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目的:探讨血清甲胎蛋白(AFP)、肌酸激酶(CK)检测、彩色多普勒超声检查及三者联合对于胎盘植入的产前诊断价值。方法:随机选取2014年3月至2016年3月在粤北人民医院产科行剖宫产术分娩的有胎盘植入高危因素的单胎妊娠孕妇82例为研究组,依据术后病理组织学诊断结果再分为植入组(28例)及非植入组(54例)。另选取剖宫产分娩的无高危因素的单胎妊娠孕妇50例为正常对照组。产前抽血测定孕妇血清AFP、CK水平。行彩色多普勒超声检查观察是否并发胎盘植入。利用受试者工作特征曲线(ROC曲线)找出其临床诊断临界值(cut off值),并比较AFP、CK、彩色多普勒超声及3者联合对胎盘植入的产前诊断价值。结果:植入组孕妇的血清AFP水平明显高于非植入组及对照组,差异有统计学意义(P<0.05);后两组比较差异无统计学意义(P>0.05);植入组、非植入组及对照组孕妇的血清CK水平比较,差异均无统计学意义。AFP产前诊断胎盘植入的界值(cut off值)为247.90ng/ml。AFP及彩色多普勒超声的曲线下面积(AZ)分别为0.659、0.714,两者灵敏度分别为42.86%、46.43%。联合应用时曲线下面积为0.828,灵敏度为78.57%,明显高于前二者单独应用。AFP值测定联合彩色多普勒超声检查较单独彩色多普勒超声、单独AFP检测诊断胎盘植入的准确率高,差异有统计学意义(P<0.05)。结论:AFP及彩色多普勒超声联合可显著提高胎盘植入产前诊断的灵敏度,优于血清AFP、彩色多普勒单项检测,而血清CK检测无意义。
Objective: To investigate the value of serum AFP, CK, color Doppler ultrasonography and prenatal diagnosis of placenta accreta. Methods: From March 2014 to March 2016, 82 pregnant women with single-placenta pregnancy who were at risk of placenta accreta in cesarean section in obstetrics department of Yuebei People’s Hospital were selected as study group. According to histopathological diagnosis Results were further divided into implantation group (28 cases) and non-implantation group (54 cases). Another selection of cesarean section delivery of non-risk factors of singleton pregnant women 50 cases of normal control group. Prenatal blood test pregnant women serum AFP, CK levels. Color Doppler ultrasound examination to observe whether the concurrent placenta accreta. The ROC curve was used to find out the cut off value of clinical diagnosis. The prenatal diagnostic value of AFP, CK, color Doppler ultrasound and placenta accreta was also compared. Results: The level of serum AFP in the pregnant women in the implantation group was significantly higher than that in the non-implantation group and the control group (P <0.05), but there was no significant difference between the two groups (P> 0.05) , Non-implantation group and control group pregnant women serum CK levels, the difference was not statistically significant. AFP prenatal diagnosis of placental implantation cutoff value of 247.90ng / ml. AFP and color Doppler ultrasound area under the curve (AZ) were 0.659,0.714, the sensitivity of the two were 42.86%, 46.43%. The combined area under the curve was 0.828, the sensitivity was 78.57%, significantly higher than the former two alone. AFP value combined with color Doppler ultrasonography compared with color Doppler ultrasound alone, AFP detection alone diagnosis of placenta accreta high accuracy, the difference was statistically significant (P <0.05). Conclusion: AFP and color Doppler ultrasound can significantly improve the sensitivity of prenatal diagnosis of placenta accreta, superior to serum AFP, color Doppler single detection, and serum CK detection of no significance.