四维超声子宫输卵管造影对女性输卵管不孕症的诊断价值及其逆流的影响因素预测模型构建  

The diagnostic value of four-dimensional ultrasound hysterosalpingography in female fallopian tube infertility and the construction of a prediction model for influencing factors of reflux

作　　者：华玲玲 白伟伟 朱美娣 阚晓纯 张婷[2] HUA Ling-ling;BAI Wei-wei;ZHU Mei-di;KAN Xiao-chun;ZHANG Ting(Department of Ultrasound,Xishan People's Hospital of Wuxi,Wuxi 214105,China;Department of Gynecology,Wuxi Maternal and Child Health Hospital,Wuxi 214002,China)

机构地区：[1]江苏省无锡市锡山人民医院超声科,江苏无锡214105 [2]江苏省无锡市妇幼保健院妇科,江苏无锡214002

出　　处：《实用医院临床杂志》2024年第6期137-143,共7页Practical Journal of Clinical Medicine

基　　金：江苏省高层次卫生人才“六个一”工程拔尖人才科研项目(编号:LGY2020023)。

摘　　要：目的对女性输卵管不孕症患者给予经阴道四维超声子宫输卵管造影(4D-HyCoSy)检查,探讨其诊断价值,分析逆流的影响因素并构建预测评估模型。方法2021年10月至2023年10月在无锡市锡山人民医院接受4D-HyCoSy检查的疑似输卵管性不孕症女性患者98例,分析4D-HyCoSy对女性输卵管不孕症的诊断价值;根据是否发生造影剂逆流将其分为逆流组(n=30)和未逆流组(n=68),分别采用单因素和多因素Logistic回归对逆流的影响因素进行分析。并根据回归结果构建多因子联合预测评估模型。结果98例患者共196条输卵管,经腹腔镜通液术确诊输卵管阻塞为104例(真阳性)。4D-HyCoSy方法判断出100例(其中真阳性98例)3D-HyCoSy方法判断出105例(其中真阳性90例)。4D-HyCoSy诊断输卵管不孕的灵敏度、特异度、准确度均较3D-HyCoSy高(P<0.05)。但3D-HyCoSy和金标准结果的一致性(Kappa)为较好,而4D-HyCoSy和金标准结果的一致性为很好。Logistic回归结果显示:年龄>35岁、宫腔操作史、既往子宫腺肌病及双侧输卵管阻塞均是4D-HyCoSy检查时造影剂逆流的危险因素(P<0.05),而子宫内膜厚度是保护因素(P<0.05)。由上述显著影响因素构建的联合模型,对造影剂逆流发生的评估效能较高,曲线下面积(AUC)及灵敏度、特异度、准确度均在0.8以上。结论4D-Hy-CoSy对女性输卵管不孕症诊断效果优于3D-HyCoSy,但造影剂逆流发生率较高,与年龄>35岁、宫腔操作史、既往子宫腺肌病、子宫内膜厚度及双侧输卵管阻塞有关。基于造影剂逆流的影响因素构建的联合预测模型的评估效能较高,可供临床应用参考。Objective To investigate the diagnostic value of transvaginal four-dimensional ultrasound hysterosalpingography(4D-HyCoSy)in female patients with tubal infertility,and to analyze the influencing factors of reflux and to construct a predictive evaluation model.Methods Ninety-eight female with suspected tubal infertility undergoing 4D-HyCoSy examination in our hospital from October 2021 to October 2023 were selected.The diagnostic value of 4D-HyCoSy for female patients with tubal infertility was analyzed.According to the occurrence of contrast agent countercurrent,the patients were divided into a countercurrent group(n=30)and a noncountercurrent group(n=68).Univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors of countercurrent.According to the regression results,a multi-factor joint prediction evaluation model was constructed.Results In the 98 patients with a total of 196 fallopian tubes,104 cases were diagnosed as fallopian tube obstruction by laparoscopic hydrotubation(the true positive).One hundred cases including 98 true positive were diagnosed by 4D-HyCoSy method.One hundred and five cases including only 90 true positive cases were diagnosed by 3D-HyCoSy method.Compared with 3D-HyCoSy,4D-HyCoSy had higher sensitivity,specificity and accuracy in the diagnosis of tubal infertility.However,the consistency(Kappa)between 3D-HyCoSy and gold standard results was good.Logistic regression results showed that age>35 years old,history of uterine cavity operation,previous adenomyosis and bilateral fallopian tube obstruction were all risk factors for contrast agent reflux during 4D-HyCoSy examination(P<0.05),while endometrial thickness was a protective factor(P<0.05).The combined model constructed by using above significant influencing factors had high evaluation efficiency for the occurrence of contrast agent reflux.The area under the ROC curve(AUC),the sensitivity,the specificity and the accuracy were all above 0.8.Conclusions The diagnostic effect of 4D-HyCoSy in

关 键 词：经阴道四维超声子宫输卵管造影 输卵管不孕症 诊断价值 逆流 影响因素 预测模型 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.6[医药卫生—诊断学]