双胎妊娠孕16~24周子宫颈长度对自发性早产的预测价值  

Prediction of Spontaneous Preterm Birth by Cervical Length at 16-24 Weeks in Twin Pregnancies

作　　者：胡青 刘宏艳 廖华 邓春艳 余海燕 HU Qing;LIU Hongyan;LIAO Hua(Department of Obstetrics and Gynecology,West China Second University,Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University Ministry of Education,Chengdu Sichuan 610041,China)

机构地区：[1]四川大学华西第二医院妇产科、出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《实用妇产科杂志》2025年第4期319-324,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨孕16~24周子宫颈长度(CL)对双胎妊娠自发性早产的预测价值。方法:对1001例双胎妊娠病例进行回顾性研究,其中自发性早产组569例,足月产组432例。采用单因素和多因素Logistic回归分析影响自发性早产的相关因素,通过受试者工作特征(ROC)曲线分析CL对自发性早产的预测价值。结果:孕16~24周,自发性早产组CL(3.460±0.866 cm)明显短于足月产组(3.711±0.589 cm),差异有统计学意义(P=0.005);子宫颈漏斗形成及其形状在足月产组与自发性早产组间差异有统计学意义(P<0.05)。多因素Logistic回归分析示,单绒毛膜性(aOR 0.161,95%CI 0.074~0.351)和孕16~24周CL(aOR 0.655,95%CI 0.496~0.864)是自发性早产发生的影响因素(P<0.05)。ROC曲线分析提示,孕16~24周CL 3.045 cm为预测孕34周前自发性早产的临界值,其敏感度为90.2%,特异度为64.9%,曲线下面积为0.650。结论:孕16~24周的CL测量是预测双胎妊娠自发性早产的潜在指标,另外,在建立自发性早产预测模型时,未来的研究也应考虑子宫颈漏斗的形状。Objective:To explore the predictive value of cervical length(CL)measured at 16-24 weeks of gestation for spontaneous preterm birth in twin pregnancies.Methods:A retrospective study was conducted on 1001 twin pregnancy cases,including 569 cases in the spontaneous preterm birth group and 432 cases in the term birth group.Univariate and multivariate Logistic regression analyses were used to identify factors associated with spontaneous preterm birth.The predictive value of CL for spontaneous preterm birth was analyzed by the receiver operating characteristic(ROC)curve.Results:At 16-24 weeks of pregnancy,the CL in the spontaneous preterm birth group(3.460±0.866 cm)was significantly shorter than that in the term birth group(3.711±0.589 cm),and the difference was statistically significant(P=0.005).There were statistically significant differences in the cervical funneling and its morphology between the term birth group and the spontaneous preterm birth group(P<0.05).Multivariate Logistic regression analysis showed that monochorionicity(aOR 0.161,95%CI 0.074-0.351)and CL at 16-24 weeks of pregnancy(aOR 0.655,95%CI 0.496-0.864)were influencing factors for spontaneous preterm birth(P<0.05).ROC curve analysis indicated that a CL cutoff of 3.045 cm at 16-24 weeks of pregnancy predicted spontaneous preterm birth before 34 weeks,with a sensitivity of 90.2%,specificity of 64.9%,and an area under the curve of 0.650.Conclusions:Measurement of CL at 16-24 weeks of pregnancy is a potential predictor of spontaneous preterm birth in twin pregnancies.In addition,when establishing a prediction model for spontaneous preterm birth,future research should also consider cervical funnel morphology.

关 键 词：子宫颈长度 孕16~24周 双胎妊娠 自发性早产 超声 

分 类 号：R714.21[医药卫生—妇产科学] R714.23[医药卫生—临床医学]