中孕期弹性超声成像宫颈机能智能定量分析预测自发性早产的临床应用价值

doi:10.16150/j.1671-2870.2021.05.005

摘要/Abstract

摘要：

目的：探讨经阴道宫颈弹性超声成像联合宫颈长度测量预测中孕期孕妇自发性早产（spontaneous preterm birth, sPTB）的应用价值。 方法：纳入2019年1月1日至2020年12月31日在我院进行产前检查的单胎妊娠孕妇431名,依据早产定义分为病例组（31例早产）和对照组（400例足月产）,所有孕妇于中孕期采用经阴道超声测量宫颈长度（cervical length,CL）,同时进行宫颈弹性超声成像,利用宫颈机能智能定量分析软件获得弹性超声参数,即弹性对比指数（elasticity contrast index,ECI）、硬度比值（hardness ratio,HR）、宫颈内口应变值（internal ostium,IOS）、宫颈外口应变值（external ostium,EOS）、宫颈内口与外口比值（IOS/EOS比值）。比较以上参数在2组间的差异,并采用受试者操作特征（receiver operating characteristic,ROC）曲线分析以上参数预测中孕期孕妇发生sPTB的临床价值。 结果：病例组的CL低于对照组,而ECI、IOS及IOS/EOS比值高于对照组;ROC曲线显示,在各弹性参数中,IOS/EOS比值（最佳阈值为0.885）的曲线下面积（area under curve,AUC）相对较大（0.696）,其预测中孕期孕妇sPTB的灵敏度和特异度为73.8%和64.2%;CL预测中孕期孕妇sPTB的AUC为0.717,取CL≤23.8 mm时其预测灵敏度和特异度分别为71.4%和74.2%;IOS/EOS比值（≥0.885）联合CL≤23.8 mm预测中孕期孕妇sPTB的AUC（0.771）和灵敏度较高（83.3%）。 结论：在中孕期孕妇中,进行阴道宫颈弹性超声智能宫颈机能定量分析,对预测sPTB发生具有一定的临床价值,其联合CL测量可提高对sPTB的预测价值。

关键词: 超声检查, 弹性成像技术, 宫颈长度, 早产

Abstract:

Objective: To evaluate the performance of cervical elastographic parameters combined with cervical length(CL) in predicting spontaneous preterm birth(sPTB) during second trimester. Methods: A total of 431 singleton pregnancies who received routine prenatal care in our hospital from 1 Jan 2019 and 31 Dec 2020 were included. Accor-ding to pregnancy outcome, subjects were divided into study group(n=31, preterm birth) and control group(n=400, term birth). CL was measured by transvaginal ultrasound, and the cervical elasticity parameters were obtained by elastography, including elasticity contrast index (ECI), hardness ratio (HR), mean strain at internal ostium (IOS), mean strain at external ostium (EOS), the ratio of IOS to EOS (IOS/EOS ). Differences in above ultrasound parameters between the two groups were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of the above ultrasound parameters in predicting sPTB. Results: CL was lower but ECI, IOS,IOS/EOS were higher in the study group than those in the control group. ROC analysis indicated that the AUC of IOS/EOS (0.885 as a cut-off value) for prediction of sPTB was larger than those of any other elastographic parameters, with sensitivity and specificity were 73.8% and specificity of 64.2%, and AUC of CL (23.8 mm as a cut-off ) was 0.717, with sensitivity of 71.4% and 74.2%. The combination of IOS/EOS and CL showed better performance for predicting sPTB, with AUC of 0.771 and sensitivity of 83.3%. Conclusions: Cervical elastography can be used to predict sPTB during second trimester, and showes better predictive performance when combined with CL.

Key words: Ultrasonography, Elasticity imaging techniques, Cervical length, Preterm birth

中图分类号:

R714

何碧媛, 周毓青, 姚秉彝, 曹力, 包丽. 中孕期弹性超声成像宫颈机能智能定量分析预测自发性早产的临床应用价值[J]. 诊断学理论与实践, 2021, 20(05): 450-455.

HE Biyuan, ZHOU Yuqing, YAO Bingyi, CAO Li, BAO Li. The clinical value of intelligent quantitative measurement of cervical elastography in predicting spontaneous preterm birth during second trimester[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(05): 450-455.

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组别	例数（n）	年龄（岁）	检查孕周（周）	体重指数（kg/m²）	辅助生殖技术（例,%）	宫颈手术史[例（%）]
病例组	31	30.5±3.0	24.1±3.1	26.4±3.2	2（6.45）	4（12.9）
对照组	400	30.8±3.1	24.7±3.5	25.6±3.1	17（4.25）	70（17.5）
t或χ²值		3.185	2.320	2.321	0.540 42	0.688 29
P值		0.067 8	0.58	0.317	0.462 3	0.406 7

组别	ECI	HR	IOS	EOS	IOS/EOS	CL（mm）
病例组	4.67	56.89	0.33	0.35	0.98	21.65
对照组	3.75	64.66	0.25	0.33	0.79	30.06
U值	2 805.5	1 816.5	2 666	2 262.5	2 819.5	935.5
P值	0.022	0.231	0.004	0.526	0.003	<0.001