自身免疫相关复发性流产子宫动脉及子宫内膜超声参数分析

doi:10.16150/j.1671-2870.2023.06.006

摘要/Abstract

摘要：

目的： 分析自身免疫相关复发性流产（recurrent spontaneous abortion，RSA）患者的子宫动脉及子宫内膜的超声血流参数，为临床诊断提RSA供参考。方法： 连续选取2021年3月至2022年3月间48例流产2次以上的连续病例,于排卵后6~9 d经阴道三维探头检测子宫内膜厚度、子宫内膜容积、子宫内膜血流动力学指标[子宫内膜血管形成指数（vascularization index，VI）、血管形成-血流指数（vascularization flow index，VFI）]及双侧子宫动脉血流参数[子宫动脉阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)、收缩期/舒张期比值(peak systolic to lowest diastolic velocity ratio,S/D)]。检测患者自身免疫相关指标（抗核抗体、抗心磷脂抗体、β₂糖蛋白Ⅰ、抗双链DNA抗体)，将结果均阴性者归入非自身免疫相关RSA组(对照组)，存在1项以上异常者为自身免疫相关RSA组(观察组)。比较2组间超声参数差异，并采用受试者工作特征（receiver operating characteristic，ROC）曲线评价超声参数预测自身免疫相关RSA的价值。结果： 本组自身免疫相关RSA病例数占临床RSA的25%。观察组VI、VFI值低于对照组（P=0.005、0.017），而双侧子宫动脉PI、RI值高于对照组（P≤0.001、0.001），余指标无差异。ROC曲线显示，子宫动脉PI值>2.895、RI值>0.885、子宫内膜VI值<1.518%、VFI值<0.140，预测自身免疫相关RSA的曲线下面积（AUC）分别为0.738、0.746、0.809、0.774。结论： 相对于非自身免疫相关RSA，自身免疫相关RSA患者的子宫动脉PI值、RI值增高，子宫内膜血流灌注减少；临床超声检查发现此类参数变化，应注意筛查自身免疫相关指标，以明确RSA原因。

关键词: 复发性流产, 免疫, 子宫动脉, 血管形成指数, 血管形成-血流指数

Abstract:

Objective: To analyze the uterine artery and endometrial blood flow parameters by in patients with autoimmune-related recurrent spontaneous abortion (RSA) for providing clinical referene. Methods: A total of 48 patients with more than 2 consecutive miscarriages from March 2021 to March 2022 were selected. Transvaginal three-dimensional ultrasound were used to measure endometrial thickness, endometrial volume, hemodynamic parameters of the endometrium [vascularization index (VI) and vascularization flow index (VFI)], and blood flow parameters [resistance index (RI), pulsatility index (PI), and peak systolic to lowest diastolic velocity ratio (S/D)] of bilateral uterine arteries were assessed in 6-9 days after ovulation. According to the autoimmune-related indexes（antinuclear antibody， anti-cardiolipin antibody、， beta 2 glycoprotein Ⅰ, anti-double strand DNA antibody）, patients were divided into observation group and control group. Patients with all negative results were classified as non-autoimmune-related RSA (control group), while those with one or more abnormal indexes were considered RSA (observation group). Ultrasonographic parameters were compared between the two groups, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of ultrasonographic parameters for autoimmune-related RSA. Results: Autoimmune-related RSA accounted for 25% of clinically recurrent miscarriages. The VI and VFI values in the observation group were lower than those in the control group（P=0.005,0.017）. The average levels of PI and RI of bilateral uterine arteries in the observation group were significantly higher than those in the control group（P≤0.001,0.001）.There was no statistical difference in endometrial thickness and endometrial volume between the two groups. ROC curve analysis showed that uterine artery PI > 2.895, RI > 0.885, endometrial VI < 1.518%, and VFI < 0.140 predicted autoimmune-related RSA with area under the curve (AUC) values of 0.738,0.746,0.809,0.774，respectively. Conclusions: Compared to other RSA cases, patients with autoimmune-related RSA have increased uterine artery PI and RI values and reduced endometrial blood flow perfusion. Clinicians should be vigilant in screening for autoimmune-related indexes in such patients during clinical ultrasound examinations.

Key words: Recurrent spontaneous abortion, Immunity, Uterine artery, Vascularization index, Vascularization flow index

中图分类号:

孔晓晓, 陈萍, 牛建梅, 吕明丽, 王慧. 自身免疫相关复发性流产子宫动脉及子宫内膜超声参数分析[J]. 诊断学理论与实践, 2023, 22(06): 550-554.

KONG Xiaoxiao, CHEN Ping, NIU Jianmei, LÜ Mingli, WANG Hui. Analysis of uterine blood flow parameters in immune-related recurrent spontaneous abortion[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 550-554.

图/表 3

表1

2组间年龄及各项超声指标参数

Indice	Control group (n=36, $x -$ ±s)	Observation group (n=12, $x -$ ±s)	P
Age (year)	31.69±4.98	34.67±3.96	0.067
Endometrial thickness（mm）	8.16±2.70	8.79±1.95	0.478
Endometrial volume（mL）	3.92±2.18	4.32±1.63	0.518
Endometrial hemodynamics
VI^*	9.01	1.43	0.005
FI	12.14±4.28	9.61±2.42	0.069
VFI^*	1.176	0.126	0.017
Uterine artery
S/D^*	6.58	11.28	0.415
PI	2.33±0.44	3.49±1.50	0.000
RI	0.84±0.04	0.90±0.07	0.001

表1

表2

图1

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Indice	AUC	95%CI of AUC	SE	P	cut off value	Sensitivity	Specificity	Youden index
VI	0.809	0.629-0.890	0.085	0.001	1.518%	63.64%	91.67%	0.553
VFI	0.774	0.599-0.870	0.102	0.013	0.140	63.64%	91.67%	0.553
PI	0.738	0.574-0.852	0.111	0.015	2.895	58.33%	93.94%	0.523
RI	0.746	0.579-0.856	0.098	0.028	0.885	50.00%	93.94%	0.440
PI+VFI combination	0.679	0.517-0.814	0.103	0.029	—	75.00%	78.79%	0.538