声触诊组织定量技术在引产结局预测中的应用研究

摘要

Objective To estimate cervical stiffness during late pregnancy with virtual touch tissue quantification technique(VTQ) and investigate the value of predicting the outcome of labor induction. Methods Cervical length in pregnancy women at 35 -41 weeks′gestation was measured through perineum ultrasound examination before labor induction,and then VTQ was applied to measure shear wave velocity (SWV)values in region of interest(ROI),the maximum,minimum and average of SWV values were obtained from multiple SWV measurement under the VTQ mode. The outcomes of labor induction were tracked and Bishop scores were recorded,vaginal delivery and cesarean delivery groups were compared using Student′s t-test for continuous variables. ROC curve was plotted to analyze the correlation between parameters and the outcome of labor induction and to determine the most accurate SWV value and cut-off value for diagnosis.Univariate and multivariate logistic regression analysis were used to determine which of the following parameters were significant predictors of the outcome of labor induction. Results The SWV mix,SWV max and SWV mean of vaginal delivery and cesarean section were (0.92 ± 0.13)m/s,(1.37 ± 0.14)m/s,(1.13 ± 0.10)m/s and (1.03 ± 0.13)m/s,(1.74 ± 0.42)m/s,(1.36 ± 0.11)m/s,respectively, there were significant differences between vaginal delivery and cesarean section(all P < 0.05).Based on ROC curve analysis,the SWV mean value in cervix was the best value for predicting the outcome of labor induction.The cut-off value of SWV mean value was 1.23 m/s,the sensitivity,specificity and Youden index were 93.8%,83.4%,0.77,respectively.The SWV value and cervical length were closely correlated to the outcome of labor induction,especially the SWV value according to multivariate logistic analysis. Conclusions VTQ can assess the cervical stiffness with SWV values during pregnancy,and it may have an application value of predicting the outcome of labor induction.%目的 应用声触诊组织定量(VTQ)技术评估妊娠晚期孕妇宫颈硬度,并探讨 VTQ技术对引产结局的预测价值.方法 对80例晚孕期孕妇行常规产科超声检查后,经会阴扫查宫颈纵切面,在二维超声基础上测量宫颈长度,然后切换至 VTQ 弹性成像模式,选择宫颈感兴趣区域(ROI),测量剪切波速度(SWV),获取最大值、最小值及平均值.追踪孕妇分娩情况,记录宫颈 Bishop 评分,并对经阴道分娩组与剖宫产组 SWV 测值进行比较.应用 ROC曲线分析宫颈 SWV 测值与引产结局的关系,确定准确性最高的参数,获得最佳临界值,同时进行单因素和多因素 Logistic回归分析研究.结果 经阴道分娩组宫颈SWV最小值、最大值、平均值分别为(0.92 ± 0.13)m/s、(1.37 ± 0.14)m/s、(1.13 ± 0.10)m/s,剖宫产组上述指标分别为(1.03 ± 0.13)m/s、(1.74 ± 0.42)m/s、(1.36 ± 0.11)m/s,两组比较差异均有统计学意义(P <0.05).ROC曲线分析显示宫颈 SWV 均值的诊断效能最佳,临界值为1.23 m/s时,敏感性为93.8%、特异性为83.4%,Youden 指数为0.77.单因素分析发现宫颈SWV 值、宫颈长度对引产结局具有一定的影响,差异有统计学意义(P <0.05);多因素分析证实宫颈SWV 值对引产结局的预测价值最有意义(P <0.05).结论 VTQ 技术能够通过测量 SWV 值的大小评估妊娠期宫颈组织硬度,在预测引产结局上具有一定的应用价值.