Application of serum markers combined with colour Doppler ultrasound in the prenatal diagnosis of pernicious placenta previa
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摘要:
目的 探讨血清基质金属蛋白酶9(matrix metalloproteinase 9, MMP-9)、肌酸激酶(creatine kinase，CK)水平联合彩超在植入性凶险性前置胎盘产前诊断中的应用价值。 方法 选取2019年1月—2020年8月于蚌埠医学院第一附属医院分娩的植入性凶险性前置胎盘患者50例为观察组(穿透型3例、植入型31例、黏连型16例)，既无前置胎盘又无胎盘植入的产妇50例为对照组，入院均行彩超、MMP-9、CK检查。2组一般资料比较采用成组t检验，单因素方差分析进行各组MMP-9、CK水平的比较，以ROC曲线获取变量的截断值，Delong检验比较各指标单独及联合诊断的ROC曲线下面积(AUC)，并比较相应约登指数大小。 结果 观察组与对照组的一般资料(年龄、孕周、孕次、产次)比较差异无统计学意义(t=1.855、0.669、1.666、0.267，均P＞0.05)，各组MMP-9、CK水平比较差异有统计学意义(F=43.134、22.600，均P < 0.05)，其中穿透型植入性凶险性前置胎盘患者CK高于植入型，植入型高于黏连型和对照组，穿透型和植入型患者MMP-9高于对照组(均P < 0.05)。CK最佳截断值为38.00 U/L，MMP-9为362.90 ng/mL，联合诊断的AUC(0.902)、约登指数(0.76)均大于各单项诊断。 结论 血清MMP-9、CK水平联合彩超有利于提高植入性凶险性前置胎盘的产前诊断价值，且优于各单项指标的检测价值。 -
关键词:
- 植入性凶险性前置胎盘 /
- 基质金属蛋白酶9 /
- 肌酸激酶 /
- 彩超
Abstract:Objective This study aimed to explore the application value of serum matrix metalloproteinase 9 (MMP-9) and creatine kinase (CK) levels combined with colour Doppler ultrasound in the prenatal diagnosis of pernicious placenta previa. Methods Fifty patients with pernicious placenta previa who were delivered in the First Affiliated Hospital of Bengbu Medical College from January 2019 to August 2020 were selected as the observation group (3 patients with penetrating type, 31 patients with implanted type and 16 patients with adhesive type), and 50 cases of non-placenta previa and non-implanted patients served as the control group. Colour Doppler ultrasound, MMP-9 and CK examinations were performed after admission. Independent sample t test was used to compare two groups of general information, and one-way analysis of variance was used to compare the levels of MMP-9 and CK in each group. The cut-off value of the variable was obtained through the ROC curve, and the Delong test compared the area under the ROC curve (AUC) of each indicator individually and in combination. Respective Youden indices were compared. Results No significant difference in general information (age, gestational age, gestation times and parity; t=1.855, 0.669, 1.666, 0.267; all P>0.05) was found between the observation group and the control group, and the differences in the levels of MMP-9 and CK in each group were statistically significant (F=43.134, 22.600, all P < 0.05). The observation group was higher than the control group, and the level of CK in the penetrating type was higher than that in the implanted type. The implanted type was higher than the adhesive type and control group, and the level of MMP-9 was higher in the penetrating and implanted type than that in the control group (P < 0.05). The best cut-off value of CK was 38.00 U/L, and MMP-9 was 362.90 ng/mL. Furthermore, the AUC (0.902) and the Youden index (0.76) of the three combined diagnoses were greater than the detection results of each individual index. Conclusion Serum MMP-9 and CK levels combined with colour Doppler ultrasound can improve the prenatal diagnosis of pernicious placenta previa, which is better than the detection value of each individual index. -
表 1 植入性凶险性前置胎盘患者与对照组产妇一般资料比较(x±s)
组别 例数 年龄(岁) 孕周(周) 孕次(次) 产次(次) 观察组 50 32.28±4.49 37.08±2.51 4.12±1.19 1.68±0.71 对照组 50 30.62±4.46 37.40±2.35 3.70±1.33 1.72±0.78 t值 1.855 0.669 1.666 0.267 P值 0.067 0.505 0.099 0.790 
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表 2 植入性凶险性前置胎盘患者与对照组产妇MMP-9和CK水平比较(x±s)
组别 例数 MMP-9(ng/mL) CK(U/L) 穿透型 3 523.49±129.72 64.00±19.08 植入型 31 453.25±77.19 47.81±14.71a 黏连型 16 365.26±138.29 38.38±11.12ab 对照组 50 283.06±119.32ab 29.92±7.34ab F值 43.134 22.600 P值 ＜0.001 ＜0.001 注：与穿透型比较，aP < 0.05；与植入型比较，bP < 0.05。
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表 4 MMP-9、CK、彩超结果与是否发生胎盘植入的二元logistic回归分析
项目 B SE Wald χ2 P值 OR值 95% CI CK 0.151 0.035 20.397 < 0.001 1.170 1.093~1.253 MMP-9 0.028 0.006 19.651 < 0.001 1.028 1.016~1.041 彩超结果 3.300 0.600 30.241 < 0.001 27.046 8.350~87.603 注：校正年龄、孕次、产次及孕周。
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表 5 MMP-9、CK、彩超和联合指标的ROC结果
指标 AUC SE P值 95% CI 截点 CK 0.829 0.043 0.045 0.741~0.897 38.00 MMP-9 0.845 0.041 0.048 0.759~0.910 362.90 彩超 0.820 0.038 0.041 0.731~0.890 联合 0.902 0.033 ＜0.001 0.827~0.953 66.03
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