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宫腔粘连发病高危因素与不孕症的相关性及对临床防治的指导

Correlation between High-risk Factors of Intrauterine Adhesions and Infertility and Its Guidance for Clinical Prevention and Treatment
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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。 Objective To explore the high-risk factors for intrauterine adhesions(IUA) and to analyze the relationship of IUA and their high-risk factors with infertility.Methods In total,150 patients who underwent hysteroscopic examination 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 regression 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%,moderate adhesions accounting for 56.41%,and severe adhesions accounting for 17.95%.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 infertility.Building a risk
作者 赵郡 张蕾 马晓琳 王莹倩 ZHAO Jun;ZHANG Lei;MA Xiaolin;WANG Yingqian(Department of Obstetrics and Gynecology,the Third Hospital of Hebei Medical University,Shijiazhuang 050082,China)
出处 《临床误诊误治》 CAS 2023年第7期109-114,共6页 Clinical Misdiagnosis & Mistherapy
基金 2019年度河北省医学科学研究课题计划项目(20190668)。
关键词 宫腔粘连 危险因素 不孕症 预测 子宫内膜炎 盆腔炎性疾病 肿瘤坏死因子-α 白细胞介素-6 Intrauterine adhesions Risk factors Infertility Prediction Endometritis Pelvic inflammatory disease Tumor necrosis factor-α Interleukin-6
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