E-cervix宫颈弹性成像联合超声参数在晚孕期孕妇分娩方式预测中的价值

doi:10.3877/cma.j.issn.1673-5250.2026.02.007

中华妇幼临床医学杂志(电子版) ›› 2026, Vol. 22 ›› Issue (02) : 148 -154. doi: 10.3877/cma.j.issn.1673-5250.2026.02.007

论著

E-cervix宫颈弹性成像联合超声参数在晚孕期孕妇分娩方式预测中的价值

高宁宁¹^,², 韩蓁¹^,^†(

), 王音², 陈小莉², 岳瑾琢²

¹西安交通大学第一附属医院妇产科，西安　710061
²西安大兴医院超声医学科，西安　710082

收稿日期:2025-11-08 修回日期:2026-01-10 出版日期:2026-04-01
通信作者: 韩蓁

Predictive value of E-cervix cervical elastography combined with ultrasonographic parameters for mode of delivery of pregnant women in the third trimester

Ningning Gao¹^,², Zhen Han¹^,^†(), Yin Wang², Xiaoli Chen², Jinzhuo Yue²

¹Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, Shaanxi Province, China
²Department of Ultrasound, Xi′an Daxing Hospital, Xi′an 710082, Shaanxi Province, China

Received:2025-11-08 Revised:2026-01-10 Published:2026-04-01
Corresponding author: Zhen Han
Supported by:
Xi′an Municipal Health Research Fund Project(2024yb50)

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引用本文：

高宁宁, 韩蓁, 王音, 陈小莉, 岳瑾琢. E-cervix宫颈弹性成像联合超声参数在晚孕期孕妇分娩方式预测中的价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2026, 22(02): 148-154.

Ningning Gao, Zhen Han, Yin Wang, Xiaoli Chen, Jinzhuo Yue. Predictive value of E-cervix cervical elastography combined with ultrasonographic parameters for mode of delivery of pregnant women in the third trimester[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(02): 148-154.

目的

探讨经阴道彩色多普勒超声联合E-cervix宫颈弹性成像参数在预测晚孕期孕妇分娩方式中的应用价值。

方法

选取2022年1月至2024年12月于西安大兴医院进行晚孕期经阴道超声检查孕妇300例为研究对象。采用回顾性分析方法，根据最终分娩方式将其分为自然分娩组(n＝201)和剖宫产术分娩组(n＝99)。对2组晚孕期孕妇宫颈长度(CL)、子宫颈角(UCA)、弹性对比指数(ECI)、硬度比、宫颈内口应变值(IOS)、宫颈外口应变值(EOS)及IOS/EOS等进行统计学分析。采用多因素非条件logistic回归分析晚孕期孕妇分娩方式的影响因素，并绘制受试者工作特征(ROC)曲线，根据曲线下面积(AUC)评价各参数及其联合对晚孕期孕妇分娩方式的预测效能。本研究遵循的程序通过西安大兴医院医学伦理委员会规定，并通过该伦理委员会审批(审批文号：KY2024-002)。

结果

①自然分娩组孕妇CL及硬度比低于剖宫产术分娩组，而UCA、ECI、IOS及EOS均大于剖宫产术分娩组，并且差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析显示，CL(OR＝4.408，95%CI：2.486~7.817，P<0.001)和硬度比(OR＝1.024，95%CI：1.005~1.043，P＝0.012)为晚孕期孕妇剖宫产术分娩的独立危险因素，而UCA(OR＝0.934，95%CI：0.911~0.957，P<0.001)为独立保护因素。③ROC曲线分析结果显示，UCA、CL、硬度比、IOS、EOS及ECI预测晚孕期孕妇自然分娩的AUC分别为0.750、0.706、0.652、0.617、0.602和0.596；多参数联合(UCA、CL、硬度比、IOS、EOS及ECI)预测的AUC为0.841(95%CI：0.792~0.890)，预测晚孕期孕妇自然分娩的敏感度为86.1%，特异度为73.7%。

结论

经阴道彩色多普勒超声联合E-cervix宫颈弹性成像多参数指标，可从晚孕期孕妇子宫解剖结构及生物力学特征多维度评估宫颈成熟度。多参数联合较单一指标对晚孕期孕妇分娩方式具有更高的预测效能，可为晚孕期分娩方式的个体化评估提供客观依据。

关键词: 宫颈弹性成像, 阴道超声, 宫颈长度, 分娩方式, 宫颈角, 孕妇

Objective

To investigate the value of transvaginal color Doppler ultrasound combined with E-cervix elastography parameters in predicting the mode of delivery of pregnant women in the third trimester.

