子宫大小与宫腔粘连的相关性研究

Correlation between uterine size and intrauterine adhesions

摘要

目的 探讨子宫大小与宫腔粘连程度的相关性。方法 选择2018年1月至2023年10月在襄阳市第一人民医院行宫腔镜检查的726例患者为研究对象,其中研究组纳入337例行宫腔粘连分离术的患者,对照组纳入389例同期行宫腔镜子宫内膜成形术、宫腔镜诊断性刮宫术、宫腔镜检查、宫腔镜子宫内避孕器取出术的患者。采用多因素Logistic回归分析宫腔粘连发生的影响因素,并用Spearman相关分析法分析子宫大小与宫腔粘连的相关性,采用受试者工作特征(ROC)曲线分析发生宫腔粘连的最佳阈值。结果 与对照组相比,宫腔粘连组患者子宫内膜厚度较薄,子宫较小,有宫内避孕装置者较少,孕次、产次、剖宫产次数、人流次数、有引产史的人数较多,差异均有统计学意义(t/χ²值介于4.402~100.799之间,P<0.05);多因素Logistic回归分析显示,有宫内避孕装置、子宫内膜较厚及子宫较大是影响患者发生宫腔粘连的保护因素(OR值介于0.059~0.554之间,P<0.05),孕次≥3、产次≥3、人工流产次数≥3是危险因素(OR值介于2.106~3.217之间,P<0.05);轻度宫腔粘连、中度宫腔粘连、重度宫腔粘连子宫大小依次降低,差异有统计学意义(F=12.099,P<0.05);子宫大小与轻、中、重度宫腔粘连均存在负相关性,且随着宫腔粘连程度增加,关联强度越高(r值分别为-0.584、-0.675、-0.744,P<0.05);子宫大小预测宫腔粘连发生风险的曲线下面积(AUC)为0.775(95%CI:0.742~0.809),灵敏度为66.5%,特异度为73.3%,诊断截断点为13.85 cm;子宫大小预测中重度宫腔粘连的AUC为0.650(95%CI:0.591~0.710),灵敏度为48.1%,特异度为77.2%,诊断截断点为12.75 cm。结论 子宫大小与宫腔粘连有关,随着子宫的增大,宫腔粘连程度减轻,其中小子宫与重度宫腔粘连发生的相关性更强。

Abstract

Objective To explore correlation between uterine size and severity of intrauterine adhesions. Methods 726 patients who underwent hysteroscopy in Xiangyang No.1 People's Hospital from January 2018 to October 2023 were selected.337 patients who underwent hysteroscopic adhesiolysis were divided into intrauterine adhesions (IUA) group (study group),and 389 patients who underwent hysteroscopic metroplasty,hysteroscopic diagnostic curettage,hysteroscopy,and hysteroscopic intrauterine contraceptive device (IUD) removal in the same period were divided into control group.Multiple Logistic regression was used to analyze influencing factors of IUA.Spearman correlation analysis was used to analyze correlation between uterine size and IUA.Receiver operating characteristic (ROC) curve was used to analyze optimal threshold for occurrence of IUA. Results Compared with the control group,the patients in the IUA group had thinner endometrium,smaller uterine size and less IUD usage,as well as higher proportions of multigravid ≥3 times,multipara ≥3 times,multiple cesarean sections,frequent induced abortions ≥3 times and history of induced delivery,the differences were significant (t/χ ²=4.402-100.799,all P<0.05).Multivariate Logistic regression analysis showed that presence of IUD,thicker endometrium and larger uterine size were protective factors for IUA(OR=0.059-0.554,all P<0.05),while multigravid ≥3 times,multipara ≥3 times,frequent induced abortions ≥3 times were risk factors for IUA (OR=2.106-3.217,all P<0.05).Uterine size decreased progressively with increase in degree of IUA from mild IUA,moderate IUA to severe IUA,and the differences were statistically significant (F=12.099,P<0.05).The uterine size was negatively correlated with varied severity of IUA,and this negative correlation increased progressively with increase in adhesion severity from mild IUA,moderate IUA to severe IUA (r=-0.584,-0.675 and -0.744 respectively,all P<0.05).The area under the curve (AUC) of uterine size for predicting risk of IUA was 0.775 (95%CI:0.742-0.809),with a sensitivity of 66.5%,a specificity of 73.3%,and the optimal diagnostic cutoff value was 13.85 cm.The AUC of uterine size for predicting risk of moderate IUA and severe IUA was 0.650 (95%CI:0.591-0.710),with a sensitivity of 48.1%,a specificity of 77.2%,and the diagnostic cutoff value was 12.75 cm. Conclusion Uterine size is associated with IUA,and with increase in uterine dimension,the severity of IUA becomes milder,while the correlation between diminutive uterus and severe IUA is more stronger.

