宫颈环扎术后子宫内膜血流参数联合术前指标对宫颈机能不全孕妇妊娠结局的预测价值

Study on the predictive value of uterine endometrial blood flow parameters after cervical ring ligation for pregnant women with cervical insufficiency on pregnancy outcomes

摘要

目的 探究宫颈机能不全孕妇宫颈环扎术后的子宫内膜特点及其联合术前指标与妊娠结局的关系。方法 选取2020年1月至2025年1月于北京市海淀区妇幼保健院行宫颈环扎术的108例宫颈机能不全孕妇（成功组75例、失败组33例）,比较两组基线资料、围术期指标及术后子宫内膜特点,Logistic回归分析妊娠结局的独立影响因素并建立预测模型。结果 失败组年龄、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）、术前宫口扩张程度、术中出血量、术后并发症及子宫内膜血流参数［搏动指数（PI）、阻力指数（RI）、收缩峰值血流速度与舒张末期血流速度比值（S/D）］显著高于成功组,术前子宫颈长度显著缩短,血流分型差异显著（成功组以Ⅲ型为主,失败组以I型为主,P<0.05）。术前宫口扩张、术前子宫颈长度、血流分型、PI、RI、S/D为妊娠结局的独立影响因素（P<0.05）。预测模型AUC为0.937（95%CI：0.901～0.962）,特异度0.804,灵敏度0.782,校准度良好（Brier=0.096）,在阈概率0.1～0.9内有较高净收益。结论 宫颈环扎术后子宫内膜不良血流参数（I型血流、PI、RI、S/D升高）与不良妊娠结局独立相关,联合术前宫口扩张及子宫颈长度可有效预测结局。高龄可能通过影响血流参数增加流产风险,术后需加强血流监测。

Abstract

Objective To investigate the relationship between endometrial characteristics and pregnancy outcomes in pregnant women with cervical insufficiency after cervical cerclage. Methods A total of 108 pregnant women with cervical insufficiency who underwent cervical cerclage at Haidian District Maternal and Child Health Hospital from January 2020 to January 2025 were selected (75 cases in the success group and 33 cases in the failure group). Baseline data, perioperative indicators, and postoperative endometrial characteristics were compared between the two groups. Logistic regression was used to identify independent influencing factors of pregnancy outcomes and to establish a prediction model. Results The failure group had significantly higher values in age, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), preoperative cervical dilatation, intraoperative blood loss, postoperative complications, and endometrial blood flow parameters [pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D)] compared to the success group. Preoperative cervical length was significantly shorter, and there was a significant difference in blood flow classification (type III predominated in the success group, while type I predominated in the failure group, P<0.05). Preoperative cervical dilatation, preoperative cervical length, blood flow classification, PI, RI, and S/D were independent influencing factors of pregnancy outcomes (P<0.05). The prediction model had an AUC of 0.937 (95%CI: 0.901-0.962), with a specificity of 0.804 and sensitivity of 0.782, and showed good calibration (Brier=0.096). It had a high net benefit within the threshold probability range of 0.1-0.9. Conclusion Abnormal endometrial blood flow parameters (type I blood flow, elevated PI, RI, and S/D) after cervical cerclage are independently associated with adverse pregnancy outcomes. Combining these with preoperative cervical dilatation and cervical length can effectively predict outcomes. Advanced age may increase the risk of miscarriage by affecting blood flow parameters, highlighting the need for enhanced postoperative blood flow monitoring.

关键词

宫颈机能不全 / 宫颈环扎术 / 子宫内膜 / 妊娠结局

Key words

cervical insufficiency / cervical cerclage / endometrium / pregnancy outcome

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基金资助

北京市海淀区卫生健康系统高层次人才发展计划项目(2022HDXD006)