标题：MRI联合血清AFP、CK诊断凶险性前置胎盘伴胎盘植入的价值

      作者：马亚宁 1，王旬 2，何娟娟 3    1.安康市中心医院CT室，陕西 安康 725000；2.安康市中心医院功能科，陕西 安康 725000；3.咸阳彩虹医院妇产科，陕西 咸阳 712000

      卷次： 2022年33卷4期

      【摘要】 目的 分析磁共振成像(MRI)联合血清甲胎蛋白(AFP)、肌酸激酶(CK)检测在凶险性前置胎盘伴胎盘植入诊断中的应用价值。方法 选取2018年5月至2020年5月在安康市中心医院接受剖宫产手术且符合纳入与排除标准的97例凶险性前置胎盘患者，其中胎盘植入组40例，非植入组57例。另选取同期在安康市中心医院接受剖宫产手术且无胎盘前置、无其他妊娠相关并发症、单胎且满足排除标准的30例孕妇作为对照组。比较三组孕妇的MRI影像学资料和血清AFP、CK水平；绘制受试者工作特征曲线(ROC)分析MRI、AFP、CK单一指标及其联合对凶险性前置胎盘伴胎盘植入的诊断价值。结果 植入组患者的AFP、CK水平明显高于非植入组和对照组，差异均有统计学意义(P<0.05)，但非植入组与对照组的血清AFP、CK水平比较差异均无统计学意义(P>0.05)；单一指标诊断时，MRI的曲线下面积(AUC)最高(0.818)，其次为CK (0.784)；MRI诊断凶险性前置胎盘伴胎盘植入的准确率、敏感度、特异度分别为84.25%、75.00%、88.51%，且MRI、CK诊断凶险性前置胎盘伴胎盘植入的AUC明显高于AFP，差异均有统计学意义(P<0.05)；MRI、AFP、CK三者联合诊断凶险性前置胎盘伴胎盘植入的AUC值为0.846，明显高于MRI联合CK或AFP联合CK的AUC值，差异均有统计学意义(P<0.05)。结论 MRI、AFP、CK对凶险性前置胎盘伴胎盘植入均可发挥一定诊断效能，但三指标联合诊断效能最佳，值得临床重视。
      【关键词】 前置胎盘；凶险性前置胎盘；磁共振；甲胎蛋白；肌酸激酶；诊断
      【中图分类号】 R714.46+2 【文献标识码】 A 【文章编号】 1003—6350（2022）04—0468—04

Value of MRI combined with serum AFP and CK in the prediction of pernicious placenta previa with placentaaccreta.
MA Ya-ning 1, WANG Xun 2, HE Juan-juan 3. 1. CT Room, Central Hospital, Ankang 725000, Shaanxi, CHINA;2. Department of Functional Diagnosis, Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA; 3. Department ofObstetrics and Gynecology, Xianyang Rainbow Hospital, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To analyze the application value of magnetic resonance imaging (MRI) combined withserum alpha-fetoprotein (AFP) and creatine kinase (CK) in the diagnosis of pernicious placenta previa (PPP) with placen-ta accreta. Methods A total of 97 patients with PPP, including 40 patients with placenta accrete (accreta group) and 57patients without placenta accreta (non-accreta group), who underwent cesarean section in Ankang Central Hospital andmet the inclusion and exclusion criteria were selected between May 2018 and May 2020. Meanwhile, 30 women withsingleton pregnancies but without placenta previa or other pregnancy complications who underwent cesarean section inAnkang Central Hospital and met the exclusion criteria were selected as the control group. MRI data and serum AFP andCK levels were compared among the three groups of pregnant women. The receiver operating characteristic (ROC)curve was plotted to analyze the diagnostic value of MRI, AFP, CK alone and in combination for PPP with placenta ac-creta. Results AFP and CK levels in the accreta group were significantly higher than those in the non-accreta groupand the control group, with statistically significant differences (P<0.05), but there was no statistically significant differ-ence between the non-accreta group and the control group (P>0.05). For single index diagnosis, the area under the curve(AUC) of MRI was the largest (0.818), followed by CK (0.784). The accuracy rate, sensitivity, and specificity of MRI todiagnose PPP with placenta accreta were 84.25%, 75.00%, and 88.51%, respectively. The AUC values of MRI and CKwere significantly larger than that of AFP to diagnose PPP with placenta accreta, with statistically significant differences(P<0.05). The AUC of combined diagnosis with the MRI, AFP and CK (0.846) was significantly higher than that of MRIcombined with CK or AFP combined with CK, with statistically significant differences (P<0.05). Conclusion MRI,AFP and CK all can be used to diagnose PPP with placenta accreta, and the efficiency of combined diagnosis with thethree indexes is the best.
      【Key words】 Placenta previa; Pernicious placenta previa (PPP); Magnetic resonance imaging (MRI); Alpha-feto-protein (AFP); Creatine kinase (CK); Diagnosis