不孕症女性四维子宫输卵管超声造影检查后自然妊娠相关因素的Cox回归分析

doi:10.3877/cma.j.issn.2095-655X.2025.01.004

摘要
图/表
参考文献
相关文章 (0)

全文: PDF (907 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的采用Cox回归分析不孕症女性四维子宫输卵管超声造影（4D-HyCoSy）检查后自然妊娠结局的相关因素。方法选择2015年3月至2023年10月在湖北省妇幼保健院超声影像科行4D-HyCoSy检查的不孕症女性患者388例，根据双侧输卵管通畅性，将不孕症女性分为Ⅰ～Ⅵ型。依据检查后12个月内自然妊娠情况，将不孕症女性分为自然妊娠成功组（n=246）和失败组（n=142）。采用Cox回归分析自然妊娠成功相关因素。建立4D-HyCoSy检查后成功自然妊娠评分系统，依据评分值分为低分组（0~6分）、中分组（7~12分）、高分组（13~18分）。采用Kaplan-Meier方法计算累积受孕率和受孕时间，并采用Log-rank检验进行组间比较。结果Ⅰ~Ⅵ型不孕症女性12个月内累积自然妊娠成功率分别为32.99％（128/388）、6.19％（24/388）、10.57％（41/388）、8.76％（34/388）、3.61％（14/388）、1.29％（5/388）；Ⅰ型12个月内自然妊娠率明显高于其他各组(χ2=88.43，57.22，68.87，112.03，137.17；均P＜0.01)；Ⅱ型、Ⅲ型与Ⅳ型，Ⅴ型与Ⅵ型之间比较，均差异无统计学意义（χ2=4.84，3.52；均P＞0.05 ）。1~3月、4~6月及7~9月、10~12月累积自然妊娠率分别是19.59％（76/388）、19.85％（77/388）、12.89％（50/388）、11.08%（43/388），7~12月的累积妊娠率较1~6月累积妊娠率明显降低（χ2=21.41，P＜0.01）。Cox回归分析发现，输卵管通畅程度、备孕时间及不孕类型是影响自然妊娠的相关危险因素。与Ⅵ型相比，Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型不孕症女性在4D-HyCoSy检查后自然妊娠的成功率显著提升（HR=6.1,95%CI：2.5～14.9,P＜0.01;HR=5.1,95%CI：2.0～13.4,P=0.001;HR=3.3,95%CI：1.3～8.4,P=0.012;HR=2.9,95%CI：1.1～7.4,P=0.028）；与原发性不孕女性相比，继发性不孕女性在4D-HyCoSy检查后自然妊娠成功率提高（HR=2.3,95%CI：1.5～3.4,P=0.030）；与备孕时间≥2年不孕症女性相比，备孕时间＜2年的不孕症女性在4D-HyCoSy检查后自然妊娠成功率也提高（HR=3.0,95%CI：2.1～4.2,P＜0.01）。低分组、中分组和高分组不孕症女性12个月累积成功自然妊娠率分别为20.00%(16/80)、63.16%(108/171)、89.05%(122/137)，3组间累积成功受孕率比较，均差异有统计学意义（χ2=40.60，104.00，26.90；均P＜0.01）。结论对于不孕症女性，可及早行4D-HyCoSy检查指导下一步治疗计划。低分组自然妊娠成功率较低，建议尽快采取辅助生殖技术；中分和高分组可选择自然期待受孕。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：四维影像, 子宫输卵管超声造影, 女性不孕症, 妊娠率

