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中华诊断学电子杂志 ›› 2025, Vol. 13 ›› Issue (01) : 26 -31. doi: 10.3877/cma.j.issn.2095-655X.2025.01.004

妇科疾病诊治

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
谭娅1, 鲁力1,†()   
  1. 1. 430070 武汉,湖北省妇幼保健院超声影像科
  • 收稿日期:2024-11-11 出版日期:2025-02-26
  • 通信作者: 鲁力

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

Ya Tan1, Li Lu1,†()   

  1. 1. Department of Ultrasound Imaging, Hubei Provincial Maternal and Child Health Hospital, Wuhan 430070, China
  • Received:2024-11-11 Published:2025-02-26
  • Corresponding author: Li Lu
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谭娅, 鲁力. 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[J/OL]. 中华诊断学电子杂志, 2025, 13(01): 26-31.

Ya Tan, Li Lu. Cox regression analysis of factors related to natural pregnancy after four-dimensional hysterosalpingocontrast sonography in women with infertility[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2025, 13(01): 26-31.

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

选择2015 年3 月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(χ2 =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(χ2=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性12 个月累积成功自然妊娠率分别为20.00%(16/80)、63.16%(108/171)、89.05%(122/137),3 组间累积成功受孕率比较,均差异有统计学意义(χ2 = 40.60,104.00,26.90;均P<0.01)。

结论

对于不孕症女性,可及早行4D-HyCoSy 检查指导下一步治疗计划。 低分组自然妊娠成功率较低,建议尽快采取辅助生殖技术;中分和高分组可选择自然期待受孕。

关键词: 四维影像, 子宫输卵管超声造影, 女性不孕症, 妊娠率

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 types Ⅰ to Ⅵ. 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 types Ⅰ to Ⅵ within 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. Type Ⅰ showed significantly higher rates than other types (χ2 =88.43, 57.22,68.87, 112.03, 137.17, all P<0.01). There were no statistically significant differences between types Ⅱ,Ⅲ, and Ⅳ, or types Ⅴ and Ⅵ (χ2=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 (χ2=21.41, P<0.01). Cox regression analysis revealed that the results of tubal patency, duration of preparation for pregnancy, and type of infertility were significant risk factors affecting natural conception. Compared with type Ⅵ, the type Ⅰ, Ⅱ,Ⅲ and Ⅳ had increased success rate of natural pregnancy after 4D-HyCoSy examination (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). Compared with primary infertility patients, secondary infertility patients had an increased success rate of natural pregnancy after 4D-HyCoSy examination (HR=2.3, 95%CI: 1.5-3.4, P=0.030). The success rate of natural pregnancy after 4D-HyCoSy examination in infertile women with preparation time <2 years was higher than that in infertile women with preparation time ≥2 years (HR=3.0, 95%CI: 2.1-4.2, P<0.01). The cumulative natural pregnancy rates over 12 months of low, medium, and high-score infertility groups were 20.00% (16/80), 63.16% (108/171),and 89.05% (122/137), respectively. The comparison of cumulative successful conception rates among the three groups showed statistically significant differences (χ2 = 40.60, 104.00, 26.90, all P<0.01).

Conclusions

For women with infertility, a 4D-HyCoSy examination can be conducted early to guide the subsequent treatment plan. The natural pregnancy success rate is lower in the low-score group, and it is recommended to promptly pursue assisted reproductive technology. The medium and high-score groups may opt for natural conception.