关键词

宫腔粘连 / 子宫大小 / 宫腔镜检查 / 宫腔粘连分离术 / 影响因素

Key words

uterine adhesion / uterine size / hysteroscopy / hysteroscopic adhesiolysis / influencing factor

参考文献

[1] Song Y T, Liu P C, Tan J, et al. Stem cell-based therapy for ameliorating intrauterine adhesion and endometrium injury[J]. Stem Cell Research & Therapy, 2021,12(1): 556.

[2] Ding C, Wei W, Ding F, et al. Ultrasound diagnostic of intrauterine adhesions:systematic review and meta-analysis[J]. Journal of Obstetrics and Gynaecology Research, 2024,50(9): 1681-1686.

[3] 武芳彩, 胡蓉. 超声在纵隔子宫诊治中的研究进展[J]. 影像研究与医学应用, 2024,8(9): 9-11.

[4] 李慧英. 人工流产患者宫腔粘连发生的影响因素分析[J]. 临床医学工程, 2020,27(12): 1719-1720.

[5] 樊真. 稽留流产清宫术后宫腔粘连状况及其影响因素分析[J]. 哈尔滨医药, 2022,42(3): 69-70.

[6] 中华医学会妇产科学分会. 宫腔粘连临床诊疗中国专家共识[J]. 中华妇产科杂志, 2015,50(12): 881-887.

[7] 陈丽, 杨霞. 中重度宫腔粘连的高危因素分析[J]. 实用妇产科杂志, 2023,39(8): 599-602.

[8] Cheng M, Chang W H, Yang S T, et al. Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy:A Meta-Analysis of Randomized Controlled Trials[J]. Life, 2020,10(11): 285.

[9] 练俊誉. 188例宫腔粘连患者宫腔粘连危险因素的分析及探讨[J]. 中国医学创新, 2024,21(5): 126-130.

[10] 刘春婷, 许丽芳. 腹腔镜子宫肌瘤切除术后并发宫腔粘连的危险因素分析[J]. 安徽医专学报, 2024,23(3): 121-122.

[11] Bortoletto P, Keefe K W, Unger E, et al. Incidence and risk factors of intrauterine adhesions after myomectomy[J]. F&S Reports, 2022,3(3): 269-274.

[12] 孙治华, 肖海涛, 周宗亚. 子宫内膜息肉患者宫腔镜切除术后宫腔粘连的Logistic回归分析[J]. 中国药物与临床, 2024,24(18): 1201-1204.

[13] Wang X, Yi J, Xie X, et al. Factors affecting pregnancy outcomes following the surgical removal of intrauterine adhesions and subsequent in vitro fertilization and embryo transfer[J]. Experimental and Therapeutic Medicine, 2019,18(5): 3675-3680.

[14] Carbonnel M, Pirtea P, de Ziegler D, et al. Uterine factors in recurrent pregnancy losses[J]. Fertility and Sterility, 2021,115(3): 538-545.

[15] 夏波, 赵豆豆, 王萌, 等. 重度宫腔粘连相关危险因素分析[J]. 中国妇幼健康研究, 2021,32(3): 355-358.

[16] Li S, Ali L. Study on Risk Factors Related to Intrauterine Adhesion Based on Meta-Analysis[J]. Computational and Mathematical Methods in Medicine, 2022: 1-8.

[17] Wu S, Chen Q, Yang X, et al. The KSR1/MEK/ERK signaling pathway promotes the progression of intrauterine adhesions[J]. Cellular Signalling, 2025,131: 111730.

[18] Ding H, Zhang H, Qiao R, et al. Comparing the efficacy and pregnancy outcome of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis in infertile women:a prospective,randomized,controlled trial study[J]. Reproductive Biology and Endocrinology, 2024;22(1): 49.

[19] Zhao G, Hu Y. Mechanistic insights into intrauterine adhesions[J]. Seminars in Immunopathology, 2024;47(1): 3.

[20] Ouyang Y, Peng Y, Zheng M, et al. The impact of intrauterine adhesions on endometrial receptivity in patients undergoing in vitro fertilization-embryo transfer[J]. Frontiers in Endocrinology, 2025,15: 1489839.

[21] Cao C, Chen Y, Li J, et al. Short-term reproductive outcomes analysis and prediction of the modified uterine stent treatment for mild to moderate intrauterine adhesions:experience at a single institution[J]. BMC Women's Health, 2024,24(1): 252.

基金资助

湖北省自然科学基金(2025AFD097)

襄阳市第一人民医院科技创新项目(XYY2025SD14)