滋养层血流频谱作为早期宫内妊娠诊断指标的探讨

目的 探讨以滋养层血流频谱作为诊断指标，诊断早期宫内妊娠（IUP）的临床应用价值。方法 对196例疑诊早期IUP的孕妇行超声检查，分析常规二维声像图表现、血流分布及频谱特征；并将超声检查结果与临床随访及病理结果进行对照分析。结果 对76例单纯以滋养层血流频谱诊断为早期IUP（单纯频谱组），对120例采用滋养层血流频谱联合宫内液性暗区诊断为早期IUP（频谱联合暗区组），2组间滋养层血流收缩期峰值流速（PSV）、舒张末期峰值流速（EDV）、阻力指数（RI）、最大收缩期速度/舒张末期速度（S/D）比值及搏动指数（PI）差异均无统计学意义（P均>0.05）。孕龄与滋养层血流的PSV（r=0.697，P<0.001）、EDV（r=0.675，P<0.001）均呈正相关，与RI（r=-0.422，P=0.023）、S/D比值（r=-0.303，P=0.030）及PI（r=-0.278，P=0.037）均呈负相关。单纯以滋养层血流频谱诊断早期IUP的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为84.62%（55/65）、72.73%（8/11）、94.83%（55/58）、44.44%（8/18）及82.89%（63/76），采用滋养层血流频谱联合宫内液性暗区诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率均为100%，诊断效能指标差异均有统计学意义（P均<0.05）。结论 滋养层血流频谱可用于诊断早期IUP，且与宫内液性暗区联合诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率更高。

Discussion of trophoblastic blood flow spectrum for diagnosing early intrauterine pregnancy

Objective To explore the application value of trophoblastic flow as the diagnostic marker for early intrauterine pregnancy (IUP). Methods Vaginal ultrasonography was performed on 196 subjects with suspected early IUP. The two-dimensional images, blood flow distribution and spectral characteristics were analyzed. And the results of ultrasonography were compared with the results of surgical pathology and clinical follow-up. Results Early IUP was diagnosed in 76 cases with trophoblastic hemodynamic spectrum alone (pure spectrum group) and 120 cases with trophoblastic hemodynamic spectrum combined with intrauterine liquid dark area (spectrum combined dark area group). There was no statistically significant difference of the value of myotrophoblast peak flow rate (PSV), end-diastolic peak flow rate (EDV), resistance index (RI), maximum systolic velocity/end-diastolic velocity (S/D) ratio and pulsatile index (PI) between the two groups (all P>0.05). Gestational age was positively correlated with PSV (r=0.697, P<0.001), EDV (r=0.675, P<0.001) of trophoblastic blood flow, and negatively correlated with RI (r=-0.422, P=0.023), S/D ratio (r=-0.303, P=0.030) and PI (r=-0.278, P=0.037). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of early IUP diagnosed with blood flow spectrum of trophoblast layer was 84.62% (55/65), 72.73% (8/11), 94.83% (55/58), 44.44% (8/18) and 82.89% (63/76), respectively. All of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of blood flow spectrum of trophoblast layer combined with intrauterine fluid dark area were all 100%. The differences of diagnostic efficacy indicators were statistically significant (all P<0.05). Conclusion Trophoblastic blood flow spectrum can be used to diagnose early IUP. And the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined diagnosis with intrauterine fluid dark area are higher.