经阴道彩色多普勒超声检测妊娠黄体血流对早期不明位置妊娠者妊娠结局的影响
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摘要
目的探讨经阴道彩超对不明位置妊娠(PUL)患者黄体血流的检测结果及其对妊娠结局的预测效果。方法纳入青岛市市立医院西院区2014年1月~2017年1月收治的PUL患者120例,根据手术病理证实的妊娠结局分为异位妊娠组58例,宫内妊娠组62例,其中宫内妊娠组经病理证实宫内早孕32例,宫内早孕流产30例。比较两组黄体回声类型、血流分级情况,并测定黄体血流阻力指数(RI)、搏动指数(PI)、收缩期峰值流速(PSV),采用受试者工作特征曲线(ROC)分析其对异位妊娠、宫内早孕流产的预测价值。结果宫内妊娠组血流分级明显优于异位妊娠组,差异有统计学意义(P<0.05);宫内妊娠组黄体血流RI、PI较异位妊娠组更低,而PSV较异位妊娠组显著增高(P<0.05);黄体血流RI、PI、PSV预测异位妊娠的曲线下面积分别为0.884、0.711、0.867;宫内早孕者黄体血流RI较宫内早孕流产患者更低,而PSV较宫内早孕流产患者显著增高(P<0.05);黄体血流RI、PSV预测宫内早孕流产的曲线下面积分别为0.829、0.830。结论经阴道彩色多普勒超声能尽早明确PUL患者的妊娠位置,对异位妊娠、宫内早孕流产的预测价值较高。
Objective To explore the detection results of the corpus luteum blood flow in pregnancy of unknown location(PUL) by transvaginal color doppler ultrasound and its prediction effect on pregnancy outcome. Methods A total of120 PUL patients admitted to the West Campus of Qingdao Municipal Hospital from January 2014 to January 2017 were enrolled in the study. According to the pathological findings of the surgery, there were 58 cases of ectopic pregnancy group and 62 cases of intrauterine pregnancy group. In the intrauterine pregnancy group, 32 cases of premature pregnancy and 30 cases of premature intrauterine abortion were confirmed. The echo type and blood flow classification of the corpus luteum and the resistance index(RI), pulsatile index(PI) and peak systolic flow velocity(PSV) between the two groups were compared. The predictive value of Receiver operator characteristic curve(ROC) on ectopic pregnancy and intrauterine pregnancy abortion was analyzed. Results The blood classification of the intrauterine pregnancy group was significantly better than that of the ectopic pregnancy group, the difference was statistically significant(P <0.05). The RI and PI of luteal blood flow in the intrauterine pregnancy group were lower than those in the ectopic pregnancy group, while the PSV in the ectopic pregnancy group was significantly higher than that in the ectopic pregnancy group(P < 0.05).The area of the luteal blood flow RI, PI, and PSV for predicting ectopic pregnancy was 0.884, 0.711,0.867. The luteal blood flow RI of the patients with intrauterine early pregnancy was lower than patients with early pregnancy abortion, while the PSV was significantly higher than patients with early pregnancy abortion(P < 0.05). The area under the curve of RI and PSV for predicting intrauterine pregnancy abortion was 0.829 and 0.830 respectively.Conclusion Transvaginal color Doppler ultrasound can identify the pregnancy position of PUL patients as early as possible, and have higher predictive value for ectopic pregnancy and intrauterine pregnancy abortion.
Objective To explore the detection results of the corpus luteum blood flow in pregnancy of unknown location(PUL) by transvaginal color doppler ultrasound and its prediction effect on pregnancy outcome. Methods A total of120 PUL patients admitted to the West Campus of Qingdao Municipal Hospital from January 2014 to January 2017 were enrolled in the study. According to the pathological findings of the surgery, there were 58 cases of ectopic pregnancy group and 62 cases of intrauterine pregnancy group. In the intrauterine pregnancy group, 32 cases of premature pregnancy and 30 cases of premature intrauterine abortion were confirmed. The echo type and blood flow classification of the corpus luteum and the resistance index(RI), pulsatile index(PI) and peak systolic flow velocity(PSV) between the two groups were compared. The predictive value of Receiver operator characteristic curve(ROC) on ectopic pregnancy and intrauterine pregnancy abortion was analyzed. Results The blood classification of the intrauterine pregnancy group was significantly better than that of the ectopic pregnancy group, the difference was statistically significant(P <0.05). The RI and PI of luteal blood flow in the intrauterine pregnancy group were lower than those in the ectopic pregnancy group, while the PSV in the ectopic pregnancy group was significantly higher than that in the ectopic pregnancy group(P < 0.05).The area of the luteal blood flow RI, PI, and PSV for predicting ectopic pregnancy was 0.884, 0.711,0.867. The luteal blood flow RI of the patients with intrauterine early pregnancy was lower than patients with early pregnancy abortion, while the PSV was significantly higher than patients with early pregnancy abortion(P < 0.05). The area under the curve of RI and PSV for predicting intrauterine pregnancy abortion was 0.829 and 0.830 respectively.Conclusion Transvaginal color Doppler ultrasound can identify the pregnancy position of PUL patients as early as possible, and have higher predictive value for ectopic pregnancy and intrauterine pregnancy abortion.
