输卵管重复异位妊娠的危险因素及临床特点巢式病例对照研究  

Risk Factors and Clinical Characteristics of Tubal Recurrent Ectopic Pregnancy:A Nested Case-control Study

作　　者：李丽芳 孙建华 可蓓 郅红艳 邓高丕[3] LI Li-Fang;SUN Jian-Hua;KE Bei;ZHI Hong-Yan;DENG Gao-Pi(School of Traditional Chinese Medicine, Macao University of Science and Technology, Macao 999078,China;Dept, of Obstetrics and Gynecology, Traditional Chinese Medicine Institute, Traditional Chinese Medicine Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021 Ningxia, China;Dept, of Obstetrics and Gynecology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405 Guangdong,China)

机构地区：[1]澳门科技大学中医药学院,澳门特别行政区999078 [2]宁夏回族自治区中医医院暨中医研究院妇产科,宁夏银川750021 [3]广州中医药大学第一附属医院妇产科,广东广州510405

出　　处：《广州中医药大学学报》2019年第7期973-978,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局重点优势病种“早期输卵管妊娠”突破项目(粤中医函[2015]19号);广东省名优中成药二次开发项目(编号:20074009)

摘　　要：【目的】探讨输卵管重复异位妊娠(REP)的危险因素及临床特点。【方法】追踪2015年1月~2017年12月收治于广州中医药大学第一附属医院妇儿中心经中西医结合治疗且有生育要求的首次输卵管妊娠患者24~48个月内的生育结局,采用巢式病例对照临床研究方法,以63例发生REP的患者为试验组(REP组),并按患者首次输卵管妊娠年龄、就业状态,以1∶4比例匹配252例未发生重复异位妊娠的患者为对照组(SEP组),进行χ2分析和多因素Logistic回归分析,比较2组患者的临床特点,分析发生REP的危险因素。【结果】(1)单因素分析结果:在P<0.1水平上初筛出β人绒毛膜促性腺激素(β-HCG)值、附加手术、不孕症史、阑尾炎史、输卵管病史、避孕史和盆腔炎性疾病史等7个与REP有关联的危险因素,其中β-HCG值、附加手术、输卵管病史在SEP组与REP组间比较,差异有统计学意义(P<0.05)。(2)多因素分析结果:不孕症病史(OR=2.461,95%CI:1.202~5.038)是REP的保护性因素,既往输卵管病史(OR=0.036,95%CI:0.147~0.882)和β-HCG值>3 000 U/L者(OR=0.429,95%CI:0.207~0.889)是发生REP的危险因素。(3)2组临床表现相似,除REP组施行附加手术者较SEP组明显增加(P<0.05)外,2组患者的年龄、病情因子评分、治疗方式、log2β-HCG值比较,差异均无统计学意义(P>0.05)。【结论】积极防治首次异位妊娠和盆腔炎性疾病,保护输卵管正常生理功能,可降低REP的发病率。Objective To study the risk factors and clinical characteristics of tubal recurrent ectopic pregnancy(REP). Methods An investigation was performed in tubal pregnancy patients admitted in Women and Children Center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2015 to December 2017. And the reproductive outcomes of the first-time tubal pregnancy patients who had the fertility requirements and have received integrated Chinese and western medicine within 24-48 months were tracked. By using retrospective nested case-control method,63 tubal REP patients served as the trial group,and with reference to the age and employment status of the first-time tubal pregnancy patients and matched at a ratio of 1∶4,252 nonrecurrent ectopic pregnancy patients from the tubal pregnancy patients served as the control group. Chi-square test and multiple Logistic regression analysis were used for the comparison of the clinical characteristics of the two groups and for the analysis of risk factors. Results (1)The results of monofactor analysis showed:based on the level of P<0.1, 7 REP-associated risk factors of β-subunit human chorionic gonadotropin(β-hCG)level,concomitant surgical procedures, history of infertility, history of appendicitis, history of disease of fallopian tube,history of contraception,and history of pelvic inflammatory diseases were found;the differences of β-hCG level,concomitant surgical procedures,and the history of pelvic inflammatory diseases between the trial group and control group were significant(P<0.05).(2)The results of multivariate analysis showed: the history of infertility was a protective factor for REP(OR = 2.461,95% CI:1.202-5.038);the history of fallopian tube disease(OR = 0.036,95% CI:0.147-0.882)and β-HCG value > 3 000 U/L(OR = 0.429,95% CI:0.207-0.889) were the risk factors for REP.(3) Except that there were more patients with concomitant surgical procedures in trial group than that in the control group(P<0.05),the differences of age,illness factor sco

关 键 词：输卵管重复异位妊娠 危险因素 临床特点 巢式病例对照临床研究 

分 类 号：R714.22[医药卫生—妇产科学]