目的 本研究旨在评估宫颈机能不全（cervical insufficiency， CI）与自发性早产（spontaneous preterm birth， SPB）之间的关联，并探讨宫颈剪切波弹性成像（shear wave elasticity， SWE）、宫颈长度（cervical length， CL）和宫颈前角（anterior cervical angle， ACA）在预测CI引起的SPB中的应用价值。 方法 本研究纳入了2023年6月至2024年1月期间在南通大学附属医院及江南大学附属妇产医院产前门诊就诊或住院治疗的786例孕妇，其中足月组723例孕妇，早产组63例孕妇。使用迈瑞Resona R9 Pro/Eagus R9s超声仪，配备剪切波弹性成像软件，进行宫颈SWEI、CL和ACA的测量。此外，按照受检孕周将孕妇分为19 ~ 23⁺⁶周、24 ~ 27⁺⁶周、28 ~ 33⁺⁶周、34 ~ 36⁺⁶周4组，评估孕周与超声参数的关系。 结果 早产组孕妇的CL平均为25.42 mm，显著低于足月组的29.71 mm（P < 0.001）。ACA在早产组平均为121°，高于足月组的99°（P < 0.001）。宫颈各部位的SWE值在早产组也显著低于足月组：外口前唇（AE）为6.47 kPa对比9.91 kPa（P < 0.001）、内口前唇（AI）为10.98 kPa对比18.62 kPa（P < 0.001）、内口后唇（PI）为11.32 kPa对比21.09 kPa（P < 0.001）、外口后唇（PE）为8.16 kPa对比13.24 kPa（P < 0.001）。CL与孕周存在显著的负相关（r = -0.278，P = 0.001）。联合预测指标在预测早产方面显示出较高的准确性和特异性，曲线下面积（AUC）达到0.952，灵敏度和特异度分别为95%和86%。 结论 宫颈SWE、CL和ACA的联合使用可以显著提高对CI导致SPB的预测效能，可以为临床医生提供了一个更全面、准确的工具，以识别高危孕妇并及时采取干预措施，减少早产的发生，改善母婴预后。

Objective To evaluate the association between cervical insufficiency （CI） and spontaneous preterm birth （SPB）， and to investigate the predictive value of shear wave elastography （SWE）， cervical length （CL）， and anterior cervical angle （ACA） in identifying SPB resulting from CI. Methods This study recruited 786 pregnant women who attended prenatal outpatient clinics or were hospitalized for treatment at the Affiliated Hospital of Nantong University and the Maternity Hospital affiliated with Jiangnan University from June 2023 to January 2024. Among these participants， 723 were full-term pregnancies and 63 were preterm pregnancies. Cervical SWEI， CL， and cervical ACA were measured using a Mindray Resona R9 Pro/Eagus R9s ultrasound device equipped with shear wave elasticity imaging software. Additionally， the participants were categorized into four gestational age groups： 19-23⁺⁶ weeks， 24-27⁺⁶ weeks， 28-33⁺⁶ weeks， and 34-36⁺⁶ weeks， to evaluate the relationship between gestational age and ultrasound parameters. Results The mean CL in the preterm group was 25.4 mm， significantly shorter than the 29.7 mm observed in the full-term group （P < 0.001）. The ACA in the preterm group was 121°， which was significantly higher than the 99° in the full-term group （P < 0.001）. Additionally， SWE values were significantly lower in the preterm group compared to the full-term group at all measured cervical sites： anterior external os （AE） 6.47 kPa versus 9.91 kPa （P < 0.001）， anterior internal os （AI） 10.98 kPa versus 18.62 kPa （P < 0.001）， posterior internal os （PI） 11.32 kPa versus 21.09 kPa （P < 0.001）， and posterior external os （PE） 8.16 kPa versus 13.24 kPa （P < 0.001）. A significant negative correlation was found between CL and gestational age （r = -0.278， P = 0.001）. The combined predictive indicators demonstrated high accuracy and specificity for predicting preterm birth， with an area under the curve （AUC） of 0.952， sensitivity of 95%， and specificity of 86%. Conclusions The integration of cervical SWE， CL measurement， and assessment of the angle of ACA can substantially enhance the predictive accuracy for SPB due to CI. This multimodal approach offers clinicians a more robust and precise tool for identifying high-risk pregnancies， enabling timely interventions that can reduce the incidence of preterm birth and improve maternal and neonatal outcomes.