摘要
目的 基于超声特征的列线图模型评估早孕流产后妊娠物残留合并子宫动静脉瘘患者的风险因素。方法 选取贵州省人民医院在2019年1月至2024年1月收治的113例早孕流产后妊娠物残留合并子宫动静脉瘘的患者为研究对象,所有患者均接受超声检查。根据患者是否发生大出血,将患者分为大出血组和非大出血组。比较两组患者的超声检查特征,并采用logistic多因素分析筛选患者发生大出血的风险因素,建立列线图模型,并通过ROC曲线评估模型对患者大出血的预测价值。结果 本研究113例早孕流产后妊娠物残留合并子宫动静脉瘘的患者中大出血占比为22.12%(25/113),超声特征表现为宫腔内不规则囊实性病灶伴特征性五彩镶嵌样血流信号,提示妊娠物残留合并子宫动静脉瘘。大出血组患者的扩张血管内径、病灶最大径、收缩期峰值流速(PSV)、舒张末期血流速度(EDV)大于非大出血组,血管阻力指数(RI)和子宫前壁下段肌层厚度比非大出血组降低,差异均有统计学意义(P<0.05)。logistic分析显示扩张血管内径、PSV、EDV是患者发生大出血的风险因素,子宫前壁下段肌层厚度是保护因素(P<0.05)。ROC曲线显示,基于多因素分析和列线图对患者大出血的预测灵敏度为96.0%,特异度为86.4%。结论 扩张血管内径增大、血流速度升高及子宫前壁肌层变薄是早孕流产后妊娠物残留合并子宫动静脉瘘患者大出血的独立预测因素,基于此建立的模型预测效能较高。
Objective To evaluate the risk factors for major hemorrhage in patients with residual pregnancy tissue(RPT)combined with uterine arteriovenous fistula(UAVF)following early pregnancy abortion by using a nomogram model based on ultrasonic features.Methods A total of 113 patients who had RPT combined with UAVF after early pregnancy abortion and were admitted to our hospital from January 2019 to January 2024 were selected as the study subjects.All the patients underwent ultrasound examination.According to the occurrence of major hemorrhage,the patients were divided into a major hemorrhage group and a non-major hemorrhage group.The ultrasonic characteristics were compared between these two groups.Logistic multivariate analysis was employed to screen the risk factors for major hemorrhage,and a nomogram model was established.The predictive value of the model for major hemorrhage was evaluated using the receiver operating characteristic(ROC)curve.Results Among the 113 patients,the incidence rate of major hemorrhage was 22.12%(25/113).Ultrasonographic features revealed irregular cysticsolid lesions within the uterine cavity,accompanied by characteristic mosaiclike color flow signals,which suggested RPT combined with UAVF.In the major hemorrhage group,the diameter of dilated vessels,the maximum lesion diameter,the peak systolic velocity(PSV),and the enddiastolic velocity(EDV)were significantly larger than those in the nonmajor hemorrhage group.Conversely,the resistance index(RI)and the thickness of the lower uterine segment myometrium were significantly smaller(all P<0.05).Logistic regression analysis indicated that the diameter of dilated vessels,PSV,and EDV were risk factors for major hemorrhage,whereas the thickness of the lower uterine segment myometrium was a protective factor(all P<0.05).The ROC curve demonstrated that the nomogram model based on multivariate analysis had a sensitivity of 96.0%and a specificity of 86.4%for predicting major hemorrhage.Conclusions An increased diameter of dilated vessels,an elevated blood flow velocity,and a thinning of the lower uterine segment myometrium are independent predictive factors for major hemorrhage in patients with RPT combined with UAVF after early pregnancy abortion.The nomogram model established based on these factors exhibits high predictive efficacy.
作者
谢平
黄正敏
张乾泉
XIE Ping;HUANG Zhengmin;ZHANG Qianquan(Department of Ultrasound,Guizhou Provincial People′s Hospital,Guiyang 550000,Guizhou,China)
出处
《实用医学杂志》
北大核心
2026年第4期685-690,共6页
The Journal of Practical Medicine
基金
贵州省卫生健康委科学技术基金项目(编号:gzwkj2023-460)。
关键词
早孕流产
娠物残留
子宫动静脉瘘
大出血
数字减影血管造影
early pregnancy loss
residual pregnancy tissue
uterine arteriovenous fistula
massive hemorrhage
digital subtraction angiography
