MRI与血清sFlt-1、hCG联合诊断凶险性前置胎盘合并胎盘植入的价值-东南大学学报医学版

MRI与血清sFlt-1、hCG联合诊断凶险性前置胎盘合并胎盘植入的价值

单位：宜宾第二人民医院产科, 四川宜宾 644000

关键词：胎盘植入凶险性前置胎盘磁共振成像可溶性血管生长因子受体人绒毛膜促性腺激素

分类号：R714.2

出版年·卷·期（页码）：2025·44·第二期（257-263）

摘要：

目的:探讨磁共振成像(MRI)与血清可溶性血管生长因子受体(sFlt-1)、人绒毛膜促性腺激素(hCG)联合诊断凶险性前置胎盘(PPP)患者合并胎盘植入的价值。方法:选取本院2020年5月至2023年5月收治的120例PPP患者为研究对象,依据病理结果将53例伴胎盘植入患者分为植入组,67例未伴胎盘植入患者分为非植入组。所有患者行MRI检查,血清sFlt-1水平检测采用酶联免疫吸附(ELISA)法,血清hCG水平检测采用电化学发光分析法;采用受试者工作特征(ROC)曲线分析MRI、血清sFlt-1、hCG单独及联合诊断PPP伴胎盘植入的价值;采用Kappa检验分析各检查方法与病理结果的一致性。结果:植入组血清hCG水平[(270.76±42.37) ng·mL^-1]高于非植入组[(203.98±48.59) ng·mL^-1],血清sFlt-1水平[(2 329.44±238.92) μg·L^-1]低于非植入组[(2 704.66±241.65)μg·L^-1)](t=7.905、8.489,P＜0.05)。MRI、血清sFlt-1、hCG单独及联合诊断PPP伴胎盘植入的AUC分别为0.831、0.792、0.779、0.912。MRI、血清sFlt-1、hCG单独及联合诊断的Kappa值分别为0.651、0.495、0.406、0.830(P＜0.05)。MRI联合血清sFlt-1、hCG诊断PPP伴胎盘植入的特异度、准确度、阳性预测值高于三者单独诊断(P＜0.05)。结论:与单独检测相比,MRI联合血清sFlt-1、hCG对PPP伴胎盘植入的诊断效能最佳,有助于提高临床诊断准确度。

Objective: To explore the value of magnetic resonance imaging(MRI) combined with serum soluble fms-like tyrosine kinase-1(sFlt-1) and human chorionic gonadotropin(hCG) in the diagnosis of pernicious placenta previa(PPP) patients with placenta implantation. Methods: 120 PPP patients admitted to our hospital from May 2020 to May 2023 were selected as the research subjects. Based on pathological results, 53 patients with placenta implantation were divided into the implantation group, and 67 patients without placenta implantation were divided into the non implantation group. MRI examinations were performed on all patients. Enzyme linked immunosorbent assay(ELISA) was used to detect serum sFlt-1 level, electrochemical luminescence analysis was applied to detect serum hCG level. Receiver operating characteristic(ROC) curve was used to analyze the value of MRI, serum sFlt-1, and hCG alone and in combination in the diagnosis of PPP with placenta implantation; Kappa test was used to analyze the consistency between various examination methods and pathological results. Results: The serum hCG level [(270.76±42.37) ng·mL^-1] in the implantation group was higher than that in the non implantation group(203.98±48.59) ng·mL^-1］, and the serum sFlt-1 level[(2 329.44±238.92) μg·L^-1]was lower than that in the non implantation group[(2 704.66±241.65) μg·L^-1](t=7.905, 8.489, P<0.05). The AUC of MRI, serum sFlt-1, and hCG alone and in combination for diagnosing PPP with placenta implantation was 0.831, 0.792, 0.779, and 0.912, respectively. In the consistency results,the Kappa values of MRI, serum sFlt-1, and hCG were 0.651, 0.495, 0.406, and 0.830 for individual and combined examinations, respectively(P<0.05). The specificity, accuracy, and positive predictive value of MRI combined with serum sFlt-1 and hCG in diagnosing PPP with placenta implantation were higher than those of the three alone(P<0.05). Conclusion: Compared with individual detection, MRI combined with serum sFlt-1 and hCG has the best diagnostic efficacy for PPP with placenta implantation, which helps to improve clinical diagnostic accuracy.

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