宫颈超声弹性成像对有LEEP史的单胎妊娠孕妇自发性早产的预测价值研究  

Study on the predictive value of cervical ultrasound elastography for spontaneous preterm birth of singleton gravidas with a history of loop electrosurgical excision procedure

作　　者：邓笛[1] 吴青青[1] 李菁华[1] 黄瑞贞 Deng Di;Wu Qingqing;Li Jinghua;Huang Ruizhen(Department of Ultrasound,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院超声科,100026

出　　处：《北京医学》2024年第4期282-285,291,共5页Beijing Medical Journal

基　　金：北京市属医院科研培育项目(PX2020059);首都医科大学附属北京妇产医院中青年学科骨干培养专项(FCYY201927)。

摘　　要：目的探讨宫颈超声弹性成像对有宫颈环形电刀切除术(loop electrosurgical excision procedure,LEEP)史的单胎妊娠孕妇自发性早产(spontaneous preterm birth,sPTB)预测的有效性。方法选取2020年12月至2022年5月首都医科大学附属北京妇产医院有LEEP史的单胎妊娠孕妇60例,根据分娩孕周是否<37周分为早产组(17例)和对照组(43例)。采用经阴道超声弹性成像测量各项参数,比较两组患者宫颈长度(cervical length,CL)、超声弹性对比指数(elasticity contrast index,ECI)、宫颈硬组织弹性占比(cervical hardness ratio,CHR)、闭合段宫颈内口组织区域应变率(closed internal cervical os strain rate,CIS)、宫颈外口组织区域应变率(external cervical os strain rate,ES)及CIS/ES比值,采用ROC曲线评估宫颈超声弹性成像对有LEEP史的单胎妊娠孕妇sPTB的预测价值。结果60例孕妇年龄25~44岁,平均(33.4±4.4)岁。早产组CL、CHR低于对照组[(2.4±0.9)cm比(2.9±0.6)cm、(58.1±18.6)%比(69.3±15.8)%],CIS高于对照组[(0.3±0.1)%比(0.2±0.1)%],差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,CL+CIS联合指标对有LEEP史的单胎妊娠孕妇sPTB风险预测的AUC为0.746,灵敏度为0.7059,特异性为0.7674,优于单独应用。结论经阴道宫颈超声弹性成像可有效用于有LEEP史的单胎妊娠孕妇sPTB风险的评估。Objective To explore the effectiveness and clinical application value of cervical ultrasound elastography in spontaneous preterm birth(sPTB)of singleton gravidas with a history of loop electrosurgical excision procedure(LEEP).Methods A total of 60 singleton gravidas with a history of LEEP in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from December 2020 to May 2022 were selected,and were divided into premature delivery group(17 cases)and control group(43 cases)according to whether the gestational week of delivery was less than 37 weeks.The parameters were measured by cervical ultrasound elastography.The cervical length(CL),elasticity contrast index(ECI),cervical hardness ratio(CHR),closed internal cervical os strain rate(CIS),external cervical os strain rate(ES)and CIS/ES ratio were analyzed.The predictive value of cervical ultrasonic elastography for sPTB in singleton gravidas with a history of LEEP were evaluated by ROC curve.Results The age of 60 gravidas ranged from 25 to 44 years,with an average of(33.4±4.4)years.The CL and CHR of the premature delivery group were smaller than those of the control group[(2.4±0.9)cm vs.(2.9±0.6)cm,(58.1±18.6)%vs.(69.3±15.8)%],the CIS was higher than that of the control group[(0.3±0.1)%vs.(0.2±0.1)%],and the differences were statistically significant(P<0.05).The ROC curve analysis showed that the AUC,sensitivity and specificity of CL+CIS combined index for predicting the risk of sPTB in singleton pregnant women with LEEP history were 0.746,0.7059 and 0.7674,which were better than those used alone.Conclusions Transvaginal cervical ultrasound elastography can be effectively used to evaluate the risk of sPTB in singleton pregnant women with LEEP history.

关 键 词：宫颈超声弹性成像 宫颈环形电刀切除术 单胎妊娠 孕妇 自发性早产 宫颈长度 预测价值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.21[医药卫生—诊断学]