發(fā)布時(shí)間：2018-03-23 08:01

  本文選題：胎盤植入　切入點(diǎn)：外體RNA　出處：《河北大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)研究經(jīng)術(shù)中及術(shù)后病理確診的胎盤植入患者血清外體RNA(exosomal RNA)及甲胎蛋白(AFP)的濃度,來(lái)探討二者對(duì)胎盤植入的診斷價(jià)值。方法:選取2014年1月至2016年12月于我院產(chǎn)科行剖宮產(chǎn)分娩的兇險(xiǎn)性前置胎盤的單胎孕婦76例(兇險(xiǎn)性前置胎盤是指既往有剖宮產(chǎn)史,此次妊娠為前置胎盤,且胎盤附著于子宮下段原剖宮產(chǎn)切口瘢痕處,發(fā)生胎盤植入機(jī)率約為50%)。根據(jù)剖宮產(chǎn)手術(shù)及術(shù)后病檢結(jié)果分為胎盤植入組(32例)與非胎盤植入組(44例),另外選取同期行剖宮產(chǎn)分娩的既往有剖宮產(chǎn)手術(shù)史,此次妊娠胎盤位置正常,無(wú)其他妊娠合并癥及并發(fā)癥的單胎孕婦50例作為對(duì)照組。分別在產(chǎn)前抽取3組孕婦的外周肘靜脈血,提取血清中的exosomal RNA并測(cè)定其濃度,檢測(cè)AFP水平,對(duì)比分析三組之間的差異,利用受試者工作特征曲線(ROC曲線)找出其臨床診斷的最佳臨界值(cut off值),比較exosomal RNA、AFP及兩者聯(lián)合時(shí)對(duì)胎盤植入的產(chǎn)前診斷價(jià)值。結(jié)果:1.三組患者的一般情況比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);胎盤植入組患者血清e(cuò)xosomal RNA濃度與非胎盤植入組及對(duì)照組相比均有顯著差異(P0.05),而AFP在胎盤植入組患者中的濃度較非胎盤植入組及對(duì)照組也明顯增高,均有顯著的統(tǒng)計(jì)學(xué)意義(P0.05見表2)。2.血清e(cuò)xosomal RNA及AFP在胎盤植入中的臨床診斷最佳臨界值(cut off值)分別為40.28ng/ml和256.56U/L。3.Exosomal RNA以40.28ng/ml作為臨床診斷閾值時(shí),其診斷胎盤植入的靈敏度、特異度及準(zhǔn)確度分別為90.6%、75.5%、81.6%;AFP以256.56U/L作為臨床診斷閾值時(shí)的靈敏度、特異度及準(zhǔn)確度分別為78.1%、85.1%、81.6%;而兩者聯(lián)合時(shí)平行診斷試驗(yàn)的靈敏度、準(zhǔn)確度分別為93.8%、76.3%;系列診斷試驗(yàn)的特異度、準(zhǔn)確度分別為95.5%、86.8%。結(jié)論:在胎盤植入的產(chǎn)前診斷中,exosomal RNA及AFP均有一定的價(jià)值,兩者單獨(dú)應(yīng)用時(shí)exosomal RNA的診斷價(jià)值略高于AFP,而二者平行及系列聯(lián)合時(shí)可顯著提高產(chǎn)前診斷的靈敏度及特異度,優(yōu)于血清e(cuò)xosomal RNA及AFP單項(xiàng)檢測(cè)。
[Abstract]:Objective: to study the concentrations of RNA(exosomal and AFP in the serum of placental accreta patients confirmed by intraoperative and postoperative pathology. Methods: from January 2014 to December 2016, 76 pregnant women with dangerous placenta previa who were delivered by cesarean section in our hospital were selected. The pregnancy was placenta previa, and the placenta attached to the scar of the former cesarean incision in the lower part of the uterus. According to the results of cesarean section and postoperative disease examination, the placenta accreta group (32 cases) and the non-placental accreta group (44 cases) were divided into two groups. 50 cases of single pregnancy with normal placenta position and no complications and complications were used as control group. The peripheral venous blood was extracted from three groups of pregnant women before antepartum, the serum exosomal RNA was extracted and its concentration was measured, and the level of AFP was measured. Comparing and analyzing the differences between the three groups, Using the operating characteristic curve of subjects to find out the best critical value of off for clinical diagnosis, to compare the value of exosomal off and its combination in the prenatal diagnosis of placenta accreta. Results: 1. The general condition of the three groups was no more than that of the control group. The concentration of serum exosomal RNA in placenta accreta group was significantly higher than that in non-placental accreta group and control group, and the concentration of AFP in placenta accreta group was significantly higher than that in non-placental accreta group and control group. There was significant statistical significance (P0.05) in Table 2. 2.The best critical value of serum exosomal RNA and AFP in clinical diagnosis of placenta accreta was 40.28ng/ml and 256.56U/L.3.Exosomal RNA. The sensitivity of 40.28ng/ml and 256.56U/L.3.Exosomal RNA in the diagnosis of placenta accreta was obtained when 40.28ng/ml was used as the diagnostic threshold of placenta accreta. The specificity and accuracy were 90.6 and 75.5 respectively. The sensitivity, specificity and accuracy of 256.56U/L as the diagnostic threshold were 78.1 and 81.6, respectively; and the sensitivity and accuracy of parallel diagnostic tests were 93.85.30.The specificity and accuracy of the series of diagnostic tests were respectively 93.85.30.The specificity and accuracy of the series of diagnostic tests were respectively 78.1% and 85.6%, respectively. Conclusion: RNA and AFP are valuable in prenatal diagnosis of placenta accreta. The diagnostic value of exosomal RNA was slightly higher than that of AFP alone, and the sensitivity and specificity of prenatal diagnosis could be significantly improved by parallel and serial combination of them, which was superior to serum exosomal RNA and single detection of AFP.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.2

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