超声联合剪切波弹性成像评估妊娠期宫颈并预测早产的价值

Ultrasound Combined with Shear Wave Elastography in the Evaluation of Cervical Pregnancy and Prediction of Premature Delivery

目的采用二维超声联合剪切波弹性成像评估不同孕周宫颈组织的长度及弹性模量值,探讨两者联合预测早产的价值。资料与方法前瞻性研究,纳入212例孕20~35周孕妇,采用常规二维超声及实时剪切波弹性成像分别测量宫颈长度及弹性模量值,长度测量为宫颈内口至外口的距离,弹性模量值的测量点放在距宫颈外口5~10 mm(下点)、15~20 mm(上点)的位置,前后壁各两点,根据妊娠结局分为早产组40例及足月产组172例,分析各指标与孕周的关系,及其对早产的预测价值。结果①宫颈前壁上点及下点、后壁上点及下点弹性模量值及总平均值随孕周呈减低趋势(r2=0.854、0.421、0.370、0.305、0.600,P均<0.001);宫颈长度随孕周呈缩短趋势(r2=0.811,P<0.001)。②早产组的宫颈长度及宫颈前壁上点弹性模量值较足月产组低(P均<0.05)。③宫颈弹性模量值、宫颈长度及两者联合预测孕妇早产的敏感度分别50.00%、50.00%和87.50%,特异度分别为79.07%、72.09%和65.70%。结论联合测量宫颈长度及宫颈弹性模量值可提高预测早产的敏感度。

Purpose To evaluate the length and elastic modulus of cervical tissue in different gestational weeks by two-dimensional ultrasound combined with shear wave elastography,and to explore the value of combined prediction of premature delivery.Materials and Methods A prospective study was carried out,212 pregnant women with 20-35 weeks were enrolled in this study,the cervical length and elastic modulus were measured by conventional two-dimensional ultrasound and shear wave elastography.Cervical length was measured from the external cervical os to the internal os,the measurement points of elastic modulus were chosen at the anterior and posterior part of the cervix,5-10 mm(lower point)and 15-20 mm(upper point)from the external cervical os,at both anterior and posterior walls.According to the pregnancy outcome,all patients were divided into 40 cases of preterm delivery group and 172 cases of full-term delivery group.The relationship between the indicators and gestational weeks and their predictive value for premature delivery were analyzed.Results①The elastic modulus of anterior wall upper point,anterior wall lower point,posterior wall upper point,posterior wall lower point and the total average value of elastic modulus were decreasing with the gestational week(r2=0.854,0.421,0.370,0.305,0.600;all P<0.001).The cervical length showed a trend of shortening with gestational weeks(r2=0.811,P<0.001).②The length of cervix and elastic modulus of anterior cervical wall in preterm delivery group were lower than those in full-term delivery group(all P<0.05).③The sensitivity of ROC curve of cervical elastic modulus,cervical length and the combination of them in predicting preterm delivery was 50.00%,50.00%and 87.50%,respectively;the specificity was 79.07%,72.09%and 65.70%,respectively.Conclusion The combination of cervical length and cervical elastic modulus can improve the sensitivity of predicting preterm labor.