Abstract：ObjectiveTo analyze the related factors of natural pregnancy outcome in infertile women after four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) examination by Cox regression analysis. MethodsA total of 388 infertile female patients who underwent 4D-HyCoSy examinations in the Ultrasound Imaging Department of Hubei Provincial Maternal and Child Health Hospital from March 2015 to October 2023 were selected. Based on the patency of the bilateral fallopian tubes, patients were classified into types Ⅰ to Ⅵ. Based on the natural pregnancy outcomes within 12 months post-examination, patients were divided into a coneeption-success group (246 cases) and a conception-failure group (142 cases). Cox regression analysis was employed to identify factors associated with successful natural pregnancy. A scoring system for successful natural pregnancy following 4D-HyCoSy examinations had been established, categorizing the conception-success patients into low-score group (0-6 points), medium-score group (7-12 points), and high-score group (13-18 points). The Kaplan-Meier method was employed to calculate cumulative pregnancy rates and time to pregnancy, and the Log-rank test was used for intergroup comparisons. ResultsThe cumulative natural pregnancy success rates for types Ⅰ to Ⅵ within 12 months were 32.99％（128/388）, 6.19％（24/388）, 10.57％（41/388）, 8.76％（34/388）, 3.61％（14/388）, and 1.29%（5/388）, respectively. Type Ⅰ showed significantly higher rates than other types (χ2=88.43, 57.22, 68.87, 112.03, 137.17, all P＜0.01). There were no statistically significant differences between types Ⅱ, Ⅲ, and Ⅳ, or types Ⅴ and Ⅵ (χ2=4.84, 3.52, all P＞0.05). The cumulative natural pregnancy rates for the periods of 1-3 months, 4-6 months, 7-9 months, and 10-12 months were 19.59%(76/388), 19.85%(77/388), 12.89%(50/388), and 11.08%(43/388), respectively. The cumulative pregnancy rate from 7 to 12 months was significantly lower than that from 1 to 6 months (χ2=21.41, P＜0.01). Cox regression analysis revealed that the results of tubal patency, duration of preparation for pregnancy, and type of infertility were significant risk factors affecting natural conception. Compared with type Ⅵ, the type Ⅰ, Ⅱ, Ⅲ and Ⅳ had increased success rate of natural pregnancy after 4D-HyCoSy examination (HR=6.1, 95%CI: 2.5-14.9, P＜0.01; HR=5.1, 95%CI: 2.0-13.4, P=0.001; HR=3.3, 95%CI: 1.3-8.4, P=0.012; HR=2.9, 95%CI: 1.1-7.4, P=0.028). Compared with primary infertility patients, secondary infertility patients had an increased success rate of natural pregnancy after 4D-HyCoSy examination (HR=2.3, 95%CI: 1.5-3.4, P=0.030). The success rate of natural pregnancy after 4D-HyCoSy examination in infertile women with preparation time ＜2 years was higher than that in infertile women with preparation time ≥2 years (HR=3.0, 95%CI: 2.1-4.2, P＜0.01). The cumulative natural pregnancy rates over 12 months of low, medium, and high-score infertility groups were 20.00% (16/80), 63.16% (108/171), and 89.05% (122/137), respectively. The comparison of cumulative successful conception rates among the three groups showed statistically significant differences (χ2=40.60, 104.00, 26.90, all P＜0.01). ConclusionsFor women with infertility, a 4D-HyCoSy examination can be conducted early to guide the subsequent treatment plan. The natural pregnancy success rate is lower in the low-score group, and it is recommended to promptly pursue assisted reproductive technology. The medium and high-score groups may opt for natural conception.

Key words： Four-dimensional image Hysterosalpingo-contrast sonography Female infertility Pregnancy rate

收稿日期: 2024-11-11

通讯作者: 鲁力，Email: luliabc2008@aliyun.com

引用本文:

谭娅鲁力. 不孕症女性四维子宫输卵管超声造影检查后自然妊娠相关因素的Cox回归分析[J]. 中华诊断学电子杂志, 2025, 13(1): 26-31.
Tan Ya,Lu Li.. Cox regression analysis of factors related to natural pregnancy after four-dimensional hysterosalpingo-contrast sonography in women with infertility. zhzdx, 2025, 13(1): 26-31.

