宫颈前角、宫颈长度及剪切波速度在宫颈机能不全自发性早产风险中的预测价值研究  

Predictive value of cervical anterior angle(ACA),cervical length(CL)and shear wave velocity(SWV)in risk of spontaneous preterm delivery with cervical incompetence

作　　者：何陈艳 应小燕[1] HE Chenyan;YING Xiaoyan(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第二附属医院妇产科,南京210000

出　　处：《新疆医科大学学报》2024年第9期1253-1258,共6页Journal of Xinjiang Medical University

基　　金：江苏省妇幼健康重点科室基金(FXK201712)。

摘　　要：目的分析宫颈前角(Anterior uterocervical angle,ACA)、宫颈长度(Cervical length,CL)及剪切波速度(Shear wave velocity,SWV)在宫颈机能不全自发性早产风险中的联合预测价值。方法以2023年2月-6月在南京医科大学第二附属医院妇产科建档的376例宫颈机能不全孕妇为研究对象,分析不同孕周(19~23 w+6 d、24~27 w+6 d、28~33 w+6 d、34~36 w+6 d)时ACA、CL、SWV与孕周的相关性。对所有孕妇随访至完成分娩,根据孕妇是否早产分为早产组与非早产组,比较2组孕妇的一般资料。经Logistic回归分析宫颈机能不全孕妇早产的风险因素,根据危险因素构建预测模型,采用受试者工作特征(Receiver operating characteristic curve,ROC)曲线分析ACA、CL、SWV对宫颈机能不全孕妇自发性早产风险的单独及联合预测效能,采取Pearson相关性分析ACA、CL及SWV与宫颈机能不全孕妇孕周的相关性。结果不同孕周的宫颈机能不全孕妇SWV、CL间,差异有统计学意义(P<0.05),且随着孕周增加SWV、CL呈下降趋势(P<0.05),不同孕周的宫颈机能不全孕妇比较,ACA差异无统计学意义(P>0.05)。Pearson相关性分析结果表明,SWV、CL与宫颈机能不全孕妇的孕周呈负相关关系(r=-0.628、-0.867,P<0.05)。ACA与宫颈机能不全孕妇的孕周无相关性(r=0.109,P=0.081)。376例孕妇中自发性早产79例,自发性早产率为21.01%(79/376),足月产297例,足月产率为78.99%(297/376)。将79例自发性早产孕妇纳入早产组,其余297例足月产孕妇分为非早产组,经单因素分析表明,两组年龄、BMI、流产次数、辅助生殖技术妊娠情况、孕周,差异无统计学意义(P>0.05),与非早产组比较,早产组ACA升高,CL、SWV降低(P<0.05)。Logistic回归分析表明ACA、CL、SWV均是导致宫颈机能不全孕妇自发性早产的重要风险因素(P<0.05),建立早产联合预测模型:Logistic(P)=-48.126+6.059×SWV+0.206×CL+0.295×ACA;ROC曲线分析表明,ACA、CL、SWV对宫颈机能不全孕�Objective To analyze the combined predictive value of anterior cervical angle(ACA),cervical length(CL),and shear wave velocity(SWV)in the risk of spontaneous preterm delivery with cervical dysfunctions.Methods A total of 376 pregnant women with cervical incompetence were enrolled in the Department of Obstetrics and Gynecology of the hospitalfrom February to June 2023.The correlation between ACA,CL,SWV and gestational weeks(19-23 w+6 d,24-27 w+6 d,28-33 w+6 d,34-36 w+6 d)was analyzed.All pregnant women were followed up to the completion of delivery and divided into preterm and non-preterm groups according to whether they were preterm or not.The general data of the 2 groups were compared,and the risk factors of preterm delivery in pregnant women with cervical immaturity were analyzed by Logistic regression,and the prediction model was built according to the risk factors.Receiver Operating Characteristic curve(ROC)curve was used to analyze the single and combined predictive efficacy of ACA,CL and SWV on the risk of spontaneous preterm delivery in pregnant women with cervical imfunction.Pearson correlation was used to analyze the correlation between ACA,CL and SWV and gestational age of pregnant women with cervical dysfunction.Results There were significant differences in SWV and CL among the pregnant women with cervical incompetence at different gestational weeks(P<0.05),and SWV and CL showed a decreasing trend with the increase of gestational weeks(P<0.05).There was no significant difference in ACA among the pregnant women with cervical dysfunction at different gestational weeks(P>0.05).The results of Pearson correlation analysis showed that SWV and CL were negatively correlated with gestational age of pregnant women with cervical incompetence(r=-0.628,-0.867,P<0.05),while ACA was not correlated with gestational age of the pregnant women with cervical incompetence(r=0.109,P=0.081).Among the 376 pregnant women,79 cases were spontaneous preterm delivery(21.01%),and 297 cases were full term delivery(78.99%).79 spontan

关 键 词：宫颈机能不全 自发性早产 剪切波速度 宫颈长度 宫颈前角 

分 类 号：R711.2[医药卫生—妇产科学]