超声检测囊芽差联合基线血栓弹力图指标对早期妊娠结局的预测价值分析

Analysis of the predictive value of ultrasound detection of sac bud difference combined with baseline thromboelastography indicators for early pregnancy outcome

目的分析超声检测囊芽差联合基线血栓弹力图指标对早期妊娠结局的预测价值。方法215例早孕孕妇,根据孕妇囊芽差的大小分为正常组(囊芽差大小为14~18 mm)、轻度小孕囊组(囊芽差大小为10~13 mm)、中度小孕囊组(囊芽差大小为6~9 mm)、重度小孕囊组(囊芽差大小为4~5 mm)和小孕囊绝对流产组(囊芽差大小为≤3 mm),分别为180、15、10、8和2例。五组孕妇均进行经阴道超声及血栓弹力图检测,比较超声检测对不同囊芽差孕妇的检测结果(正常妊娠率及异常流产率),不同孕囊芽差孕妇基线血栓弹力图指标[反应时间(R)值、凝血时间(K)值、Angel角、最大振幅(MA)值、凝血综合系数(CI)值];分析超声检测对早期妊娠结局的预测价值。结果正常组、轻度小孕囊组、中度小孕囊组、重度小孕囊组和小孕囊绝对流产组正常妊娠率分别为93.33%、86.67%、70.00%、0和0,异常流产率分别为6.67%、13.33%、30.00%、100.00%、100.00%;五组孕妇的妊娠结局比较差异具有统计学意义(P<0.05)。对215例早孕孕妇进行妊娠结局跟踪统计,正常妊娠孕妇204例,异常流产孕妇11例;超声检测的预测结果为正常妊娠孕妇188例,异常流产孕妇27例;超声检测对早孕孕妇妊娠结局的灵敏度为89.22%(182/204),特异度为45.45%(5/11),阳性预测值为96.81%(182/188),阴性预测值为18.52%(5/27),准确率达到86.98%(187/215)。五组孕妇的R值、K值、Angel角、MA值、CI值比较差异具有统计学意义(P<0.05);R值、K值由小到大依次为正常组、轻度小孕囊组、中度小孕囊组、重度小孕囊组、小孕囊绝对流产组,而Angel角、MA值、CI值由小到大与上述顺序相反。结论囊芽差大小与妊娠结局有关,偏大或偏小均会导致流产;超声检测可以有效预测流产的发生几率,可以用基线血栓弹力图指标评估孕妇的凝血状态,以此指导临床抗凝治疗。

Objective To analyze the predictive value of ultrasound detection of sac bud difference combined with baseline thromboelastography indicators for early pregnancy outcome.Methods 215 cases of early pregnant women were divided into the normal group(with a sac bud difference of 14-18 mm),the mild small gestational sac group(with a sac bud difference of 10-13 mm),and the moderate small gestational sac group(with a sac bud difference of 6-9 mm),severe small gestational sac group(with a sac bud difference of 4-5 mm)and small gestational sac absolute abortion group(with a sac bud difference of≤3 mm)according to the size of the gestational sac difference of pregnant women,with 190,15,10,8 and 2 cases in each group.Transvaginal ultrasound and thromboelastography were performed in all five groups of pregnant women to compare the detection results(normal pregnancy rate and abnormal abortion rate)and baseline thromboelastography indicators[reaction time(R)value,coagulation time(K)value,Angel Angle,maximum amplitude(MA)value,and comprehensive coagulation index(CI)value]for pregnant women with different sac bud difference.The predictive value of ultrasound detection for early pregnancy outcome was analyzed.Results The normal pregnancy rates of the normal group,mild small gestational sac group,moderate small gestational sac group,severe small gestational sac group and small gestational sac absolute abortion group were 93.33%,86.67%and 70.00,0,0,and the abnormal abortion rates were 6.67%,13.33%,30.00%,100.00%,and 100.00%.There were significant differences in pregnancy outcomes among the five groups(P<0.05).215 cases of early pregnant women were followed up,with 204 cases of normal pregnancy and 11 cases of abnormal miscarriage;ultrasound detected 188 cases of normal pregnancy and 27 cases of abnormal miscarriage.The sensitivity of ultrasound detection for pregnancy outcome of early pregnant women was 89.22%(182/204),the specificity was 45.45%(5/11),the positive predictive value was 96.81%(182/188),and the negative predictive value was 18.52%(5/27),and the accuracy reached 86.98%(187/215).There were significant differences in R value,K value,Angel Angle,MA value and CI value among the five groups(P<0.05).The R and K values in descending order were normal group,mild small gestational sac group,moderate small gestational sac group,severe small gestational sac group and small gestational sac absolute abortion group,whereas the Angel angle,MA and CI values in descending order were in the opposite order to the above.Conclusion Sac bud difference is related to pregnancy outcome.Either too large or too small will lead to miscarriage.Ultrasound detection can effectively predict the risk of miscarriage.Baseline thromboelastography can be used to evaluate the coagulation status of pregnant women and guide clinical anticoagulation treatment.