The Analysis between Uterocervical Angles and Cervical Length in Predicting Preterm Labor
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摘要:
目的 研究子宫颈长度（CL）与子宫宫颈角（前角aUCA和后角pUCA）的早产预测价值，探索宫颈超声预测早产的新指标，以提供新的早产预测思路。 方法 对孕24～27+6周的252例妇女进行前瞻性队列研究，经阴道测量CL、aUCA和pUCA，根据分娩时间分为足月组和早产组，比较2组间各项指标的差异及彼此间的早产预测效能。 结果 236例足月产，16例早产，2组间aUCA和pUCA差异均存在统计学意义（P < 0.05），而CL无统计学意义（ P > 0.05）；计算出3项子宫颈超声指标的ROC曲线下面积（AUC），只有aUCA的AUC明显大于0.5，其阈值为102.22°；aUCA联合CL预测早产的ROC曲线下面积为0.715，联合因子的阈值为-2.385。 结论 孕24～27+6周单活胎孕妇CL的早产预测性欠佳，当aUCA≥102.22°需警觉自发性早产的发生，推荐联合aUCA和CL对无症状的孕妇进行早产预测；CL、pUCA的早产预测价值有待进一步研究。 Abstract:Objective To study the value of the cervical length （CL） and uterocervical angles （involving anterior uterocervical angles and posterior uterocervical angles） in predicting preterm labor to find new predicting markers via transvaginal ultrasound （TVU） and provide new predicting thoughts. Methods A total of 252 pregnant women selected from 24 to 27+6 weeks of gestation underwent TVU to measure their CL, aUCA and pUCA, and finally were divided into the normal group and the premature group according their delivery time. The difference and value of above markers between the two groups were compared in predicting preterm. Results Among them, 236 gave birth at term, and 16 went into labor prematurely.There was a statistically significant difference in aUCA and pUCA between the two groups （P < 0.05）, while there was no statistically significant difference in CL （ P > 0.05）. By calculating the area under the ROC curve （AUC） of three cervical ultrasound indicators, only the AUC of aUCA was significantly greater than 0.5, with a threshold of 102.22°; The area under the ROC curve for predicting preterm birth using aUCA combined with CL was 0.715, and the threshold for the combined factor was -2.385. Conclusion The predictive value of premature delivery for CL in single live pregnant women aged 24-27+6 weeks is not good. Compared with CL, the measurement of aUCA through TVU is more effective in predicting preterm birth and when measuring aUCA ≥102.22°, the occurrence of premature birth should be highly vigilant. The joint variable combined aUCA and CL is recommended as the predicting marker for pregnant women with single fetus but without any symptom. the predicting value of CL and pUCA need to be studied further. -
图 5 联合因子、aUCA和CL的ROC曲线对比图
Figure 5. Comparison of Associated factors，aUCA and CL’s ROC graphs
表 1 足月与早产组间CL、aUCA和pUCA的比较（
$\bar x \pm s $ ）Table 1. Compare of CL，aUCA，pUCA between mature and premature groups （
$\bar x \pm s $ ）指标 足月组 早产组 t P CL（cm） 3.68 ± 0.71 3.34 ± 0.71 −1.861 0.064 aUCA（°） 91.72 ± 29.57 109.55 ± 27.43 2.343 0.02* pUCA（°） 114.16 ± 29.45 98.69 ± 32.60 −2.02 0.045* *P < 0.05。 
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表 2 早产与子宫宫颈角的Logistic回归分析
Table 2. Logistic regression analysis between premature and UCAs
变量 B S.E. Wald P OR OR 95%CI 下限 上限 aUCA 0.052 0.018 8.406 0.004 1.053 1.017 1.091 pUCA −0.043 0.013 4.528 0.045 0.978 0.960 0.997
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表 3 aUCA预测早产分布情况（n）
Table 3. Distribution of aUCA predicting premature （n）
分组 早产 足月产 总数 aUCA ≥ 102.22° 11 91 102 aUCA < 102.22° 5 141 146 总数 16 232 248
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