Clinical value of transvaginal ultrasound combined with fetal fibronectin in predicting spontaneous premature delivery
-
摘要:
目的 分析经阴道超声测量子宫宫颈前角（ACA）、宫颈长度（CL）联合胎儿纤维连接蛋白（fFN）预测自发性早产（SPB）的临床价值。 方法 选取2019年6月~2022年6月我院收治的98例先兆早产孕妇为研究对象，根据是否发生SPB将其分为SPB组（n=33）和足月组（n=65）。采用单因素及Logistic多因素回归分析先兆早产孕妇发生SPB的风险因素。通过绘制ROC曲线评估ACA、CL及fFN对SPB的预测效能。 结果 经单因素分析，两组孕前BMI、胎膜早破、宫内感染、羊水过多、妊娠期糖尿病情况及ACA、CL、fFN水平的差异有统计学意义（P < 0.05）。经Logistic多因素回归分析，胎膜早破、ACA、fFN是先兆早产孕妇发生SPB的风险因素（OR>1，P < 0.05），孕前BMI、CL是先兆早产孕妇发生SPB的保护因素（OR < 1，P < 0.05）。ROC曲线显示，当ACA≥ 116.500°时，预测先兆早产孕妇发生SPB的AUC为0.630，敏感度为48.5%，特异性为69.2%。当CL≤25.000 mm时，AUC为0.667，敏感度为54.5%，特异性为73.8%。当fFN≥96.155 μg/L时，AUC为0.652，敏感度为60.6%，特异性为69.2%。三者联合预测的AUC为0.740，敏感度为72.7%，特异性为75.4%。 结论 经阴道超声测量ACA、CL及fFN水平均对预测先兆早产孕妇发生SPB具有一定预测价值，且三者联合预测效能更佳。 Abstract:Objective To analyze the clinical value of the transvaginal ultrasound measurement of the anterior uterocervical angle (ACA) and cervical length (CL) combined with fetal fibronectin (fFN) for predicting spontaneous preterm birth (SPB). Methods Ninety-eight pregnant women with threatened preterm birth were selected as research objects from June 2019 to June 2022. They were divided into SPB group (n=33) and full-term group (n=65) according to whether SPB occurred. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of SPB in pregnant women with threatened premature labor. The predictive efficiency of ACA, CL and fFN to SPB were evaluated by drawing ROC curve. Results Univariate analysis showed that there were statistically significant differences in pre-pregnancy BMI, premature rupture of membranes, intrauterine infection, excessive amniotic fluid, gestational diabetes and ACA, CL and fFN levels between the two groups (P < 0.05). Multivariate logistic regression analysis showed that premature rupture of membranes, ACA and fFN were risk factors for SPB in pregnant women with threatened premature labor (OR>1, P < 0.05). BMI and CL before pregnancy were protective factors for SPB in pregnant women with threatened premature labor (OR < 1, P < 0.05). ROC analysis showed that when ACA ≥116.500°, the area under curve (AUC) of predicting SPB in pregnant women with threatened preterm birth was 0.630, the sensitivity was 48.5%, and the specificity was 69.2%. When CL ≤25.000 mm, the AUC was 0.667, the sensitivity was 54.5%, and the specificity was 73.8%. When fFN ≥96.155 μg/L, the AUC was 0.652, the sensitivity was 60.6%, and the specificity was 69.2%. The AUC of combined prediction was 0.740, the sensitivity was 72.7%, and the specificity was 75.4%. Conclusion The ACA, CL and fFN measured by transvaginal ultrasound have a certain predictive value for predicting SPB in pregnant women with threatened premature labor, and the combined predictive efficacy of the three is better. -
图 2 ACA、CL、fFN及三者联合预测先兆早产孕妇发生SPB的ROC曲线图
Figure 2. ROC curve of ACA, CL, fFN and their combined prediction of SPB in pregnant women with threatened preterm labor.
