对不孕不育症病因初筛临床路径的初步建立

A pilot study on clinic approach for etiology screening of infertility

目的设计、实践和推广一项实用、科学、合理的对不孕不育的病因进行初步筛查的临床方案和路径。方法在江苏省8个基层医疗单位的不孕门诊试点,对不孕不育的初诊夫妇进行精液常规检测、女性排卵监测、盆腔妇科检查和输卵管碘油造影的四步病因初筛检查。结果在江苏省8个市、区级医院和妇幼保健院所的不孕不育门诊按上述路径进行不孕不育夫妇的初筛,共6501对夫妇。女方平均年龄28.4岁,初筛平均费用为776.5元。向上级医院转诊的比例为8.8%。初筛路径导出的诊断分类,排卵因素占25.28%(其中持续无排卵占94.71%,卵巢功能减退占5.29%);盆腔因素占48.73%(其中输卵管因素占81.12%,子宫内膜异位症占16.9%,子宫畸形占1.99%);男性因素占16.11%(其中无精症占8.89%,少弱畸精子症占87.84%,性功能障碍占3.27%);不明原因占9.88%。结论我们的初步研究证明这个不孕不育病因初筛方案是一个切实可行、经济科学的临床路径。初步的使用结果表明,获得的关于不孕不育的病因构成数据是可靠、可信、合理的。

Objective： To design, test and practise a practical, scientific and reasonable clinic approach tor screening etiology of infertility. Methods： A screening strategy with 4 steps of semen analysis, ovulation monitoring, special pelvic examination and hysterosalphingeography for diagnosing infertility was designed and practised in 8 local infertility clinics in Jiangsu Province. Results： According to the protocol, 6501 infertile couples had been investigated since their first visit. The mean age of the females was 28.4 years old. The total cost for each couple for screening was 776.5 RMB, and 8.8% of the patients were referred to central hospital. The etiology of infertility was classified into anovulation, 25. 28% （chronic anovulation 94. 71%, prematured ovarian failure 5. 29%）; pelvic problems, 48.73% （tube factor 81.12%, endometriosis 16.9%, malformation of uterus 1. 99%）; male infertility, 16.11% （azoospermia 8.89%, oligospermia 87.84%, dispareunia 3.27%）; and unexplained infertility, 9.88 %. Conclusions： Our preliminary investigation indicated the screening protocol is a practical, economical and scientific clinic approach for diagnosing infertility, and the constituent ratio of the etiology of infertility from study is reliable and acceptable.