Methods

A total of 300 pregnant women who underwent late-pregnancy ultrasound examination at Xi′an Daxing Hospital from January 2022 to December 2024 were retrospectively enrolled. According to the mode of delivery, they were divided into a vaginal delivery group (n=201) and a cesarean delivery group (n=99). Cervical parameters including cervical length (CL), uterocervical angle (UCA), elasticity contrast index (ECI), hardness ratio, internal os strain (IOS), external os strain (EOS), and IOS/EOS were analyzed. Multivariate unconditional logistic regression analysis was performed to identify factors associated with the mode of delivery. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of individual parameters and the combined model. This study was approved by the Medical Ethics Committee of Xi′an Daxing Hospital (Approval No. KY2024-002).

Results

① Compared with the cesarean delivery group, the vaginal delivery group showed significantly lower CL and hardness ratio, and significantly higher UCA, ECI, IOS, and EOS (all P<0.05). ② Multivariate logistic regression analysis demonstrated that CL (OR=4.408, 95%CI: 2.486-7.817, P<0.001) and hardness ratio (OR=1.024, 95%CI: 1.005-1.043, P=0.012) were independent risk factors for cesarean delivery of pregnant women in the third trimester, whereas UCA (OR=0.934, 95%CI: 0.911-0.957, P<0.001) was an independent protective factor. ③ROC curve analysis showed that the area under the curve (AUC) for predicting vaginal delivery was 0.750 for UCA, 0.706 for CL, 0.652 for hardness ratio, 0.617 for IOS, 0.602 for EOS, and 0.596 for ECI. The combined model (UCA, CL, hardness ratio, IOS, EOS, and ECI) achieved an AUC of 0.841 (95%CI: 0.792-0.890), with a sensitivity of 86.1% and a specificity of 73.7%.

Conclusions

Transvaginal color Doppler ultrasound combined with E-cervix elastography can comprehensively evaluate cervical maturity from both anatomical and biomechanical perspectives. A multiparametric combined model demonstrates superior predictive performance compared with single parameters and may provide an objective basis for individualized assessment of delivery mode of pregnant women in the third trimester.

Key words: Cervical elastography, Transvaginal ultrasound, Cervical length, Mode of delivery, Uterocervical angle, Pregnant women

表1 2组晚孕期孕妇的一般临床资料比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	孕次[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	1次	≥2次
自然分娩组	201	30.0(27.0，33.0)	26.1(24.8，27.7)	39.6(39.2，40.2)	116(57.8)	85(42.3)
剖宫产术分娩组	99	30.0(27.0，33.0)	26.9(25.2，28.1)	39.5(39.2，40.1)	58(58.6)	41(41.4)
统计量		Z＝1.01	Z＝1.93	Z＝1.25	χ²<0.01
P值		0.314	0.054	0.210	0.984

表1 2组晚孕期孕妇的一般临床资料比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	孕次[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	1次	≥2次
自然分娩组	201	30.0(27.0，33.0)	26.1(24.8，27.7)	39.6(39.2，40.2)	116(57.8)	85(42.3)
剖宫产术分娩组	99	30.0(27.0，33.0)	26.9(25.2，28.1)	39.5(39.2，40.1)	58(58.6)	41(41.4)
统计量		Z＝1.01	Z＝1.93	Z＝1.25	χ²<0.01
P值		0.314	0.054	0.210	0.984

图1　本研究1例自然分娩孕妇(27岁，G₁P₀，孕龄为38^＋6孕周)的经阴道彩色多普勒超声声像图[图1A：宫颈弹性成像测量图；图1B：宫颈角测量图(UCA为102.75°，CL为2.51 cm，ECI为5.13，硬度比为34.04%，IOS为0.57，EOS为0.38，IOS/EOS为1.50)]　图2　本研究1例剖宫产术分娩孕妇(35岁，G₂P₁，孕龄为37^＋5孕周)的经阴道彩色多普勒超声声像图[图2A：宫颈弹性成像测量图；图2B：宫颈角测量图(UCA为98.56°，CL为4.00 cm，ECI为5.45，硬度比为39.80%，IOS为0.35，EOS为0.47，IOS/EOS为0.74)]注：UCA为宫颈角，CL为宫颈长度，ECI为弹性对比指数，IOS为宫颈内口应变值，EOS为宫颈外口应变值，IOS/EOS为宫颈内外口应变比值

表2 2组晚孕期孕妇经阴道彩色多普勒超声测量的宫颈参数比较[M(Q₁，Q₃)]

