E-Cervix弹性成像评估不同分娩史孕妇妊娠期宫颈组织差异的研究  

E-Cervix elastography evaluation in pregnant women with different delivery history

作　　者：杜柳[1] 古裕均 吴利红[1] 张立鹤 谢红宁[1] DU Liu;GU Yujun;WU Lihong;ZHANG Lihe;XIE Hongning(Department of Ultrasonic Medicine,The First Affiliated Hospital of Sun Yat-Sen University,Guangdong 510080,China)

机构地区：[1]中山大学附属第一医院超声医学科,广东广州510080 [2]广东省人民医院超声科,广东广州510080

出　　处：《影像诊断与介入放射学》2024年第1期63-70,共8页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金青年科学基金项目(82202156);广州市科技计划项目基金资助项目(202201011238)。

摘　　要：目的探讨不同分娩方式生育史孕妇宫颈E-Cervix参数随孕周的变化规律,以及不同分娩方式对再次妊娠时的宫颈软硬度和长度的影响。方法前瞻性收集2022年6月—2023年6月在我院定期产检的单胎妊娠孕妇,分别于11~14周、20~24周、28~32周经阴道超声测量孕妇宫颈的E-Cervix弹性参数。根据既往有无生育史及分娩方式,将研究对象分为初产妇组(A组)、经产妇无剖宫产史组(B组)和经产妇合并剖宫产史组(C组)。采用Friedman检验比较各组孕妇3个孕周段各宫颈参数值的差异,Mann-Whitney U检验比较初产妇与经产妇无剖宫产史及经产妇合并剖宫产史的宫颈各参数值差异。结果共纳入191例孕妇,其中A组101例,B组49例,C组41例。A组宫颈弹性值3个孕周段的差异均具有统计学意义(P<0.05);B组除应变比值(Ratio)外,余宫颈弹性值在3个孕周段的差异均具有统计学意义(P<0.05);C组除弹性对比指数(ECI)及Ratio外,余宫颈弹性值在3个孕周段的差异均具有统计学意义(P<0.05)。随着孕周段的增加,3组硬度比值(HR)逐渐减小,宫颈内口平均应变值(IOS)、宫颈外口平均应变值(EOS)逐渐增大。A组3个孕周段宫颈长度(CL)值中位数分别为3.36、3.51、3.49(P<0.05);B组3个孕周段CL值中位数分别为3.27、3.58、3.50(P<0.05);C组3个孕周段CL值中位数分别为3.38、3.73、3.63(P=0.057)。3组孕妇宫颈长度呈现出先增长再缩短的发展趋势。中孕期A组ECI值中位数小于B组(2.34比2.63),HR值中位数大于B组(89.81%比87.20%),CL值中位数小于C组(3.51比3.73),且差异均有统计学意义(P=0.008、P=0.024、P=0.034)。早孕期及晚孕期各项宫颈参数值在A组与B组及A组与C组间的差异均无明显统计学意义(P>0.05)。结论E-Cervix技术客观地反映出不同分娩方式生育史孕妇妊娠期宫颈组织随孕周增加均产生一系列生理变化。不同分娩方式会影响再次妊娠时的宫颈弹性和宫颈长度的变化,�Objective To explore the changes of E-Cervix elastography parameters in pregnant women with different delivery history and gestational age,and to analyze the effects of different delivery modes on cervical stiffness and length during the next pregnancy.Methods 191 women with singleton pregnancy and regular prenatal examination in our hospital from June 2022 to June 2023 were enrolled and categorized as primiparas(A,101),multiparas without history of cesarean section(B,49)and multiparas with history of cesarean section(C,41).E-Cervix technology was used to measure the cervical stiffness and lengths at 11-14 weeks,20-24 weeks and 28-32 weeks of gestation by transvaginal ultrasound.The E-Cervix parameters were compared using Friedman test and Mann-Whitney U test.Results In group A,all E-Cervix parameters were significantly different(P<0.05)among the three trimesters.In group B,all E-Cervix parameters except for the Ratio showed significant differences among the three trimesters(P<0.05).In group C,all E-Cervix parameters except for the Ratio and elasticity contrast index(ECI)showed significant differences among the three trimesters(P<0.05).As the gestational age increased,the cervical hardness ratio(HR)became smaller whereas the internal cervical os and external cervical os became bigger among three groups.The median cervical length(CL)showed a development trend of first increasing and then decreasing with the advancing trimesters in all 3 groups(A:3.36,3.51,3.49,P=0.009;B:3.27,3.58,3.50,P=0.001;C:3.38,3.73,3.63,P=0.057).In the second trimester,group B had significantly higher ECI(P=0.008)and lower HR(P=0.024)than group A and CL of group C was longer(P=0.034).In the first and third trimesters,there was no significant difference in the cervical parameters between group A and group B or C.Conclusion The E-Cervix parameters reflect physiological cervical changes with increasing gestational age.In the second trimester,women without previous cesarean section have softer and less homogeneous cervical tissue whereas women w

关 键 词：宫颈 弹性超声成像 宫颈长度 分娩方式 

分 类 号：R445.1[医药卫生—影像医学与核医学]