四维子宫输卵管超声造影影像学特征对不孕患者造影术后自然妊娠的预测价值

Predictive value of four-dimensional hysterosalpingo-contrast sonography imaging features for natural pregnancy after the procedure in infertile patients

摘要

目的 研究四维子宫输卵管超声造影(4D-HyCoSy)影像学特征对不孕患者造影术后自然妊娠的预测价值。方法 选择2020年1月至2022年6月在广西壮族自治区人民医院门诊拟诊为不孕并行4D-HyCoSy的220例女性患者为研究对象,根据4D-HyCoSy后3个月内是否成功自然妊娠分为自然妊娠组(59例)及未自然妊娠组(161例).比较组间超声征象差异,应用Logistic回归分析筛选出预测不孕患者造影术后自然妊娠的影响因素;绘制受试者工作特征(ROC)曲线评估模型的预测价值。结果 自然妊娠组推注造影剂量、无造影剂返流、推注压力小/无阻力、盆腔无粘连带、输卵管走行自然柔和及卵巢周围环状包绕的占比均高于未自然妊娠组,差异具有统计学意义(χ²/Z值介于-2.313~61.801之间,P<0.05);多因素Logistic回归模型结果显示,推注压力小/无阻力、输卵管走行自然柔和、卵巢周围环状包绕是输卵管性不孕患者4D-HyCoSy后自然妊娠的独立影响因素(OR值介于6.100~15.817之间,P<0.05);推注压力、输卵管走形及卵巢包绕情况三者联合预测输卵管性不孕患者4D-HyCoSy后自然妊娠的曲线下面积(AUC)为0.877,灵敏度为0.797,特异度为0.845,约登指数为0.642。结论 4D-HyCoSy影像学特征对不孕患者超声造影术后3个月内自然妊娠具有一定的预测效能,可为临床诊疗决策提供一定的超声影像参考.

Abstract

Objective To investigate the predictive value of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) imaging features for natural conception after the procedure in infertile women. Methods A total of 220 female patients diagnosed with infertility and undergoing 4D-HyCoSy at the People's Hospital of Guangxi Zhuang Autonomous Region between January 2020 and June 2022 were enrolled. Based on whether natural pregnancy was achieved within 3 months after 4D-HyCoSy, patients were divided into the natural pregnancy group (n=59) and the non-natural pregnancy group (n=161). Ultrasound signs between the two groups were compared, and logistic regression analysis was applied to identify factors influencing natural pregnancy after the procedure in infertile patients. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of the model. Results The natural pregnancy group showed higher proportions of smaller injected contrast agent volume, absence of reflux, low injection pressure or no resistance, absence of pelvic adhesions, smooth and natural fallopian tube course, and circumferential ovarian encasement compared with the non-natural pregnancy group, with statistically significant differences (χ²/Z values ranging from -2.313 to 61.801, P<0.05). Multivariate logistic regression identified low/no injection pressure, smooth and natural fallopian tube course, and circumferential ovarian encasement as independent predictors of natural pregnancy after 4D-HyCoSy in patients with tubal infertility (OR values ranging from 6.100 to 15.817, P<0.05). The combination of injection pressure, tubal morphology, and ovarian encasement yielded an area under the curve (AUC) of 0.877, with a sensitivity of 0.797, specificity of 0.845, and Youden's index of 0.642. Conclusion 4D-HyCoSy imaging features demonstrate considerable predictive value for natural pregnancy within three months after contrast sonography in infertile women, providing valuable ultrasonographic reference for clinical decision-making.

关键词

输卵管 / 四维超声造影 / 影像学特征 / 不孕 / 自然妊娠 / 预测价值

Key words

fallopian tube / four-dimensional contrast-enhanced ultrasound / imaging feature / infertility / natural pregnancy / predictive value

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基金资助

广西医药卫生自筹经费科研课题(Z20190652)