超声参数对剖宫产瘢痕妊娠大出血的预测价值  

The predictive value of ultrasound parameters for cesarean scar induced pregnancy hemorrhage

作　　者：张涛[1] 翟爱丽[1] 李晶培 樊晓然 尚琳[1] 朱继红[1] ZHANG Tao;ZHAI Aili;LI Jingpei;FAN Xiaoran;SHANG Lin;ZHU Jihong(Department of Obstetrics and Gynecology,Baoding First Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院妇产科,河北保定071000

出　　处：《安徽医学》2024年第3期291-294,共4页Anhui Medical Journal

基　　金：保定市科技计划项目(编号:2141ZF077)。

摘　　要：目的超声参数建立logistic回归模型,并分析其预测剖宫产瘢痕妊娠大出血风险发生的价值。方法选取2019年12月至2021年12月在保定市第一中心医院接受治疗的剖宫产瘢痕妊娠患者120例作为研究对象,将术中大出血者记为观察组(35例),出血量少者记为对照组(85例)。检测患者人绒毛膜促性腺激素(HCG)水平,并进行超声检查,比较两组超声指标及HCG水平。采用多因素分析剖宫产瘢痕妊娠大出血发生的影响因素,绘制受试者工作特征(ROC)曲线评估结合超声参数的logistic模型的预测价值。结果两组患者血流分级、病灶类型比较,差异有统计学意义(P<0.05),观察组病灶为(31.58±3.89)cm,较对照组大,残余肌层厚度为(0.98±0.23)cm,较对照组薄,差异有统计学意义(P<0.05)。多因素分析结果显示,病灶较大、残余肌层较薄及血流分级为3级为主要影响因素(P<0.05);ROC曲线结果显示,曲线下面积为0.945(95%CI:0.888~0.978),灵敏度、特异度分别为94.29%和88.24%。结论对剖宫产瘢痕妊娠患者根据病灶大小、残余肌层厚度及血流分级等超声参数构建的logistic回归模型能够有效预测患者术中大出血的发生风险。Objective To establish a logistic regression model of ultrasound parameters combination,and analyzed its value in predict⁃ing the risk of major bleeding in cesarean scar pregnancy.Methods A total of 120 patients with cesarean section scar pregnancy who re⁃ceived treatment in Baoding First Central Hospital from December 2019 to December 2021 were gathered as the research objects.Patients with significant intraoperative bleeding were recorded as the observation group(35 cases),and those with minimal bleeding as the control group(85 cases).The level of human chorionic gonadotropin(HCG)in the patients was detected,and the ultrasound indexes and HCG levels were com⁃pared between the two groups.Multivariate analysis was performed to analyze the factors affecting the occurrence of cesarean scar pregnancy bleeding,and draw ROC curve was drawn to evaluate the predictive value of logistic model combined with ultrasound parameters.Results There were significant differences in blood flow grading and lesion type between the two groups(P<0.05);the lesions in the observation group were significantly larger[(31.58±3.89)cm vs(28.46±3.12)cm](P<0.05),and the thickness of the residual muscle layer was significantly thin⁃ner[(0.98±0.23)cm vs(1.52±0.45)cm](P<0.05).The results of multivariate regression analysis showed that larger lesions,thinner residual myometrium and blood flow of grade 3 were independent risk factors for massive bleeding in cesarean section scar pregnancy(P<0.05);incorpo⁃rating the above factors into the Logistic regression model could obtain the probability of massive bleeding in patients with cesarean section scar pregnancy,and then draw the ROC curve was drawn according to the probability value,and the results showed that,ROC curve was 0.945(95%CI:0.888~0.978),and the sensitivity was 94.29%,88.24%,respectively.Conclusions A logistic regression model constructed based on ultrasound parameters such as lesion size,residual muscle layer thickness,and blood flow grading can effectively predict the risk

关 键 词：瘢痕妊娠 超声参数 预测价值 大出血 LOGISTIC回归模型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.461[医药卫生—诊断学]