经阴道超声联合血清学指标对孕6周存活胚胎后续停育的早期预测价值OA
Early predictive value of transvaginal ultrasound combined with serological indicators for subsequent embryonic demise in live embryos at 6 weeks'gestation
目的 探讨孕6周经阴道超声(transvaginal ultrasound,TVS)参数联合血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)、孕酮(progesterone,P)水平对已确认存活的胚胎在孕12周前发生胚胎停育的预测价值.方法 回顾性分析2023年1月至2025年6月于中国人民解放军南部战区海军第一医院行早孕检查的400名孕妇.所有纳入者于孕6周经TVS证实为宫内存活妊娠(可见胚芽及原始心管搏动).根据随访至孕12周超声是否仍存在心管搏动分为继续妊娠组(n=320)和胚胎停育组(n=80).比较两组孕妇在孕6周时的TVS参数[孕囊平均直径(mean sac diameter,MSD)、卵黄囊直径(yolk sac diameter,YSD)及形态、头臀长(crown-rump length,CRL)]及同期血清β-hCG、P水平.采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析各单项及联合指标对后续胚胎停育的预测效能.结果 胚胎停育组孕妇在孕6周的MSD、CRL均显著小于继续妊娠组,YSD异常比例及血清β-hCG、P水平均显著低于继续妊娠组(P<0.05).多因素Logistic回归显示,CRL偏小(OR=2.252)、YSD异常(OR=3.759)、β-hCG水平低(OR=1.984)、P水平低(OR=1.716)是后续胚胎停育的独立危险因素(P<0.05).ROC曲线分析显示TVS参数联合血清β-hCG、P的预测模型曲线下面积为0.921(95%CI:0.891～0.951),敏感度为86.3%,特异性为84.4%,其预测效能优于任一单项指标.结论 在孕6周已确认胚胎存活的前提下,综合评估CRL、YSD形态、血清β-hCG及P水平,可有效预测后续发生胚胎停育的风险,为实现早孕期高危妊娠的识别和分层管理提供依据.
Objective To investigate the predictive value of combining transvaginal ultrasound(TVS)parameters with serum β-human chorionic gonadotropin(β-hCG)and progesterone(P)levels at 6 weeks'gestation for subsequent embryonic demise before 12 weeks in embryos with confirmed viability.Methods A retrospective analysis was conducted on 400 pregnant women who underwent early pregnancy examination in the First Naval Hospital of PLA Southern Theater Command from January 2023 to June 2025.All included subjects had confirmed intrauterine viable pregnancy(presence of embryo and primitive cardiac pulsation)by TVS at 6 weeks'gestation.Based on the presence or absence of cardiac pulsation on follow-up ultrasound at 12 weeks,they were divided into continuing pregnancy group(n=320)and embryonic demise group(n=80).TVS parameters[mean sac diameter(MSD),yolk sac diameter(YSD)and morphology,crown-rump length(CRL)]and simultaneous serum β-hCG and P levels at 6 weeks were compared between two groups.The predictive efficacy of individual and combined indicators for subsequent embryonic demise was analyzed using receiver operating characteristic(ROC)curve.Results At 6 weeks'gestation,the MSD and CRL were significantly smaller,the proportion of abnormal YSD was significantly higher,and serum β-hCG and P levels were significantly lower in embryonic demise group compared to continuing pregnancy group(P<0.05).Multivariate Logistic regression analysis showed that smaller CRL(OR=2.252),abnormal YSD(OR=3.759),low β-hCG level(OR=1.984),and low P level(OR=1.716)were independent risk factors for subsequent embryonic demise(P<0.05).ROC curve analysis revealed that the combined predictive model of TVS parameters,serum β-hCG,and P had an area under the curve of 0.921(95%CI:0.891-0.951),with a sensitivity of 86.3%and a specificity of 84.4%.Its predictive efficacy was superior to any single indicator.Conclusion Under the premise of confirmed embryonic viability at 6 weeks'gestation,comprehensive evaluation of CRL,YSD morphology,serum β-hCG,and P levels can effectively predict the risk of subsequent embryonic demise.This provides a basis for the early identification and stratified management of high-risk pregnancies in the first trimester.
彭焕亭;张金梅;李水莉
中国人民解放军南部战区海军第一医院特诊科,广东 湛江 524000中国人民解放军南部战区海军第一医院妇产科,广东 湛江 524000中国人民解放军南部战区海军第一医院特诊科,广东 湛江 524000
医药卫生
经阴道超声β-人绒毛膜促性腺激素孕酮胚胎停育早期预测
Transvaginal ultrasoundβ-Human chorionic gonadotropinProgesteroneEmbryonic demiseEarly prediction
《中国现代医生》 2026 (12)
38-42,5
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