| 张英伟,徐宁,李西娜,等.三维能量超声联合血清 PAPP-A、FFN检测诊断前置胎盘合并胎盘植入价值[J].安徽医药,2025,29(7):1420-1424. |
| 三维能量超声联合血清 PAPP-A、FFN检测诊断前置胎盘合并胎盘植入价值 |
| Value of three-dimensional energy ultrasound combined with serum PAPP-A and FFN in the diagnosis of placenta praevia with placental implantation abnormality |
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| DOI：10.3969/j.issn.1009-6469.2025.07.031 |
| 中文关键词: 前置胎盘 植入性胎盘 三维能量超声 妊娠相关蛋白 A 纤维连接蛋白 诊断 |
| 英文关键词: Placenta praevia Placenta increta Three dimensional energy ultrasound Pregnancy associated plasma protein A Fibronectin Diagnosis |
| 基金项目:陕西省重点研发计划项目( 2022SF-278) |
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| 中文摘要: |
| 目的探讨血清妊娠相关蛋白 A(PAPP-A)、纤维连接蛋白( FFN)联合三维能量超声对前置胎盘( PP)合并胎盘植入(PIA)的诊断价值。方法收集西安市人民医院(西安市第四医院) 2020年 6月至 2023年 6月治疗的 100例 PP病人作为研究对象，根据最终病理结果分为 36例 PIA组和 64例非 PIA组。血清 PAPP-A、FFN水平检测分别采用放射免疫法和酶联免疫吸附分析，所有病人行术前三维能量超声检查并记录血管参数:血流指数(FI)、血管指数(VI)、血管血流指数( VFI)；三维能量超声、血清 PAPP-A、FFN水平单独及联合诊断 PP合并 PIA的价值采用受试者工作特征曲线( ROC曲线)进行分析；三维能量超声和病理结果间的一致性采用 Kappa检验分析。结果 PP病人中 PIA组与非 PIA组 3种方法 5种参数结果对比， PIA组 PAPP-A［( 864.16±159.74)g/L比( 644.75±132.58)g/L］、 FFN［(45.57±5.36)g/L比( 37.42±5.29)g/L］、三维能量超声血管参数高于非 PIA组(均 P<0.001)。血清 PAPP-A、FFN水平诊断 PP合并 PIA的曲线下面积( AUC)分别为 0.78、0.74。三维能量超声检查结果与最终病理结果的一致性较高， Kappa值为 0.64(P<0.05)。三维能量超声单独及三者联合血清 PAPP-A、FFN水平诊断 PP合并 PIA的 AUC分别为 0.81、0.90，联合诊断 AUC显著高于三维能量超声、 PAPP-A、FFN单独诊断( Z=2.12、3.25、4.38，P<0.05)。三者联合诊断 PP合并 PIA的灵敏度高于三维能量超声、 PAPP-A、FFN单独诊断，阴性预测值高于 PAPP-A、FFN单独诊断，差异有统计学意义( P<0.017)。结论三维能量超声联合血清 PAPP-A、FFN可提高诊断 PP合并 PIA的灵敏度和阴性预测值，诊断效能更佳。 |
| 英文摘要: |
| Objective To investigate the diagnostic value of serum pregnancy associated plasma protein A (PAPP-A), fetal fibronec-tin (FFN) and three-dimensional energy ultrasound in placenta praevia (PP) with placental implantation abnormality (PIA). Methods One hundred patients with PP treated in Xi 'an People's Hospital (Xi 'an Fourth Hospital) from June 2020 to June 2023 were collectedas research objects. According to the final pathological results, they were grouped into 36 PIA groups and 64 non PIA groups. SerumPAPP-A and FFN levels were detected using radioimmunoassay and enzyme-linked immunosorbent assay, respectively. All patients un-derwent preoperative three-dimensional energy ultrasound examination and vascular parameters were recorded: blood flow index (FI),vascular index (VI), and vascular flow index (VFI); ROC curve was applied to analyze the value of three-dimensional energy ultrasound, serum PAPP-A and FFN levels alone and in combination in diagnosing PP with PIA; Kappa test was applied to analyze the consistencybetween three-dimensional energy ultrasound and pathological results.Results Comparison of 3 methods and 5 parameters between PIA group and non PIA group showed that, serum PAPP-A [(864.16 ± 159.74) g/L vs. (644.75 ± 132.58) g/L], FFN [(45.57 ± 5.36) g/L vs. (37.42 ± 5.29) g/L] and three-dimensional energy ultrasound vascular parameters were higher in the PIA group than in the non PIA group (P<0.001). The areas under the curve (AUC) of serum PAPP-A and FFN levels in diagnosis of PP with PIA were 0.78 and 0.74, respectively. The results of three-dimensional energy ultrasound examination showed high consistency with pathological results, with a Kappa value of 0.65 (P<0.05). The AUCs of PP with PIA diagnosed by three-dimensional energy ultrasound alone or in combination with serum PAPP-A and FFN levels were 0.81 and 0.90, respectively. The AUC of the combined diagnosis was significantly higher than that of three-dimensional energy ultrasound, PAPP-A, and FFN alone (Z=2.12, 3.25, 4.38, P < 0.05). The sensitivity of the combined di-agnosis of PP with PIA was higher than those of three-dimensional power ultrasound, PAPP-A and FFN alone, and the negative predic-tive value of the combined diagnosis of PP with PIA was higher than PAPP-A and FFN alone (P<0.017).Conclusion Three dimension-al power ultrasound combined with serum PAPP-A and FFN can improve the sensitivity and negative predictive value in the diagnosisof PP with PIA, and the diagnostic efficacy is better. |
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