不孕症女性四维子宫输卵管超声造影检查后自然妊娠相关因素的Cox回归分析  

Cox regression analysis of factors related to natural pregnancy after four-dimensional hysterosalpingo-contrast sonography in women with infertility

作　　者：谭娅 鲁力[1] Tan Ya;Lu Li(Department of Ultrasound Imaging,Hubei Provincial Maternal and Child Health Hospital,Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院超声影像科,武汉430070

出　　处：《中华诊断学电子杂志》2025年第1期26-31,共6页Chinese Journal of Diagnostics(Electronic Edition)

摘　　要：目的采用Cox回归分析不孕症女性四维子宫输卵管超声造影(4D-HyCoSy)检查后自然妊娠结局的相关因素。方法选择2015年3月至2023年10月在湖北省妇幼保健院超声影像科行4D-HyCoSy检查的不孕症女性患者388例,根据双侧输卵管通畅性,将不孕症女性分为Ⅰ~Ⅵ型。依据检查后12个月内自然妊娠情况,将不孕症女性分为自然妊娠成功组(n=246)和失败组(n=142)。采用Cox回归分析自然妊娠成功相关因素。建立4D-HyCoSy检查后成功自然妊娠评分系统,依据评分值分为低分组(0~6分)、中分组(7~12分)、高分组(13~18分)。采用Kaplan-Meier方法计算累积受孕率和受孕时间,并采用Log-rank检验进行组间比较。结果Ⅰ~Ⅵ型不孕症女性12个月内累积自然妊娠成功率分别为32.99%(128/388)、6.19%(24/388)、10.57%(41/388)、8.76%(34/388)、3.61%(14/388)、1.29%(5/388);Ⅰ型12个月内自然妊娠率明显高于其他各组(χ^(2)=88.43,57.22,68.87,112.03,137.17;均P<0.01);Ⅱ型、Ⅲ型与Ⅳ型,Ⅴ型与Ⅵ型之间比较,均差异无统计学意义(χ^(2)=4.84,3.52;均P>0.05)。1~3月、4~6月及7~9月、10~12月累积自然妊娠率分别是19.59%(76/388)、19.85%(77/388)、12.89%(50/388)、11.08%(43/388),7~12月的累积妊娠率较1~6月累积妊娠率明显降低(χ2=21.41,P<0.01)。Cox回归分析发现,输卵管通畅程度、备孕时间及不孕类型是影响自然妊娠的相关危险因素。与Ⅵ型相比,Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型不孕症女性在4D-HyCoSy检查后自然妊娠的成功率显著提升(HR=6.1,95%CI:2.5~14.9,P<0.01;HR=5.1,95%CI:2.0~13.4,P=0.001;HR=3.3,95%CI:1.3~8.4,P=0.012;HR=2.9,95%CI:1.1~7.4,P=0.028);与原发性不孕女性相比,继发性不孕女性在4D-HyCoSy检查后自然妊娠成功率提高(HR=2.3,95%CI:1.5~3.4,P=0.030);与备孕时间≥2年不孕症女性相比,备孕时间<2年的不孕症女性在4D-HyCoSy检查后自然妊娠成功率也提高(HR=3.0,95%CI:2.1~4.2,P<0.01)。低分组、中分组和高分组不孕症女�Objective To analyze the related factors of natural pregnancy outcome in infertile women after four-dimensional hysterosalpingo-contrast sonography(4D-HyCoSy)examination by Cox regression analysis.Methods A total of 388 infertile female patients who underwent 4D-HyCoSy examinations in the Ultrasound Imaging Department of Hubei Provincial Maternal and Child Health Hospital from March 2015 to October 2023 were selected.Based on the patency of the bilateral fallopian tubes,patients were classified into typesⅠtoⅥ.Based on the natural pregnancy outcomes within 12 months post-examination,patients were divided into a coneeption-success group(246 cases)and a conception-failure group(142 cases).Cox regression analysis was employed to identify factors associated with successful natural pregnancy.A scoring system for successful natural pregnancy following 4D-HyCoSy examinations had been established,categorizing the conception-success patients into low-score group(0-6 points),medium-score group(7-12 points),and high-score group(13-18 points).The Kaplan-Meier method was employed to calculate cumulative pregnancy rates and time to pregnancy,and the Log-rank test was used for intergroup comparisons.Results The cumulative natural pregnancy success rates for typesⅠtoⅥwithin 12 months were 32.99%(128/388),6.19%(24/388),10.57%(41/388),8.76%(34/388),3.61%(14/388),and 1.29%(5/388),respectively.TypeⅠshowed significantly higher rates than other types(χ^(2)=88.43,57.22,68.87,112.03,137.17,all P<0.01).There were no statistically significant differences between typesⅡ,Ⅲ,andⅣ,or typesⅤandⅥ(χ^(2)=4.84,3.52,all P>0.05).The cumulative natural pregnancy rates for the periods of 1-3 months,4-6 months,7-9 months,and 10-12 months were 19.59%(76/388),19.85%(77/388),12.89%(50/388),and 11.08%(43/388),respectively.The cumulative pregnancy rate from 7 to 12 months was significantly lower than that from 1 to 6 months(χ^(2)=21.41,P<0.01).Cox regression analysis revealed that the results of tubal patency,duration of preparation for

关 键 词：四维影像 子宫输卵管超声造影 女性不孕症 妊娠率 

分 类 号：R71[医药卫生—妇产科学]