阴超联合瘢痕部位血管化参数诊断早期瘢痕妊娠的研究  

Application of vaginal ultrasound combined with vascularization parameters of scar site in early detection of scar pregnancy

作　　者：韩冰 张萌萌 韩紫娜 马素红 HAN Bing;ZHANG Mengmeng;HAN Zina;MA Suhong(Ultrasound Department of Hengshui Second People's Hospital,Hebei,Hengshui 053000,China)

机构地区：[1]河北省衡水市第二人民医院超声科,河北衡水053000

出　　处：《中国实验诊断学》2025年第2期164-168,共5页Chinese Journal of Laboratory Diagnosis

基　　金：衡水市科技计划项目(2020014065Z)。

摘　　要：目的观察阴超联合瘢痕部位血管化参数在瘢痕妊娠早期检出中的价值,旨在为临床瘢痕妊娠孕妇的早期检出提供影像学检查参考依据。方法研究对象选自河北省衡水市第二人民医院2022年1月至2023年12月期间收治的100例剖宫产再妊娠孕妇,所有纳入对象均接受手术病理、阴道超声检查及三维能量多普勒技术检查,分析阴超与瘢痕部位血管化参数[血管化血流指数(VFI)、血流指数(FI)、血管化指标(VI)]单独及联合诊断早期瘢痕妊娠的效能分析。结果入组100例剖宫产再妊娠孕妇经病理结果显示,其中瘢痕妊娠80例,占比80.00%(80/100),宫颈妊娠10例,占比10.00%(10/100),滋养细胞疾病4例,占比4.00%(4/100),妊娠流产6例,占比6.00%(6/100);与非瘢痕妊娠组相比,瘢痕妊娠组VFI、FI、VI值均较高,差异有统计学意义(P<0.05);经绘制ROC曲线图,结果显示血管化参数(VFI、FI、VI)预测瘢痕妊娠的AUC均>0.800;将经ROC曲线图得到各指标的最佳阈值作为本次研究预测瘢痕妊娠的的阳性分界值,三维能量多普勒技术检出瘢痕妊娠73例,占比73.00%(73/100),与金标准的一致性一般(Kappa=0.638);阴道超声检出瘢痕妊娠70例,占比70.00%(70/100),与金标准的一致性一般(Kappa=0.620);联合诊断检出瘢痕妊娠78例,占比78.00%(78/100),与金标准的一致性好(Kappa=0.819);三种诊断方法特异性、阳性预测值及阴性预测值对比,差异无统计学意义(P>0.05),联合诊断敏感性、准确度>三维能量多普勒技术>阴道超声,差异有统计学意义(P<0.05)。结论剖宫产后不足1年的孕妇再妊娠时,瘢痕妊娠的发生率较高,针对高度疑似瘢痕妊娠的孕妇可通过开展阴道超声与三维能量多普勒技术联合检查,旨在提高瘢痕妊娠的早期检出,为临床进一步干预提供必要的影像学参考。Objective To observe the value of the vascularization parameters in the early detection of scar pregnan-cy,in order to provide imaging reference for the early detection of clinical scar pregnancy.Methods The subjects were selected from 100 pregnant women with re-pregnancy after cesarean section admitted to our hospital from January 2022 to December 2023.All subjects underwent surgical pathology,vaginal ultrasonography and three-dimensional energy Doppler examination.To analyze the efficacy of Yin ultrasound and scar site vascularization parameters(VFI,FI,VI)in the diagnosis of early scar pregnancy alone and in combination.Results The pathological results of 1oo cases of recur-rent cesarean section pregnancy showed that 80 cases of scar pregnancy,accounting for 80.00%(80/100),10 cases of cervical pregnancy,accounting for 10.00%(10/100),4 cases of trophoblastic disease,accounting for 4.00%(4/100),6 cases of pregnancy abortion.6.00%(6/100);Compared with the non-scar pregnancy group,the VFI,FI and VI values of the scar pregnancy group were higher,and the difference was statistically significant(P<0.05).After ROC curves were drawn(see Figure 1),the results showed that vascularization parameters(VFI,FI,VI)predicted the AUC of scar pregnancy to be>0.800.The optimal threshold of each index obtained by ROC curve was used as the positive cut-off value for predicting scar pregnancy in this study.Three-dimensional energy Doppler technology detected 73 cases of scar pregnancy,accounting for 73.00%(73/100),which was generally consistent with the gold standard(Kappa=0.638).Scar pregnancy was detected by vaginal ultrasound in 70 cases,accounting for 70.00%(70/100),which was generally consistent with the gold standard(Kappa=0.620).Scar pregnancy was detected in 78 cases,accounting for 78.00%(78/100),which was in good agreement with the gold standard(Kappa=0.819).There was no statistical sig-nificance in the specificity,positive predictive value and negative predictive value of the three diagnostic methods(P>O.05),while the sensit

关 键 词：瘢痕妊娠 经阴道彩色多普勒超声 三维能量多普勒技术 血管化参数 预测价值 诊断效能 

分 类 号：R714.22[医药卫生—妇产科学] R445.1[医药卫生—临床医学]