基于子宫内膜结构与子宫螺旋动脉血流参数构建人工授精妊娠预测模型及验证  

Construction and validation of pregnancy prediction model of artificial insemination by husband based on endometrial structure and uterine spiral artery blood flow parameters

作　　者：庾广聿[1] 范嘉琪 陈施蓓 高磊磊 余晴[1] 周超 于春梅 金珍 Yu Guangyu;Fan Jiaqi;Chen Shibei;Gao Leilei;Yu Qing;Zhou Chao;Yu Chunmei;Jin Zhen(Department of Assisted Reproductive Medicine,Nanxishan Hospital of Guangxi Zhuang Autonomous Region,Guilin 541002,Guangxi Zhuang Autonomous Region,China;Department of Obstetrics and Gynecology,Zhejiang Provincial People’s Hospital,Hangzhou 310000,Zhejiang Province,China;Reproductive Center,Changzhou Maternal and Child Health Hospital,Changzhou 213000,Jiangsu Province,China;Department of Reproductive Endocrinology,Zhejiang Provincial People’s Hospital,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]广西壮族自治区南溪山医院辅助生殖科,广西壮族自治区桂林市541002 [2]浙江省人民医院妇科,浙江省杭州市310000 [3]常州市妇幼保健院生殖中心,江苏省常州市213000 [4]浙江省人民医院生殖内分泌科,浙江省杭州市310000

出　　处：《中国组织工程研究》2024年第19期3061-3068,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(82001539),项目负责人:高磊磊;广西科技计划项目(广西妇产疾病临床医学研究中心-桂科AD22035223),项目参与人:庾广聿;广西壮族自治区卫生健康委员会自筹经费科研课题(Z20211073),项目负责人:庾广聿。

摘　　要：背景:现子宫内膜结构及子宫螺旋动脉血流参数对夫精宫腔内人工授精(artificial insemination by husband,AIH)妊娠率的影响水平尚不明确,该研究通过校准其他混杂因素后,确定了其独立影响因素,并构建了预测模型,具有较好的临床应用效能。目的:基于子宫内膜结构及子宫螺旋动脉血流参数构建AIH临床妊娠预测模型及验证。方法:回顾性分析2017年1月至2021年1月于常州市妇幼保健院接受AIH助孕治疗患者共1299例,将其中1182例未临床妊娠者纳入未妊娠组,117例临床妊娠者纳入妊娠组;通过1∶1倾向评分匹配,妊娠组与未妊娠组各匹配成功93例;采用单、多因素分析筛选子宫内膜结构及子宫螺旋动脉血流参数对AIH结局的影响因素,通过受试者工作曲线确定各独立影响因素的最佳截断值,限制性立方样条法分析各独立影响因素对AIH妊娠影响的风险趋势,临床决策曲线与临床影响曲线对该联合预测模型的临床应用效能进行检验。结果与结论:①倾向评分后妊娠组与未妊娠组各非内膜因素均无显著统计学意义,数据具有较好的均衡性(P>0.05);②单因素分析结果显示,内膜下血管化指数、血流指数、血管化血流指数、子宫动脉阻力指数、子宫动脉搏动指数、收缩期最高血流速度/舒张期末血流速度、基底子宫内膜到外子宫肌层内层平均交界区、最大交界区厚度为AIH妊娠的影响因素(P<0.05);③多因素Logistic回归结果显示,基底子宫内膜到外子宫肌层内层平均交界区厚度、子宫动脉搏动指数、血管化血流指数为AIH妊娠的独立影响因素,影响大小依次为血管化血流指数>基底子宫内膜到外子宫肌层内层平均交界区厚度>子宫动脉搏动指数;④受试者工作曲线显示,血管化血流指数的曲线下面积为0.704(0.629,0.779),最佳截断值为6.26;基底子宫内膜到外子宫肌层内层平均交界区厚度的曲线下面积为0.660(BACKGROUND:The impact of the endometrium’s structure and spiral artery blood flow parameters on the pregnancy rate of artificial insemination by husband remains unclear.This study identified the independent factors and constructed a prediction model with good clinical application efficacy after calibration of other confounding factors.OBJECTIVE:To construct and validate a clinical pregnancy prediction model for artificial insemination by husband based on endometrial structure and uterine spiral artery blood flow parameters.METHODS:A retrospective analysis was conducted on 1299 patients who underwent artificial insemination by husband treatment at Changzhou Maternal and Child Health Hospital from January 2017 to January 2021.The non-pregnancy group consisted of 1182 patients,while the pregnancy group included 117 patients.Out of these patients,93 cases were successfully matched between the pregnancy and non-pregnancy groups using a 1:1 propensity score matching method.Single-factor and multi-factor analyses were used to screen the endometrial structure and uterine spiral artery blood flow parameters to determine their influence on artificial insemination by husband outcomes.The optimal cutoff value was established for each independent influencing factor through receiver operating curve analysis and their risk trend affecting artificial insemination by husband pregnancy outcomes was analyzed using a restricted cubic spline.The clinical efficacy of this combined forecast model was tested by using clinical decision curve and clinical influence curve methods.RESULTS AND CONCLUSION:(1)There was no statistical significance in non-endometrial factors between the pregnancy group and the non-pregnancy group,and the data had a good balance by propensity score matching(P>0.05).(2)Single-factor analysis identified several subendometrial parameters as significant influencing factors of artificial insemination by husband pregnancy outcomes,including vascularization index,flow index,vascular flow index,resistance index,pulsati

关 键 词：三维超声检测 子宫内膜结构 子宫螺旋动脉血流参数 夫精人工授精 预测模型 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R717