血清标志物在高分级胎盘植入谱系（PAS）患者保留胎盘原位保守治疗中的应用价值

摘要(中文译文)

探讨血清标志物与胎盘植入谱系疾病（PAS）患者保守治疗成功之间的关联。本研究为回顾性病例对照研究，纳入2011年至2025年间接受保守治疗（胎盘原位保留）的高级别PAS患者。治疗遵循法兰克福PAS方案，即在剖宫产术后将胎盘原位保留，随后行子宫动脉栓塞术及二期手术。定期实验室检查包括血清标志物检测，包括β-人绒毛膜促性腺激素（β-hCG）、血清胎盘生长因子（PlGF）、孕酮及妊娠相关血浆蛋白A（PAPP-A）。采用随机截距混合效应模型评估随访期间标志物水平与子宫保留之间的关联。研究共纳入24例女性，其中7例子宫保留成功者β-hCG、PlGF及孕酮水平较低，中位数分别为1469（282.2，5532）、117（27.2，258）和24.5（4.2，66），而17例需行子宫切除术者中位数分别为9041（3563，16824）、227.2（129，368）和60（47，83），但PAPP-A水平无差异。混合效应模型显示β-hCG、PAPP-A及孕酮随时间下降（P < 0.001），而PlGF无此变化。子宫保留患者的β-hCG下降速率更高，尤其在随访前两周内，系数为311 mIU/mL/天。保守性PAS治疗后β-hCG、PlGF及孕酮水平依次下降，子宫保留成功与血清β-hCG水平呈负相关。行二期手术的最佳时间窗可能为剖宫产术后2-3周。

Abstract

To investigate the association between serum markers and successful conservative management of patients with placenta accreta spectrum (PAS). This was a retrospective case-control study where patients with high-grade PAS between 2011 and 2025 undergoing conservative leaving the placenta in situ were included. The management followed the Frankfurt PAS Procedure where the placenta was left in situ after cesarean section (CS) followed by uterine artery embolization and two-step surgery. Regular laboratory investigations included the assessment of serum markers including beta human chorionic gonadotropin (β-hCG), serum placental growth factor (PlGF), progesterone, and pregnancy-associated plasma protein A (PAPP-A). Mixed effects models with random intercept were utilized to assess the association between the marker levels and uterine preservation over follow-up time. The study included 24 women, seven of which with successful uterine preservation had lower β-hCG, PlGF and progesterone with medians of 1469 (282.2, 5532), 117 (27.2, 258), and 24.5 (4.2, 66) compared to the 17 needing hysterectomy with medians of 9041 (3563, 16 824), 227.2 (129, 368), and 60 (47, 83), respectively, but no difference in PAPP-A levels. The mixed effects models showed a decline for β-hCG, PAPP-A, progesterone over time (P < 0.001), but not for PlGF. The rate of β-hCG drop was higher for patients with preserved uterus especially within the first two weeks of follow-up with a coefficient of 311 mIU/mL per day. β-hCG, PlGF and progesterone levels successively decrease after conservative PAS management, and there is a negative association between successful uterine retention and serum β-hCG levels. The optimal window for performing a two-step surgery might be 2-3 weeks post CS.

如何引用

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 的其他文献

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