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血清HCG、AFP水平 联合MRI在前置胎盘 植入及其分类诊断 中的应用*

作者:李 萍 翟俊英 李宛玲

所属单位:河南省南阳市第一人民医院妇产科(河南 南阳 473000)

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摘要

目的 探讨血清人绒毛膜促性腺 激素(HCG)、甲胎蛋白(AFP)水平联合磁共 振成像(MRI)在前置胎盘植入及其分类诊 断中的应用。方法 选择我院收治的65例 前置胎盘植入患者为前置胎盘植入组, 另选择同期收治的60例单纯前置胎盘患 者为单纯前置胎盘组,50例无前置胎盘 无植入产妇为对照组,三组产妇产前均 进行血清HCG、AFP与MRI检查,比较不同 检查方法对前置胎盘植入及其分类诊断结 果。结果 前置胎盘植入组血清HCG、AFP 水平均显著高于单纯前置胎盘组和对照组 (P<0.05)。穿透型患者血清HCG、AFP水平 均显著高于粘连型和植入型(P<0.05), 植入型患者血清HCG水平显著高于粘连型 (P<0.05)。HCG+AFP+MRI对粘连型胎盘植 入检出率为96.55%,对植入型胎盘植入检 出率为95.65%,对穿透型胎盘植入检出率 为100%,均高于单纯血清HCG、AFP和MRI 检测。结论 血清HCG、AFP联合MRI可明确 前置胎盘植入及胎盘植入类型,临床应用 价值较高。

Objective To investigate the application of levels of serum human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) combined with magnetic resonance imaging (MRI) in implantation and classification diagnosis of placenta previa. Methods 65 patients with placenta previa implantation in the hospital were enrolled in the placenta previa implantation group. The other 60 patients with single placenta previa in the same period were enrolled in the single placenta previa group. 50 parturients without placenta previa or implantation were enrolled in the control group. The serum HCG, AFP and MRI examination were performed on parturients in the three groups. The results of placenta previa implantation and classification diagnosis with different examination methods were compared. Results The levels of serum HCG and AFP in the placenta previa implantation group were significantly higher than those in the single placenta previa group and the control group (P<0.05). The levels of serum HCG and AFP in the penetrating patients were significantly higher than those in the adhesion type and implanted type patients (P<0.05). The serum HCG level of the implanted patients was significantly higher than that of the adhesion type patients (P<0.05). The implantation detection rates of adhesion placenta, implanted placenta and penetrating placenta with HCG with AFP and MRI were 96.55%, 95.65% and 100%, respectively, all higher than those with either of the three. Conclusion Serum HCG, AFP combined with MRI can identify the placenta previa implantation and type of placenta implantation.

【关键词】人绒毛膜促性腺激素;甲胎蛋 白;磁共振成像;前置胎盘植 入;分类诊断

【中图分类号】R714.46+2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.02.026

前言

前置胎盘是指妊娠28周后胎盘位于子宫下段,位置低于胎先露 部,多伴有胎盘植入,会引起产妇子宫穿孔和大出血,增加母婴死 亡风险[1-2]。超声是产前前置胎盘植入重要诊断方法,但其易受多种 影响,特异度不高,并且对植入分型有关征象描述存在差异,容易误 诊[3]。尽管磁共振成像(MRI)前置胎盘植入诊断中应用不如超声广泛, 但其组织分辨率高,对前置胎盘植入检测敏感度较好[4]。本次研究对 前置胎盘植入患者进行血清HCG、AFP与MRI检查,观察其在前置胎盘植 入及其分类诊断中的应用价值。具体报告如下。