经阴道超声联合血清巨噬细胞抑制因子-1、妊娠相关血浆蛋白A水平对早期子宫瘢痕妊娠的诊断价值研究

The value of transvaginal ultrasound combined with serum macrophage inhibitory cytokine-1 and pregnancy-associated plasma protein A levels in the diagnosis of early uterine scar pregnancy

目的探讨经阴道超声联合血清巨噬细胞抑制因子-1(MIC-1)、妊娠相关血浆蛋白A(PAPP-A)水平对早期子宫瘢痕妊娠的诊断价值。方法选取2019年1月至2021年1月金华市妇幼保健院诊治的78例临床诊断为子宫瘢痕妊娠的患者作为研究对象(子宫瘢痕妊娠组)。选取同期的74例孕检结果正常且有1次剖宫产史的孕妇为对照组。所有研究对象均接受经阴道超声检查,采用电生化发光全自动免疫分析仪检测血清MIC-1、PAPP-A水平。采用受试者工作特征(ROC)曲线评价血清MIC-1、PAPP-A水平预测子宫瘢痕妊娠的价值,分析经阴道超声联合血清MIC-1、PAPP-A对子宫瘢痕妊娠的诊断价值。结果与对照组比较,子宫瘢痕妊娠组血清MIC-1、PAPP-A较低,差异具有统计学意义(P<0.05)。经阴道超声在子宫瘢痕妊娠诊断中的准确度为90.79%,灵敏度为89.74%,特异度为91.89%;血清MIC-1在子宫瘢痕妊娠诊断中的准确度为80.92%,血清PAPP-A在子宫瘢痕妊娠诊断中的准确度为84.21%;联合检测在子宫瘢痕妊娠诊断中的准确度为94.74%,灵敏度为94.87%,特异度为94.59%。结论经阴道超声联合血清MIC-1、PAPP-A诊断早期子宫瘢痕妊娠的准确度高于单一指标,其在早期子宫瘢痕妊娠诊断中具有一定的临床应用价值。

Objective To investigate the diagnostic value of transvaginal ultrasound combined with serum macrophage inhibitory cytokine-1(MIC-1) and pregnancy-associated plasma protein A(PAPP-A) in early uterine scar pregnancy. Methods A total of 78 patients who were clinically diagnosed with uterine scar pregnancy in Jinhua Maternal and Child Health Hospital from January 2019 to January 2021 were selected as the research object(uterine scar pregnancy group). During the same period, 74 pregnant women with history of a cesarean section and normal pregnancy examination results were selected as the control group. All pregnant women underwent transvaginal ultrasound examination, the serum MIC-1 and PAPP-A levels were detected with electrochemical luminescence automatic immunoassay analyzer. The value of serum MIC-1 and PAPP-A levels in predicting uterine scar pregnancy was evaluated with receiver operating characteristic(ROC) curve, the diagnostic value of transvaginal ultrasound combined with serum MIC-1 and PAPP-A for uterine scar pregnancy was analyzed. Results Compared with the control group, serum MIC-1 and PAPP-A were lower in the uterine scar pregnancy group(P<0.05). The accuracy, sensitivity and specificity of transvaginal ultrasound in the diagnosis of pregnancy with uterine scar were 90.79%, 89.74% and 91.89% respectively. The accuracy of serum MIC-1 in the diagnosis of uterine scar pregnancy was 80.92%, and that of serum PAPP-A was 84.21%. The accuracy, sensitivity and specificity in the diagnosis of pregnancy with uterine scar were 94.74%, 94.87% and 94.59% respectively. Conclusions The accuracy of transvaginal ultrasound combined with serum MIC-1 and PAPP-A in the diagnosis of early uterine scar pregnancy is higher than a single index, which is of great significance for the diagnosis of early uterine scar pregnancy.