Key words: Four-dimensional image, Hysterosalpingo-contrast sonography, Female infertility, Pregnancy rate
图1 四维子宫输卵管超声造影输卵管通畅性检查图像 注:a 图示右侧输卵管通畅,输卵管走行自然、柔和,伞端可见造影剂包绕;b 图示左侧输卵管通而不畅,输卵管走行僵硬、曲折,伞端可见少量造影剂溢出;c 图示双侧输卵管阻塞,双侧输卵管显影至近端,伞端未见明显造影剂包绕(箭头所示)
图2 不孕症女性患者4D-HyCoSy 检查后不同输卵管通畅程度在12 个月内自然妊娠成功和失败的例数 注:Ⅰ型为双侧输卵管通畅;Ⅱ型为一侧输卵管通畅,另一侧通而不畅; Ⅲ型为双侧输卵管通而不畅;Ⅳ型为一侧输卵管阻塞,另一侧通畅;Ⅴ型为一侧输卵管通而不畅,另一侧阻塞;Ⅵ型为双侧输卵管阻塞;4D-HyCoSy 为四维子宫输卵管超声造影
表1 两组不孕症女性患者一般资料及4D-HyCoSy 检查后不同输卵管通畅程度在12 个月内自然妊娠成功率比较
项目 自然妊娠成功组(n=246) 自然妊娠失败组(n=142) 统计量 P值
年龄＜35岁[例(%)] 154(62.60) 85(59.86) χ 2=0.286 0.593
体重指数(kg/m2,xˉ±s) 21.54±3.67 23.14±2.23 t=0.675 0.432
经产妇[例(%)] 108(43.90) 72(50.70) χ 2=1.675 0.196
原发性不孕[例(%)] 121(49.19) 52(36.62) χ 2=5.755 0.016
备孕时间＜2年[例(%)] 111(45.12) 43(30.28) χ 2=8.283 0.004
流产史[例(%)] 56(22.76) 43(30.28) χ 2=2.677 0.102
盆腔手术史[例(%)] 43(17.48) 17(11.97) χ 2=2.089 0.148
盆腔炎病史[例(%)] 23(9.35) 11(7.75) χ 2=0.289 0.591
宫腔手术史[例(%)] 72(29.27) 37(26.06) χ 2=0.460 0.498
多囊卵巢病史[例(%)] 7(2.85) 3(2.11) χ 2=0.193 0.661
子宫内膜厚度(mm,xˉ±s) 7.21±1.21 6.62±1.02 t=0.321 0.875
肌瘤[例(%)] 87(35.37) 43(30.28) χ 2=1.045 0.307
痛经[例(%)] 43(17.48) 18(12.68) χ 2=1.568 0.211
异位妊娠史[例(%)] 11(4.47) 4(2.82) χ 2=0.663 0.415
输卵管通畅程度[例(%)] χ 2=74.601 0.000
Ⅰ型 128(52.03) 27(19.01)
Ⅱ型 24(9.76) 8(5.63)
Ⅲ型 41(16.67) 21(14.79)a
Ⅳ型 34(13.82) 32(22.54)ab
Ⅴ型 14(5.69) 39(27.46)abcd
Ⅵ型 5(2.03) 15(10.56)abcd
表2 不孕症女性患者4D-HyCoSy 检查后自然妊娠成功的Cox 多因素回归分析
因素 B SE Waldχ 2值 HR值 95%CI P值 分数(分)
输卵管通畅性
Ⅵ型 - - - - - - 0
Ⅳ型 1.0 0.47 4.9 2.9 1.1~7.4 0.028 5
Ⅲ型 1.2 0.47 6.3 3.3 1.3~8.4 0.012 6
Ⅱ型 1.6 0.49 10.9 5.1 2.0~13.4 0.001 8
Ⅰ型 1.8 0.45 15.6 6.1 2.5~14.9 0.000 9
不孕类型
原发性不孕 - - - - - - 0
继发性不孕 0.6 0.15 17.5 2.3 1.5~3.4 0.030 3
不孕时间
≥2年 - - - - - - 0
＜2年 1.1 0.18 39.3 3.0 2.1~4.2 0.000 6
表3 不孕症女性患者4D-HyCoSy 检查后不同输卵管通畅程度自然妊娠时间比较
组别 例数 受孕成功例数 平均妊娠时间(月,xˉ±s,95%CI) 中位妊娠时间(月)
全组 388 246 8.0±0.2(7.6~8.4) 9.0
低分组(0~6分) 80 16 11.0±0.3(10.4~11.6) -
中分组(7~12分) 171 108 8.3±0.3(7.8~8.9) 10.0
高分组(13~18分) 137 122 5.8±0.3(5.3~6.4) 5.0
图3 不孕症女性患者4D-HyCoSy 检查后不同输卵管通畅程度12 个月累积受孕率 注:低分组为0~6 分,中分组为7~12 分,高分组为13~18 分;4D-HyCoSy 为四维子宫输卵管超声造影
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