经阴道超声联合胎儿纤维连接蛋白预测自发性早产的临床价值

  目的  分析经阴道超声测量子宫宫颈前角（ACA）、宫颈长度（CL）联合胎儿纤维连接蛋白（fFN）预测自发性早产（SPB）的临床价值。  方法  选取2019年6月~2022年6月我院收治的98例先兆早产孕妇为研究对象，根据是否发生SPB将其分为SPB组（n=33）和足月组（n=65）。采用单因素及Logistic多因素回归分析先兆早产孕妇发生SPB的风险因素。通过绘制ROC曲线评估ACA、CL及fFN对SPB的预测效能。  结果  经单因素分析，两组孕前BMI、胎膜早破、宫内感染、羊水过多、妊娠期糖尿病情况及ACA、CL、fFN水平的差异有统计学意义（P < 0.05）。经Logistic多因素回归分析，胎膜早破、ACA、fFN是先兆早产孕妇发生SPB的风险因素（OR>1，P < 0.05），孕前BMI、CL是先兆早产孕妇发生SPB的保护因素（OR < 1，P < 0.05）。ROC曲线显示，当ACA≥ 116.500°时，预测先兆早产孕妇发生SPB的AUC为0.630，敏感度为48.5%，特异性为69.2%。当CL≤25.000 mm时，AUC为0.667，敏感度为54.5%，特异性为73.8%。当fFN≥96.155 μg/L时，AUC为0.652，敏感度为60.6%，特异性为69.2%。三者联合预测的AUC为0.740，敏感度为72.7%，特异性为75.4%。  结论  经阴道超声测量ACA、CL及fFN水平均对预测先兆早产孕妇发生SPB具有一定预测价值，且三者联合预测效能更佳。 

Clinical value of transvaginal ultrasound combined with fetal fibronectin in predicting spontaneous premature delivery

  Objective  To analyze the clinical value of the transvaginal ultrasound measurement of the anterior uterocervical angle (ACA) and cervical length (CL) combined with fetal fibronectin (fFN) for predicting spontaneous preterm birth (SPB).  Methods  Ninety-eight pregnant women with threatened preterm birth were selected as research objects from June 2019 to June 2022. They were divided into SPB group (n=33) and full-term group (n=65) according to whether SPB occurred. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of SPB in pregnant women with threatened premature labor. The predictive efficiency of ACA, CL and fFN to SPB were evaluated by drawing ROC curve.  Results  Univariate analysis showed that there were statistically significant differences in pre-pregnancy BMI, premature rupture of membranes, intrauterine infection, excessive amniotic fluid, gestational diabetes and ACA, CL and fFN levels between the two groups (P < 0.05). Multivariate logistic regression analysis showed that premature rupture of membranes, ACA and fFN were risk factors for SPB in pregnant women with threatened premature labor (OR>1, P < 0.05). BMI and CL before pregnancy were protective factors for SPB in pregnant women with threatened premature labor (OR < 1, P < 0.05). ROC analysis showed that when ACA ≥116.500°, the area under curve (AUC) of predicting SPB in pregnant women with threatened preterm birth was 0.630, the sensitivity was 48.5%, and the specificity was 69.2%. When CL ≤25.000 mm, the AUC was 0.667, the sensitivity was 54.5%, and the specificity was 73.8%. When fFN ≥96.155 μg/L, the AUC was 0.652, the sensitivity was 60.6%, and the specificity was 69.2%. The AUC of combined prediction was 0.740, the sensitivity was 72.7%, and the specificity was 75.4%.  Conclusion  The ACA, CL and fFN measured by transvaginal ultrasound have a certain predictive value for predicting SPB in pregnant women with threatened premature labor, and the combined predictive efficacy of the three is better.