孕早期阴道超声s-Flow检查联合血清ACA及anti-β2GPI评估先兆流产患者不良妊娠结局价值

Value of the examination by transvaginal ultrasonography s-Flow combined with the levels of serum anti cardiolipin antibody and anti-β2 glycoproteinⅠantibody of pregnant women during the first trimester of pregnancy for evaluating their adverse pregnancy outcomes

目的:探讨孕早期行阴道双向能量多勒普技术(s-Flow)联合血清抗心磷脂抗体(ACA)及抗β2-糖蛋白Ⅰ(anti-β2GPI)检查预测先兆流产患者不良妊娠结局价值。方法:收集本院妇产科2018年6月-2020年6月收治的320例先兆流产孕妇临床资料,检测超声血流分型、血清ACA、anti-β2GPI水平,根据妊娠结果分为正常组(n=241例)和不良组(n=79例)。采取logistic回归分析影响不良妊娠结局的因素,受试者工作特征(ROC)曲线评估上述指标的预测价值。结果:两组血流信号分级比较有差异(P<0.05),不良组血清ACA、anti-β2GPI水平高于正常组(P<0.05)。logistic回归分析,阴道s-Flow技术血流信号分级、血清ACA、anti-β2GPI均为不良妊娠结局发生的独立危险因素(P<0.05)。评估不良妊娠结局的曲下面积阴道s-Flow技术血流信号分级0.578;血清ACA截断值>3.87 mIU/ml时曲下面积0.787,anti-β2GPI截断值>7.29 U/ml时曲下面积为0.745,以阴道s-Flow技术血流信号分级、ACA、anti-β2GPI联合预测不良妊娠结局的曲下面积0.881,敏感度81.0%、特异度79.3%。结论:孕早期行阴道s-Flow技术联合血清ACA及antiβ2GPI抗体检测对评估妊娠结局有较好效能。

Objective:To investigate the value of the blood flow signal lassification by vaginal bidirectional energy Doppler technique(s Flow)combined with the detections of serum anti-cardiolipin antibody(ACA)and anti-β2-glyco-protein I(anti-β2GPD)antibody of pregnant women during the first trimester of pregnancy for evaluating their adverse pregnancy outcomes.Methods:The clinical data of 320 pregnant women with threatened preterm labor or threatened a-bortion from June 2018 to June 2020 were cllected.The blood flow signal classification of these women were examined.by sFlow,and the levels of serum ACA and antirβ2 GPI antibody of these women were detected.According to the fi-nal pregnancy results,these women were divided into group A(241 cases with normal pregnancy outcome)and group B(79 cases with adverse pregnancy outcomes).Logistic regression was used to analyze the factors affecting the adverse pregnancy outcomes of the women.The predictive value of the blood flow cassification by vaginal s-Flow,and the ser-um ACA and anti-β2GPI antibody levels of the women for the pregnancy outcomes was asessed by receiver operating characteristie(ROC)curve.Results:There was significant difference in the blood flow signal lassification of the women between the two groups(P<0.05).The serum ACA and anti-β2GPI antibody levels of the women in group B were significantly higher than those of the women in group A(P<0.05).Logistic regression analysis showed that the blood flow signal classification by vaginal sFlow,and the levels of serum ACA and antiβ2GPI antibody of the women were the independent risk factors of their adverse pregnancy outcomes(P<0.05).The arca under the curve of the blood flow signal lassification by vaginal s-Flow of the women for evaluating their adverse pregnancy outcomes was 0.578.The area under the curve of the serum ACA level with the cut off value>3.87 mIU/ml of the women for evalua-ting their adverse pregnancy outcomes was 0.787.The area under the curve of the serum anti-β2GPI antibody level with the cut-off walue>7.29 U/ml of the women for evaluating their adverse pregnancy outcomes was 0.745.The area un-der the curve,the sensitivity,and the specificity of the combined of the blood flow signal cassification by vaginal s-Flow and the serum ACA and anti-β2GPI antibody levels of the women for evaluating their adverse pregnancy outcomes were 0.881,81.0%,and 79.3%。respectively.Conclusion:The blood flow signal classification by vaginal s-Flow com-bined with the detections of the serum ACA and anti-β2GPI antibody of the pregnant women during the first trimester of pregnancy for evaluating their pregnancy outcomes has better efficacy.