引文
[1]马蓉,王静,赵蕾.血清β-h CG、孕酮、子宫内膜厚度在早期不明位置妊娠患者中的诊断价值[J].中国妇幼保健,2016,31(7):1417-1419.
[2]陈国庆,乔宠.生化妊娠病因及治疗的研究进展[J].中国计划生育和妇产科,2016,8(9):16-19.
[3]宋洁,方春英,甄莉霞.异位妊娠临床发病的相关危险因素调查分析[J].中国妇幼保健,2016,31(2):373-375.
[4]李莉,刘巧玲.血清β-h CG、孕酮水平及子宫内膜厚度检测对早期不明位置妊娠者异位妊娠的诊断价值[J].现代医学,2016,44(12):1768-1771.
[5]廖晓红.彩色多普勒超声检测异位妊娠患者卵巢黄体血流动力学变化的应用价值分析[J].中国实验诊断学,2015,19(5):826-827.
[6]张建国,方开峰,韩路.经腹部超声联合经阴道超声对早期异位妊娠的诊断价值[J].安徽医药,2016,20(1):152-153.
[7]Durfee SM,Frates MC.Sonographic spectrum of the corpus luteum inearlypregnancy:gray-scale,color,andpulsed Doppler appearance[J].J Clin Ultrasound,1999,27(2):55-59.
[8]芦笛,杨娜,任永变,等.β-HCG比值联合子宫内膜厚度预测早期不明位置妊娠者异位妊娠的临床价值[J].中国性科学,2016,25(9):113-116.
[9]李海萍,鲁敏,胡桂英,等.不明部位妊娠的临床研究进展[J].广东医学,2016,37(13):2045-2047.
[10]杨志芹,黄学惠.持续性异位妊娠的诊治及预防进展[J].生殖与避孕,2015,35(2):126-130.
[11]Rombauts L,Mcmaster R,Motteram C,et al.Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of 8120 assisted reproduction,technology cycles[J].Hum Reprod,2015,30(12):2846-2852.
[12]Farquhar CM.Ectopic pregnancy[J].Lancet,2005,366(9485):583-591.
[13]游英,郑莉娟.经腹及经阴道彩色多普勒超声诊断异位妊娠的对比研究[J].四川医学,2015,36(9):1341-1343.
[14]杜菲,侯素平,牟荣骥.超声检查联合人绒毛膜促性腺激素检测对未知部位妊娠结局的预测[J].临床误诊误治,2015,28(11):95-98.
[15]李兴华.经阴道超声鉴别诊断输卵管妊娠与妊娠黄体囊肿的价值[J].中华实用诊断与治疗杂志,2015,29(1):78-80.
[16]周慧丽,米婉琴,向红,等.经阴道彩色多普勒超声在宫内妊娠及异位妊娠中的诊断价值[J].中国医刊,2016,51(8):68-72.
[17]黄清梅,陈巧玲,周丽冰,等.经腹和经阴道超声在鉴别诊断异位妊娠与卵巢黄体破裂中的临床价值[J].中国妇幼保健,2017,32(12):2798-2800.
[18]杨浩,陈文卫,张屹辉.经阴道彩色多普勒超声在早期宫内妊娠黄体检测中的应用价值[J].中国妇幼保健,2017,32(7):1582-1584.
[19]孟丹艳,邵汝标.宫角部妊娠的超声诊断特点与误诊分析[J].中国医药科学,2016,6(9):171-173.
