摘要
目的:不孕症的发病率呈逐年上升的趋势,其中30%以上与输卵管通畅性异常相关。四维超声子宫输卵管造影(4-dimensional hysterosalpingo-contrast sonography,4D HyCoSy)在诊断输卵管通畅性上既克服了三维成像的不足,特异性和准确性均较高,又避免了碘剂过敏、X线辐射等危害,接受度好且易掌握,在临床应用越来越广泛,但是目前尚无研究探讨4D HyCoSy与自然妊娠可能性相关的影像学标准。本研究对临床拟诊输卵管性不孕患者的临床资料及4D HyCoSy的影像特点进行分析,建立一种基于影像学特征的造影术后自然妊娠的预测模型。方法:回顾性分析湖南省光琇医院2017年2月至2018年5月拟诊为输卵管性不孕症、具有完整4D HyCoSy影像学资料且显示至少一侧输卵管通畅的患者,收集患者的一般临床资料及影像数据,并随访患者造影术后3个月内的自然妊娠情况,将其分成自然妊娠组与非自然妊娠组。采用二元logistic回归分析各个变量与造影术后自然妊娠之间的相关性,将单因素logistic回归中差异有统计学意义(P<0.05)的变量纳入自然妊娠概率预测模型,并通过10倍交叉法验证预测模型的分类能力。结果:收集到符合要求且遵医嘱试孕3个月的1085名临床拟诊输卵管性不孕患者,其临床特征(年龄、不孕年限)及4D HyCoSy影像学特征(月经结束后3~7 d的内膜厚度、左侧输卵管显影情况、左侧卵巢周围造影剂弥散情况、右侧卵巢周围造影剂弥散情况)是术后3个月自然妊娠的独立预测因素。建立自然妊娠概率预测模型,10倍交叉法验证得出的曲线下面积(area under the curve,AUC)均大于0.75,最佳AUC为0.868。预测模型得出的Q值为自然妊娠概率,截断值是0.5,当Q值大于0.5时建议试孕3个月,小于0.5时建议采用辅助生殖技术助孕。结论:基于输卵管性不孕患者的临床及4D HyCoSy的影像学特征成功建立了输卵管性不孕症女性造
Objective:The incidence of infertility is increasing,more than 30%of them having related abnormal tubal patency.Four-dimensional(4D)hysterosalpingo-contrast sonography(HyCoSy)overcomes the shortcomings of 3D HyCoSy in the diagnosis of tubal patency,showing high specificity and accuracy.In addition,4D HyCoSy discards iodine allergy and X-ray radiation and possesses easy-operating,contributing to good acceptance in clinical practice.However,there is no research to explore the imaging standards related to the possibility of natural pregnancy after 4D HyCoSy.If a predictive model of postoperative natural pregnancy was established using the analysis of clinical data combined with imaging characteristics of 4D HyCoSy of patients with tubal factor infertility,clinical decision-making can be wisely guided in the future.This study aims to establish a predictive model of natural pregnancy after 4D HyCoSy based on clinical data and imaging characteristics of patients with tubal factor in fertility.Methods:A retrospective study was conducted for patients who were diagnosed with tubal factor infertility in Hunan Guangxiu Hospital from February 2017 to May 2018.The patients ought to possess complete 4D HyCoSy imaging data and at least one-sideunobstructed fallopian tube.General clinical data and imaging data were collected.Pregnancy outcome was followed up till 3 months after 4D HyCoSy.According to pregnancy outcome,patients were divided into a pregnancy group and a non‐pregnancy group.Binary logistic regression was used to analyze the correlation between various variables and natural pregnancy after 4D HyCoSy.The variables with significant difference(P<0.05)in single-factor logistic regression were included in the natural pregnancy probability prediction model.The classification accuracy was further verified with 10-fold cross-validation.Results:A total of 1085 patients with clinically suspected tubal factor infertility who met the requirements and followed the doctors’prescription were collected.Clinical characteristics(
作者
赵行平
费玲燕
顾盼
徐大宝
张白云
杨益民
ZHAO Xingping;FEI Lingyan;GU Pan;XU Dabao;ZHANG Baiyun;YANG Yimin(Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Ultrasound,Hunan Guangxiu Hospital,Changsha 410205,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2022年第11期1600-1607,共8页
Journal of Central South University ：Medical Science
基金
国家重点研发项目(2018YFC1004800)
湖南省科技计划项目(2021SK53704,2020SK53605)。
关键词
四维超声子宫输卵管造影
不孕症
输卵管通畅性
自然妊娠
预测模型
four-dimensional hysterosalpingo-contrast sonography
infertility
tubal patency
natural pregnancy
predictive model
