核磁共振结合血清甲胎蛋白、肌酸激酶水平诊断凶险型前置胎盘合并胎盘植入的价值
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摘要
目的对核磁共振(MRI)结合血清甲胎蛋白(AFP)、肌酸激酶(CK)表达诊断凶险型前置胎盘合并胎盘植入的价值进行探讨。方法选取2015年1月-2016年10月收治的90例凶险型前置胎盘患者,根据手术和术后病理结果分为凶险型前置胎盘合并胎盘植入组(简称植入组,53例)和凶险型前置胎盘非胎盘植入组(简称非植入组,37例),比较两组患者静脉血中AFP、CK的水平,并将所有患者的MRI结果、血清学检查结果及两者联合检查结果与病理结果进行比较。结果植入组血清AFP和CK表达水平显著高于非植入组(P<0.05)。MRI、血清学检查及二者联用的诊断灵敏度(71.74%vs.67.92%)、漏诊率(28.3%vs.32.13%)、阴性预测值(63.34%vs.63.0%)和符合率(71.12%vs.72.25%)之间比较,差异具有统计学意义(P<0.05),联合诊断的灵敏度(90.56%)、阴性预测值(86.84%)和符合率(90.00%)均显著高于单独的MRI或血清学检查(P<0.05),漏诊率(9.43%)低于单独的MRI或血清学检查(P<0.05)。结论 MRI联合血清AFP、CK表达检测能提高诊断的灵敏度和诊断符合率,优于单项检测,具有一定的诊断价值。
Objective To explore the value of magnetic resonance imaging( MRI) combined with serum alpha fetoprotein( AFP) and creatine kinase( CK) in diagnosis of pernicious placenta previa complicated with placental implantation. Methods Ninety patients with pernicious placenta previa treated in Cangzhou Municipal Central Hospital from January 2015 to October 2016 were selected and divided into placental implantation group( 53 patients with pernicious placenta previa complicated with placental implantation) and non-placental implantation group( 37 patients with pernicious placenta previa) according to surgical and pathological results after surgery. The levels of AFP and CK in venous blood samples of the two groups were compared. MRI results,serological test results,and the results of MRI combined with serological test were compared with the pathological results. Results The expression levels of serum AFP and CK in placental implantation group were statistically significantly higher than those in non-placental implantation group( P < 0. 05). The sensitivity,missed diagnosis rate,negative predictive value,and coincidence rate of MRI were 71. 74%,28. 3%,63. 34%,and 71. 12%,respectively. The sensitivity,missed diagnosis rate,negative predictive value,and coincidence rate of serological test were 67. 92%,32. 13%,63. 0%,and 72. 25%,respectively. The sensitivity,negative predictive value,and coincidence rate of combined detection of MRI and serological test were90. 56%,86. 84%,and 90. 00%,which were statistically significantly higher than those of single MRI and single serological test( P <0. 05); the missed diagnosis rate of combined detection of MRI and serological test was 9. 43%,which was statistically significantly lower than those of single MRI and single serological test( P<0. 05). Conclusion MRI combined with serum AFP and CK detection can improve the diagnostic sensitivity and accuracy,which is better than those of single MRI and single serological test,MRI combined with serum AFP and CK detection has a certain diagnostic value.
Objective To explore the value of magnetic resonance imaging( MRI) combined with serum alpha fetoprotein( AFP) and creatine kinase( CK) in diagnosis of pernicious placenta previa complicated with placental implantation. Methods Ninety patients with pernicious placenta previa treated in Cangzhou Municipal Central Hospital from January 2015 to October 2016 were selected and divided into placental implantation group( 53 patients with pernicious placenta previa complicated with placental implantation) and non-placental implantation group( 37 patients with pernicious placenta previa) according to surgical and pathological results after surgery. The levels of AFP and CK in venous blood samples of the two groups were compared. MRI results,serological test results,and the results of MRI combined with serological test were compared with the pathological results. Results The expression levels of serum AFP and CK in placental implantation group were statistically significantly higher than those in non-placental implantation group( P < 0. 05). The sensitivity,missed diagnosis rate,negative predictive value,and coincidence rate of MRI were 71. 74%,28. 3%,63. 34%,and 71. 12%,respectively. The sensitivity,missed diagnosis rate,negative predictive value,and coincidence rate of serological test were 67. 92%,32. 13%,63. 0%,and 72. 25%,respectively. The sensitivity,negative predictive value,and coincidence rate of combined detection of MRI and serological test were90. 56%,86. 84%,and 90. 00%,which were statistically significantly higher than those of single MRI and single serological test( P <0. 05); the missed diagnosis rate of combined detection of MRI and serological test was 9. 43%,which was statistically significantly lower than those of single MRI and single serological test( P<0. 05). Conclusion MRI combined with serum AFP and CK detection can improve the diagnostic sensitivity and accuracy,which is better than those of single MRI and single serological test,MRI combined with serum AFP and CK detection has a certain diagnostic value.
