胎盘植入超声评分量表的临床价值研究

Study on the clinical value of placenta accreta ultrasound scoring scale

目的评价胎盘植入超声评分量表在产前预测胎盘植入类型及凶险程度中的临床价值。方法选择2020年9月~2022年3月行胎盘植入超声评分量表评分并分娩的胎盘植入患者112例作为实验组,选择2019年9月~2020年8月未行胎盘植入超声评分量表评分并分娩的胎盘植入患者139例作为对照组。比较实验组和对照组术前磁共振成像(MRI)检查占比、术前介入占比及住院费用;比较实验组不同类型胎盘植入患者的超声评分,采用受试者工作特征曲线(ROC)分析不同类型胎盘植入患者的超声评分预测界值;比较实验组不同超声评分患者的术前MRI检查占比、术前介入占比、手术时间、术中出血量、住院费用、子宫切除率。结果实验组患者术前MRI检查占比47.3%、术前介入占比14.3%及住院费用10046(3720,53483)元均低于对照组的63.3%、27.3%、12303(5015,61224)元,差异具有统计学意义(P<0.05)。实验组112例患者超声评分为(4.14±1.69)分。根据术中所见或病理结果将实验组患者分为粘连型79例、植入型23例、穿透型10例,超声评分分别为(3.41±1.03)、(5.57±1.56)、(6.70±1.70)分。三种类型胎盘植入患者超声评分比较差异具有统计学意义(P<0.05);三种类型胎盘植入患者两两比较差异具有统计学意义(P<0.05)。超声评分越高,胎盘植入程度越严重。ROC曲线显示:粘连型和植入型的预测界值为5分,≥5分时考虑为植入型,<5分时考虑为粘连型;植入型和穿透型的预测界值为7分,>7分时考虑为穿透型,≤7分时考虑为植入型。根据ROC界值预测将实验组胎盘植入患者超声评分分为<5分组(79例)、5~7分组(23例)、>7分组(10例),三组患者术前MRI检查占比、术前介入占比、手术时间、术中出血量、住院费用、子宫切除率比较差异具有统计学意义(P<0.05)。结论胎盘植入超声评分量表对产前预测胎盘植入类型及其凶险程度具有较好的应用价值,对降低术前过度诊断,改善母婴结局发挥重要作用。因其价格低、易于开展、诊断正确率高等优点可作为诊断首选。

Objective To evaluate the clinical value of placenta accreta ultrasound scoring scale in prenatally predicting the type and risk of placenta accreta.Methods 112 patients with placenta accreta who were scored by placenta accreta ultrasound scoring scale and gave birth from September 2020 to March 2022 were selected as the experimental group;139 patients with placenta accreta who were not scored by placenta accreta ultrasound scoring scale and gave birth from September 2019 to August 2020 were selected as the control group.Comparison was made on percentage of preoperative magnetic resonance imaging(MRI)examination,the percentage of preoperative intervention and hospitalization expenses between the experimental group and the control group;ultrasound scores of patients with different types of placenta accreta in the experimental group,and the receiver operating characteristic(ROC)curve was used to analyze the predictive thresholds of ultrasound scores in patients with different types of placenta accreta;percentage of preoperative MRI examination,percentage of preoperative intervention,operation time,intraoperative blood loss,hospitalization cost,and hysterectomy rate of patients with different ultrasound scores in the experimental group.Results The percentage of preoperative MRI examination 47.3%,preoperative intervention 14.3%and hospitalization cost 10046(3720,53483)yuan of the experimental group were lower than 63.3%,27.3%and 12303(5,015,61,224)yuan of the control group,and the differences were all statistically significant(P<0.05).The ultrasound score of 112 patients in the experimental group was(4.14±1.69)points.Patients in the experimental group were divided into 79 cases of adhesion type,23 cases of implant type,and 10 cases of penetration type according to intraoperative findings or pathology,with ultrasound scores of(3.41±1.03),(5.57±1.56),and(6.70±1.70)points,respectively.The higher the ultrasound score,the more severe the placenta accreta.The ROC curve shows:the predictive threshold value of adhesion type and implant type was 5 points,when it was≥5 points,it was considered as implant type,and when it was≤5 points,it was considered as adhesion type;the predictive threshold value of implant type and penetration type was 7 points,when it was>7 points,it was considered as penetration type,and when it was≤7 points,it was considered as implant type.According to the prediction of the ROC threshold,the ultrasound scores of the patients with placenta accreta in the experimental group were divided into<5 points group(79 cases),5-7 points group(23 cases),and>7 points group(10 cases).The differences were statistically significant(P<0.05)when comparing the percentage of preoperative MRI examination,percentage of preoperative intervention,operation time,intraoperative blood loss,hospitalization cost,and hysterectomy rate in the three groups.Conclusion Placenta accreta ultrasound scoring scale has a good value for prenatal prediction of the type of placental implantation and its dangerous degree,and plays an important role in reducing preoperative over-diagnosis and improving maternal and infant outcomes.It can be the first choice for diagnosis because of its low price,easy to perform and high correct diagnostic rate.