子宫动脉血流联合多参数对胎盘植入性疾病的诊断价值研究

Value of Uterine Artery Blood Flow Associated with Multiple Parameters in the Diagnosis of Placenta Accreta Spectrum Disorders

目的探讨子宫动脉血流联合多参数在胎盘植入性疾病诊断中的应用价值。方法本研究为回顾性队列研究,选取2017年1月—2021年12月就诊于首都医科大学附属北京妇产医院且诊断为前置胎盘的孕妇为研究对象。通过医院电子病历系统获取孕妇的一般资料、既往史、产检信息[子宫动脉搏动指数(pulsatility index,PI)和胎盘超声征象等]、手术信息。根据手术结果将其分为胎盘植入组与非植入组。分析子宫动脉PI值联合剖宫产史及超声征象诊断胎盘植入性疾病的价值。结果共纳入符合标准的前置胎盘孕妇80例,其中植入组34例,非植入组46例。与非植入组相比,植入组孕妇的年龄(P=0.017)、剖宫产史(P<0.001)均显著升高,子宫动脉平均PI值显著降低(P=0.006),胎盘后低回声带局部中断或消失(P<0.001)、胎盘后丰富血流(P<0.001)、子宫-膀胱交界线中断/消失/不规则(P=0.003)等超声征象均具有显著性差异;子宫动脉PI值、剖宫产史、超声征象三者联合诊断胎盘植入性疾病的ROC曲线下面积为0.96(95%CI:0.93~0.99),灵敏度为97.06%(95%CI:91%~100%),特异度为65.22%(95%CI:51%~79%)。结论子宫动脉血流PI值联合多参数预测胎盘植入性疾病的灵敏度较高,有助于早期发现胎盘植入性疾病并及早进行干预。

Objective To explore the application value of uterine artery blood flow associated with mul-tiple parameters in the diagnosis of placenta accreta spectrum disorders.Methods This study was a retrospec-tive cohort study.Pregnant women diagnosed with placenta previa were selected from Beijing Obstetrics and Gynecology Hospital,Capital Medical University,from January 2017 to December 2021.The general informa-tion,past history,antenatal information[including pulsatility index(PI)of uterine artery,ultrasonic signs,etc.]and operation information of the pregnant women were obtained through the hospital electronic medical re-cord system.According to the results of operation,the patients were divided into accreta group and non-accreta group.The diagnostic value of uterine artery PI associated with multiple parameters in the placenta accreta spec-trum disorders was analysed.Results A total of 80 pregnant women were divided into accreta group(34 ca-ses)and non-accreta group(46 cases)according to the inclusion and exclusion criteria.Compared with the non-accreta group,the age of pregnant women in the accreta group(P=0.017)and history of cesarean section(P<0.001)significantly increased,and the mean PI of uterine artery significantly decreased(P=0.006).There were significant differences in ultrasonic signs such as local interruption or disappearance of the posterior placental lower vocal cords(P<0.001),abundant blood flow after placenta(P<0.001),and interruption or disappearance or irregularity of the boundary of the uterus and bladder(P=0.003).The area under the ROC curve of uterine artery PI,cesarean section history and ultrasonic signs in the diagnosis of placenta accreta spectrum disorders was 0.96(95%CI:0.93-0.99),the sensitivity was 97.06%(95%CI:91%-100%),and the specificity was 65.22%(95%CI:51%-79%).Conclusions Uterine artery blood flow PI associated with multiple parameters has high sensitivity in the prediction of placenta accreta spectrum disor-ders,which is helpful in the early detection of this disease.