宫颈环扎术后经阴道超声测量参数预测早产的临床价值

Value of ultrasonic measurement of cervical parameters in predicting the risk of premature delivery after cervical cerclage

摘要:

目的 研究宫颈环扎术后经阴道超声测量参数预测早产的临床价值。方法 回顾性分析2019年1月—2021年1月咸宁市中心医院收治的310例因宫颈机能不全（CIC）行宫颈环扎术孕妇的临床资料。追踪孕妇妊娠结局，根据孕妇术后是否发生早产将其分为早产组与足月组，分别有83例和227例。比较两组孕妇年龄、分娩方式、既往妊娠次数、人工流产史、宫颈手术史、手术时间、宫颈环扎术孕周、体质量指数、宫颈参数［宫颈内口宽度、环扎线距内口距离、环扎线距外口距离、子宫宫颈前角（ACA）、宫颈长度（CL）］、血清指标［白细胞计数、血小板/淋巴细胞比值（PLR）、淋巴细胞/单核细胞比值（LMR）、超敏C反应蛋白（hs-CRP）、白细胞介素-2（IL-2）、白细胞介素-10（IL-10）、白细胞介素-17（IL-17）］及胎儿纤维连接蛋白（fFN）水平。受试者工作特征（ROC）曲线分析CL、环扎线距内口距离、ACA、白细胞计数、hs-CRP、fFN、IL-2、IL-10、IL-17预测宫颈环扎术后早产的诊断价值，采用多因素Logistic逐步回归分析宫颈环扎术后早产的危险因素。结果 两组孕妇年龄、分娩方式、既往妊娠次数、人工流产史、宫颈手术史、手术时间、宫颈环扎术孕周、宫颈内口宽度、环扎线距外口距离、体质量指数、PLR、LMR比较，差异无统计学意义（P >0.05）。早产组CL、环扎线距内口距离短于足月组，ACA大于足月组，白细胞计数、hs-CRP、fFN、IL-2、IL-17水平高于足月组，IL-10低于足月组（P <0.05）。ROC曲线分析，CL的AUC值最高，为0.952（95% CI：0.910，0.984），环扎线距内口距离的敏感性最高，为0.969（95% CI：0.713，0.911），CL的特异性最高，为0.927（95% CI：0.643，0.902）。多因素Logistic逐步回归分析结果显示：CL ≤ 25.266 mm［O^R=2.897（95% CI：1.174，7.149）］、环扎线距内口距离≤ 12.450 mm［O^R=3.513（95% CI：1.665，7.412）］、ACA ≥ 107.772 °［O^R=2.735（95% CI：1.126，6.643）］、白细胞计数≥10.509×10⁹/L［O^R=2.684（95% CI：1.089，6.615）］、hs-CRP ≥ 8.860 mg/L［OR=2.841（95% CI：1.168，6.910）］、fFN ≥ 50.439 μg/L［O^R=2.874（95% CI：1.167，7.079）］、IL-2 ≥ 722.622 ng/L［O^R=2.817（95% CI：1.085，7.314）］、IL-10 ≤ 446.039 ng/L［O^R=2.669（95% CI：1.451，4.909）］、IL-17 ≥ 27.237 ng/L［O^R=2.886（95% CI：1.054，7.902）］是宫颈环扎术孕妇术后早产的危险因素（P <0.05）。结论 宫颈环扎术孕妇术后早产与白细胞计数、hs-CRP、fFN、IL-2、IL-10、IL-17血清因子有关，CL、环扎线距内口距离、ACA超声宫颈参数预测宫颈环扎术后早产风险有一定临床价值。

Abstract:

Objective To study the value of ultrasonic measurement of cervical parameters in predicting the risk of premature delivery after cervical cerclage.Methods The clinical data of 310 patients admitted to our hospital for cervical cerclage from January 2019 to January 2021 were retrospectively analyzed. According to the postoperative pregnancy outcome of the patients, they were divided into preterm (n = 83) and full-term (n = 227) groups. The age, mode of delivery, number of previous pregnancies, history of induced abortion, history and duration of cervix surgery, gestational week of cervical cerclage, body mass index, cervix parameters [width of the inner cervical os, distance of stitches from the inner cervical os, distance of stitches from the outer cervical os, anterior cervical angle (ACA), and cervical length (CL) ], serum indicators [white blood cell count, platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), high-sensitivity C-reactive protein (hs-CRP), interleukin-2 (IL-2), interleukin-10 (IL-10), and interleukin-17 (IL-17) ] and fetal fibronectin (fFN) levels were compared between the two groups. The values of CL, distance of stitches from the inner cervical os, ACA, white blood cell count, hs-CRP, fFN, IL-2, IL-10, and IL-17 in predicting premature delivery after cervical cerclage was analyzed via receiver operating characteristic (ROC) curves, and the risk factors for premature delivery after cervical cerclage were clarified by multivariable Logistic regression analysis.Results There were no significant differences in age, mode of delivery, number of previous pregnancies, history of induced abortion, history and duration of cervix surgery, gestational week of cervical cerclage, width of the inner cervical os, distance of stitches from the outer cervical os, body mass index, PLR and LMR between the two groups (P > 0.05). Compared with the full-term group, the CL and the distance of stitches from the inner cervical os were shorter, ACA was larger, white blood cell count and levels of hs-CRP, fFN, IL-2 and IL-17 were higher, and the IL-10 level was lower in the preterm group (P < 0.05). ROC curve analysis exhibited that the area under the ROC curve (AUC) of CL was the highest [0.952 (95% CI: 0.910, 0.984) ], the sensitivity of distance of stitches from the inner cervical os was the highest [0.969 (95% CI: 0.713, 0.911) ], and that the specificity of CL was the highest [0.927 (95% CI: 0.643, 0.902) ]. Multivariable Logistic regression analysis showed that CL ≤ 25.266 mm [O^R =2.897 (95% CI: 1.174, 7.149) ], distance of stitches from the inner cervical os ≤ 12.450 mm [O^R = 3.513 (95% CI: 1.665, 7.412) ], ACA ≥ 107.772 [O^R = 2.735 (95% CI: 1.126, 6.643) ], white blood cell count ≥ 10.509×10⁹/L [O^R = 2.684 (95% CI: 1.089, 6.615) ], hs-CRP ≥ 8.860 mg/L [O^R = 2.841 (95% CI: 1.168, 6.910) ], fFN ≥ 50.439 μg/L [O^R = 2.874 (95% CI: 1.167, 7.079) ], IL-2 ≥ 722.622 ng/L [O^R = 2.817 (95% CI: 1.085, 7.314) ], IL-10 ≤ 446.039 ng/L [O^R = 2.669 (95% CI: 1.451, 4.909) ] and IL-17 ≥ 27.237ng/L [O^R = 2.886 (95% CI: 1.054, 7.902) ] were the risk factors for premature delivery after cervical cerclage (P < 0.05).Conclusions Premature delivery after cervical cerclage is related to white blood cell count and serum levels of hs-CRP, fFN, IL-2, IL-10, and IL-17. Cervix parameters including CL, distance of stitches from the inner cervical os, and ACA measured via ultrasound are also of certain value in predicting the risk of premature delivery after cervical cerclage.