链接本文:

http://www.zhzdxzz.com/CN/10.3877/cma.j.issn.2095-655X.2025.01.004 或 http://www.zhzdxzz.com/CN/Y2025/V13/I1/26

［1］Phillips K，Olanrewaju RA，Omole F.Infertility：evaluation and management［J］.Am Fam Physician，2023，107(6):623-630. ［2］Qu E，Zhang M，Ju J，et al.Is Hysterosalpingo-contrast sonography (HyCoSy) using sulfur hexafluoride microbubbles (SonoVue) sufficient for the assessment of fallopian tube patency? A systematic review and meta-analysis［J］.J Ultrasound Med，2023，42(1):7-15.DOI：10.1002/jum.15988. ［3］刘玉君，谭庆英，李汝斐，等.经阴道4D-HyCoSy在输卵管不孕诊断中的应用［J］.影像科学与光化学，2022，40(3):565-569.DOI：10.7517/issn.1674-0475.211215. ［4］刘洁嫚,罗鹭,袁惠.TVS4D-HyCOSy评价输卵管通畅准确性的回归分析［J］.影像技术，2022，34(5):36-40.DOI:10.3969/j.issn.1001-0270.2022.05.07. ［5］Wang W,Zhou Q,Gong Y,et al.Assessment of fallopian tube fimbria patency with 4-dimensional hysterosalpingo-contrast sonography in infertile women［J］.J Ultrasound Med,2017,36(10):2061-2069.DOI:10.1002/jum.14244. ［6］Groszmann YS，Benacerraf BR.Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination［J］.Fertil Steril，2016，105(6):1381-1393.DOI：10.1016/j.fertnstert.2016.03.026. ［7］Lindborg L，Thorburn J，Bergh C，et al.Influence of HyCoSy on spontaneous pregnancy：a randomized controlled trial［J］.Hum Reprod，2009，24(5):1075-1079.DOI：10.1093/humrep/den485. ［8］Sr DRB，Grundy S，Sullivan LM，et al.Validation of the Framingham coronary heart disease prediction scores：results of a multiple ethnic groups investigation［J］.JAMA，2001，286(2):180-187.DOI：10.1001/jama.286.2.180. ［9］陈玉梅，黄小芳，方义英.经阴道四维超声子宫输卵管造影评估输卵管通畅性的临床价值研究［J］.中国医学创新，2022，19(32):125-128.DOI：10.3969/j.issn.1674-4985.2022.32.029. ［10］Lovsin B， Tomazevic T. Hysterosalpingo-contrast sonography for infertility investigation［J］.Int J Gynaecol Obstet，2010，108(1):70-71.DOI：10.1016/j.ijgo.2009.08.011. ［11］Chunyan G，Bin P，Ping Y，et al.Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography［J］.Biomed Res Int，2018（2018）:4901281.DOI：10.1155/2018/4901281. ［12］Liu Y，Zhang N，He Y，et al.Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography［J］.BMC Pregnancy Childbirth，2020，20(1):638.DOI：10.1186/s12884-020-03315-x. ［13］Pei R.Comparison of effectiveness as well as advantages and disadvantages of different dimensions of hysterosalpingo-contrast sonography for diagnosis of lesions associated with female infertility［J］.Comput Math Methods Med，2022（2022）:7508880.DOI：10.1155/2022/7508880. ［14］王鹏,李阳.不孕症四维子宫输卵管超声造影术分级与自然受孕率之间的关系［J］.医学影像学杂志,2022,32(6):1019-1023. ［15］Bisogni FA，Galanti F，Riccio S，et al.4D-HyCoSy performed in a reproductive center：retrospective analysis of pain perception，complications and spontaneous pregnancy rate after the technique［J］.Eur Rev Med Pharmacol Sci，2021，25(23):7468-7475.DOI：10.26355/eurrev_202112_27444. ［16］Sormunen T，Aanesen A，Fossum B，et al.Infertility-related communication and coping strategies among women affected by primary or secondary infertility［J］.J Clin Nurs，2018，27(1-2):e335-e344.DOI：10.1111/jocn.13953.