孙倩 穆柯晓

[摘要] 目的 探討经阴道彩超对不明位置妊娠（PUL）患者黄体血流的检测结果及其对妊娠结局的预测效果。 方法 纳入青岛市市立医院西院区2014年1月～2017年1月收治的PUL患者120例，根据手术病理证实的妊娠结局分为异位妊娠组58例，宫内妊娠组62例，其中宫内妊娠组经病理证实宫内早孕32例，宫内早孕流产30例。比较两组黄体回声类型、血流分级情况，并测定黄体血流阻力指数（RI）、搏动指数（PI）、收缩期峰值流速（PSV），采用受试者工作特征曲线（ROC）分析其对异位妊娠、宫内早孕流产的预测价值。 结果 宫内妊娠组血流分级明显优于异位妊娠组，差异有统计学意义（P < 0.05）；宫内妊娠组黄体血流RI、PI较异位妊娠组更低，而PSV较异位妊娠组显著增高（P < 0.05）；黄体血流RI、PI、PSV预测异位妊娠的曲线下面积分别为0.884、0.711、0.867；宫内早孕者黄体血流RI较宫内早孕流产患者更低，而PSV较宫内早孕流产患者显著增高（P < 0.05）；黄体血流RI、PSV预测宫内早孕流产的曲线下面积分别为0.829、0.830。 结论 经阴道彩色多普勒超声能尽早明确PUL患者的妊娠位置，对异位妊娠、宫内早孕流产的预测价值较高。

[关键词] 不明位置妊娠；彩色多普勒超声；黄体血流

[中图分类号] R714；R445 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0119-04

[Abstract] Objective To explore the detection results of the corpus luteum blood flow in pregnancy of unknown location （PUL） by transvaginal color doppler ultrasound and its prediction effect on pregnancy outcome. Methods A total of 120 PUL patients admitted to the West Campus of Qingdao Municipal Hospital from January 2014 to January 2017 were enrolled in the study. According to the pathological findings of the surgery， there were 58 cases of ectopic pregnancy group and 62 cases of intrauterine pregnancy group. In the intrauterine pregnancy group， 32 cases of premature pregnancy and 30 cases of premature intrauterine abortion were confirmed. The echo type and blood flow classification of the corpus luteum and the resistance index （RI）， pulsatile index （PI） and peak systolic flow velocity （PSV） between the two groups were compared. The predictive value of Receiver operator characteristic curve （ROC） on ectopic pregnancy and intrauterine pregnancy abortion was analyzed. Results The blood classification of the intrauterine pregnancy group was significantly better than that of the ectopic pregnancy group， the difference was statistically significant （P < 0.05）. The RI and PI of luteal blood flow in the intrauterine pregnancy group were lower than those in the ectopic pregnancy group， while the PSV in the ectopic pregnancy group was significantly higher than that in the ectopic pregnancy group （P < 0.05）.The area of the luteal blood flow RI， PI， and PSV for predicting ectopic pregnancy was 0.884， 0.711， 0.867. The luteal blood flow RI of the patients with intrauterine early pregnancy was lower than patients with early pregnancy abortion， while the PSV was significantly higher than patients with early pregnancy abortion （P < 0.05）. The area under the curve of RI and PSV for predicting intrauterine pregnancy abortion was 0.829 and 0.830 respectively. Conclusion Transvaginal color Doppler ultrasound can identify the pregnancy position of PUL patients as early as possible， and have higher predictive value for ectopic pregnancy and intrauterine pregnancy abortion.

[Key words] Pregnancy of unknown location； Color Doppler ultrasound； Luteal blood flow

妊娠女性中，早期不明位置妊娠（pregnancy of unknown location，PUL）占比8%～31%[1-2]。目前，临床对早期妊娠诊断已有多种方法，如超声检查、血清学检测等，但血清学测定仅可确定有无妊娠，无法确定妊娠部位[3-4]。近年来，经阴道超声以安全、探头频率高、分辨率高等优势用于多种妇科疾病诊断中，对病灶定位准确性良好[5-6]。鉴于此，选取青岛市市立医院西院区（以下简称“我院”）120例PUL患者为研究对象，分析经阴道彩色多普勒超声对PUL患者妊娠结局的预测效果，现报道如下：

1 资料与方法

1.1 一般资料

选取我院2014年1月～2017年1月收治的PUL患者120例。经手术病理证实早期异位妊娠组58例，宫内妊娠组62例。异位妊娠组均为输卵管妊娠，年龄20～41岁，平均（27.63±4.51）岁；孕35～72 d，平均（46.14±10.15）d。宫内妊娠组宫内早孕32例、宫内早孕流产30例；……