宫内外同时妊娠患者临床结局的预测指标

Predictor of Pregnancy Outcomes for Patients with Heterotopic Pregnancy

【目的】评估经阴道超声(TVS)对宫内外同时妊娠(HP)的早期诊断价值和探索影响其临床预后的预测指标。【方法】回顾性分析85例2003年1月至2017年9月在我院诊断治疗的HP患者,采用Logistic回归分析其临床结局与一般特征、超声特点和不同处理方式的关系。【结果】共80例患者经TVS检查可正确诊断为HP,1例被误诊为附件扭转,4例术后被证实有宫内妊娠。因此,经TVS诊断HP的敏感性为94.1%(80/85),49例(57.6%)患者在执行首次TVS时被怀疑为HP。51例患者完成分娩,其中11例早产。当TVS确诊HP时,宫内妊娠囊无胎心搏动的患者流产率为60.0%(15/25),而宫内妊娠有胎心搏动的患者流产率13.3%(8/60),两者具有显著差异(χ2=19.472,P <0.001)。多因素Logistic回归结果显示,宫内妊娠囊具有胎心搏动的HP患者妊娠结局更倾向于活产(OR=0.024,95%CI=0.004~0.147,P <0.001)。【结论】尽管TVS诊断HP具有高敏感性,但仅一半的患者在首次TVS时被怀疑为HP。当经TVS诊断为HP时,宫内妊娠囊具有胎心搏动是患者良好临床预后的重要影响因素。

【Objective】The aim of the study was to assess the value of transvaginal sonography(TVS)in the diagno-sis of heterotopic pregnancy(HP),and explore the early predictors of clinical outcomes in these patients.【Methods】Be-tween January 2003 and September 2017,85 cases of HP were recruited and retrospectively reviewed.The relationships between clinical outcomes and general characteristics,sonographic features and different management options were ana-lyzed by Logistic regression analysis.【Results】Among these cases,80 were accurately diagnosed by TVS,1 was misdiag-nosed as adnexal torsion by TVS,and four were confirmed to have IUPs after the surgical treatment.Hence,the sensitivi-ty of TVS for detecting HP was 94.1%(80/85),49(57.6%)of the patients had suspected HP when TVS was initially per-formed.Live births occurred for 51 patients,11 of whom delivered preterm.The abortion rate of patients without IUP car-diac activity group was 60%(15/25),while the rate of abortion was 13.3%(8/60)in the patients with IUP cardiac activi-ty group at HP diagnosis,and the difference was significant(χ2=19.472,P<0.001).Logistic regression analysis iden-tified that the pregnancy outcome of HP patients with cardiac activity in IUP was more pone to live birth(OR=0.024,95%CI=0.004-0.147,P<0.001).【Conclusions】These results indicate that TVS detected HP with high sensitivity,but only a half of patients had suspected HP when they were performed the first TVS scan.Furthermore,an IUP with cardiac activity at HP diagnosis was an important predictor of a favorable prognosis.