彩色多普勒超声联合血清肿瘤坏死因子-α、游离雌三醇对凶险性前置胎盘合并胎盘植入的诊断价值研究

The diagnostic value of color Doppler ultrasonography combined with serum tumor necrosis factor-αand free estriol for pernicious placenta previa combined with placenta accrete

目的探讨多普勒彩色超声联合血清肿瘤坏死因子-α(TNF-α)、游离雌三醇(FE_(3))对凶险性前置胎盘(PPP)合并胎盘植入的诊断价值。方法选取2018年1月至2021年3月河北省中医院收治的75例PPP患者作为研究对象,根据产后病理分为胎盘植入组(n=32)和无胎盘植入组(n=43);另选取37例同期健康孕妇作为对照组。所有研究对象分娩前均行多普勒彩色超声检查及血清TNF-α、FE_(3)检查,采用四格表法分析多普勒彩色超声诊断PPP合并胎盘植入的价值,绘制受试者工作特征(ROC)曲线分析多普勒彩色超声联合血清TNF-α、FE_(3)水平对PPP合并胎盘植入的诊断效能。结果胎盘植入组、无胎盘植入组血清TNF-α均高于对照组,血清FE_(3)水平均低于对照组(P<0.05);胎盘植入组血清TNF-α高于无胎盘植入组,血清FE_(3)水平低于无胎盘植入组(P<0.05)。血清TNF-α、FE_(3)诊断PPP合并胎盘植入的曲线下面积(AUC)分别为0.820、0.795,灵敏度分别为74.4%、87.5%,特异度分别为65.1%、67.4%;多普勒彩色超声诊断PPP合并胎盘植入的灵敏度、特异度、准确度分别为71.9%、76.7%、74.7%。多普勒彩色超声联合血清TNF-α、FE_(3)水平诊断PPP合并胎盘植入的AUC、灵敏度、特异度分别为0.876、90.6%、86.0%,均高于血清TNF-α、FE_(3)及多普勒彩色超声单一诊断。结论血清TNF-α、FE_(3)水平对PPP合并胎盘植入具有一定的诊断价值,联合多普勒彩色超声检查诊断效能更高。

Objective To investigate the diagnostic value of serum tumor necrosis factor-α(TNF-α),free estriol(FE_(3))combined with color Doppler ultrasound in the diagnosis of pernicious placenta previa(PPP)with placenta accreta.Methods 75 patients with PPP admitted to Hebei Hospital of Traditional Chinese Medicine from January 2018 to March 2021 were selected and divided into placenta accreta group(n=32)and non-placenta accreta group(n=43)based on postpartum pathological diagnosis;the other 37 healthy pregnant women were selected as a control group.All subjects underwent prenatal Doppler ultrasonography and serum TNF-α,FE_(3) examinations.Four-slice method was used to analyze the value of Doppler ultrasound in the diagnosis of PPP combined with placenta accreta,and the receiver operator characteristic(ROC)curve was used to analyze the diagnostic efficacy of Doppler ultrasound combined with serum TNF-αand FE_(3) examinations for PPP combined with placental accreta.Results Serum TNF-αin the placenta accreta group and non-placenta accreta group were higher than those in the control group,and the serum FE_(3) level was lower than that in the control group(P<0.05);the placenta accreta group serum TNF-αwas higher than that without placenta accrete,the serum FE_(3) level was lower than that in the non-placenta accreta group(P<0.05).The area under the curve(AUC)of serum TNF-αand FE_(3) in the diagnosis of PPP with placental accreta was 0.820 and 0.795,respectively,the sensitivity was 74.4%,87.5%,and the specificity was 65.1%and 67.4%,respectively;the sensitivity,specificity and accuracy of Doppler ultrasound in the diagnosis of PPP with placental accreta was 71.9%,76.7%,and 74.7%,respectively;the AUC,sensitivity and specificity of serum TNF-αandFE_(3) combined with color Doppler ultrasound in the diagnosis of PPP with placenta accreta were 0.876,90.6%,and 86.0%,respectively,which were higher than those of serum TNF-α,FE_(3) and Doppler ultrasound single diagnosis.Conclusions Serum TNF-αand FE_(3) levels have a certain diagnostic value for PPP with placental accreta.The combined Doppler ultrasound has a higher diagnostic efficiency.