经阴道超声评价不全流产和完全流产的临床研究
发布时间：2018-08-30 17:04
【摘要】：目的：探讨经阴道超声（Transvaginal sonography，TVS）对不全流产和完全流产的诊断价值。 材料与方法：182例早孕流产患者，流产后第6～8天进行首次常规TVS检查，观察早孕流产后宫腔内膜清晰与否、是否有妊娠绒毛组织残留、残留物回声情况等二维声像图，测量子宫内膜厚度和/或子宫纵轴位宫腔前后径（A-P值）及残留物大小。采用彩色多普勒技术（Color Doppler flow imaging，CDFI）对宫腔内残留物进行血流信号检测；运用脉冲多普勒技术（Pulsed wave ultrasound，，PW）对血流信号作描记，获得子宫动脉阻力指数（Resistivity index，RI）值和子宫螺旋动脉RI值。对于TVS检查疑似不全流产患者均行清宫术取病理组织送活检；而TVS检查显示无明显不全流产证据的患者于流产后第13～15天复查TVS，再次记录子宫内膜厚度，并随访至流产后首次月经来临。如复查疑似有不全流产可能，则行清宫术进行病理活检。 采用独立样本t检验比较不全流产组和完全流产组双侧子宫动脉RI值和子宫螺旋动脉RI值；采用配对t检验比较完全流产后第6～8天和第13～15天的子宫内膜厚度。以病理学结果为金标准，计算出二维超声及CDFI对182例流产后患者的诊断效能；通过对子宫螺旋动脉RI值制作受试者特征曲线（Receiver operating characteristic，ROC），计算出其诊断不全流产和完全流产的最佳诊断界值，并分析其敏感性、特异性、准确性、阳性预测值和阴性预测值。对同时完成二维超声和CDFI和PW检查的93例患者，采用2检验比较二者在不全流产的诊断效能。 结果：（1）不全流产组与完全流产组左侧子宫动脉RI值分别为0.804±0.089、0.796±0.095，两组之间的差异无统计学意义（t=0.367，P＞0.001）。不全流产组与完全流产组右侧子宫动脉RI值分别为0.798±0.050、0.804±0.089，两组之间的差异无统计学意义（t=0.295，P＞0.001）。 （2）不全流产组和完全流产组子宫螺旋动脉RI值分别为0.540±0.037、0.618±0.096，两组之间的差异有统计学意义（t=3.558，P＜0.001）。 （3）完全流产组流产后第6～8天和第13～15天子宫内膜厚度分别为0.470±0.175cm、0.664±0.305cm，两者之间的差异有统计学意义（t=4.514，P＜0.001）。 （4）二维超声及CDFI对182例流产后（以A-P值≥1.0cm为诊断不全流产的标准）患者的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为95.56%（43/45）、77.37%（106/137）、81.87%（132/182)、58.11%(43/74)和98.15%(106/108)。 （5）根据子宫螺旋动脉RI值制作ROC曲线，曲线下面积为0.883，子宫螺旋动脉RI值在诊断不全流产的最佳诊断界值为0.58，以RI≤0.58判断为不全流产，＞0.58判断为完全流产，其敏感性、特异性、准确性、阳性预测值和阴性预测值分别为86.36%（39/45）、73.91%（35/48）、79.57%(74/93)、75.00%（39/52）和85.37%（35/41）。 （6）同时完成二维超声和CDFI以及PW检查的93例患者，两者诊断不全流产的效能比较：PW检查的敏感性低于二维超声和CDFI（95.56%vs.86.36%），但二者差异无统计学意义（2=2.195，P=0.138）；PW检查的特异性及准确性均明显高于二维超声和CDFI（35.42%vs.72.92%；64.52%vs.79.57%），且二者之间的差异均有显著统计学意义（2=13.594，P＜0.001；2=19.619，P＜0.001)。 结论：完全流产后第6～8天子宫内膜厚度小于第13～15天子宫内膜厚度。子宫动脉RI值判断不全流产价值有限；PW检查诊断不全流产的敏感性低于二维超声和CDFI，特异性及准确性均明显高于二维超声和CDFI，子宫螺旋动脉RI值能够较好的鉴别不全流产和完全流产，有较高的临床实用性。
[Abstract]:Objective: To evaluate the value of transvaginal sonography (TVS) in the diagnosis of incomplete and complete abortion.