表 1 先兆早产孕妇发生SPB的单因素分析
Table 1. Univariate analysis of SPB in pregnant women with threatened preterm labor
因素 SPB组（n=33） 足月组（n=65） χ2/t P 年龄（岁, Mean±SD） 33.39±5.23 32.35±5.52 0.897 0.372 孕周（周, Mean±SD） 32.12±2.70 31.78±2.39 0.637 0.526 孕前BMI（kg/m2, Mean±SD） 21.96±1.09 23.72±1.54 5.856 < 0.001 孕次（次, Mean±SD） 2.21±1.02 2.06±0.93 0.730 0.467 产次（次, Mean±SD） 0.70±0.68 0.74±0.71 0.267 0.790 流产次数（次, Mean±SD） 0.73±0.72 0.74±0.67 0.068 0.946 产检次数（次, Mean±SD） 4.76±1.17 4.48±1.12 1.152 0.252 胎膜早破 是（n=26） 15 11 9.141 0.002 否（n=72） 18 54 胎盘早剥 是（n=18） 8 10 1.145 0.285 否（n=80） 25 55 宫内感染 是（n=4） 4 0 8.214 0.004 否（n=94） 29 65 羊水过多 是（n=36） 18 18 6.791 0.009 否（n=62） 15 47 瘢痕子宫 是（n=21） 9 12 1.009 0.315 否（n=77） 24 53 妊娠期高血压 是（n=15） 6 9 0.317 0.573 否（n=83） 27 56 妊娠期糖尿病 是（n=21） 13 8 9.538 0.002 否（n=77） 20 57 ACA（°, Mean±SD） 115.79±6.71 112.75±6.31 2.203 0.030 CL（cm, Mean±SD） 29.70±3.74 31.58±3.10 2.654 0.009 fFN（μg/L, Mean±SD） 113.11±18.31 104.81±12.76 2.617 0.010 SPB: 自发性早产; ACA: 子宫宫颈前角; CL: 宫颈长度; fFN: 胎儿纤维连接蛋白. 
下载: 导出CSV
表 2 先兆早产孕妇发生SPB的多因素Logistic回归分析
Table 2. Multifactor Logistic regression analysis of SPB in pregnant women with threatened preterm labor
变量 回归系数 标准误 Wald χ2 P OR OR 95% CI 孕前BMI -0.841 0.186 20.338 < 0.001 0.431 0.299~0.622 胎膜早破 1.321 0.530 6.217 0.013 3.748 1.327~10.591 ACA 0.075 0.037 4.138 0.042 1.078 1.003~1.159 CL -0.163 0.074 4.882 0.027 0.849 0.735~0.982 fFN 0.037 0.016 5.267 0.022 1.037 1.005~1.070 常量 -8.236 5.218 2.491 0.115
下载: 导出CSV
表 3 ACA、CL、fFN及三者联合对先兆早产孕妇发生SPB的预测效能
Table 3. Predictive efficacy of ACA, CL, fFN and their combination on SPB in pregnant women with threatened preterm labor
检测指标 AUC SE P Cut-off值 敏感度（%） 特异性（%） 阳性预测值（%） 阴性预测值（%） 准确度（%） Youden指数 95% CI ACA（°） 0.630 0.059 < 0.001 116.500 48.5 69.2 44.4 72.6 62.2 0.177 0.515~0.745 CL（mm） 0.667 0.060 < 0.001 25.000 54.5 73.8 51.4 76.2 67.3 0.284 0.549~0.785 fFN（μg/L） 0.652 0.064 < 0.001 96.155 60.6 69.2 50.0 77.6 66.3 0.298 0.526~0.778 三者联合 0.740 0.053 < 0.001 - 72.7 75.4 60.0 84.5 74.5 0.481 0.636~0.844
下载: 导出CSV
-
[1] 王玲, 王晋, 祁晓英, 等. 双胎妊娠宫颈剪切波弹性成像测值对自发性早产的预测价值[J]. 川北医学院学报, 2021, 36(3): 297-301. doi: 10.3969/j.issn.1005-3697.2021.03.06 [2] Strauss JF Ⅲ, et al. Spontaneous preterm birth: advances toward the discovery of genetic predisposition[J]. Am J Obstet Gynecol, 2018, 218(3): 294-314.e2. doi: 10.1016/j.ajog.2017.12.009 [3] Norman JE. Progesterone and preterm birth[J]. Int J Gynaecol Obstet, 2020, 150(1): 24-30. doi: 10.1002/ijgo.13187 [4] Thain S, Yeo GSH, Kwek K, et al. Spontaneous preterm birth and cervical length in a pregnant Asian population[J]. PLoS One, 2020, 15(4): e0230125. doi: 10.1371/journal.pone.0230125 [5] 孔琳, 潘平山, 谭芸, 等. 阴道分泌物胎儿纤维连接蛋白水平和宫颈长度对先兆早产孕妇发生自发性早产的预测价值及先兆早产孕妇发生自发性早产的危险因素[J]. 广西医学, 2020, 42(15): 1935-8, 1958. