Value of serum creatine kinase, soluble vascular endothelial growth factor receptor-1 combined with MRI in evaluating placenta accrete
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摘要:
目的 分析血清肌酸激酶（CK）、可溶性血管内皮生长因子受体-1（sFlt-1）联合MRI征象检查评估胎盘植入的价值。 方法 选择本院2015年4月~2021年4月收治的108例可疑胎盘植入患者作为研究对象，依据产后病理诊断结果将患者分为胎盘植入组（n=30）及非胎盘植入组（n=78）。检测所有孕妇产前血清CK和sFlt-1水平，并进行MRI检查。比较两组血清CK、sFlt-1水平，MRI检查异常征象（胎盘内暗带、胎盘内血管、子宫膨大、子宫边界中断）发生率。采用Pearson相关性分析血清CK、sFlt-1水平与胎盘植入的相关性；采用Spearman相关性分析胎盘内暗带、胎盘内血管、子宫膨大、子宫边界中断与胎盘植入的相关性；采用ROC曲线分析血清CK、sFlt-1水平联合MRI检查评估胎盘植入的临床价值。 结果 胎盘植入组的血清CK水平高于非胎盘植入组，sFlt-1水平低于非胎盘植入组（P < 0.05）；胎盘植入组MRI检查出现胎盘内暗带、胎盘内血管、子宫膨大、子宫边界中断的发生率高于非胎盘植入组（P < 0.05）。相关性分析显示，血清CK水平、胎盘内暗带、胎盘内血管、子宫膨大、子宫边界中断与胎盘植入与胎盘植入呈正相关关系（r=0.503、0.511、0.416、0.422、0.436，P < 0.05），血清sFlt-1水平与胎盘植入呈负相关关系（r=-0.486，P < 0.05）。ROC曲线分析结果显示，血清CK、sFlt-1水平联合MRI检查评估胎盘植入的曲线下面积为0.945，敏感度为90.0%，特异性为93.6%，明显优于各指标单独评估。 结论 血清CK、sFlt-1水平及胎盘内暗带、胎盘内血管、子宫膨大、子宫边界中断等MRI征象均与胎盘植入的发生密切相关，血清CK、sFlt-1水平联合MRI检查对胎盘植入具有显著的临床价值。 Abstract:Objective To analyze the value of serum creatine kinase (CK), soluble vascular endothelial growth factor receptor-1 (sFlt-1) combined with MRI examination in evaluating placenta accreta. Methods A total of 108 patients with suspected placenta accreta who were admitted to our hospital from April 2015 to April 2021 were selected. According to the results of postpartum pathological diagnosis, the patients were divided into placenta accreta group (n=30) and non-placenta accreta group (n=78). Prenatal serum CK and sFlt-1 levels of all pregnant women were detected, and MRI was performed. The serum CK and sFlt-1, and the incidence of abnormal signs on MRI (intraplacental dark zone, intraplacental blood vessels, uterine enlargement, and uterine border interruption) were compared between the two groups. Pearson correlation was used to analyze the correlation between serum CK and sFlt-1 levels and placenta accreta. Spearman correlation was used to analyze the correlation between placental dark zone, intraplacental blood vessels, uterine enlargement, uterine border interruption and placenta accreta. The clinical value of placenta accreta was evaluated by ROC curve of serum CK and sFlt-1 levels combined with MRI examination. Results The serum CK in the placenta accreta group was higher than that in the non-placenta accreta group, and the sFlt-1 was lower than that in the non-placenta accreta group (P < 0.05). The uterine enlargement and the incidence of uterine border interruption were higher than those in the non-placenta accreta group (P < 0.05). Correlation showed that serum CK, intraplacental dark zone, intraplacental blood vessels, uterine enlargement, and uterine border disruption were positively correlated with placenta accreta (r=0.503, 0.511, 0.416, 0.422, 0.436, P < 0.05). Serum sFlt-1 level was negatively correlated with placenta accreta (r=-0.486, P < 0.05). The results of ROC curve analysis showed that the AUC of serum CK and sFlt-1 levels combined with MRI in evaluating placenta accreta was 0.945, the sensitivity was 90.0%, and the specificity was 93.6%, which was significantly better than the evaluation of each index alone. Conclusion Serum CK and sFlt-1 levels and MRI signs such as dark zone in placenta, intraplacental blood vessels, uterine enlargement and uterine border interruption are closely related to the occurrence of placenta accreta. Serum CK and sFlt-1 levels combined with MRI have significant clinical value in placenta accreta. -
图 1 胎盘植入患者的影像学表现
A：患者1; B：患者2; C：患者3.
Figure 1. Imaging manifestations of patients with placenta implantation.
图 2 MRI异常征象评估胎盘植入的ROC曲线
Figure 2. ROC curve of abnormal MRI signs in evaluating placenta implantation.
图 3 血清CK、sFlt-1水平联合MRI异常征象评估胎盘植入的ROC曲线
Figure 3. ROC curve of serum CK and sFlt-1 levels combined with abnormal MRI signs in evaluating placenta implantation.
表 1 两组产前血清CK、sFlt-1水平比较
Table 1. Comparison of prenatal serum CK and sFlt-1 levels between the two groups (Mean±SD)
组别 CK（U/L） sFlt-1（ng/mL） 胎盘植入组（n=30） 137.66±27.25 2.32±0.34 非胎盘植入组（n=78） 76.84±22.72 2.97±0.32 t 11.774 9.292 P < 0.001 < 0.001 CK: 肌酸激酶; sFlt-1: 可溶性血管内皮生长因子受体-1 
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表 2 两组术前MRI检查异常征象发生情况比较
Table 2. Comparison of the occurrence of abnormal signs of preoperative MRI examination in the two groups [n(%)]
MRI检查异常征象 胎盘植入组（n=30） 非胎盘植入组（n=78） χ2 P 胎盘内暗带 17（56.67） 8（10.26） 26.232 < 0.001 胎盘内血管 8（26.67） 1（1.28） 18.277 < 0.001 子宫膨大 10（33.33） 1（1.28） 24.331 < 0.001 子宫边界中断 16（53.33） 6（7.69） 27.825 < 0.001
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表 3 血清CK、sFlt-1水平及MRI检查异常征象与胎盘植入的相关性分析
Table 3. Correlation analysis of serum CK and sFlt-1 levels and MRI examination for abnormal findings and placental implantation
项目 CK sFlt-1 胎盘内暗带 胎盘内血管 子宫膨大 子宫边界中断 胎盘植入 r 0.503 -0.486 0.511 0.416 0.422 0.436 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 < 0.05
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表 4 血清CK、sFlt-1水平联合MRI检查对胎盘植入的评估效能
Table 4. Serum levels of CK and sFlt-1 combined with MRI examination assessed the efficacy of placental implantation
检验结果变量 曲线下面积 标准误 P 95% CI 下限 上限 血清CK水平 0.952 0.022 < 0.001 0.893 0.984 血清sFlt-1水平 0.929 0.023 < 0.001 0.863 0.970 胎盘内暗带 0.732 0.049 < 0.001 0.638 0.813 胎盘内血管 0.627 0.042 0.002 0.529 0.718 子宫膨大 0.660 0.044 < 0.001 0.563 0.749 子宫边界中断 0.728 0.049 < 0.001 0.634 0.809 联合检测 0.945 0.025 < 0.001 0.884 0.980
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