阴道超声参数联合血清TSP-1、ANGPTL4检测诊断孕早期先兆流产及不良妊娠结局的预后价值  

Diagnostic value of the vaginal ultrasound parameters combined with the detections of the serum thrombospondin-1 and angiopoietin-like protein 4 of women with threatened miscarriage for their adverse pregnancy outcomes and prognosis

作　　者：王晓燕 纪海霞 WANG Xiaoyan;JI Haixia(Yantai Yeda Hospital,Yantai,Shandong Province,264006)

机构地区：[1]烟台业达医院,264006

出　　处：《中国计划生育学杂志》2025年第3期685-691,共7页Chinese Journal of Family Planning

摘　　要：目的:探究阴道超声联合血清血小板反应蛋白1(TSP-1)、血管生成素样蛋白4(ANGPTL4)检测对孕早期先兆流产的诊断及预后价值。方法:收集2021年3月-2024年3月本院收治的孕早期先兆流产孕妇167例作为病例组,产前检查健康孕妇167例为对照组;对病例组保胎治疗10 d后,根据预后是否继续妊娠分为妊娠结局良好组(n=94)和不良组(n=73)。检测血清TSP-1、ANGPTL4水平;Pearson法分析TSP-1、ANGPTL4水平与阴道超声参数的相关性;采用多因素logistic分析孕早期孕妇先兆流产发生影响因素;受试者工作特征(ROC)曲线评估阴道超声联合血清TSP-1、ANGPTL4检测对孕早期孕妇先兆流产的诊断及预后价值。结果:病例组流产次数、阴道分泌物呈褐色、暗红色及阴道分泌物质地较为稠厚占比均高于对照组,超声参数收缩期峰值流速(PSV)值和ANGPTL4水平低于对照组,阻力指数(RI)、收缩期上升支加速度时间(ACT)值和TSP-1水平高于对照组;TSP-1与PSV呈负相关,与RI、ACT呈正相关;ANGPTL4与PSV呈正相关,与RI、ACT呈负相关(均P<0.05)。PSV升高和ANGPTL4升高为孕早期先兆流产的保护因素,流产≥2次、阴道分泌物颜色呈褐色、暗红色,RI升高、ACT升高、TSP-1升高为孕早期先兆流产发生的危险因素(P<0.05)。PSV、RI、ACT、TSP-1、ANGPTL4联合诊断孕早期先兆流产发生的曲线下面积(AUC)为0.956,大于各指标单独诊断;5项联合评估先兆流产不良妊娠结局的AUC为0.971,大于各指标单独预测(P<0.05)。结论:孕早期先兆流产孕妇PSV和ANGPTL4水平降低,RI、ACT和TSP-1水平增加,PSV、RI、ACT联合血清TSP-1、ANGPTL4检测对孕早期先兆流产诊断及不良妊娠结局预后价值较高。Objective:To explore the diagnostic value of the vaginal ultrasound parameters combined with the detections of the serum thrombospondin-1(TSP-1)and angiopoietin-like protein 4(ANGPTL4)of women with threatened miscarriage for their adverse pregnancy outcomes and prognosis.Methods:From March 2021 to March 2024,167 pregnant women with threatened miscarriage during the first trimester of pregnancy who accepted treatment in the hospital were included in study group,and 167 healthy pregnant women who underwent prenatal examinations in the hospital were included in control group.After 1o days of the fetal preservation treatment for the women in the studygroup,there were 94 women with continued pregnancy in group A and 73 women with abortion in group B according to whether the pregnancy continued or not.The levels of serum TSP-1 and ANGPTL4 of the women in the two groups were detected.Pearson method was used to analyze the correlation between the TSP-1 and the ANGPTL4 levels of the women and their vaginal ultrasound parameters.Multivariate logistic analysis was used to analyze the influencing factors of the threatened abortion of the pregnant women during the first trimester of pregnancy.Receiver operating characteristic(ROC)curve was used to evaluate the values of the transvaginal ultrasound parameters combined with the serum TSP-1 and ANGPTL4 levels of the pregnant women during the first trimester of pregnancy for predicting their threatened abortion and their prognosis.Results:The number of abortions,and the proportions of the brown or dark red vaginal secretion and the thick vaginal secretion of the women in the study group were significantly higher than those of the women in the control group.The peak systolic velocity(PSV)value and the ANGPTL4 level of the women in the study group were significantly lower than those of the women in the control group.The values of the resistance index(RI),systolic acceleration time of ascending branch(ACT),and the TSP-1 level of the women in the study group were significantly higher

关 键 词：先兆流产 早孕期 阴道超声参数 血小板反应蛋白1 血管生成素样蛋白4 诊断 预后 

分 类 号：R71[医药卫生—妇产科学]