基于四维超声子宫输卵管造影的影像学特征建立造影剂逆流子宫肌层风险的诺模图预测模型  

Nomogram-based predictive model for intra-myometrial contrast agent reflux using imaging features from 4D hysterosalpingo-contrast sonography

作　　者：杨霞 潘亮颖 赵行平 易靖佳 王琳 张白云 YANG Xia;PAN Liangying;ZHAO Xingping;YI Jingjia;WANG Lin;ZHANG Baiyun(Department of Ultrasound,Women and Children’s Hospital of Hunan,Changsha 410208;Department of Gynecology,Third Xiangya Hospital,Central South University,Changsha 410013;Department of Ultrasound,Hunan Guangxiu Hospital,Changsha 410205;Department of Ultrasound,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410008,China)

机构地区：[1]湖南妇女儿童医院超声科,长沙410208 [2]中南大学湘雅三医院妇科,长沙410013 [3]湖南省光琇医院超声科,长沙410205 [4]湖南省妇幼保健院超声科,长沙410008

出　　处：《中南大学学报(医学版)》2025年第1期61-71,共11页Journal of Central South University :Medical Science

基　　金：芙蓉实验室科技攻关项目(2023SK2019)。

摘　　要：目的:根据世界卫生组织(World Health Organization,WHO)的分析报告,全球不孕症患病率呈逐年上升趋势。分析造影剂逆流子宫肌层的相关风险因素,对降低造影剂逆流的发生率及治疗女性不孕症具有重要的意义。目前,临床上缺乏预评估输卵管造影逆流子宫肌层的有效指标,判断标准主要依赖于医生经验和患者症状。本研究旨在运用四维超声子宫输卵管造影的影像学特征来评价造影剂逆流子宫肌层的危险因素,并构建诺模图(nomogram)风险预测模型,为临床不孕症的诊疗提供参考。方法:本研究回顾性分析2020年1月1日至2022年12月15日在湖南妇女儿童医院和中南大学湘雅三医院就诊的1274例行四维子宫输卵管超声造影(hysterosalpingo-contrast sonography,HyCoSy)手术检查的不孕症女性患者的影像学特征。将发生造影剂逆流子宫肌层的不孕症患者设为逆流组(n=234),未发生造影剂逆流子宫肌层的不孕症患者设为未逆流组(n=1040)。对研究的基线变量与造影剂逆流子宫肌层结局依次采用单因素Logistic分析和多因素Logistic分析,筛选出有统计学意义的变量构建nomogram预测模型。通过Bootstrap分析进行内部验证,重复抽样次数为500。结果:未逆流组与逆流组的年龄分别为(30.66±4.83)和(31.82±5.27)岁,差异有统计学意义(P=0.0011)。未逆流组的不孕症类型以原发性不孕为主(50.96%),逆流组则以继发性不孕为主(76.50%),且72.65%的患者存在妇科手术史,组间差异均有统计学意义(均P<0.001)。逆流组出现月经量异常和主观不适情况的患者比例高于未逆流组,而未逆流组则较逆流组使用造影剂更多,差异均有统计学意义(P=0.0016、P<0.001、P<0.001)。在影像学方面,未逆流组与逆流组在内膜厚度、输卵管管壁光滑程度和卵巢周围造影剂弥散程度等方面存在不同,表现为未逆流组内膜厚度更厚,输卵管管壁更光滑、更通畅。NomogrObjective:According to the World Health Organization(WHO),infertility rates have been steadily rising worldwide.Identifying risk factors for contrast agent reflux into the myometrium during hysterosalpingo-contrast sonography(HyCoSy)is of clinical significance in reducing this complication and improving infertility treatment.However,there is currently no standardized pre-evaluation method for predicting intra-myometrial contrast reflux,with clinical assessment often relying on physician experience and patient symptoms.This study aims to identify imaging risk factors for contrast agent reflux into the myometrium using four-dimensional(4D)HyCoSy and to construct a nomogram-based predictive model to assist in clinical decision-making.Methods:A retrospective analysis was conducted on 1274 infertile women who underwent 4D HyCoSy at the Women and Children’s Hospital of Hunan and the the Third Xiangya Hospital of Central South University from January 1,2020,to December 15,2022.Patients were divided into a reflux group(n=234)and a non-reflux group(n=1040)based on the presence of intra-myometrial contrast reflux.Univariate and multivariable Logistic regression analyses were used to identify significant predictors,which were then used to construct a nomogram model.Internal validation was performed using 500 bootstrap resamples.Results:The age of the reflux group was significantly higher than that of the non-reflux group[(31.82±5.27)years vs(30.66±4.83)years,P=0.0011].Primary infertility was more common in the non-reflux group(50.96%),while secondary infertility dominated in the reflux group(76.50%),with 72.65%having a history of gynecological surgery(P<0.001).Abnormal menstrual volume and discomfort during the procedure were more common in the reflux group,while the non-reflux group tolerated higher contrast agent doses(P<0.001).Imaging differences included endometrial thickness,tubal wall smoothness,and peritoneal contrast dispersion,with the non-reflux group showing thicker endometrium and smoother,more patent tubes.

关 键 词：子宫输卵管超声造影 造影剂 子宫肌层 逆流 影像学特征 诺模图 预测模型 

分 类 号：R711.6[医药卫生—妇产科学]