人类软骨糖蛋白-39和甲胎蛋白联合超声在植入性前置胎盘中的应用

姚扣云; 杜丹丽; 李祥

doi:10.16766/j.cnki.issn.1674-4152.002464

人类软骨糖蛋白-39和甲胎蛋白联合超声在植入性前置胎盘中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002464

蚌埠医学院第一附属医院妇产科，安徽蚌埠 233004

基金项目:

安徽省自然科学基金青年项目 2008085QH407

详细信息

通讯作者:
杜丹丽，E-mail: dudanli0224@sina.com

中图分类号: R714.462 R445.1
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出版历程
- 收稿日期: 2021-09-28
- 网络出版日期: 2022-09-05

Application of human cartilage glycoprotein 39 and alpha-fetoprotein combined ultrasound in prenatal diagnosis of implanted placenta previa

Department of Gynecology and Obstetrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨孕晚期人类软骨糖蛋白-39(YKL-40)、甲胎蛋白(AFP)联合超声对植入性前置胎盘的评估价值。方法收集2020年11月—2021年5月于蚌埠医学院第一附属医院分娩的前置胎盘孕妇90例为研究组，依据术中所见和(或)术后病理结果，分为植入组(穿透性4例，植入性17例，粘连性29例)50例和非植入组40例，并收集同期正常孕妇40例为对照组，入院均行YKL-40、AFP与超声检查。结果非植入组和对照组YKL-40、AFP水平低于植入组(均P＜0.05)，其中粘连性前置胎盘YKL-40低于植入性，植入性低于穿透性(均P＜0.05)，植入性和粘连性前置胎盘AFP低于穿透性(均P＜0.05)。ROC曲线分析，血清YKL-40、AFP的最佳截断值分别为320.284 pg/mL、277.895 μg/mL，其曲线下的面积为0.780、0.812。联合诊断的AUC(0.895)、约登指数(0.675)、灵敏度(90.0%)、阴性预测值(85.3%)均高于单项检测。结论血清YKL-40、AFP水平联合超声有利于提高植入性前置胎盘的诊断效能。
- 植入性前置胎盘 /
- 人类软骨糖蛋白-39 /
- 甲胎蛋白 /
- 超声
Abstract: Objective To evaluate the value of human cartilage glycoprotein-39 (YKL-40) and alpha fetoprotein (AFP) combined with ultrasound in placenta previa implantation. Methods A total of 90 pregnant women with placenta previa who delivered in the First Affiliated Hospital of Bengbu Medical College from November 2020 to May 2021 were enrolled as the research group. According to the intraoperative and/or postoperative pathological results, they were divided into the implantation group (4 cases of penetrating type, 17 cases of implantation type and 29 cases of adhesion type), 50 cases of non-implantation group and 40 cases of non-implantation group. In addition, 40 normal pregnant women in the same period were collected as the control group, and all received YKL-40, AFP and ultrasound examination. Results The levels of YKL-40 and AFP in the non-implantable group and control group were lower than those in the implantable group (all P < 0.05). The levels of YKL-40 in the implantable group were lower than those in the implantable group, and those in implantable group were lower than those in the penetrating group (all P < 0.05). AFP in the implantable group and implantable group were lower than those in the penetrating group (all P < 0.05). ROC curve analysis showed that the optimal cut-off values of serum YKL-40 and AFP were 320.284 pg/mL and 277.895 μg/mL, respectively, and the areas under the curve were 0.780 and 0.812, respectively. The AUC (0.895), Yuden index (0.675), sensitivity (90.0%) and negative predictive value (85.3%) of combined diagnosis were higher than those of single tests. Conclusion Serum YKL-40 and AFP levels combined with ultrasound can improve the diagnostic efficiency of placenta previa.
- Implantable placenta previa /
- Human cartilage glycoprotein 39 /
- Alpha fetoprotein /
- Ultrasonic

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图 1 AFP、YKL-40、超声及联合指标的ROC曲线

Figure 1. ROC curves of AFP, YKL-40, ultrasound and combined indexes

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表 1 3组孕妇一般资料比较

Table 1. Comparison of general data among three groups of pregnant women

组别	例数	年龄(x±s，岁)	孕周(x±s，周)	孕次[M(P₂₅, P₇₅)，次]	产次[M(P₂₅, P₇₅)，次]
植入组	50	31.240±5.427	35.880±0.940	3.00(2.00, 5.00)	1.00(1.00, 1.00)
非植入组	40	31.225±4.633	36.250±0.981	3.00(2.00, 4.75)	1.00(0, 2.00)
对照组	40	31.050±5.277	36.225±1.025	3.00(2.00, 4.00)	1.00(0.25, 2.00)
统计量		0.018^a	2.057^a	0.251^b	0.084^b
P值		0.983	0.132	0.882	0.976
注：^a为F值，^b为H值。

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表 2 3组孕妇血清AFP、YKL-40比较(x±s)

Table 2. Comparison of serum AFP and YKL-40 in three groups(x±s)

组别	例数	AFP(μg/mL)	YKL-40(pg/mL)
植入组	50	300.609±50.270	341.605±51.809
非植入组	40	253.032±36.440^a	304.719±41.138^a
对照组	40	255.790±11.943^a	301.270±18.946^a
F值		23.069	13.842
P值		＜0.001	＜0.001
注：与植入组比较，^aP < 0.05。

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表 3 各类型植入组前置胎盘孕妇AFP、YKL-40水平比较(x±s)

Table 3. Comparison of AFP and YKL-40 levels in pregnant women with placenta previa in different implantation groups(x±s)

组别	例数	AFP(μg/mL)	YKL-40(pg/mL)
穿透性	4	389.265±40.264	403.361±17.614
植入性	17	300.054±40.994^a	358.001±49.294^a
粘连性	29	288.706±44.929^a	323.476±47.192^ab
F值		9.465	6.753
P值		＜0.001	0.003
注：与穿透性比较，^aP < 0.05；与植入性比较，^bP < 0.05。

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表 4 AFP、YKL-40、超声及联合指标的ROC结果

Table 4. ROC results of AFP, YKL-40, ultrasound and combined indexes

项目	AUC	SE	P值	95% CI	截点
AFP	0.812	0.047	＜0.001	0.720~0.903	277.895
YKL-40	0.780	0.053	＜0.001	0.675~0.884	320.284
超声	0.815	0.047	＜0.001	0.722~0.908
联合	0.895	0.034	＜0.001	0.828~0.962

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