C型臂X光机引导下输卵管再通术后1年内不孕风险列线图模型的构建与验证  

Construction and validation of nomograph model of risk of infertility within one year after C-arm X-ray guided fallopian tube recanalization

作　　者：劳斌章 陈建铭[2] 陈树秋 Lao Binzhang;Chen Jianming;Chen Shuqiu(Qinzhou Hospital of Integrated Traditional and Western Medicine,Qinzhou 535000,China;Qinzhou Lingshan County People’s Hospital,Qinzhou 535400,China;Qinzhou Maternal and Child Health Care Hospital,Qinzhou 535000,China)

机构地区：[1]钦州市中西医结合医院,钦州535000 [2]钦州市灵山县人民医院,钦州535400 [3]钦州市妇幼保健院,钦州535000

出　　处：《广西医科大学学报》2022年第9期1463-1468,共6页Journal of Guangxi Medical University

摘　　要：目的:探讨输卵管阻塞患者在C型臂X光机引导下介入再通后1年内术后自然妊娠的影响因素,并建立列线图模型,对其自然妊娠概率进行个体化预测和指导。方法:回顾性分析267例输卵管梗阻患者的临床指标,通过随访获取患者介入治疗后1年内自然妊娠情况(自然妊娠和不孕)。通过比较自然妊娠和不孕患者临床指标,将差异有统计学意义的指标纳入训练集进行多因素Logistic回归分析,并绘制列线图,验证组数据用于验证模型。采用ROC曲线和校准图验证模型的预测效能及准确度。结果:术后1年内共有112例(42.0%)成功自然妊娠。多因素Logistic回归分析结果显示,年龄>35岁(OR=2.45,95%CI:1.10~5.60)、继发性不孕(OR=2.37,95%CI:1.09~5.36)、远端输卵管阻塞(OR=3.21,95%CI:1.48~7.18)、流产次数≥2次(OR=3.02,95%CI:1.17~8.45)、有宫腔操作史(OR=2.41,95%CI:1.04~5.78)是C型臂X光机引导下,输卵管阻塞再通术后1年内不孕风险的独立危险因素(均P<0.05)。验证组数据绘制ROC曲线下AUC为0.781,且预测模型校准曲线与标准曲线接近。结论:列线图模型能较好地判断患者术后1年内自然妊娠概率,有助于指导患者妊娠。Objective:To investigate the factors influencing postoperative natural pregnancy in patients with tubal obstruction within 1 year after C-arm guided fallopian tube recanalization,and to establish a nomograph model for individualized prediction and guidance of their natural pregnancy probability.Methods:Clinical indices of267 patients with tubal obstruction were retrospectively analyzed,and the status of natural pregnancy(spontaneous pregnancy or infertility)within 1 year after the treatment was obtained from patients by follow-up.By comparing the clinical indices of pregnant and infertile patients,the indicators with statistically significant differences were included in the training set for multi-factor logistic regression analysis,nomographs were drawn,and data from the validation group were used to validate the model.Receiver operating characteristic(ROC)curves and calibration plots were used to verify the predictive efficacy and accuracy of the model.Results:A total of 112 patients(42.0%)had successful spontaneous pregnancies within 1 year after surgery.Multifactorial logistic regression analysis showed that age>35 years(OR=2.45,95%CI:1.10-5.60),secondary infertility(OR=2.37,95%CI:1.09-5.36),distal tubal obstruction(OR=3.21,95%CI:1.48-7.18),≥2 miscarriages(OR=3.02,95%CI:1.17-8.45),and a history of uterine manipulation(OR=2.41,95%CI:1.04-5.78)were independent risk factors for the risk of infertility within 1 year after C-arm guided fallopian tube recanalization(all P<0.05).The AUC under the ROC curve plotted for the validation group data was0.781 and the predictive model calibration curve was close to the standard curve.Conclusion:The nomograph model can determine the probability of natural pregnancy within 1 year after surgery and help guide patients to pregnancy.

关 键 词：输卵管阻塞 输卵管介入治疗 自然妊娠 列线图 临床预测模型 

分 类 号：R711.76[医药卫生—妇产科学]