组别	例数	UCA(°)	CL(cm)	ECI	硬度比(%)	IOS	EOS	IOS/EOS
自然分娩组	201	109(102，115)	2.68(2.00, 3.01)	4.00(3.20, 5.13)	39(30, 59)	0.41(0.34, 0.52)	0.35(0.29, 0.43)	1.16(0.88, 1.56)
剖宫产术分娩组	99	97(89，105)	3.01(2.78, 3.28)	3.49(2.80, 4.55)	52(40, 62)	0.37(0.30, 0.43)	0.32(0.25, 0.39)	1.18(0.90, 1.45)
Z值		7.03	5.81	2.70	4.29	3.30	2.87	0.12
P值		<0.001	<0.001	0.007	<0.001	<0.001	0.004	0.884

表2 2组晚孕期孕妇经阴道彩色多普勒超声测量的宫颈参数比较[M(Q₁，Q₃)]

组别	例数	UCA(°)	CL(cm)	ECI	硬度比(%)	IOS	EOS	IOS/EOS
自然分娩组	201	109(102，115)	2.68(2.00, 3.01)	4.00(3.20, 5.13)	39(30, 59)	0.41(0.34, 0.52)	0.35(0.29, 0.43)	1.16(0.88, 1.56)
剖宫产术分娩组	99	97(89，105)	3.01(2.78, 3.28)	3.49(2.80, 4.55)	52(40, 62)	0.37(0.30, 0.43)	0.32(0.25, 0.39)	1.18(0.90, 1.45)
Z值		7.03	5.81	2.70	4.29	3.30	2.87	0.12
P值		<0.001	<0.001	0.007	<0.001	<0.001	0.004	0.884

表3 影响晚孕期孕妇分娩方式因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
硬度比(连续变量)	0.024	0.009	7.111	0.012	1.024	1.005~1.043
EOS(连续变量)	－1.942	1.424	1.860	0.179	0.130	0.008~2.432
CL(连续变量)	1.483	0.292	25.794	<0.001	4.408	2.486~7.817
UCA(连续变量)	－0.069	0.013	28.172	<0.001	0.934	0.911~0.957
IOS(连续变量)	－2.094	1.387	2.279	0.131	0.123	0.008~1.868
ECI(连续变量)	－0.060	0.134	0.200	0.651	0.941	0.724~1.224

表3 影响晚孕期孕妇分娩方式因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
硬度比(连续变量)	0.024	0.009	7.111	0.012	1.024	1.005~1.043
EOS(连续变量)	－1.942	1.424	1.860	0.179	0.130	0.008~2.432
CL(连续变量)	1.483	0.292	25.794	<0.001	4.408	2.486~7.817
UCA(连续变量)	－0.069	0.013	28.172	<0.001	0.934	0.911~0.957
IOS(连续变量)	－2.094	1.387	2.279	0.131	0.123	0.008~1.868
ECI(连续变量)	－0.060	0.134	0.200	0.651	0.941	0.724~1.224

图3 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线注：联合指标为UCA、CL、硬度比、IOS、EOS及ECI联合。ROC曲线为受试者工作特征曲线，UCA为子宫颈角，CL为宫颈长度，IOS为宫颈内口应变值，EOS为宫颈外口应变值，ECI为弹性对比指数

表4 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线分析结果

预测指标	ROC曲线			最佳临界值	敏感度(%)	特异度(%)
预测指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)
UCA	0.750	0.690~0.810	<0.001	101.58°	76.1	69.7
CL	0.706	0.647~0.766	<0.001	2.54 cm	43.3	90.9
硬度比	0.652	0.589~0.715	<0.001	35.76%	39.8	85.9
IOS	0.617	0.515~0.684	<0.001	0.41	55.2	65.7
EOS	0.602	0.535~0.669	0.002	0.40	35.8	82.8
ECI	0.596	0.527~0.665	0.003	3.06	81.1	38.4
联合指标^a	0.841	0.792~0.890	<0.001	－	86.1	73.7

表4 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线分析结果

预测指标	ROC曲线			最佳临界值	敏感度(%)	特异度(%)
预测指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)
UCA	0.750	0.690~0.810	<0.001	101.58°	76.1	69.7
CL	0.706	0.647~0.766	<0.001	2.54 cm	43.3	90.9
硬度比	0.652	0.589~0.715	<0.001	35.76%	39.8	85.9
IOS	0.617	0.515~0.684	<0.001	0.41	55.2	65.7
EOS	0.602	0.535~0.669	0.002	0.40	35.8	82.8
ECI	0.596	0.527~0.665	0.003	3.06	81.1	38.4
联合指标^a	0.841	0.792~0.890	<0.001	－	86.1	73.7

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Predictive value of E-cervix cervical elastography combined with ultrasonographic parameters for mode of delivery of pregnant women in the third trimester

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Predictive value of E-cervix cervical elastography combined with ultrasonographic parameters for mode of delivery of pregnant women in the third trimester