宫颈角测量联合剪切波弹性成像在中晚期孕妇中对早产的预测价值

Predictive value of cervical angle measurement combined with Shear wave elastography for preterm deli-very in middle and late pregnant women

目的:探讨经阴道超声宫颈角测量联合剪切波弹性成像预测25~36周孕妇发生早产的临床应用价值。方法:将2021年2月-2021年9月在我院行常规产前检查的150例孕妇纳入本研究。按分娩时间在孕37周前、后将所有受试者分为早产组和足月产组。经阴道超声测量宫颈长度(CL)和宫颈角,采用剪切波弹性成像技术测量宫颈内口前、后唇(A、C点)及外口前、后唇(B、D点)的杨氏模量平均值(E_(mean))和最大值(E_(max))。对年龄、孕周、CL、宫颈角及宫颈A、B、C、D四点的E_(mean)和E_(max)等变量进行单因素和多因素分析,筛选影响早产的危险因素,并采用ROC曲线评估各危险因素单独及联合模型对早产的诊断效能。进一步将将危险因素进行并联和串联诊断(筛查指标中任意一项检查结果阳性则并联诊断试验结果为阳性,全部指标的检查结果均为阳性则串联诊断试验结果为阳性),比较不同诊断试验预测早产的效能。结果:CL、宫颈角和A点E_(mean)为早产的危险因素(P<0.05)。ROC曲线分析结果显示三个危险因素(CL、宫颈角和A点E_(mean))联合诊断的AUC最大(AUC=0.856),诊断符合率最高(90.7%)。三个危险因素独立预测早产的诊断效能指标中仅特异度的差异有统计学意义(P<0.05),其它指标的差异均无统计学意义(P>0.05)。并联诊断试验中,CL+宫颈角+A点E_(mean)、CL+宫颈角和CL预测早产的敏感度的差异有统计学意义(P<0.05);串联诊断试验中,CL+宫颈角+A点E_(mean)、CL+宫颈角和CL预测早产的特异度的差异有统计学意义(P<0.05)。结论:宫颈长度、宫颈角及宫颈内口前唇的杨氏模量平均值三者联合诊断可提高对中晚期孕妇发生早产的预测效能。

Objective:To explore the clinical value of transvaginal ultrasound cervical angle measurement combined with shear wave elastography in predicting preterm delivery in pregnant women at 25~36 weeks.Methods:A total of 150 pregnant women who underwent routine prenatal examination in our hospital from February 2021 to September 2021 were included in this study.All subjects were divided into preterm delivery group and term delivery group according to delivery time before and after 37 weeks of gestation.Transvaginal ultrasound was used to measure cervical length(CL)and cervical angle,and shear wave elastography was used to measure the mean(E_(mean))and maximum(E_(max))Young's modulus of the anterior and posterior lips of the inner cervix(points A and C)and the anterior and posterior lips of the outer cervix(points B and D).The age,gestational week,CL,cervical angle and E_(mean) and E_(max) at points A,B,C and D of the cervix was studied using univariate and multifactorial analysis to explore the risk factors of preterm delivery,and the receiver operation cha-racteristic(ROC)curve analysis was performed to assess the diagnostic efficacy of each risk factor selected out and combination of them for preterm delivery.Then,the selected risk factors were included in parallel and tandem diagnostic tests.A positive result in any one of the screening indexes resulted in a positive parallel diagnostic test,and a positive result in all indexes resulted in a positive tandem diagnostic test.The diagnostic efficacy of the different diagnostic test in predicting preterm delivery was evaluated and compared.Results:CL,cervical angle,and E_(mean) of point A were influencing factors for preterm delivery.The results of ROC curve analysis showed that the combination of CL,cervical angle and E_(mean) of point A had the largest AUC(0.856)and the highest diagnostic accuracy(90.7%)in diagnosing preterm delivery compared with each of the three factors alone;the difference in the specificity of the three indexes for predicting preterm delivery was statistically significant(P<0.05),and the diffe-rence in the other diagnostic efficacy indexes among the three factors was not statistically significant(all P<0.05).The difference in the sensitivity of CL+cervical angle+A-point E_(mean),CL+cervical angle,and CL in the parallel diagnostic test for predicting preterm delivery was statistically significant(P<0.05),and the difference in the specificity of the above indicators in the tandem diagnostic tests for predicting preterm delivery was statistically significant(P<0.05).Conclusion:The combined diagnosis of cervical length,cervical angle and Young's modulus of the anterior lips of the inner cervix can improve the efficacy of predicting preterm delivery in middle and late pregnant women.