Materials and Methods: 182 cases of early pregnancy abortion were examined by TVS for the first time from 6 to 8 days after abortion. The endometrial thickness, A-P value and residual size were measured by two-dimensional ultrasonography. Color Doppler flow imaging (CDFI) was used to detect the blood flow signals of intrauterine residues. Pulsed wave ultrasound (PW) was used to record the blood signals to obtain the value of resistance index (RI) of uterine artery and RI of uterine spiral artery. The uterine biopsy was performed in all the pregnant women, and the TVS examination showed that the patients without evident incomplete abortion were reexamined on the 13th to 15th day after abortion. The endometrial thickness was recorded again and followed up until the onset of the first menstruation after abortion.
The RI values of bilateral uterine arteries and uterine spiral arteries in incomplete abortion group and complete abortion group were compared by independent sample t test, and the endometrial thickness of 6-8 days and 13-15 days after complete abortion was compared by paired t test. The diagnosis of 182 cases of post-abortion patients by two-dimensional ultrasound and CDFI was calculated according to the golden standard of pathological results. Efficiency: The best diagnostic thresholds for incomplete abortion and complete abortion were calculated by making the receiver operating characteristic (ROC) of the uterine spiral artery RI, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were analyzed. In 93 patients, 2 tests were used to compare the diagnostic efficiency of two patients in incomplete abortion.
Results: (1) The RI values of the left uterine artery in incomplete abortion group and complete abortion group were 0.804 (+ 0.089) and 0.796 (+ 0.095), respectively. There was no significant difference between the two groups (t = 0.367, P > 0.001). The RI values of the right uterine artery in incomplete abortion group and complete abortion group were 0.798 (+ 0.050) and 0.804 (+ 0.089), respectively. There was no significant difference between the two groups (t = 0.29). 5, P > 0.001).
(2) The RI values of uterine spiral artery in incomplete abortion group and complete abortion group were 0.540 (+ 0.037) and 0.618 (+ 0.096) respectively. The difference between the two groups was statistically significant (t = 3.558, P < 0.001).
(3) The endometrial thickness of the complete abortion group was 0.470 (+ 0.175 cm) and 0.664 (+ 0.305 cm) on the 6th to 8th and 13th to 15th days after abortion, respectively. The difference between the two groups was statistically significant (t = 4.514, P < 0.001).
(4) The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of two-dimensional ultrasound and CDFI were 95.56% (43/45), 77.37% (106/137), 81.87% (132/182), 58.11% (43/74) and 98.15% (106/108) respectively.
(5) ROC curve was made according to RI value of uterine spiral artery. The area under the curve was 0.883. The best diagnostic threshold of RI value of uterine spiral artery was 0.58. The best diagnostic threshold of incomplete abortion was RI < 0.58. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 86.36% (39/45), 73.58 and 0.58 respectively. .91% (35/48), 79.57% (74/93), 75% (39/52) and 85.37% (35/41).
(6) Ninety-three patients with incomplete abortion underwent two-dimensional ultrasound, CDFI and PW simultaneously. The sensitivity of PW was lower than that of two-dimensional ultrasound and CDFI (95.56% vs. 86.36%), but there was no significant difference between them (2 = 2.195, P = 0.138); the specificity and accuracy of PW were significantly higher than that of two-dimensional ultrasound and CDFI (35.42% vs. 72). 92%; 64.52% vs. 79.57%, and the difference between them was statistically significant (2 = 13.594, P < 0.001; 2 = 19.619, P < 0.001).
Conclusion:The thickness of endometrium on the 6th to 8th day after complete abortion is less than that on the 13th to 15th day.The value of RI in judging incomplete abortion is limited.The sensitivity of PW in diagnosing incomplete abortion is lower than that of two-dimensional ultrasound and CDFI.The specificity and accuracy of PW in diagnosing incomplete abortion are obviously higher than that of two-dimensional ultrasound and CDFI. Identification of incomplete abortion and complete abortion is of high clinical utility.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R169.42
本文编号：2213713
[Abstract]:Objective: To evaluate the value of transvaginal sonography (TVS) in the diagnosis of incomplete and complete abortion.
