盆腔子宫内膜异位症患者术后自然妊娠的影响因素分析及列线图模型构建  

Analysis of Influencing Factors of Spontaneous Pregnancy in Patients with Pelvic Endometriosis After Surgery and Construction of a Nomogram Model

作　　者：刘鹏[1] 周春娅[1] 朱会蓉 邓艳 万宗淋 周幸杰 罗鳗琳 Liu Peng;Zhou Chunya;Zhu Huirong(Department of Gynecology,Pengzhou People′s Hospital,Pengzhou,Sichuan 611930,China)

机构地区：[1]彭州市人民医院妇科,四川彭州611930

出　　处：《四川医学》2024年第7期739-744,共6页Sichuan Medical Journal

摘　　要：目的分析盆腔子宫内膜异位症患者术后自然妊娠的影响因素,并构建列线图模型。方法选取2016年6月至2020年1月我院收治的盆腔子宫内膜异位症不孕患者239例,以6∶4比例将患者分为建模组143例和验证组96例,根据术后是否自然妊娠,将患者分为未妊娠组(n=46)和妊娠组(n=97)。多因素Logistic回归分析影响盆腔子宫内膜异位症患者术后自然妊娠的因素。采用R软件构建预测盆腔子宫内膜异位症患者术后自然妊娠的列线图模型,应用ROC曲线探索列线图模型对盆腔子宫内膜异位症患者术后自然妊娠的预测效率。结果未妊娠组患者术后采用促排卵治疗的比例低于妊娠组,差异有统计学意义(P<0.05);未妊娠组年龄≥35岁、不孕时间≥3年、r-AFS分期为Ⅲ~Ⅳ期、术前AMH<1μg/L占比均高于妊娠组,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄≥35岁、r-AFS分期为Ⅲ~Ⅳ期、术前AMH<1μg/L是盆腔子宫内膜异位症患者术后未妊娠的危险因素(P<0.05),采用促排卵治疗是盆腔子宫内膜异位症患者术后妊娠的保护因素(P<0.05)。基于以上影响因素用R软件建立预测盆腔子宫内膜异位症患者术后自然妊娠的列线图模型,Hosmer-Lemeshow拟合优度检验显示,内部验证χ^(2)=6.854,P=0.552;外部验证χ^(2)=5.741,P=0.676;内部验证ROC曲线下面积为0.819;外部验证ROC曲线下面积为0.811。结论本研究构建的预测盆腔子宫内膜异位症患者术后自然妊娠的列线图模型,具有较好的区分度和一致性。Objective To analyze the influencing factors of spontaneous pregnancy in patients with pelvic endometriosis after surgery,and to construct an nomogram model.Methods A total of 239 infertile patients with pelvic endometriosis admitted to our hospital from June 2016 to January 2020 were selected,and the patients were divided into a modeling group(143 cases)and a verification group(96 cases)with a ratio of 6∶4.According to whether there was a natural pregnancy after surgery,patients were divided into a non-pregnant group(n=46)and a pregnant group(n=97).Multivariate Logistic regression analysis was used to analyze the factors influencing the natural pregnancy of patients with pelvic endometriosis after surgery.The nomograph model for predicting the natural pregnancy of patients with pelvic endometriosis after surgery was constructed with R software,the ROC curve was used to explore the predictive efficiency of nomogram model for natural pregnancy in patients with pelvic endometriosis after surgery.Results The proportion of patients receiving ovulation induction therapy after surgery in the non pregnancy group was lower than that in the pregnancy group,with a statistically significant difference(P<0.05).The proportion of age≥35 years,the proportion of infertility time≥3 years,the proportion of r-AFS stageⅢ~Ⅳ,and the proportion of preoperative AMH<1μg/L in non pregnancy group were significantly higher than those in pregnancy group(P<0.05).Logistic regression analysis showed that age≥35 years,r-AFS stageⅢ~Ⅳ,and preoperative AMH<1μg/L were risk factors for non pregnancy in patients with pelvic endometriosis(P<0.05),ovulation induction therapy was a protective factor for pregnancy in patients with pelvic endometriosis(P<0.05).Based on the above influencing factors,the nomograph model for predicting the natural pregnancy of patients with pelvic endometriosis after surgery was established with R software,the Hosmer-Lemeshow goodness of fit test showed that,internal verification χ^(2)=6.854,P=0.552,externa

关 键 词：子宫内膜异位症 自然妊娠 影响因素 列线图 

分 类 号：R711.71[医药卫生—妇产科学]