超声多模态评分联合子宫血流灌注参数对复发性流产患者发生不良妊娠结局的诊断价值

Diagnostic value of ultrasound multimodal scores combined with uterine blood perfusion parameters for adverse pregnancy outcomes in patients with recurrent abortion

目的分析超声多模态评分联合子宫血流灌注参数对复发性流产(RSA)患者发生不良妊娠结局的诊断价值。方法回顾性分析2019年1月至2021年12月在武汉市中医医院就诊的290例RSA患者的病历资料,根据孕12周内是否发生流产将患者分为不良妊娠结局组(60例)和良好妊娠结局组(230例)。比较两组激素指标[卵泡生成激素(FSH)、黄体生成激素(LH)、雌二醇(E 2)、睾酮(T)、孕酮(P)、人绒毛膜促性腺激素(β-HCG)]、超声多模态评分、子宫血流灌注参数[搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速(S/D)比值]。采用多因素Logistic回归分析RSA患者发生不良妊娠结局的危险因素。绘制受试者工作特征(ROC)曲线分析超声多模态评分、子宫血流灌注参数对RSA患者发生不良妊娠结局的诊断价值。结果不良妊娠结局组超声多模态评分、P、β-HCG水平低于良好妊娠结局组,且PI、RI、S/D比值均高于良好妊娠结局组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,超声多模态评分、P水平降低,PI、RI和S/D比值升高为RSA患者发生不良妊娠结局危险因素(P<0.05)。ROC曲线分析结果显示,超声多模态评分联合各子宫血流灌注参数诊断RSA患者发生不良妊娠结局的曲线下面积为0.911。结论超声多模态评分联合子宫血流灌注参数可有效诊断RSA患者发生不良妊娠结局,能为临床预防RSA患者发生不良妊娠结局提供指导。

Objective To analyze the value of ultrasonic multimodal scores combined with uterine blood perfusion parameters in diagnosing adverse pregnancy outcomes in patients with recurrent abortion(RSA).Methods The medical records of 290 RSA patients treated in Wuhan Hospital of Traditional Chinese Medicine from January 2019 to December 2021 were retrospectively analyzed,and the patients were divided into an adverse pregnancy outcome group(60 cases)and a good pregnancy outcome group(230 cases)according to whether abortion occurred within 12 weeks of gestation.Hormone indexes[follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E 2),testosterone(T),progesterone(P),human chorionic gonadotropin(β-HCG)],ultrasonic multimodal scores,uterine blood perfusion parameters[pulse index(PI),resistance index(RI),peak systolic flow rate/end-diastolic flow rate(S/D)ratio]were compared between the two groups.Multivariate Logistic regression was used to analyze the risk factors of adverse pregnancy outcomes in RSA patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of ultrasonic multimodal scores and uterine blood perfusion parameters for adverse pregnancy outcomes in RSA patients.Results The ultrasound multimodal scores,P andβ-HCG levels in the adverse pregnancy outcome group were lower than those in the good pregnancy outcome group,and the PI,RI and S/D ratio in the adverse pregnancy outcome group were higher than those in the good pregnancy outcome group,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that the decrease of ultrasonic multimodal score and P level and the increase of PI,RI and S/D ratio were risk factors for adverse pregnancy outcomes in RSA patients(P<0.05).ROC curve analysis results showed that the area under the curve of ultrasonic multimodal scores combined with various uterine blood perfusion parameters diagnosed adverse pregnancy outcomes in RSA patients was 0.911.Conclusion Ultrasonic multimodal scores combined with uterine blood perfusion parameters can effectively diagnose adverse pregnancy outcomes in RSA patients and provide guidance for clinical prevention of adverse pregnancy outcomes in RSA patients.