超声E-cervix宫颈弹性成像预测早产的临床价值

Clinical value of ultrasound E-cervix cervical elastography in predicting preterm birth

目的应用超声E-cervix宫颈弹性成像评估宫颈机能,分析其预测早产的临床价值。方法选取于我院建档并规律接受产检孕妇200例(妊娠组)和行孕前常规检查者100例(体检组),妊娠组根据生产情况再分为早产组31例和足月产组169例。各组均行超声E-cervix宫颈弹性成像检查,获取宫颈长度(CL)、弹性对比指数(ECI)、硬度比值(HR)、宫颈外口应变率(EOS)、宫颈内口应变率(IOS)及其比值(IOS/EOS)。比较早产组与足月产组、体检组与妊娠组各临床资料和弹性参数的差异;采用多因素Logistic回归分析早产的相关影响因素,绘制受试者工作特征(ROC)曲线分析各弹性参数单独及联合应用预测早产的效能。结果早产组宫颈手术史占比、ECI、IOS、IOS/EOS均高于足月产组,CL、HR均低于足月产组,差异均有统计学意义(均P<0.05)。妊娠组CL、IOS、IOS/EOS均高于体检组,HR低于体检组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析表明,宫颈手术史、ECI、IOS、IOS/EOS是早产的相关危险因素,CL、HR是早产的相关保护因素(均P<0.05)。ROC曲线分析表明,CL、ECI、IOS、IOS/EOS、HR预测早产的曲线下面积分别为0.802、0.745、0.795、0.795、0.803,各参数联合应用的曲线下面积为0.928。结论应用超声E-cervix宫颈弹性成像评估宫颈机能可准确预测早产,其中ECI、IOS、IOS/EOS是早产的相关危险因素,CL、HR是早产的相关保护因素。

Objective To evaluate the cervical function by ultrasound E-cervix elastography,and to analyze its clinical value in predicting preterm birth.Methods A total of 200 pregnant women who had established a file in our hospital and received regular prenatal examination(pregnancy group)and 100 women who underwent routine pre-pregnancy examination(physical examination group)were selected,and the pregnancy group was further divided into 31 cases of preterm birth(preterm delivery group)and 169 cases of term birth(term delivery group)according to the production situation.Ultrasound E-cervix cervical elastography was performed to obtain cervical length(CL),elasticity contrast index(ECI),hardness ratio(HR),external cervical os(EOS),internal cervical os(IOS),and ratio of internal and external cervical os(IOS/EOS).The differences in clinical data and elastography parameters were compared between the preterm delivery group and the term delivery group,the physical examination group and the pregnancy group.Multivariate Logistic regression was used to analyze the related factors of preterm birth.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of each elastography parameter alone or in combination in predicting preterm birth.Results The proportion of cervical surgery history,ECI,IOS and IOS/EOS in the preterm delivery group were higher than those in the term delivery group,CL and HR were lower than those in the term delivery group,and the differences were statistically significant(all P<0.05).The CL,IOS,IOS/EOS in the pregnancy group were higher than those in the physical examination group,HR was lower than that in the physical examination group,and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that the cervical surgery history ECI,IOS,IOS/EOS were related risk factors for preterm birth,CL and HR were related protective factors for preterm birth(all P<0.05).ROC curve analysis showed that the area under the curve of CL,ECI,IOS,IOS/EOS and HR for predicting preterm birth were 0.802,0.745,0.795,0.795 and 0.803,respectively,and the area under the curve of the combined application of each parameter was 0.928.Conclusion The evaluation of cervical function by ultrasound E-cervix cervical elastography can accurately predict preterm birth,among which ECI,IOS,IOS/EOS are related risk factors for preterm birth,and CL and HR are related protective factors for preterm birth.