辅助生殖技术后异位妊娠发生的类型及危险因素探讨

An Analysis of the Type and Risk Factor of Ectopic Pregnancy after Assisted Reproductive Technology

目的：探讨辅助生殖技术（ART）后发生异位妊娠（EP）的类型及危险因素。方法：收集2008年1月至2013年6月在本中心行ART后发生EP及同期宫内妊娠（IUP）各97例患者的临床资料,分别作为EP组和IUP组,观察发生EP的类型,并对其危险因素进行单因素及多因素Logistic回归分析。结果：97例EP中输卵管妊娠85例（87.63%）,宫角妊娠5例（5.15%）,宫内外同时妊娠4例（4.12%）。单因素分析结果显示,EP组继发不孕的比例明显高于IUP组（χ2=8.25,P〈0.1）,既往有人工流产史和输卵管手术史患者的比例高于对照组（χ^2=2.72,P〈0.1;χ^2=12.44,P〈0.1）,HCG日子宫内膜厚度比IUP组薄（χ^2=3.61,P〈0.1）。将单因素分析有差异的因素纳入多因素Logistic回归分析,结果显示,继发不孕（OR=2.072,95%CI 1.129~3.804,P〈0.05）,输卵管手术史（OR=3.770,95%CI 1.684~8.438,P〈0.05）,HCG日子宫内膜厚度（OR=0.496,95%CI0.285~0.862,P〈0.05）为行ART后发生EP的独立危险因素。结论：ART后特殊部位EP有所增加。继发不孕、有输卵管手术史或HCG日子宫内膜较薄的患者在行ART后发生EP的风险显著增加。

Objective： To analyze the type and risk factor of ectopic pregnancies （EP）in patients who conceived by assisted reproductive technology（ART）. Methods ：97 patients who had ectopic pregnancies and 97 pa tients who were intrauterine pregnancy （IUP）after ART from January 2008 to June 2013 were enrolled in this work. The type of ectopic pregnancies was retrospectively analyzed and the single factor analysis and multiple logistic regression analysis were made. Results ：84 of the 97 EP cases were tubal pregnancies（87. 63% ） ,5 were cornual pregnancies（5. 15% ） ,and 4 were heterotopic pregnancies（4. 12% ）. The single factor analysis showed that the incidence of secondary infertility in EP group was significantly higher than that in control group （x^2 = 8.25 ,P〈0. 1 ）. The incidences of history of induced abortion（x^2 =2.72 ,P〈0. 1 ）and tubal surgery（x^2 =12.44, P 〈0. 1 ）in EP group were both significantly higher than those in control group. The endometrial thickness in EP group on the day of HCG was significantly lower than that in control group （x^2 = 3.61, P 〈 0. 1 ）. The secondary infertility（ OR=2. 072,95% CI 1. 129 -3. 804, P〈0. 05） ,history of tubal surgery（ OR-3. 770,95% CI 1. 684 - 8.438, P 〈 0. 05） and endometrial thickness （ OR = 0. 496,95% CI 0. 285 - 0. 862, P 〈 0.05 ） were risk factors of EP. Conclusions：After ART,the risk of ectopic pregnancies in special-sites increased. The risk of ectopic pregnancies after ART increased in patients who were secondary infertility or had a history of tubal surgery and a thinner endometrium on the day of HCG.