摘要
目的 探究宫腔粘连发病的高危因素,分析宫腔粘连及其高危因素与不孕症的关系.方法 选取2017年6 月—2022 年6 月行宫腔镜检查150 例的临床资料,根据是否发生宫腔粘连分为粘连组和无粘连组,收集并分析2组病例资料,比较不同情况宫腔镜检查患者不孕症发生率,采用多因素Logistic回归分析探讨宫腔粘连发病的高危因素,并绘制森林图,构建宫腔粘连发病风险预警模型,受试者工作特征曲线分析风险预警模型的预测价值.结果 宫腔粘连发生率为26.00%(39/150),其中轻度粘连占25.64%、中度粘连占56.41%、重度粘连占17.95%.宫腔粘连、有宫腔操作史、合并盆腔炎、合并子宫内膜炎、有宫腔感染史、宫腔操作次数≥3 次、血清肿瘤坏死因子-α(TNF-α)≥20 ng/L的宫腔镜检查患者不孕症发生率分别高于无宫腔粘连、无宫腔操作史、未合并盆腔炎、未合并子宫内膜炎、无宫腔感染史、宫腔操作次数＜3 次、血清TNF-α＜20 ng/L患者(P＜0.05,P＜0.01).宫腔操作史、合并盆腔炎、合并子宫内膜炎、宫腔感染史、宫腔操作次数、白细胞介素-6(IL-6)、IL-8、TNF-α均为宫腔粘连发病的独立危险因素(P＜0.01).风险预警模型预测宫腔粘连发病的曲线下面积为0.923,敏感度为 79.49%,特异度为 98.20%.结论 宫腔粘连发病的影响因素较多,且宫腔粘连合并高危因素患者不孕症风险高.构建宫腔粘连发病风险预警模型,并及时采取防治措施有望成为改善女性生殖健康的新途径.
Abstract
Objective To explore the high-risk factors for intrauterine adhesions(IUA)and to analyze the relation-ship of IUA and their high-risk factors with infertility.Methods In total,150 patients who underwent hysteroscopic examina-tion from June 2017 to June 2022 were selected for clinical data.They were divided into two groups based on the occurrence of IUA:the adhesion group and the non-adhesion group.Case data from the two groups were collected and analyzed to compare the incidence of infertility in patients undergoing hysteroscopic examination under different conditions.Multivariate Logistic re-gression analysis was used to explore the high-risk factors for IUA,and forest maps were drawn to construct a risk warning model for IUA.The predictive value of the risk warning model was analyzed based on the receiver operating characteristic(ROC)curve.Results The incidence of IUA was 26.00%(39/150),with mild adhesions accounting for 25.64%,mod-erate adhesions accounting for56.41%,and severe adhesions accounting for17.95%.The incidence of infertility in patients with IUA,history of intrauterine cavity operation,pelvic inflammation,endometritis,history of intrauterine infection,times of uterine cavity operation≥3,serum tumor necrosis factor-α(TNF-α)≥20 ng/L undergoing hysteroscopy was higher than that in patients without IUA,history of intrauterine operation,pelvic inflammation,endometritis,history of intrauterine infection,times of intrauterine operation＜3,and serum TNF-α＜20 ng/L(P＜0.05,P＜0.01).History of intrauterine operation,pelvic inflammation,endometritis,intrauterine infection,times of intrauterine operation,and serum interleukin 6(IL-6),IL-8,and TNF-α were all independent risk factors for IUA(P＜0.01).The area under the ROC curve of the risk warning model in predicting IUA was 0.923,with a sensitivity of 79.49%and a specificity of 98.20%.Conclusion There are many influencing factors for the incidence of IUA,and patients with IUA combined with high-risk factors have a high risk of infertil-ity.Building a risk warning model for IUA and taking timely preventive measures are expected to become a new approach to improvement of female reproductive health.
基金项目
2019年度河北省医学科学研究课题计划项目(20190668)
国家科技期刊平台
NSTL
万方数据