Materials and Methods: 182 cases of early pregnancy abortion were examined by TVS for the first time from 6 to 8 days after abortion. The endometrial thickness, A-P value and residual size were measured by two-dimensional ultrasonography. Color Doppler flow imaging (CDFI) was used to detect the blood flow signals of intrauterine residues. Pulsed wave ultrasound (PW) was used to record the blood signals to obtain the value of resistance index (RI) of uterine artery and RI of uterine spiral artery. The uterine biopsy was performed in all the pregnant women, and the TVS examination showed that the patients without evident incomplete abortion were reexamined on the 13th to 15th day after abortion. The endometrial thickness was recorded again and followed up until the onset of the first menstruation after abortion.
The RI values of bilateral uterine arteries and uterine spiral arteries in incomplete abortion group and complete abortion group were compared by independent sample t test, and the endometrial thickness of 6-8 days and 13-15 days after complete abortion was compared by paired t test. The diagnosis of 182 cases of post-abortion patients by two-dimensional ultrasound and CDFI was calculated according to the golden standard of pathological results. Efficiency: The best diagnostic thresholds for incomplete abortion and complete abortion were calculated by making the receiver operating characteristic (ROC) of the uterine spiral artery RI, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were analyzed. In 93 patients, 2 tests were used to compare the diagnostic efficiency of two patients in incomplete abortion.
Results: (1) The RI values of the left uterine artery in incomplete abortion group and complete abortion group were 0.804 (+ 0.089) and 0.796 (+ 0.095), respectively. There was no significant difference between the two groups (t = 0.367, P > 0.001). The RI values of the right uterine artery in incomplete abortion group and complete abortion group were 0.798 (+ 0.050) and 0.804 (+ 0.089), respectively. There was no significant difference between the two groups (t = 0.29). 5, P > 0.001).
(2) The RI values of uterine spiral artery in incomplete abortion group and complete abortion group were 0.540 (+ 0.037) and 0.618 (+ 0.096) respectively. The difference between the two groups was statistically significant (t = 3.558, P < 0.001).
(3) The endometrial thickness of the complete abortion group was 0.470 (+ 0.175 cm) and 0.664 (+ 0.305 cm) on the 6th to 8th and 13th to 15th days after abortion, respectively. The difference between the two groups was statistically significant (t = 4.514, P < 0.001).
(4) The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of two-dimensional ultrasound and CDFI were 95.56% (43/45), 77.37% (106/137), 81.87% (132/182), 58.11% (43/74) and 98.15% (106/108) respectively.
(5) ROC curve was made according to RI value of uterine spiral artery. The area under the curve was 0.883. The best diagnostic threshold of RI value of uterine spiral artery was 0.58. The best diagnostic threshold of incomplete abortion was RI < 0.58. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 86.36% (39/45), 73.58 and 0.58 respectively. .91% (35/48), 79.57% (74/93), 75% (39/52) and 85.37% (35/41).
(6) Ninety-three patients with incomplete abortion underwent two-dimensional ultrasound, CDFI and PW simultaneously. The sensitivity of PW was lower than that of two-dimensional ultrasound and CDFI (95.56% vs. 86.36%), but there was no significant difference between them (2 = 2.195, P = 0.138); the specificity and accuracy of PW were significantly higher than that of two-dimensional ultrasound and CDFI (35.42% vs. 72). 92%; 64.52% vs. 79.57%, and the difference between them was statistically significant (2 = 13.594, P < 0.001; 2 = 19.619, P < 0.001).
Conclusion:The thickness of endometrium on the 6th to 8th day after complete abortion is less than that on the 13th to 15th day.The value of RI in judging incomplete abortion is limited.The sensitivity of PW in diagnosing incomplete abortion is lower than that of two-dimensional ultrasound and CDFI.The specificity and accuracy of PW in diagnosing incomplete abortion are obviously higher than that of two-dimensional ultrasound and CDFI. Identification of incomplete abortion and complete abortion is of high clinical utility.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R169.42
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