子宫内膜血流特征对早期异位妊娠的诊断价值研究  

The diagnostic value of endometrial blood flow characteristics in early ectopic pregnancy

作　　者：孙秀利 高瑜 李妘[3] SUN Xiuli;GAO Yu;LI Yun(Department of Gynecology,Shaanxi Provincial Tuberculosis Control Hospital(Shaanxi Fifth People's Hospital),Xi'an 710100,Shaanxi,China;Department of Internal Medicine,Shaanxi Provincial Tuberculosis Control Hospital(Shaanxi Fifth People's Hospital),Xi'an 710100,Shaanxi,China;Department ofGynecology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,China)

机构地区：[1]陕西省结核病防治院(陕西省第五人民医院)妇科,西安710100 [2]陕西省结核病防治院(陕西省第五人民医院)内科,西安710100 [3]汉中市中心医院妇科,陕西汉中723000

出　　处：《中国性科学》2022年第4期79-83,共5页Chinese Journal of Human Sexuality

基　　金：陕西省重点研发项目(S2020-YF-YBSF-0042)。

摘　　要：目的分析子宫内膜血流特征对早期异位妊娠的诊断价值。方法选取2017年1月至2020年12月汉中市中心医院接诊的146例不明位置早期妊娠患者作为研究对象,根据手术或病理结果分为宫内妊娠组(n=87)和异位妊娠组(n=59)。所有患者均接受经阴道彩色多普勒超声检查,检测子宫内膜厚度、形态类型、对称性,以及子宫内膜动脉的血流分型、阻力指数(RI)、搏动指数(PI)、收缩期峰值流速(PSV)、舒张末期流速(EDV)。采用受试者工作特征(ROC)曲线下面积(AUC)评价子宫内膜血流参数对早期异位妊娠的诊断效能。结果异位妊娠组子宫内膜动脉血流类型以0型和Ⅰ型为主,和宫内妊娠组比较,差异具有统计学意义(P<0.05);异位妊娠组子宫内膜动脉RI、PI均明显大于宫内妊娠组,PSV、EDV均明显小于宫内妊娠组,差异具有统计学意义(P<0.05);经ROC曲线分析,子宫内膜动脉RI、PI、PSV、EDV预测早期异位妊娠的AUC分别为0.890、0.625、0.645、0.845,最佳诊断截断值分别为0.83、1.45、5.32cm/s、2.76cm/s;子宫内膜动脉RI和EDV诊断早期异位妊娠的灵敏度、特异度及符合率均较高。结论子宫内膜血流呈低速高阻特征,是诊断早期异位妊娠的重要依据,其中RI、EDV诊断效能较好,可作为异位妊娠诊断的新指标。Objective To analyze the diagnostic value of endometrial blood flow characteristics in early ectopic pregnancy.Methods From January 2017 to December 2020,146 patients with early pregnancy at unknown location in Hanzhong Central Hospital were selected as subjects.According to the surgical or pathological results they were divided into intrauterine pregnancy group(n=87)and ectopic pregnancy group(n=59).All patients underwent transvaginal color Doppler ultrasonography to measure endometrial thickness,morphological type,symmetry and endometrial arterial flow pattern,resistance index(RI),pulsatile index(PI),peak systolic velocity(PSV)and end diastolic velocity(EDV).The area under the curve(AUC)of receiver operating characteristic(ROC)was used to evaluate the diagnostic efficacy of endometrial blood flow parameters in early ectopic pregnancy.Results The main blood flow types of endometrial artery in ectopic pregnancy group are type 0 and type Ⅰ,and the difference is statistically significant compared with intrauterine pregnancy group(P<0.05).Endometrial artery RI and PI in ectopic pregnancy group are significantly higher than those in intrauterine pregnancy group,PSV and EDV are significantly lower than those in intrauterine pregnancy group(P<0.05).The AUC of RI,PI,PSV and EDV in predicting early ectopic pregnancy are 0.890,0.625,0.645 and 0.845,the best diagnostic cut-off values are 0.83,1.45,5.32 cm/s and 2.76 cm/s,the sensitivity,specificity and coincidence rate of endometrial artery RI and EDV in the diagnosis of early ectopic pregnancy are high.Conclusions Endometrial blood flow is characterized by low speed and high resistance,which is an important basis for the diagnosis of early ectopic pregnancy,the RI and EDV have better diagnostic efficiency and can be used as new indicators for the diagnosis of ectopic pregnancy.

关 键 词：异位妊娠 宫内妊娠 子宫内膜 阻力指数 舒张末期流速 

分 类 号：R714[医药卫生—妇产科学]