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剪切波弹性成像结合宫颈长度预测妊娠20~27周自发性早产的价值

Value of shear wave elastography combined with cervical length in predicting spontaneous preterm birth at 20 to 27 weeks of gestation

    摘要
  • 摘要:
    目的 探讨剪切波弹性成像(SWE)结合宫颈长度(CL)测量预测妊娠20~27周发生自发性早产(SPB)的价值。
    方法 选取2020年1月—2022年6月在本院建档孕检的161例孕妇为研究对象。所有孕妇在妊娠20~27周接受CL测量和超声SWE检测，获取CL及SWE参数; 追踪孕妇发生SPB情况，分析CL及SWE参数与发生SPB的相关性。
    结果 161例孕妇中，共有34例发生SPB。早产与非早产孕妇SWE参数中的宫颈外口应变率(EOS)、弹性对比指数(ECI)、宫颈内口应变率(IOS)、硬度比值(HR)比较，差异有统计学意义(P < 0.05); 早产与非早产孕妇的CL比较，差异也有统计学意义(P < 0.05)。Spearman相关性分析显示, ECI、IOS、EOS与早产发生呈正相关(P < 0.05), HR、CL则与早产发生呈负相关(P < 0.05)。受试者工作特征(ROC)曲线显示, CL预测早产发生的曲线下面积(AUC)为0.800, 截断值为2.710 cm; SWE参数中ECI、HR、IOS、EOS预测早产发生的AUC分别为0.651、0.642、0.705、0.653, 截断值分别为5.140、53.650%、0.320、0.330。ROC曲线显示, SWE参数联合CL预测早产发生的AUC为0.813, 高于4项SWE参数联合预测的AUC, 差异有统计学意义(P < 0.05), 其最大约登指数的敏感度、特异度分别为0.794、0.732。
    结论 CL及SWE参数中的ECI、HR、IOS、EOS在预测孕20~27周孕妇发生SPB中具有一定的价值，尤其是5项指标联合预测的价值较高，其预测的临界值分别为2.710 cm、5.140、53.650%、0.320、0.330。

     

    Abstract:
    Objective To explore the value of shear wave elastography (SWE) combined with cervical length (CL) measurement in predicting spontaneous preterm birth (SPB) at 20 to 27 weeks of gestation.
    Methods A total of 161 pregnant women with antenatal care and examination in the hospital from January 2020 to June 2022 were selected as research objects. All pregnant women underwent CL measurement and SWE detection by ultrasound during 20 to 27 weeks of gestation to obtain CL and SWE parameters. The occurrence of SPB was followed up, and the correlations of CL and SWE parameters with the occurrence of SPB were analyzed.
    Results Among the 161 pregnant women, 34 patients experienced SPB. There were significant differences in the external os strain (EOS), elastic contrast index (ECI), internal os strain (IOS), and hardness ratio (HR) of SWE parameters between pregnant women with and without preterm birth (P < 0.05). Similarly, there was a significant difference in CL between the two groups (P < 0.05). Spearman correlation analysis showed that ECI, IOS and EOS were positively correlated with the occurrence of preterm birth (P < 0.05), while HR and CL were negatively correlated with the occurrence of preterm birth (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) for CL in predicting preterm birth was 0.800, with a cut-off value of 2.710 cm. Among the SWE parameters, the AUCs for ECI, HR, IOS and EOS in predicting preterm birth were 0.651, 0.642, 0.705 and 0.653 respectively, with cut-off values of 5.140, 53.650%, 0.320 and 0.330 respectively. The ROC curve showed that the AUC for predicting preterm birth by SWE parameters combined with CL was 0.813, which was significantly higher than the AUC for prediction by the combination of the four SWE parameters (P < 0.05). The sensitivity and specificity at the maximum Youden index were 0.794 and 0.732 respectively.
    Conclusion CL, as well as ECI, HR, IOS and EOS among SWE parameters, have certain value in predicting SPB in pregnant women at 20 to 27 weeks of gestation, especially when the five indicators are combined for prediction. The critical values for prediction are 2.710 cm, 5.140, 53.650%, 0.320 and 0.330 respectively.

     

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