彩色多普勒超声与血清CK、AFP相关性在前置胎盘合并产前胎盘植入的诊断价值

Diagnostic value of color Doppler ultrasound in correlation with serum CK and AFP for placenta previa with prenatal placental implantation

目的分析彩色多普勒超声与血清肌酸激酶(CK)、甲胎蛋白(AFP)相关性在前置胎盘合并产前胎盘植入的诊断价值。方法选择2019年1月至2021年12月在深圳市龙岗区人民医院收治的96例疑似前置胎盘合并产前胎盘植入患者,年龄23~43岁,平均年龄32.35岁(标准差11.41岁);孕周31~41周,平均孕周35.70周(标准差8.52周)。均行产前彩色多普勒超声检查并分组。行剖宫产,作病理检查。通过酶联免疫吸附分析(ELISA)法检测CK、AFP表达水平。比较两种收缩期峰值血流速度(PSV)水平、搏动指数(PI)、血管阻力指数(RI),分析彩色多普勒超声参数与CK、AFP的相关性。采用受试者工作特性(ROC)曲线分析PSV、PI、RI和三者联合诊断结果比较。结果经彩色多普勒超声检测明确前置胎盘合并产前胎盘植入患者有48例,手术病理检测显示粘连型16例,植入型20例,穿透型12例。依据产前超声图像将其分为48例前置胎盘合并产前胎盘植入患者为研究组,48例非前置胎盘合并产前胎盘植入人员为对照组。两组年龄、孕周差异无统计学意义(P>0.05)。与对照组相比,研究组PSV水平上升,PI、RI下降[(43.23±5.71)cm/s vs(36.74±5.39)cm/s、0.48±0.11 vs 0.68±0.15、0.88±0.31 vs 1.39±0.45。P<0.05]。与粘连型患者相比,植入型患者PSV、CK、AFP水平上升,PI(0.65±0.11 vs 0.77±0.13)、RI(1.24±0.36 vs 1.47±0.59)下降(P<0.05);与植入型患者相比,穿透型患者PSV、CK、AFP水平上升,PI(0.58±0.10 vs 0.65±0.11)、RI(0.80±0.25 vs 1.24±0.36)下降(P<0.05)。PSV、CK、AFP表达水平与不同类型的前置胎盘合并产前胎盘植入呈正相关(r=0.546、0.630、0.547),PI、RI水平与不同类型的前置胎盘合并产前胎盘植入呈负相关(r=-0.481、-0.479)。ROC曲线分析,与PSV、PI、RI单项诊断相比,三项联合诊断对前置胎盘合并产前胎盘植入的诊断价值较高,灵敏度93.80%,特异度91.70%,准确度92.75%(P=0.001)。结论彩色多普勒超声参数在前置胎盘合并产前胎盘植入有着较高的使用价值,且与CK、AFP具有一定的相关性,可用于对前置胎盘合并产前胎盘植入症状变化的评估予以诊治。

Objective To analyze diagnostic value of correlation between color Doppler ultrasound and serum creatine kinase(CK)and alpha-fetoprotein(AFP)in placenta previa with prenatal placental implantation.Methods From January 2019 to December 2021,a total of 96 patients with suspected placenta previa and prenatal placental implantation were enrolled,which aged 23-43 years old with mean age of 32.35 years old(standard deviation 11.41 years old);gestational weeks was 31-41 weeks with mean gestational weeks of 35.70 weeks(standard deviation 8.52 weeks).The patients performed prenatal color Doppler ultrasound examination and grouped.The cesarean section and pathological examination were performed.The expres sion levels of serum CK and AFP were detected by enzyme-linked immunosorbent assay(ELISA).The peak systolic velocity(PSV),pulsatility index(PI)and vascular resistance index(RI)were compared between 2 groups,and correlation between color Doppler ultrasound parameters and serum CK,AFP was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the comparison of PSV,PI,RI and combined diagnosis results.Results There were 48 cases of placenta previa combined with prenatal placenta implantation confirmed by color Doppler ultrasound,the surgical pathology showed 16 cases of adhesion type,20 of implantation type and 12 of penetrating type.According to prenatal ultrasound images,all of them were divided into placenta previa combined with prenatal placenta implantation(n=48,study group)and non-placenta previa combined with prenatal placenta implantation(n=48,control group).There was no significant difference in age and pregnancy cycle be-tween 2 groups(P>0.05).Compared with control group,the level of PSV in study group was significantly increased,but PI and RI significantly decreased[(43.23±5.71)cm/s vs(36.74±5.39)cm/s,0.48±0.11 vs 0.68±0.15,0.88±0.31 vs 1.39±0.45.P<0.05].Compared with adhesion type,the levels of PSV,CK and AFP were significantly increased,PI(0.65±0.11 vs 0.77±0.13)and RI(1.24±0.36 vs 1.47±0.59)significantly decreased in implantation type(P<0.05).Compared with implantation type,the levels of PSV,CK and AFP were significantly increased,PI(0.58±0.10 vs 0.65±0.11)and RI(0.80±0.25 vs 1.24±0.36)significantly decreased in penetrating type(P<0.05).The expression levels of PSV,CK and AFP were positively correlated with different types of placenta previa combined with prenatal placenta implantation(r=0.546,0.630,0.547),and levels of PI and RI were negatively correlated with different types of placenta previa combined with prenatal placenta implantation(r=-0.481,-0.479).The ROC curve analysis showed that compared with single diagnosis of PSV,PI and RI,the diagnostic value of combination method in placenta previa combined with prenatal placenta implantation was higher,with sensitivity of 93.80%,specificity of 91.70%and accuracy of 92.75%(P=0.001).Conclusion It is demonstrated that color Doppler ultrasound parameters show high practical value in placenta previa combined with prenatal placenta implantation,and have certain correlation with CK and AFP,which can be used to evaluate the changes in symptoms of placenta previa combined with prenatal placental implantation.