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202015006.htm [6] Gulersen M, et al. The risk of spontaneous preterm birth in asymptomatic women with a short cervix (≤25 mm) at 23-28 weeks'gestation[J]. Am J Obstet Gynecol MFM, 2020, 2(2): 100059. doi: 10.1016/j.ajogmf.2019.100059 [7] Chen JN, Gong GL, Zheng WH, et al. Diagnostic accuracy of quantitative fetal fibronectin to predict spontaneous preterm birth: a meta-analysis[J]. Int J Gynaecol Obstet, 2021, 153(2): 220-7. doi: 10.1002/ijgo.13550 [8] Singh PK, Srivastava R, Kumar I, et al. Evaluation of uterocervical angle and cervical length as predictors of spontaneous preterm birth [J]. Indian J Radiol Imaging, 2022, 32(1): 10-5. doi: 10.1055/s-0041-1741411 [9] 张晓娇, 陈慧月. 孕中期子宫颈弹性应变率联合子宫颈前角超声测量对早产的预测价值[J]. 实用妇产科杂志, 2022, 38(4): 274-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202204011.htm [10] 胡晶晶, 任敏, 包怡榕, 等. 宫颈环扎术后经阴道超声测量参数对预测早产的临床价值[J]. 中国临床医学影像杂志, 2020, 31(11): 823-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202011017.htm [11] 中华医学会妇产科学分会产科学组. 早产临床诊断与治疗指南(2014)[J]. 中华围产医学杂志, 2015(4): 241-5. doi: 10.3760/cma.j.issn.1007-9408.2015.04.01 [12] Daskalakis G, Goya M, Pergialiotis V, et al. Prevention of spontaneous preterm birth[J]. Arch Gynecol Obstet, 2019, 299(5): 1261-73. doi: 10.1007/s00404-019-05095-y [13] Jain V. Guideline No. 398: progesterone for prevention of spontaneous preterm birth[J]. J Obstet Gynaecol Can, 2020, 42(6): 806-12. doi: 10.1016/j.jogc.2019.04.012 [14] 李小叶, 刘叶君, 李慧, 等. 自发性早产的影响因素及血清f FN、MCP-1、PAF的预测价值分析[J]. 现代生物医学进展, 2022, 22(6): 1142-6, 1155. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202206030.htm [15] Conde-Agudelo A, et al. Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and metaanalysis[J]. Am J Obstet Gynecol, 2020, 223(1): 42-65.e2. doi: 10.1016/j.ajog.2019.12.266 [16] D'Antonio F, et al. Role of progesterone, cerclage and pessary in preventing preterm birth in twin pregnancies: a systematic review and network meta-analysis[J]. Eur J Obstet Gynecol Reproductive Biol, 2021, 261: 166-77. doi: 10.1016/j.ejogrb.2021.04.023 [17] 叶芸, 沈倩, 杨雁芬, 等. 宫颈长度联合宫颈分泌物胎盘α-1微球蛋白预测先兆早产孕妇早产的价值研究[J]. 中国全科医学, 2021, 24 (6): 706-11. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202106031.htm [18] Farràs Llobet A, Higueras T, Calero IZ, et al. Prospective evaluation of the uterocervical angle as a predictor of spontaneous preterm birth[J]. Acta Obstet Gynecol Scand, 2020, 99(11): 1511-8. [19] 牟莹莹, 侯玉娇, 王伟. 宫颈长度联合PAMG-1、fFN检测对先兆早产孕妇早产的预测价值及其危险因素分析[J]. 重庆医学, 2022, 51 (10): 1736-40. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202210025.htm [20] Ercan I, et al. Evaluation of the predictive role of anterior uterocervical angle in preterm labor in twin gestation through meta-analysis [J]. J Gynecol Obstet Hum Reprod, 2022, 51(6): 102397. [21] 陶玉程, 丁文波, 武心萍, 等. 孕晚期超声测量宫颈前角及宫颈长度预测自发性早产价值[J]. 中国计划生育学杂志, 2021, 29(12): 2679-82. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202112042.htm -
点击查看大图
图(2) / 表(3)
计量
- 文章访问数: 169
- HTML全文浏览量: 95
- PDF下载量: 10
- 被引次数: 0
