1、to临床研究292BME&Clin Med,May 2023,Vol.27,No.3生物医学工程与临床2 0 2 3年5月第2 7 卷第3期网络出版时间：2 0 2 3-0 4-2 10 9：10：54D0I：10.13339/j.c n k i.s g l c.2 0 2 30 42 0.0 0 4网络出版地址：https:/ P-1对胎盘植入的诊断价值分析鲁桂玲，刘爱华，王文琴，崔红摘要：目的为探讨彩色多普勒超声联合妊娠相关的血浆蛋白A(PAPP-A）、低密度脂蛋白受体相关蛋白1(LRP-1)对胎盘植入的诊断价值。方法选择2 0 19年至2 0 2 1年在海安市人民医院收治的单胎妊娠孕产妇
2、18 0 例，根据产后临床诊断和病理诊断结果分别纳入非胎盘植人者90 例和胎盘植人者90 例作为对照组和研究组。研究组孕妇年龄2 8 40 岁，平均年龄34.7 5岁；单胎妊娠，其中初产妇和经产妇分别为2 8 例、6 2 例（2 次40 例，3次2 2 例）；剖宫产史者16 例。对照组孕妇年龄2 6 41岁，平均年龄35.0 1岁；单胎妊娠，其中初产妇和经产妇分别为31例、59例（2 次38 例，3次2 1例）；剖宫产史者18 例。在手术前对所有孕产妇进行彩色多普勒超声检查，并采用酶联免疫吸附分析（ELISA）法测定血清PAPP-A、LR P-1表达水平。以病理诊断为金标准,绘制受试者工作特性
3、(ROC)曲线，比较彩色多普勒超声诊断、血清PAPP-A诊断、LRP-1诊断和三者联合诊断对胎盘植人的诊断价值。结果研究组孕妇血清PAPP-A、LR P-1表达水平高于对照组,差异均具有统计学意义(P0.05)；与对照组相比,研究组孕妇的剖宫产史比例明显更高(P0.001）,且其超声图像特征主要表现为胎盘后可见丰富血流信号、胎盘后肌层变薄甚至消失、胎盘后间隙消失、胎盘前置、胎盘陷窝、子宫-膀胱交界线不规则、胎盘附着处可见局部向子宫外凸包块等(P0.05)。血清PAPP-A预测胎盘植人的曲线下面积（AUC)为0.7 33 95%可信区间（CI)0.7370.864，最佳截断值为40 56.5mU
4、/L，灵敏度、特异度分别为57.8%、7 0.0%；血清LRP-1预测胎盘植人的AUC为0.6 7 5(95%CI0.7150.846），最佳截断值为4.12 g/mL,灵敏度、特异度分别为52.2%、7 4.4%；彩色多普勒超声、血清PAPP-A、血清LRP-1三者联合诊断的ROCAUC为0.8 8 7(95%CI0.8210.932），灵敏度、特异度分别为8 4.4%、6 7.8%，灵敏度显著高于各单一指标检测。结论相比单一检测，彩色多普勒超声联合血清PAPP-A、LR P-1诊断对胎盘植人鉴别诊断具有较高灵敏度，在术前筛查诊断方面具有重要临床应用价值关键词：胎盘植人；彩色多普勒超声；妊娠
5、相关血浆蛋白A(PAPP-A)；低密度脂蛋白受体相关蛋白1(LRP-1)；联合诊断中图分类号：R714.2;R445.1文献标识码：A文章编号：10 0 9-7 0 90(2 0 2 3)0 3-0 2 92-0 6Diagnostic value of color Doppler ultrasound combined with serum PAPP-A and LRP-1 for placenta implantationLU Gui-ling,LIU Ai-hua,WANG Wen-qin,CUI Hong(Department of Ultrasound,Haian People s
6、Hospital AfiliatedNantong University,Haian226600,Jiangsu,China)Abstract:Objective To investigate diagnostic value of color Doppler ultrasound combined with serum pregnancy-associatedplasma protein A(PAPP-A)and low density lipoprotein receptor-related protein-1(LRP-1)in placenta implantation.MethodsF
7、rom 2019 to 2021,a total of 180 singleton pregnant women were enrolled,and all of them were divided into control group(n=90,non-placental implantation)and study group(n=90,placental implantation)according to results of postpartum clinical di-agnosis and pathological diagnosis.In study group,pregnant
8、 women were 28-40 years old with mean age of 34.75 years old;28 cases were primipara and 62 cases of multiparas(40 cases with 2 times and 22 with 3 times);16 cases with cesarean sectionhistory.In control group,pregnant women were 26-41 years old with mean age of 35.01 years old;31 cases were primipa
9、raand 59 cases of multiparas(38 cases with 2 times and 21 with 3 times);:18 cases with cesarean section history.All of themwere examined by color Doppler ultrasound,and the expression levels of serum PAPP-A and LRP-1 were determined by en-zyme-linked immunosorbent assay(ELISA).Based on pathological
10、diagnosis,the receiver operating characteristic(ROC)curve was compared.The diagnostic value of color Doppler ultrasound,serum PAPP-A,LRP-1 single application and com-bined detection for placental implantation was compared.Results The expression levels of serum PAPP-A and LRP-1 instudy group were obv
11、ious higher than those in control group,and the differences were statistically significant(P 0.05).Compared with control group,the proportion of cesarean section rate in study group was significantly higher(P O.001).The charac-teristics of ultrasound images were mainly manifested as abundant blood f
12、low signals visible at posterior placenta,thinning oreven disappearance of posterior placenta muscular layer,disappearance of posterior placenta space,placenta previa,placentallacunae,irregular boundary of between uterus and bladder,and local uterine convex mass at placental attachment(P 0.05).The作者
13、单位：海安市人民医院超声科，江苏海安2 2 6 6 0 0作者简介：鲁桂玲（197 9一），女，江苏海安市人，本科，副主任医师，主要从事超声诊断相关方向研究。电话：1396 2 7 547 98。E-mail：LIAO。版权保护，不得翻录。BME&ClinMed,1V2023.Vo1.27.No.3生物医学工程与临床2 0 2 3年5月第2 7 卷第3期293.area under curve(AUC)of serum PAPP-A in predicting placental implantation was 0.73395%confidence interval(CI)0.737-0.8
14、64,and optimal cut-off value was 4 056.5 mU/L,while sensitivity and specificity were 57.8%and 70.0%,respectively.The AUC ofserum LRP-1 in predicting placental implantation was 0.675(95%CI 0.715-0.846)and optimal cut-off value was 4.12 g/mL,while sensitivity and specificity were 52.2%and 74.4%,respec
15、tively.The ROC AUC of combined diagnosis of color Dopplerultrasound,serum PAPP-A and LRP-1 was 0.887(95%CI 0.821-0.932),and the sensitivity and specificity were 84.4%and67.8%,respectively;the sensitivity was significantly higher than that of each single index.ConclusionIt is demonstrated thatcolor D
16、oppler ultrasound combined with serum PAPP-A and LRP-1 has higher sensitivity than single detection in differential di-agnosis of placental implantation,which shows important clinical application value in preoperative screening diagnosis.Key words:placenta implantation;color Doppler ultrasound;pregnancy-associated plasma protein A(PAPP-A);low densitylipoprotein receptor-related protein 1(LRP-1);combined detection胎盘植入是指胎盘绒毛异常侵人创伤性子宫内膜肌层,属于一种病态附着胎盘。植入胎盘会导致产妇在分娩时胎盘剥离不全，引发大出血、子宫破裂或切除等严重并发症，对产妇和新生儿的生
