早中孕期经阴道超声测量子宫颈长度对单胎孕妇自发性早产的预测价值  

Predictive value of transvaginal ultrasound measurement of cervical length in first and second trimester on spontaneous preterm birth in singleton pregnancies

作　　者：吴茜[1] 陈俊雅[1] 张潇潇[1] 范丽欣[1] 朱毓纯[1] 景柏华[1] 王林林[1] 黄瑞娜[1] 李晨[1] 李秀梅 杨慧霞[1] Wu Qian;Chen Junya;Zhang Xiaoxiao;Fan Lixin;Zhu Yuchun;Jing Baihua;Wang Linlin;Huang Ruina;Li Chen;Li Xiumei;Yang Huixia(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《中华围产医学杂志》2022年第5期326-331,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨经阴道超声测量单胎孕妇早孕及中孕期子宫颈长度(cervical length,CL)及其对自发性早产的预测价值。方法本研究为回顾性研究。2019年1月至2019年6月在北京大学第一医院建档并自早孕期进行序贯测量CL的2254例单胎孕妇。所有孕妇均经阴道超声测量早孕期(孕11~13周+6)和中孕期(孕21~23周+6)的CL。采用t检验、χ^(2)检验或Fisher精确概率法、logistic回归分析模型等统计学方法,主要比较早产组与足月组早孕及中孕期CL的差异,并探究早产的独立危险因素以及早孕和中孕期CL对于自发性早产的预测价值。结果(1)2254例孕妇的早孕及中孕期CL分别为(36.1±4.2)mm(22.4~52.6 mm)与(36.9±5.3)mm(2.9~59.7 mm),短子宫颈发生率分别为0.31%(7/2254)和1.46%(33/2254)。当早孕期CL≤25.0和>25.0~≤30.3 mm时,中孕期发生短子宫颈的风险均增加[OR值(95%CI)分别为43.92(6.83~282.49)和6.59(1.97~22.00),P值均<0.05]。(2)2254例孕妇中共69例(3.06%)早产,其中早产与足月组的早孕期CL、短子宫颈发生率比较差异均无统计学意义[(35.2±4.5)与(36.1±4.1)mm,t=-1.78,P=0.076;1.5%(1/69)与0.3%(6/2185),χ^(2)=2.98,P=0.084],但早产组中孕期CL较短,短子宫颈发生率较高[(33.6±6.7)与(37.0±5.2)mm,t=-5.12;8.7%(6/69)与1.2%(27/2185),χ^(2)=25.80,P值均<0.001]。(3)多因素回归分析显示,年龄≥35岁(OR=2.05,95%CI:1.22~3.46)、自发性早产史(OR=25.25,95%CI:5.01~127.28)、辅助生殖技术助孕(OR=10.39,95%CI:2.39~50.33)、中孕期短子宫颈为早产的独立危险因素。(4)早孕期CL≤25.0、>25.0~≤30.3、>30.3~≤33.0、>33.0~≤35.7、>35.7~≤38.7 mm分别与>38.7 mm进行比较,早产的发生风险差异均无统计学意义(P值均>0.05)。将中孕期CL≤25.0、>25.0~≤29.5、>29.5~≤33.6、>33.6~≤36.8、>36.8~≤40.1 mm分别与>40.1 mm进行比较,早产的风险均相对升高[OR值(95%CI)分别为17.64(4.99~62.32)、6.89(2.11~22.55)、3.58(1.34~9.59)、4.04(1.58~10.32)、3.34(1.28~8.67),P�Objective To explore the predictive value of transvaginal ultrasound measurement of cervical length(CL)in the first and second trimester on spontaneous preterm birth in singleton pregnant women.Methods This study retrospectively recruited 2254 singleton pregnancies without severe comorbidities at Peking University First Hospital from January 2019 to June 2019.CL was measured for all subjects using transvaginal ultrasound in the first(11-13+6 weeks)and second trimester(21-23+6 weeks).Differences in CL between women with preterm(preterm group)and full-term delivery(full-term group)as well as the CL during the first and second trimester were compared.The independent risk factors for preterm birth and the predictive value of CL in the first and second trimester for spontaneous preterm birth were also explored.Fisher's exact test,t-test,χ^(2)test,and logistic regression analysis,etc,were adopted for statistical analysis.Results(1)For the 2254 subjects,CL measured in the first trimester and second trimester were(36.1±4.2)mm(22.4-52.6 mm)and(36.9±5.3)mm(2.9-59.7 mm),respectively.The incidence of short cervix in the first trimester and second trimester were 0.31%(7/2254)and 1.46%(33/2254),respectively.When CL was≤25.0 mm(OR=43.92,95%CI:6.83-282.49)or>25.0-≤30.3 mm(OR=6.59,95%CI:1.97-22.0)in the first trimester,the risk of short cervix increased in the second trimester(both P<0.05).(2)The total incidence of preterm delivery was 3.06%(69/2254).CL and the incidence of short cervix did not differ significantly in the first trimester between the preterm and full-term group[(35.2±4.5)and(36.1±4.1)mm,t=-1.78,P=0.076;1.5%(1/69)and 0.3%(6/2185),χ^(2)=2.98,P=0.084].Compared with the full-term group,CL was shorter and the incidence of short cervix was higher in the second trimester in the preterm group[(33.6±6.7)vs(37.0±5.2)mm,t=-5.12;8.7%(6/69)vs 1.2%(27/2185),χ^(2)=25.80,P<0.001].(3)Multivariate regression analysis showed that age≥35 years(OR=2.05,95%CI:1.22-3.46),history of spontaneous preterm birth(OR=25.25,95%CI

关 键 词：宫颈长度测量 超声检查 早产 妊娠初期 妊娠中期 

分 类 号：R714.21[医药卫生—妇产科学]