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A model established for predicting natural pregnancy possibility based on the imaging characteristics of 4-dimensional hysterosalpingo-contrast sonography

Zhao, X.; Fei, L.; Gu, P.; Xu, D.; Zhang, B.; Yang, Y.

Zhong Nan da Xue Xue Bao. Yi Xue Ban 47(11): 1600-1607

2022

ISSN/ISBN: 1672-7347
PMID: 36481639
Accession: 080712981

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Summary
目的: 不孕症的发病率呈逐年上升的趋势，其中30%以上与输卵管通畅性异常相关。四维超声子宫输卵管造影(4-dimensional hysterosalpingo-contrast sonography，4D HyCoSy)在诊断输卵管通畅性上既克服了三维成像的不足，特异性和准确性均较高，又避免了碘剂过敏、X线辐射等危害，接受度好且易掌握，在临床应用越来越广泛，但是目前尚无研究探讨4D HyCoSy与自然妊娠可能性相关的影像学标准。本研究对临床拟诊输卵管性不孕患者的临床资料及4D HyCoSy的影像特点进行分析，建立一种基于影像学特征的造影术后自然妊娠的预测模型。方法: 回顾性分析湖南省光琇医院2017年2月至2018年5月拟诊为输卵管性不孕症、具有完整4D HyCoSy影像学资料且显示至少一侧输卵管通畅的患者，收集患者的一般临床资料及影像数据，并随访患者造影术后3个月内的自然妊娠情况，将其分成自然妊娠组与非自然妊娠组。采用二元logistic回归分析各个变量与造影术后自然妊娠之间的相关性，将单因素logistic回归中差异有统计学意义(P<0.05)的变量纳入自然妊娠概率预测模型，并通过10倍交叉法验证预测模型的分类能力。结果: 收集到符合要求且遵医嘱试孕3个月的1 085名临床拟诊输卵管性不孕患者，其临床特征(年龄、不孕年限)及4D HyCoSy影像学特征(月经结束后3~7 d的内膜厚度、左侧输卵管显影情况、左侧卵巢周围造影剂弥散情况、右侧卵巢周围造影剂弥散情况)是术后3个月自然妊娠的独立预测因素。建立自然妊娠概率预测模型，10倍交叉法验证得出的曲线下面积(area under the curve，AUC)均大于0.75，最佳AUC为0.868。预测模型得出的Q值为自然妊娠概率，截断值是0.5，当Q值大于0.5时建议试孕3个月，小于0.5时建议采用辅助生殖技术助孕。结论: 基于输卵管性不孕患者的临床及4D HyCoSy的影像学特征成功建立了输卵管性不孕症女性造影术后自然妊娠的预测模型，此模型可有效辅助临床进行个体化决策。.

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