摘要
目的探讨母体外周血胎儿DNA量、肌酸激酶(CK)、甲胎蛋白(AFP)在孕妇前置胎盘合并胎盘粘连或植入中的预测价值。方法回顾性收集2018年4月至2019年4月河北省承德市中心医院剖宫产术中证实为前置胎盘患者72例,其中合并胎盘粘连患者23例为胎盘粘连组,合并胎盘植入患者19例为胎盘植入组,单纯前置胎盘患者30例为单纯前置胎盘组。均于孕20~27周检测母体外周血胎儿DNA量、CK、AFP,比较三组一般资料、母体外周血胎儿DNA量、CK、AFP,分析母体外周血胎儿DNA量、CK、AFP之间关联性及对前置胎盘情况的预测价值,同时,统计不良妊娠结局发生率,并根据妊娠结局分为不良妊娠结局患者与良好妊娠结局患者,比较两者母体外周血胎儿DNA量、CK、AFP水平,分析前置胎盘不良妊娠结局发生的影响因素。结果胎盘植入组母体外周血胎儿DNA量、CK、AFP水平明显高于胎盘粘连组、单纯前置胎盘组[(1018.96±442.15)copies/ml比(659.27±320.26)和(390.64±102.53)copies/ml、(103.54±26.39)U/L比(88.30±20.65)和(62.78±15.84)U/L、(319.65±62.14)μg/L比(284.62±55.96)和(232.64±48.62)μg/L],差异有统计学意义(P<0.01)。母体外周血胎儿DNA量与CK、AFP呈正相关(r=0.899和0.769,P<0.01),CK与AFP呈正相关(r=0.782,P<0.01)。母体外周血胎儿DNA量预测前置胎盘合并胎盘粘连的AUC最大,为0.842,灵敏度和特异度分别为78.26%、83.33%。不良妊娠结局患者母体外周血胎儿DNA量、CK、AFP水平高于良好妊娠结局患者[(928.64±257.73)copies/ml比(460.02±188.95)copies/ml、(105.83±26.88)U/L比(66.33±20.39)U/L、(292.52±58.39)μg/L比(259.29±42.65)μg/L],差异有统计学意义(P<0.05)。胎盘粘连、胎盘植入、产后出血量、母体外周血胎儿DNA量、CK、AFP水平均为前置胎盘不良妊娠结局的影响因素(OR=3.544、4.183、3.413、3.222、3.109和3.313,95%CI 1.905~6.593、2.401~7.286、1.832~6.359、1.729~6.005、1.659~5.827和1.831~5.994,P<0.01)。结论母体外周血胎儿DNA量、CK、AFP在孕妇前置胎盘合并胎盘粘连或植入中具有一定预测价值,且与前置胎盘患者妊娠结局密切相关,早期检测上述指标有助于临床合理制定干预措施,促进妊娠结局改善。
Objective To investigate the predictive value of maternal peripheral blood fetal DNA,creatine kinase(CK),and alpha-fetoprotein(AFP)in pregnant women with placenta previa complicated with adhesion or implantation.Methods From April 2018 to April 2019,72 patients with placenta previa confirmed by cesarean section in Chengde Central Hospital were retrospectively collected.Among them,23 patients complicated with placental adhesion were enrolled in the placenta adhesion group,19 patients complicated with placenta implantation were in the placenta implantation group,and 30 patients with simple placenta previa were in the simple placenta previa group.The amount of fetal DNA,CK and AFP in maternal peripheral blood were measured at 20 to 27 weeks of gestation.The general data of the three groups,the amount of fetal DNA in maternal peripheral blood,CK and AFP were compared.The value of the amount of fetal DNA,CK,and AFP in maternal peripheral blood for predivting placenta previa were analyzed.At the same time,the incidence of adverse pregnancy outcomes was counted,and patients were divided into adverse pregnancy outcomes group and good pregnancy outcomes group according to pregnancy outcomes.The fetal DNA amount,CK and AFP levels in the maternal peripheral blood of the two were compared,and the factors affecting the adverse pregnancy outcome of placenta previa were analyzed.Results The levels of fetal DNA,CK and AFP in the maternal peripheral blood of the placenta implantation group were significantly higher than those of the placenta adhesion group and the simple placenta previa group:(1018.96±442.15)copies/ml vs.(659.27±320.26)copies/ml and(390.64±102.53)copies/ml,(103.54±26.39)U/L vs.(88.30±20.65)U/L and(62.78±15.84)U/L,(319.65±62.14)μg/L vs.(284.62±55.96)and(232.64±48.62)μg/L,and the difference was statistically significant(P<0.01).The amount of fetal DNA in maternal peripheral blood was positively correlated with CK and AFP(r=0.899 and 0.769,P<0.01),and CK was positively correlated with AFP(r=0.782,P<0.01).The AUC of maternal peripheral blood fetal DNA in predicting placenta previa complicated with placenta adhesion was 0.842,and the sensitivity and specificity were 78.26%and 83.33%respectively.The levels of fetal DNA,CK and AFP in maternal peripheral blood of patients with adverse pregnancy outcomes were higher than those of patients with good pregnancy outcomes:(928.64±257.73)copies/ml vs.(460.02±188.95)copies/ml,(105.83±26.88)U/L vs.(66.33±20.39)U/L and(292.52±58.39)μg/L vs.(259.29±42.65)μg/L,and the difference was statistically significant(P<0.05).Placenta adhesion,placenta implantation,postpartum hemorrhage,maternal peripheral blood fetal DNA,CK and AFP levels were influential factors for the adverse pregnancy outcome of placenta previa(OR=3.544,4.183,3.413,3.222,3.109 and 3.313,95%CI 1.905 to 6.593,2.401 to 7.286,1.832 to 6.359,1.729 to 6.005,1.659 to 5.827 and 1.831 to 5.994,P<0.01).Conclusions The amount of fetal DNA,CK and AFP in maternal peripheral blood have a certain predictive value in placenta previa complicated with placental adhesion or implantation,and are closely related to the pregnancy outcome of patients with placenta previa.Early detection of the above indicators will help clinically to formulate reasonable intervention measures and promote the improvement of pregnancy outcomes.
作者
张晓月
邱晓茹
吴欣欣
Zhang Xiaoyue;Qiu Xiaoru;Wu Xinxin(Department of Obstetrics and Gynecology,Chengde Central Hospital,Hebei Chengde 067000,China)
出处
《中国医师进修杂志》
2021年第11期1039-1045,共7页
Chinese Journal of Postgraduates of Medicine
基金
河北省承德市科技支撑课题计划(201801A012)。
关键词
前置胎盘
肌酸激酶
甲胎蛋白类
母体外周血
胎盘粘连
胎盘植入
Placenta previa
Creatine kinase
Alpha-fetoproteins
Maternal peripheral blood
Placenta adhesion
Placenta implantation
