目的：分析比较超声征象、磁共振成像（magnetic resonance imaging,MRI）多序列与血清甲胎蛋白（alpha-fetoprotein,AFP）联合在胎盘植入分级及不良妊娠结局中的预测价值,为胎盘植入临床评估提供参考。方法：选取2021年3月—2023年1月我院收治的192例胎盘植入剖宫产分娩孕妇,依据分娩后病理结果分级：Ⅰ级（83例）、Ⅱ级（78例）、Ⅲ级（31例）,并统计不良妊娠结局发生情况（术中出血≥1 500 mL和/或子宫切除）。产前均行超声检查、MRI检查及血清AFP检查,分析末次超声征象、MRI多序列、血清AFP与其联合对胎盘植入的联合预测价值。结果：192例中不良妊娠结局79例、良好妊娠结局113例。胎盘植入Ⅰ级组、Ⅱ级组、Ⅲ级组超声征象、MRI多序列征象出现比例比较差异有统计学意义,血清AFP水平比较,Ⅲ级组高于Ⅱ级组、Ⅰ级组,Ⅱ级组高于Ⅰ级组;不良妊娠结局组、良好妊娠结局组超声征象、MRI多序列征象出现比例比较差异有统计学意义;血清AFP水平比较,不良妊娠结局组高于良好妊娠结局组;ROC曲线显示,MRI多序列联合血清AFP预测胎盘植入分级、不良妊娠结局的AUC分别为0.949（95%CI：0.907~0.975）、0.939（95%CI：0.895~0.969）,预测效能优于超声征象联合血清AFP。结论：MRI多序列联合血清AFP在胎盘植入分级、不良妊娠结局预测中有较高应用价值,预测效能优于超声征象联合血清AFP。
Abstract
Objective To analyze and compare the predictive value of ultrasound signs, magnetic resonance imaging (MRI) multi-sequences, and serum alpha-fetoprotein (AFP) in the grading of placental implantation and adverse pregnancy outcomes, and to provide a reference for clinical evaluation of placental implantation. Methods A total of 192 pregnant women who underwent cesarean section for placenta implantation in our hospital from March 2021 to January 2023 were selected. According to the pathological results after delivery, they were classified into grade I (83 cases), grade II (78 cases), and grade III (31 cases). and the occurrence of adverse pregnancy outcomes (intraoperative bleeding≥1 500 mL and/or hysterectomy) was counted. All patients underwent ultrasound, MRI, and serum AFP examinations before delivery. The combined predictive value of the last ultrasound sign, MRI multi-sequence, serum AFP, and their combination for placental implantation were analyzed. Results Of the 192 cases, 79 had adverse pregnancy outcomes and 113 had good pregnancy outcomes. The proportion of ultrasound signs and MRI multiple sequence signs of placenta implantation in grade Ⅰ, Ⅱ and Ⅲ groups had statistical significance. The level of serum AFP in grade Ⅲ group was higher than that in grade Ⅱ and Ⅰ groups, and grade Ⅱ group was higher than that in grade Ⅰ group. There were significant differences in the proportion of ultrasound signs and MRI multiple sequence signs between the adverse pregnancy outcome group and the good pregnancy outcome group. Comparison of serum AFP levels was higher in the poor pregnancy outcome group than in the good pregnancy outcome group. The receiver operating characteristic (ROC) curve showed that the AUC of MRI multi-sequence combined with serum AFP for predicting placental implantation grading and adverse pregnancy outcomes were 0.949 (95%CI: 0.907-0.975) and 0.939 (95%CI: 0.895-0.969), respectively, with better predictive performance than ultrasound signs combined with serum AFP. Conclusion The combination of MRI multi-sequence and serum AFP has high application value in the grading of placental implantation and the prediction of adverse pregnancy outcomes, and its predictive efficacy is superior to that of ultrasound signs combined with serum AFP.
关键词
胎盘植入 /
超声 /
磁共振成像 /
甲胎蛋白 /
妊娠结局 /
受试者工作特征曲线
Key words
placental implantation /
ultrasound /
magnetic resonance imaging /
alpha-fetoprotein /
pregnancy outcome /
receiver operating characteristic curve
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基金
保定市科技计划项目“胎儿闭合性脊柱裂产前超声筛查现状及影响因素”（2241ZF062）
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