相关细胞因子对不孕症的影响分析及育龄期女性子宫内膜异位症预测模型构建

Analysis of the Effects of Relevant Cytokines on Infertility and Construction of a Predictive Model for Endometriosis in Women of Reproductive Age

金凤梅 ¹马清杰 ¹付久园²

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作者信息

1. 河北省承德市中心血站, 河北承德 067000
2. 承德医学院附属医院, 河北承德 067000
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摘要

目的:分析相关细胞因子对不孕症的影响,并建立育龄期女性子宫内膜异位症治疗后不孕症的预测模型.方法:纳入2020 年3 月至2022 年3 月医院108 例育龄期女性子宫内膜异位症患者,所有患者入院时均接受血清学检测.随访1 年,观察其自然妊娠情况,依据妊娠结果分为自然妊娠组与不孕组,对比两组基线资料及血清学检测指标,建立育龄期女性子宫内膜异位症预测模型,并分析相关细胞因子对不孕症的影响.结果:随访 1 年,108 例育龄期女性子宫内膜异位症患者中成功妊娠 66 例(61.11%),未成功妊娠42 例(38.89%);不孕组子宫内膜异位症Ⅲ期-Ⅳ期、未接受促排卵治疗的患者占比高于自然妊娠组(χ2 =6.495、5.945,P<0.05);不孕组白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)水平高于自然妊娠组(t=7.345、4.095、5.739,P<0.05);绘制血清学细胞因子预测育龄期女性子宫内膜异位症患者发生不孕症的受试者工作曲线(ROC),结果显示,IL-1β、IL-18、TNF-α水平对育龄期女性子宫内膜异位症患者发生不孕症具有一定预测价值(AUC = 0.837、0.711、0.779,P<0.05),联合预测价值更高(AUC=0.864);经 Logistic 回归分析,结果显示,子宫内膜异位症Ⅲ期-Ⅳ期、未接受促排卵治疗、高 IL-1β、IL-18、TNF-α 水平是育龄期女性子宫内膜异位症患者发生不孕症的危险因素(OR=4.730、4.173、16.216、1.012、4.631,P<0.05),将其带入回归方程可得:Logit(P)=-15.285+1.554X1+1.429X2+2.786X3+0.012X4+1.533X5.结论:子宫内膜异位症Ⅲ期-Ⅳ期、未接受促排卵治疗、高 IL-1β、IL-18、TNF-α 水平是育龄期女性子宫内膜异位症患者发生不孕症的危险因素,建立的Logistic回归模型可预测育龄期女性子宫内膜异位症患者发生不孕症的可能性,有助于帮助医务人员识别不孕症高风险者.

Abstract

Objective:To analyze the influence of related cytokines on infertility and to establish a pre-diction model for infertility after treatment of women of reproductive age with endometriosis.Methods:A total of 108 cases of women of reproductive age with endometriosis from March 2020 to March 2022 were included in the study.They were followed up for one year to observe their natural pregnancy.According to the pregnancy results,they were divided into natural pregnancy group and infertility group.The baseline data and serological test indicators of the two groups were compared to establish a female endometriosis model of reproductive age and analyze the effects of related cytokines on infertility.Results:One year follow-up showed that among 108 women of reproductive age with endometriosis,66 cases(61.11%)were pregnant successfully and 42 cases(38.89%)were not.The proportion of patients with endometriosis in stage Ⅲ～Ⅳ and not receiving ovulation induction in the infertility group was higher than that in the natural pregnancy group(χ2=6.495 and 5.945,P<0.05).The levels of IL-1β,IL-18 and TNF-α in the infertility group were higher than those in the natu-ral pregnancy group(t=7.345,4.095,5.739,P<0.05).The ROC curve of serum cytokine levels predic-ting infertility in women of reproductive age with endometriosis was drawn,and the results showed that IL-1β,IL-18,and TNF-α levels had certain predictive value for infertility in women of reproductive age with endo-metriosis(AUC=0.837,0.711,0.779,P<0.05).After logistic regression analysis,the results showed that endometriosis stage Ⅲ～Ⅳ,not receiving ovulation induction therapy,high IL-1β,IL-18,and TNF-α lev-els were risk factors for infertility in female endometriosis patients of reproductive age(OR = 4.730,4.173,16.216,1.012,and 4.631,P<0.05),which was brought into the regression equation to obtain:logit(P)=-15.285 + 1.554X1 + 1.429X2 + 2.786X3 + 0.012X4 + 1.533X5.Conclusion:Endometriosis stage Ⅲ～Ⅳ,not receiving ovulation induction therapy,high IL-1β,IL-18,and TNF-α levels are the risk factors for infertility in women of childbearing age with endometriosis.The established Logistic regression model can predict the possibility of infertility in women of childbearing age with endometriosis,and it is helpful for medi-cal staff to identify high-risk infertility patients.

关键词

子宫内膜异位症/育龄期女性/细胞因子/不孕症

Key words

Endometriosis/Women of reproductive age/Cytokines/Barrenness

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基金项目

承德市科学技术研究与发展计划(2020)(202006A017)

出版年

2024

河北医学

河北省医学会

河北医学

CSTPCD

影响因子：1.915

ISSN：1006-6233

参考文献量15

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