引文
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[5]申炜,李耀波.植入(侵入)性前置胎盘MRI的临床应用进展[J].磁共振成像,2014,5(3):236-240.
[6]Bredaki FE,Sciorio C,Wright A,et al.Serum alpha-fetoprotein in the three trimesters of pregnancy:effects of maternal characteristics and medical history[J].Ultrasound Obstet Gynecol,2015,45(6):698-706.
[7]Haris M,Singh A,Cai K,et al.A technique for in vivo mapping of myocardial creatine kinase metabolism[J].Nat Med,2014,20(2):209.
[8]Vintzileos AM,Ananth CV,Smulian JC.Using ultrasound in the clinical management of placental implantation abnormalities[J].Am J Obstet Gynecol,2015,213(4):70-7.
[9]郑小丽,徐坚民,杨敏洁.晚孕期胎盘植入的MRI诊断及分型[J].放射学实践,2015,15(3):264-268.
[10]屠京慧,李莹.胎盘植入保守治疗的临床分析[J].中国全科医学,2014,17(18):2139-2141.
[11]Algebally AM,Yousef RRH,Badr SSH,et al.The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation[J].Pol J Radiol,2014,79(14),409-416.
[12]梁媚珍,唐莉,思敏,等.凶险型前置胎盘诊治进展[J].中国医学创新,2015,21(12):153-156.
[13]金日男,许红雁,钟永红,等.血清甲胎蛋白联合彩色超声检查在胎盘植入产前诊断中的价值[J].现代妇产科进展,2016,25(8):611-613.
[14]Rodríguez L,Sanchez R,Hernndez J,et al.Results of 12 years'combined maternal serum alpha-fetoprotein screening and ultrasound fetal monitoring for prenatal detection of fetal malformations in Havana City,Cuba[J].Prenat Diagn,2015,17(4):301-304.
[2]Salleh N,Giribabu N.Leukemia inhibitory factor:roles in embryo implantation and in nonhormonal contraception[J].Sci World J,2014,14(10):201514.
[3]Du X,Xie X,Wang Y.Uterine artery suture:a preventive approach for pernicious placenta previa[J].Cell Biochem Biophys,2014,68(2):407.
[4]刘淼,王永红,邹小玲.胎盘边缘切口在凶险型前置胎盘剖宫产术中的应用效果评价[J].湘南学院学报:医学版,2014,16(2):26-28.
[5]申炜,李耀波.植入(侵入)性前置胎盘MRI的临床应用进展[J].磁共振成像,2014,5(3):236-240.
[6]Bredaki FE,Sciorio C,Wright A,et al.Serum alpha-fetoprotein in the three trimesters of pregnancy:effects of maternal characteristics and medical history[J].Ultrasound Obstet Gynecol,2015,45(6):698-706.
[7]Haris M,Singh A,Cai K,et al.A technique for in vivo mapping of myocardial creatine kinase metabolism[J].Nat Med,2014,20(2):209.
[8]Vintzileos AM,Ananth CV,Smulian JC.Using ultrasound in the clinical management of placental implantation abnormalities[J].Am J Obstet Gynecol,2015,213(4):70-7.
[9]郑小丽,徐坚民,杨敏洁.晚孕期胎盘植入的MRI诊断及分型[J].放射学实践,2015,15(3):264-268.
[10]屠京慧,李莹.胎盘植入保守治疗的临床分析[J].中国全科医学,2014,17(18):2139-2141.
[11]Algebally AM,Yousef RRH,Badr SSH,et al.The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation[J].Pol J Radiol,2014,79(14),409-416.
[12]梁媚珍,唐莉,思敏,等.凶险型前置胎盘诊治进展[J].中国医学创新,2015,21(12):153-156.
[13]金日男,许红雁,钟永红,等.血清甲胎蛋白联合彩色超声检查在胎盘植入产前诊断中的价值[J].现代妇产科进展,2016,25(8):611-613.
[14]Rodríguez L,Sanchez R,Hernndez J,et al.Results of 12 years'combined maternal serum alpha-fetoprotein screening and ultrasound fetal monitoring for prenatal detection of fetal malformations in Havana City,Cuba[J].Prenat Diagn,2015,17(4):301-304.