孕中期超声宫颈管长度联合血清白蛋白检测对双胎妊娠早产的预测价值

Predictive value of cervical length measured via ultrasound combined with serum albumin in the second trimester of pregnancy for preterm birth in twin pregnancies

摘要:

目的 探讨孕中期超声宫颈管长度（CL）联合血清白蛋白（ALB）检测对双胎妊娠早产的预测价值。方法 回顾性分析2019年3月—2022年6月在安徽医科大学附属宿州医院定期产检的113例双胎妊娠孕妇的临床资料，依据是否发生早产分为早产组和非早产组，分别有31和82例。对比两组孕妇的临床资料、超声CL、血清ALB水平。多因素逐步Logistic回归模型分析双胎妊娠早产的相关因素。绘制受试者工作特征（ROC）曲线，评价超声CL、血清ALB及两者联合预测双胎妊娠早产的价值。结果 两组孕妇年龄、孕前BMI、检查孕周、孕产史、受孕方式、合并妊娠期糖尿病、合并妊娠期高血压、Hb、WBC、PLT、TC、TG、Scr及BUN比较，差异均无统计学意义（P >0.05）。早产组胎膜厚度大于非早产组（P <0.05），单绒毛膜双羊膜囊占比高于非早产组（P <0.05）。早产组超声CL短于非早产组（P <0.05），血清ALB水平低于非早产组（P <0.05）。多因素逐步Logistic回归分析，结果显示：胎膜厚度厚［O^R=2.901（95% CI：1.047，8.039）］、超声CL短［O^R=0.299（95% CI：0.108，0.828）］、血清ALB水平低［O^R=0.309（95% CI：0.112，0.857）］是影响双胎妊娠孕妇早产发生的危险因素（P <0.05）。ROC曲线分析结果显示，超声CL、血清ALB及两者联合对双胎妊娠早产预测的敏感性分别为83.87%（95% CI：0.655，0.939）、87.10%（95% CI：0.692，0.958）、80.65%（95% CI：0.619，0.919），特异性分别为87.80%（95% CI：0.783，0.937）、71.95%（95% CI：0.608，0.810）、98.78%（95% CI：0.925，0.999），曲线下面积分别为0.896（95% CI：0.825，0.946）、0.811（95% CI：0.726，0.878）、0.910（95% CI：0.841，0.955）。结论 孕中期超声CL、血清ALB联合检测对双胎妊娠早产的预测效能较高。

Abstract:

Objective To investigate the predictive value of cervical length (CL) measured via ultrasound combined with serum albumin (ALB) in the second trimester of pregnancy for preterm birth in twin pregnancies.Methods The clinical data of 113 women with twin pregnancies who received regular antenatal care in our hospital from March 2019 to June 2022 were analyzed retrospectively. According to whether the pregnant women had premature delivery, they were divided into premature delivery group (n = 31) and non-premature delivery group (n = 82). The clinical data, CL measured via ultrasound and the serum level of ALB were compared between the two groups. The multivariable Logistic regression analysis was conducted to determine factors affecting preterm birth in twin pregnancies. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was applied to assess the predictive value of CL measured via ultrasound, serum ALB and their combination for preterm birth in twin pregnancies.Results There was no difference in maternal age, pre-pregnancy body mass index, gestational week at the examination, pregnancy history, the way of conception, proportion of pregnant women complicating gestational diabetes mellitus, proportion of pregnant women complicating pregnancy-induced hypertension, and levels of Hb, WBC, PLT, TC, TG, Scr and BUN between the two groups (P > 0.05). The thickness of fetal membranes in the premature delivery group was greater than that in the non-premature delivery group (P < 0.05). The proportion of monochorionic diamniotic twin pregnancies in the premature delivery group was higher than that in the non-premature delivery group (P < 0.05). The CL measured via ultrasound in the premature delivery group was shorter than that in the non-preterm delivery group (P < 0.05). The serum level of ALB in the premature delivery group was lower than that in the non-premature delivery group (P < 0.05). The multivariable regression analysis exhibited that the greater thickness of fetal membranes [O^R = 2.901, (95% CI: 1.047, 8.039) ], shorter CL measured via ultrasound [O^R = 0.299, (95% CI: 0.108, 0.828) ], and lower serum level of ALB [O^R = 0.309, (95% CI: 1.112, 0.857) ] were independent risk factors for preterm birth in twin pregnancies (P < 0.05). The ROC curve analysis indicated that the sensitivities of CL measured via ultrasound, serum level of ALB and their combination in predicting preterm birth in twin pregnancies were 83.87% (95% CI: 0.655, 0.939), 87.10% (95% CI: 0.692, 0.958), and 80.65% (95% CI: 0.619, 0.919), with the specificities being 87.80% (95% CI: 0.783, 0.937), 71.95% (95% CI: 0.607, 0.810, and 98.78% (95% CI: 0.924, 0.999), and AUCs being 0.896 (95% CI: 0.825, 0.946), 0.811 (95% CI: 0.726, 0.878), and 0.910 (95% CI: 0.841, 0.955).Conclusions The combined detection of CL and serum ALB in the second trimester of pregnancy has high predictive efficacy for preterm birth in twin pregnancies.