MRI联合血清AMH、AFP水平在剖宫产术后早期子宫瘢痕妊娠诊断中的临床价值分析

Clinical Value of MRI Combined with Serum AMH and AFP Levels in the Diagnosis of Early Uterine Scar Pregnancy after Cesarean Section

目的 探讨核磁共振(MRI)联合血清抗苗勒管激素(AMH)、甲胎蛋白(AFP)对剖宫产术后早期子宫瘢痕妊娠(CSP)的诊断价值。方法 选取2020年2月-2022年3月期间本院收治的疑似CSP患者133例为研究对象。收集其基本资料(年龄、距上次剖宫产时间、停经天数、剖宫产史等),所有CSP患者均接受MRI检查。酶联免疫吸附法(ELISA)测定血清AMH、 AFP水平;受试者工作特征(ROC)曲线分析血清AMH、AFP水平对CSP的诊断效能;采用Kappa检验分析MRI单独及联合血清AMH、AFP诊断CSP与金标准病理结果的一致性;采用四线格分析并比较MRI、血清AMH、AFP单独及联合对CSP的诊断效能。结果本研究经MRI确诊81例CSP孕妇,52例非CSP孕妇。以手术病理诊断结果作为参考,MRI诊断CSP的灵敏度为78.72%,特异度为82.05%。CSP组血清AMH水平显著低于非CS P组,AF P水平显著高于非CSP组(P<0.05);血清AMH、AFP诊断CSP的AUC分别为0.785、0.824,特异度分别为84.62%、87.18%,灵敏度分别为76.60%、78.72%。MRI、血清AM H、血清AFP单独诊断CS P的Kappa值为0.554、0.547、0.592,三者联合诊断CSP的Kappa值最高,为0.746(P<0.05)。MRI联合血清AMH、AFP诊断CSP的灵敏度及阴性预测值明显高于MRI、血清AMH、AFP单独诊断,准确度明显高于MRI、血清AMH单独诊断(P<0.05)。结论 CSP患者血清AMH低表达,血清AFP高表达,MRI联合血清AMH、AFP对早期CSP进行综合诊断弥补了单一MRI诊断的不足,具有较高临床应用价值。

Objective To investigate the diagnostic value of magnetic resonance imaging(MRI)combined with serum anti Mullerian hormone(AMH)and alpha fetoprotein(AFP)in early uterine scar pregnancy(CSP)after cesarean section.Methods A total of 133 patients with suspected CSP admitted to our hospital from March 2020 to March 2022 were regarded as the study subjects.The basic data(age,time from the last planned labor,days of menopause,history of planned labor,etc.)were collected,and all patients with CSP underwent MRI examination.Serum AMH and AFP were measured by ELISA;the diagnostic efficacy of serum AMH and AFP levels on CSP was analyzed by ROC curve;Kappa test was used to analyze the consistency between MRI alone or in combination with serum AMH and AFP in diagnosing CSP and gold standard pathological results;four line grid analysis was used to compare the diagnostic efficacy of MRI,serum AMH and AFP alone and in combination for CSP.Results In this study,81 pregnant women with CSP and 52 pregnant women without CSP were confirmed by MRI.The sensitivity and specificity of MRI in the diagnosis of CSP were 78.72%and 82.05%respectively.Serum AMH level in CSP group was greatly lower than that in non CSP group,and AFP level was greatly higher than that in non CSP group(P<0.05);the AUC of serum AMH and AFP in diagnosing CSP was 0.785 and 0.824 respectively,the specificity was 84.62%and 87.18%respectively,and the sensitivity was 76.60%and 78.72%respectively.The Kappa value of MRI,serum AMH,and serum AFP was 0.554,0.547,and 0.592 respectively for diagnosing CSP,while the Kappa value of CSP diagnosed by three methods was the highest(0.746)(P<0.05).The sensitivity and negative predictive value of MRI combined with serum AMH and AFP were significantly higher than that of MRI combined with serum AMH and AFP alone,and the accuracy was significantly higher than that of MRI combined with serum AMH alone(P<0.05).Conclusion Serum AMH expression is low in patients with CSP,while serum AFP expression is high.MRI combined with serum AMH and AFP can make up for the deficiency of single MRI diagnosis for early CSP,which has high clinical application value.