[20]李周源,曹毅.孕康口服液治疗先兆性流产和习惯性流产临床观察[J].中国性科学,2016,25(2):122-124.
[21]汪春燕,范凌晔,秦明丽.保胎无忧片联合盐酸利托君治疗晚期先兆流产的疗效观察[J].现代药物与临床,2016,31(8):1216-1219.
[22]闫建军.腹部彩色超声与阴道彩色超声在诊断早期异位妊娠的诊断率对比研究[J].河北医学,2016,22(6):1002-1004.
[2]陈国庆,乔宠.生化妊娠病因及治疗的研究进展[J].中国计划生育和妇产科,2016,8(9):16-19.
[3]宋洁,方春英,甄莉霞.异位妊娠临床发病的相关危险因素调查分析[J].中国妇幼保健,2016,31(2):373-375.
[4]李莉,刘巧玲.血清β-h CG、孕酮水平及子宫内膜厚度检测对早期不明位置妊娠者异位妊娠的诊断价值[J].现代医学,2016,44(12):1768-1771.
[5]廖晓红.彩色多普勒超声检测异位妊娠患者卵巢黄体血流动力学变化的应用价值分析[J].中国实验诊断学,2015,19(5):826-827.
[6]张建国,方开峰,韩路.经腹部超声联合经阴道超声对早期异位妊娠的诊断价值[J].安徽医药,2016,20(1):152-153.
[7]Durfee SM,Frates MC.Sonographic spectrum of the corpus luteum inearlypregnancy:gray-scale,color,andpulsed Doppler appearance[J].J Clin Ultrasound,1999,27(2):55-59.
[8]芦笛,杨娜,任永变,等.β-HCG比值联合子宫内膜厚度预测早期不明位置妊娠者异位妊娠的临床价值[J].中国性科学,2016,25(9):113-116.
[9]李海萍,鲁敏,胡桂英,等.不明部位妊娠的临床研究进展[J].广东医学,2016,37(13):2045-2047.
[10]杨志芹,黄学惠.持续性异位妊娠的诊治及预防进展[J].生殖与避孕,2015,35(2):126-130.
[11]Rombauts L,Mcmaster R,Motteram C,et al.Risk of ectopic pregnancy is linked to endometrial thickness in a retrospective cohort study of 8120 assisted reproduction,technology cycles[J].Hum Reprod,2015,30(12):2846-2852.
[12]Farquhar CM.Ectopic pregnancy[J].Lancet,2005,366(9485):583-591.
[13]游英,郑莉娟.经腹及经阴道彩色多普勒超声诊断异位妊娠的对比研究[J].四川医学,2015,36(9):1341-1343.
[14]杜菲,侯素平,牟荣骥.超声检查联合人绒毛膜促性腺激素检测对未知部位妊娠结局的预测[J].临床误诊误治,2015,28(11):95-98.
[15]李兴华.经阴道超声鉴别诊断输卵管妊娠与妊娠黄体囊肿的价值[J].中华实用诊断与治疗杂志,2015,29(1):78-80.
[16]周慧丽,米婉琴,向红,等.经阴道彩色多普勒超声在宫内妊娠及异位妊娠中的诊断价值[J].中国医刊,2016,51(8):68-72.
[17]黄清梅,陈巧玲,周丽冰,等.经腹和经阴道超声在鉴别诊断异位妊娠与卵巢黄体破裂中的临床价值[J].中国妇幼保健,2017,32(12):2798-2800.
[18]杨浩,陈文卫,张屹辉.经阴道彩色多普勒超声在早期宫内妊娠黄体检测中的应用价值[J].中国妇幼保健,2017,32(7):1582-1584.
[19]孟丹艳,邵汝标.宫角部妊娠的超声诊断特点与误诊分析[J].中国医药科学,2016,6(9):171-173.
[20]李周源,曹毅.孕康口服液治疗先兆性流产和习惯性流产临床观察[J].中国性科学,2016,25(2):122-124.
[21]汪春燕,范凌晔,秦明丽.保胎无忧片联合盐酸利托君治疗晚期先兆流产的疗效观察[J].现代药物与临床,2016,31(8):1216-1219.
[22]闫建军.腹部彩色超声与阴道彩色超声在诊断早期异位妊娠的诊断率对比研究[J].河北医学,2016,22(6):1002-1004.