEDF联合MRI与单项诊断效能。结果凶险性前置胎盘植入组患者胎盘组织中PEDF阳性表达率低于凶险性前置胎盘非植入组患者,差异有统计学意义(P<0.05)。PEDF对凶险性前置胎盘植入诊断的ROC的AUC为0.821(95%CI:0.731~0.892),诊断灵敏度为68.97%,特异度为76.92%,准确度为72.16%。MRI对凶险性前置胎盘植入的灵敏度为75.86%,特异度为74.36%,准确度为74.23%。联合诊断凶险性前置胎盘植入的灵敏度为89.66%,特异度为84.62%,准确度为87.63%。与PEDF、MRI单项诊断相比,联合诊断灵敏度、特异度均显著升高,差异有统计学意义(P<0.05)。结论凶险性前置胎盘产妇胎盘组织中PEDF表达下调,在凶险性前置胎盘植入中具有一定的诊断价值,联合MRI后诊断价值更优。

Objective To investigate the expression of pigment epithelium derived factor(PEDF) in dangerous placenta previa and the diagnostic value of combined magnetic resonance imaging(MRI) in dangerous placenta previa. Methods 97 cases of dangerous placenta previa were divided into dangerous placenta previa implantation group(n=59) and dangerous placenta previa non-implantation group(n=38) according to the results of operation and pathology. All parturients were examined by MRI, the expression of PEDF in placenta was detected by immunohistochemistry, and the diagnostic value of PEDF was explored by ROC analysis, and the diagnostic efficacy of PEDF combined with MRI was compared with that of single diagnosis. Results The positive expression rate of PEDF in placenta tissues of patients with dangerous placenta previa was lower than that of patients without dangerous placenta previa, and the difference was significant(P<0.05). The AUC of PEDF for the diagnosis of dangerous placenta previa implantation was 0.821(95% CI: 0.731–0.892), the diagnostic sensitivity was 68.97%, the specificity was 76.92%, and the accuracy was 72.16%. The sensitivity of MRI to dangerous placenta previa implantation was 75.86%, the specificity was 74.36%, and the accuracy was 74.23%. The sensitivity of combined diagnosis to dangerous placenta previa implantation was 89.66%, the specificity was 84.62%, and the accuracy was 87.63%. Compared with the single diagnoses of PEDF and MRI, the sensitivity and specificity of combined diagnosis increased significantly(P<0.05). Conclusion The expression of PEDF in placenta tissue of women with dangerous placenta previa is down-regulated, which has certain diagnostic value in dangerous placenta previa implantation, and the diagnostic value of combined with MRI is better.